Policies of inclusion and the mentally ill: Long term care in a new environment

We propose “policies of inclusion” as a conceptualization of current mental health long-term care policy. Inclusionary policies refer to the fact that deinstitutionalization, and all the policy changes associated with it, resulted in the forcible inclusion back into society of patients formerly excluded by institutional placement. This compelled both society and the patient to change in profound but often unpredicted ways. This conceptualization can explain and unite many phenomena associated with deinstitutionalization—for example, how its problems resemble those of racial desegregation, why it results in increasing differentiation of types of patients, and how it turned what had formerly been a mental health problem into a broader welfare problem. The paper ends with suggestions about future research implied by this conceptualization.