ABSTRACT
This chapter reviews and evaluates the meaning and significance of the Worcester story for the larger mental health field. Current evidence indicates that like earlier attempts at institutional reform, deinstitutionalization as practiced in the 1970s failed to develop a system of humane care for the chronically mentally ill. This assessment will be supported by a review of the parallels in the cycles of institutional reform, in the context of the fundamental social forces that have conditioned American social policy toward the care of the mentally ill. Institutional change, however, was administrative and contextual, emphasizing the locus more than the modes of care and treatment. State mental hospitals for the past century or more have been remarkably successful as ‘tools’ or resources for realizing the purposes of a variety of internal and external interest groups. It is fashionable to offer proposals for reform on the assumption that current modes of service delivery constitute a ‘nonsystem’ that requires ‘rational’ realignment.
