Out of the wards and onto the streets? Deinstitutionalization and homelessness in Britain

Abstract

In the last decade there has been growing concern about the numbers of mentally ill homeless people on the streets in Britain. It is widely believed that this is a direct consequence of the closure of hospital asylums. In this report we examine the existing evidence for such a link drawing on material collected in recent British studies. Several tentative conclusions can be drawn from the available information: (1) rates of severe mental illness amongst the long-term homeless are considerably in excess of what might be expected given general population rates of these disorders; (2) schizophrenia accounts for the majority of these illnesses; (3) levels of disability (both social and symptomatic) are broadly similar to those found in long-stay populations; (4) the majority have never experienced long periods of hospitalization and are not those people who have been discharged as part of the planned closure of a large mental hospital; (5) recent studies demonstrating an apparent failure to deliver effective ongoing care to this population precisely echo studies conducted four decades ago. It is likely that the present crisis of visibility is the consequence of long-standing failures to provide assertive community care coupled with the less widely publicised reduction in direct access hostels which since the mid-1950s have served as unacknowledged asylums for large numbers of mentally ill people.