‘Mainstreaming’ has hurt psychiatric patients
I wasn’t around in the 1960s when the concept of “de-institutionalisation” swept the globe as the best way to care for people with psychiatric illness in society.
My psychiatry lecturers taught me it was a fabulous idea to open up the asylums, sell off the real estate and allow those with mental illness to live in the community when they had no skills or resources to do so. They knew a life where, if they were unwell, a doctor or a dentist would visit them at the asylum.
They were seen to be better off in society, and not because asylums as a concept were awful, although the asylums were so run down that by the time they left they were glad to see the back of them.
In the 1990s I was a medical student studying psychiatry while working as a community pharmacist in a nice leafy area in Melbourne, Australia. As patients left the asylums to live in the community, and we began to look after them in the pharmacy, the concept of mainstreaming was introduced. Mainstreaming was a term that defined the process of moving acute psychiatric services on to “mainstream” hospital grounds, with patients presenting for admission via the emergency department. (It occurred at a time when emergency departments were perhaps not run the way they are now, beholden to state government penalties, bed block, and hospital administration budgets. There was no pandemic either.) Even the term mainstream smacked of stigma, but it is still spoken of now as a relatively new concept that is all about improving the care of the patient with mental illness.