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July/August 2015 Issue

Editor's Note: The Kindest Care
By Marianne Mallon
Social Work Today
Vol. 15 No. 4 P. 4

Our cover story was generated by an editorial in the Journal of the American Medical Association by several ethicists who view the deinstitutionalization movement of the 1960s and 1970s as a failure of the community mental health system to meet the needs of people with the most severe mental illnesses. Instead, they contend, it has turned into "transinstitutionalization" in which those with severe mental illnesses have been sentenced to jails and prisons, been frequent visitors in emergency departments, and become victims of violence and abuse. They argue that the only way they can receive humane care is in the structured setting of an institution, an "asylum," but not with the negative connotation of those of years gone by.

Social Work Today asked many social workers about their thoughts on this idea and most disagreed with a return to large-scale institutionalization. According to Phyllis Solomon, PhD, a professor at the University of Pennsylvania School of Social Policy & Practice, just because the community mental health system hasn't figured out a way to best treat the people with the most severe mental illness, that doesn't mean they should be isolated in institutions.

"I don't think there are easy answers, but I certainly don't think we should go back to institutions," Solomon says. "We should figure out a way to do it in the community."

Solomon says more social workers need to open themselves up to working with clients with serious mental illness. Sometimes these clients are seen as the "impossible" cases and work with them is seen as beneath the level of highly educated social workers. Social workers' talents, advocacy skills, and focus on the whole person could go a long way in helping these clients thrive in the community and avoid institutionalization, Solomon says.

And wouldn't this indeed be the kindest care?

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Marianne Mallon