Two‑wave deinstitutionalization left service gaps

The U.S. experienced two distinct deinstitutionalization waves — starting in the 1950s for psychiatric patients and later for people with developmental disabilities — driven by medications, exposés (e.g., Willowbrook), federal policy, and state cost-cutting; but community services often failed to scale, producing persistent gaps in care. The article documents the timeline, key actors (NIMH, Congress, state governments), and consequential litigation and consent decrees that reveal how reform intentions collided with funding and implementation limits. — Understanding this history explains present-day policy tradeoffs around homelessness, incarceration, and mental-health funding, and informs current debates about whether to rebuild institutional capacity or invest in community supports.