This article examines the discrepancies between the rhetoric surrounding deinstitutionalization and community care and the reality of the abandonment of the seriously mentally ill to their fate. It discusses how the earlier commitment to the asylum came to be abandoned, analyzes various attempts to explain why the mentally ill were decanted from institutions into a largely unreceptive community, and dissects the shortcomings of these actions. The realities of care in the community and the connections of deinstitutionalization to the collapse of public psychiatry, the epidemic of homelessness, and the place of jails as our primary in-patient response to serious mental illness are explored, as is the curious political coalition that endorsed the end of the asylum. The connections of deinstitutionalization to the rise of neoliberal ideas are documented, and the impact of the changed public policy on the life expectancy of those with serious mental illness is analyzed.

中文翻译：

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“社区关怀”：去机构化的历史视角。

本文考察了围绕去机构化和社区护理的言论与严重精神病患者被抛弃命运的现实之间的差异。它讨论了早期对庇护的承诺是如何被放弃的，分析了各种试图解释为什么精神病患者从机构中转移到一个基本上不接受社区的尝试，并剖析了这些行动的缺点。探讨了社区护理的现实以及去机构化与公共精神病学崩溃、无家可归的流行以及监狱作为我们对严重精神疾病的主要住院反应之间的联系，以及好奇的政治联盟同意结束庇护。