A lot of this post is copied from the Autistic Self Advocacy Network ASAN Institutions: The Old, The New, and What We Should Do and Cycle of Institutions toolkits. https://autisticadvocacy.org/policy/toolkits/institutions/ and https://autisticadvocacy.org/wp-content/uploads/2020/10/PL-cycle-clpc.pdf
ASAN says institutions nowadays look different than the old ones, but they can be similar. Some institutions look like farms or campuses on which several houses or cottages are located on a large piece of land. They may also be large buildings. ASAN describes institutions as “bad places to live.” ASAN is in favor of closing all institutions for good. I believe we need at least some institutions, and we need to make them better, not get rid of them altogether.
The ASAN cycle of institutions is the reason institutions keep closing and opening again. This cycle is as follows:
New institutions get made. They say they are not like the old institutions or that they are not institutions at all. They say these new places will help people with disabilities, but they look and act a lot like the old institutions.
People get sent to the new institutions and don't actually get help. They don't get to go to school, learn how to do jobs, or learn how to live on their own. People start getting hurt in the new institutions just like the old ones.
People started to notice how bad the new institutions were. A government worker might visit one of the reports that shows up on TV or in the newspaper.
People try to think of new ways of helping people with disabilities. They couldn't think of a way to help them live in the community, so they came up with a new kind of institution.
Repeat Steps 1-4
This is the process of innovation and improving things: having something fail and then coming up with new solutions that meet the same needs. This process is benign, if not helpful, in making our institutions better.
Another cycle of institutions I feel is worth mentioning is the cycle of trans-institutionalization, which is when people with mental illness and money are shifted from mental health institutions to correctional institutions. This cycle is as follows:
Someone has a mental health crisis. They are denied admission to a hospital. They are released from the Emergency Room to the street with no follow-up mental health care.
They continue to decompensate until they commit a crime and get arrested. In the court system, they are treated as a criminal, and the crime was a symptom of their illness.
Since insanity defenses rarely work, they go to prison, where they are abused by other inmates and the officers. They get deeper into the mental illness, and recovery becomes more difficult.
While in prison, correctional officials sometimes feel the inmate needs mental health treatment, and they transfer them to a forensic psychiatric hospital. This is rare because other inmates will fake mental illness to avoid prison or get access to drugs given at the forensic hospital.
They are often released from prison with just clothing, $50, and a bus pass to get home or to a shelter. No longer do they provide referrals to mental health professionals upon release from prison. Oftentimes, they are homeless and without a supportive family. They have no access to mental health care because they do not get Medicaid right away.
They decompensate and have another crisis.
Repeat Steps 1-6
This is what trans-institutionalization looks like in practice. I am urging States to gradually stop incarcerating those with mental illness and provide them with treatment in a hospital instead. We need to make better use of our forensic commitment laws (I.e., Not Guilty by Reason of Insanity, Incompetent to Stand Trial, Guilty but Mentally Ill, etc.) to do this.
Please take a moment and comment to let me know you were here and what you thought of my blog.
