04/24/2026
The more you know!
Deinstitutionalization is the big shift people are usually referring to when the words community-based care are discussed. But for context purposes, community-based care was supposed to do so much more than just provide a route to deinstitutionalization. We have been trying (against really strong headwinds) to build a robust continuum of care for our communities for more than 50 years.
For much of the 20th century, severe mental illness was often treated in large state psychiatric hospitals, sometimes for years. Over time, concerns about patients’ rights, reports of poor conditions, and the development of psychiatric medications helped drive a move away from long-term institutional care.
From a community education perspective, the key idea is that mental health care became something that should happen “where people live,” not far away behind hospital walls. That meant expanding outpatient therapy, crisis services, case management, peer support, supportive housing, and help with everyday needs like employment and transportation. Community mental health centers and local providers became the front door for many services, with hospitals used more for short-term stabilization rather than long stays.
This shift brought real benefits—less isolation, more autonomy, and care that can be more culturally and family-connected. But it also created challenges when communities didn’t get enough funding, staffing, or coordinated services to replace what hospitals used to provide. In those gaps, people can end up cycling through ERs, jails, shelters, or unstable housing, which is why many communities now emphasize “continuum of care” systems that link prevention, early intervention, crisis response, treatment, and long-term supports.