A Mental Health System in Recovery: The Era of Deinstitutionalisation in California

Abstract

In this chapter, the authors provide snapshots illustrating the development and impact of California’s mental health policies since the 1970s. Using historical primary source documents, oral history interviews and ethnographic observations, the authors tell the stories of how family members of individuals with mental illness, policymakers and clients themselves both reacted to and helped create California’s responses to challenges and paradoxes of deinstitutionalisation. The chapter shows how, in spite of the development of comprehensive community-based services and supports and the emergence of a service delivery philosophy—the recovery model—that was designed to facilitate independence and social integration, lofty ideals of system reform have often proven irreconcilable with clinical and socioeconomic realities. Consequently, neither new mental health services nor new service philosophies have been able to adequately address the significant challenges that Californians with serious mental illness continue to face in the era of deinstitutionalisation.