Support Needed for Social Reintegration of People with Schizophrenia

Asahi Shimbun Morning Edition – October 31, 1998

It has been reported that many of the more than one million homeless people in the United States suffer from schizophrenia. This stems in part from the drastic reduction in psychiatric beds from 510,000 to one-fifth that number in 1963, during President Kennedy’s administration—a change whose effects are still felt today.

This was the result of a combination of a movement criticizing the harms of long-term institutionalization and the government's cost-cutting measures in healthcare. Once implemented, the policy was not reversed.

In Japan as well, a poem stating "Birds need the sky, fish need water, and people need society" became a slogan. It reflected the idea that instead of spending their lives in hospitals after losing the will to live, people with mental illnesses should live vibrantly in their communities.

The 1993 film The Saint of Fort Washington depicts a city in the wake of deinstitutionalization. Matt Dillon, playing a man recently discharged after being treated for schizophrenia, finds that the derelict building where he used to live has been demolished. He is placed in a massive, gymnasium-like shelter but ends up living on the streets, washing car windows and begging for tips.

With a saintly expression tinged with quiet sorrow, he takes pictures of his fellow homeless companions using a camera with no film. The strained smile he occasionally forces remains unforgettable.

Schizophrenia can take five to ten years to stabilize. The stress of re-entering a competitive society after discharge is immense. People who had been under 24-hour care suddenly have to manage everything—medication, meals, and daily tasks—on their own, often forced into abrupt independence.

Reducing the number of institutions alone will not lead to successful social participation for people with schizophrenia. In Japan, support residences and welfare homes have finally begun to appear. Independent discharges into single-room apartments or group homes, and efforts to create supportive living environments after discharge, are gradually being developed. However, public understanding remains insufficient.

What is truly needed is carefully tailored support for each individual patient...