There are many pros and cons to having institutions available for people with mental illness or developmental disabilities to live.
They should only be available when someone's needs exceed the capacity of community-based options, or when they prefer to live in a congregate care setting, provided they have other choices. Choices should not only include receiving services in an institution or none at all.
Choice should not only include discussing the community, but also visiting and experiencing community living arrangements, including supportive employment. Exposure to the community should include activities with people with and without disabilities. Therefore, Special Olympics should not be the only option for exercise and physical activity. Perhaps, they could try out a weight room or gym for exercise. Again, community living is an option (keyword: option), not a must for everyone, and there is no firm rule about what options should be explored by the individual.
As a side note: reducing the institutional census should not involve just releasing people to improve statistics, without appropriate life and coping skills. When this happens, it creates a situation that will require longer and longer periods in institutional settings.
Also, when we close institutions, individuals who need them get directed to go to other available institutions, such as traditional correctional facilities, which are certainly not appropriate for this population.l
For me, I got the right medication and therapy in an institution, especially when I was a danger to myself and others, but it took way too long before they wanted to start planning discharge. Services like Programs of Assertive Community Treatment and Involuntary Outpatient Commitment are ideal when they can be safely accommodated.
I am only in favor of institutional settings if someone is dangerously mentally ill and/or has dangerous challenging behaviors and needs to be there or chooses to live there or when the system cannot accommodate a less destructive placement.
These internal committees that review forensic service recipients' privileges and discharges need to be eliminated. These committees in New Jersey are known as the Special Status Patient Review Committee (SSPRC) and the Clinical Assessment Review Panel (CARP)
Discharge planning should start at admission to avoid situations where it takes an exorbitant amount of time to get people back to the community, including those on forensic status. Discharge is not an “if”, it is a “when”. Meaning, discharge should be thought of as something that will happen for everyone, not just a mere possibility.
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