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The transition from institutional (custodial) to community-based care of mental disorders, which was facilitated by development of psychoactive drugs and modern office-based psychotherapeutic methods. It was perceived as a progressive trend because custodial care often had punitive elements, and was said to be cheaper than custodial care. As a bureaucratic process, it was sometimes heartless. Not all of the people with chronic mental disorders who had previously lived in mental hospitals and other long-stay institutions were identified and effectively treated by community-based psychiatric services after they had been ejected from the institutions that sheltered them. An unintended consequence has been the emergence of a new public health problem: a sharp increase in the prevalence of homeless mentally ill people. Enlightened psychiatrists and mental health administrators have avoided this problem by establishing a therapeutic community. See also long-term care.

Subjects: Social Work — Public Health and Epidemiology.

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