Learning From History: Deinstitutionalization of People with Mental Illness as Precursor to Long-Term Care Reform

Considers the deinstitutionalization of state mental hospital patients over the past fifty years, and uses this as a model for evaluating reform efforts of custodial and long-term care services for the elderly

Guilty By Reason of Insanity: Unforeseen Consequences of California\u27s Deinstitutionalization Policy

Beginning with the passage of the Lanterman-Petris- Short Act in 1969, deinstitutionalization in California has had a devastating effect on the mentally ill. Instead of affording the mentally ill with more rights and protections, the process of shutting down state psychiatric hospitals and impeding psychiatric care for those in need caused a cascade effect leading to an increase of homelessness and incarceration. Over the past four decades, prisons and jails in California have become the de facto state mental hospitals, with severely mentally ill individuals having nearly a four-to-one chance of ending up in jail or prison over a psychiatric facility of some variety. This restructuring of mental health services has contributed to the ever-increasing problem of mass incarceration – a problem that has reached epidemic levels in recent years. To that end, solutions to this problem include: community-based mental health services, reopening some state psychiatric hospitals with greater oversight, funding medical research into improved treatment options, and community education aimed at fostering a greater understanding of mental health issues

Entrepreneurial sons, patriarchy and the Colonels' experiment in Thessaly, rural Greece

Existing studies within the field of institutional entrepreneurship explore how entrepreneurs influence change in economic institutions. This paper turns the attention of scholarly inquiry on the antecedents of deinstitutionalization and more specifically, the influence of entrepreneurship in shaping social institutions such as patriarchy. The paper draws from the findings of ethnographic work in two Greek lowland village communities during the military Dictatorship (1967–1974). Paradoxically this era associated with the spread of mechanization, cheap credit, revaluation of labour and clear means-ends relations, signalled entrepreneurial sons’ individuated dissent and activism who were now able to question the Patriarch’s authority, recognize opportunities and act as unintentional agents of deinstitutionalization. A ‘different’ model of institutional change is presented here, where politics intersects with entrepreneurs, in changing social institutions. This model discusses the external drivers of institutional atrophy and how handling dissensus (and its varieties over historical time) is instrumental in enabling institutional entrepreneurship

Deviancy, Dependency, and Disability: The Forgotten History of Eugenics and Mass Incarceration

Three widely discussed explanations of the punitive carceral state are racism, harsh drug laws, and prosecutorial overreach. These three narratives, however, only partially explain how our correctional system expanded to its current overcrowded state. Neglected in our discussion of mass incarceration is our largely forgotten history of the long-term, wholesale institutionalization of the disabled. This form of mass detention, motivated by a continuing application of eugenics and persistent class-based discrimination, is an important part of our history of imprisonment, one that has shaped key contours of our current supersized correctional system. Only by fully exploring this forgotten narrative of long-term detention and isolation will policy makers be able to understand, diagnose, and solve the crisis of mass incarceration

Reforming Competence Restoration Statutes: An Outpatient Model

Defendants who suffer from mental illness and are found incompetent to stand trial are often ordered committed to an inpatient mental health facility to restore their competence, even if outpatient care may be the better treatment option. Inpatient facilities are overcrowded and place the defendants on long waiting lists. Some defendants then spend weeks, months, or even years in their jail cell, waiting for a transfer to a hospital bed.Outpatient competence restoration programs promise to relieve this pressure. But even if every state suddenly opened a robust outpatient competence restoration program, an obstacle looms: the statutes governing competence restoration, which default to the inpatient treatment model. Several states mandate inpatient restoration in their statutory scheme. The rest allow for outpatient restoration, but the language of these laws often preserves the inpatient default by requiring defendants to meet a series of nebulous criteria before allowing them to participate in outpatient treatment. This Article is the first to examine how the language of competence restoration statutes, even those that allow for outpatient treatment, defaults to commitment to an inpatient facility. I do so by examining the wide latitude these statutes give to judges to place defendants in inpatient care and show how that discretion, paired with widespread false presumptions about the mentally ill, leads to overcommitment of incompetent defendants in state mental health facilities.I propose amendments to these statutes that will encourage judges to place defendants in outpatient care. Statutes must flip from inpatient-required or inpatient-unless to outpatient-unless, defaulting to outpatient treatment unless some specific criteria justify committing the defendant to an inpatient facility. Such a change would relieve pressure on inpatient facilities, opening up space for those who truly need inpatient treatment for competence to be restored. It would also ensure that specific criteria—not misunderstandings or fears about the mentally ill—inform the decision to commit the defendant to inpatient care

1993 Juvenile Justice and Delinquency Prevention Act Compliance Monitoring Report

The Juvenile Justice and Delinquency Prevention Act (JJDPA) mandates removal of status offenders and nonoffenders from secure detention and correctional facilities, sight and sound separation of juveniles and adults, and removal of juveniles from adult jails and lockups. In Alaska, no instances of a status offender held in secure detention was recorded in 1993, as compared with 485 violations in the baseline year of 1976. 16 separation violations were recorded in 1992, representing a 98% reduction from the 1976 baseline of 824 violations. 59 jail removal violations were projected, representing a 94% reduction from the 1980 baseline and an 25% increase from 1992.Alaska Department of Health and Social Services, Division of Family and Youth ServicesA. General Information / B. Removal of Status Offenders and Nonoffenders from Secure Detention and Correctional Facilities / C. De Minimis Request / D. Progress Made in Achieving Removal of Status Offenders and Nonoffenders from Secure Detention and Correctional Facilities / E. Separation of Juveniles and Adults / F. Removal of Juveniles from Adult Jails and Lockups / G. De Minimis Request: Numerical / H. De Minimis Request: Substantive / APPENDICES / I. Method of Analysis / II. 1993 Violations by Offense Type and Location / III. Common Offense Acronym