Deinstitutionalization and the Impact of Antipsychotics Versus Policy Change

The introduction of antipsychotics in 1954 is widely considered central to the depopulation of US state mental hospitals. Using US Census data and time-series analysis to estimate the impact of chlorpromazine and policy change on state mental hospital population changes, this study found that the post-1954 depopulation was associated with important demographic changes in age and diagnosis. From 1954 to 1961, the resident count of patients diagnosed with “schizophrenia” in state mental hospitals did not significantly decline but rather significantly declined between 1961 and 1966. Additionally, depopulation between 1954 and 1961 occurred among patients below age 55 but between 1961 and 1966 occurred among patients aged 55 and over. This depopulation of the elderly occurred across diagnoses and coincided with policy changes, which allowed for federal medical assistance for the aged. The conclusion of this study is that policy change and economic incentives had a greater impact on deinstitutionalization than the advent of antipsychotics.