Thanks for your comments. The common explanation that deinstitutionalization works well when there are adequate community services (and access to those services) sounds good on paper, but works poorly in practice. Community services, access, and resources are highly variable, with most being inadequate (usually because of a combination of resource problems, unfortunate priorities, poor services, access limitations related to inadequate case finding or follow-up, and/or access problems related to misguided focus on the "rights" of patients to be miserable).

ACT programs (Assertive/Aggressive Community Treatment) tend to be very good, but they are only available to a tiny fraction of the patients who need them. Almost all community mental health (and mental reardation) service centers have heard of the concept, which has been around for over a decade, and many have tried it. The outcome studies are virtually unanimous that the programs work, both for patients themselves and for saving dollars. Nevertheless, once the newness wears off, attention wanes and funding dries up (or does not expand to meet the need), as legislators and community leaders tend to divert the dollars to something else that has garnered the public's (or media's) attention.

One last thing: I am amazed at the number of very smart people who think the operative phrase is "least restrictive setting." It's not. The complete phrase is "least restrictive clinically appropriate setting." Those two extra words make all the difference between real help and mindless political correctness.