Gee, I Wonder If There's a Connection Here

One of the recurring claims is that mental hospitals were bad places for the severely mentally ill--that they would have been a lot better off in a community setting. Harding's "Vermont Longitudinal Study of Persons with Severe Mental Illness" a 25 year study of the first patients deinstitutionalized back in the 1960s, claimed that patients did as well in a community setting as they would have done in a mental hospital.

Several critics of deinstitutionalization (such as Gerald Grob, the Mad Among Us, 294-5) have suggested that this was because the subjects were people who had lived for many years in institutions, and had internalized the discipline and rules sufficiently to live on the outside. Of course, as with the sane, aging tends to scrape off some of the rough edges.

I can't find a copy of Harding's paper online (it was published in the American Journal of Psychiatry in 1987, just before journals started to routinely put their stuff in PDF format), but I notice that some of the papers that cite it seem to have some interesting characteristics. For example, Julian Leff and Noam Trieman, “Long-stay Patients Discharged From Psychiatric Hospitals,” British Journal of Psychiatry 176(3)[2000]:217-22, talks about the success of deinstitutionalization of long-stay patients in Britain--how those that were deinstitutionalized did as well, and often better, than those that remained institutionalized.

But when you read the paper, you discover that the average age of the group that was discharged was 54 years, and of 670 patients discharged, 126 died during the study period (and no explanation of the causes of death--did they freeze to death, commit suicide, get run over by cars?), and "nine could not be traced." Amazingly enough, the study assumes that these former patients that could not be interviewed were representative of those who could be. Furthermore, 47% of the former patients refused to answer one of the survey forms, the Social Network Schedule.

It's hard for me to take seriously the conclusions that they reached with problems like this.