Introduction

Compared to earlier times, citizens now have access to a larger number of mental health providers and services, as well as a greater variety of programs. Mental illness no longer need mean that a person will spend the rest of his or her life on the back wards of state hospitals. State hospital residents, especially the elderly, were discharged without adequate preparation, often to inappropriate community placements, and lacked continuity of care. Few follow-up studies were conducted to find out where discharged patients went and what happened to them. Deinstitutionalization of state hospital patients represents an attempted transfer of financial responsibility from state mental health budgets to federal Medicaid and Social Security Supplemental Security Income budgets. A political-economic approach informs us that the general direction of mental health services will reflect underlying social structures. The chapter also presents an overview on the key concepts discussed in this book.