Mapping Urban Hotels: Life Space of the Chronic Mental Patient
Authors: Sweeney Dorothy , Garrison John , Dabrowski Catherine , McGettigan Peggy 
Published: April 2021

ABSTRACT

Large numbers of patients with severe mental illnesses and skill deficits associated with long-term institutionalization are being discharged into communities that often are unprepared to care for them. Although benevolent in intent, the legislation enabling deinstitutionalization lacks explicitly stated provisions to establish adequate living arrangements for this new population. The housing shortage has led to ad hoc solutions such as the use of singleroom-occupancy hotels as unofficial halfway houses. Urban hotels having financial problems or located in poor neighborhoods often have welcomed chronic mental patients or their welfare checks) as residents. This paper is a beginning effort by community-based practitioners to describe the deprived, yet often complex, life space of ex-patients living in urban hotels.

Beginning over 15 years ago, under the aegis of the community mental health movement, large numbers of patients with severe mental illnesses have been discharged from state hospitals into community living. Many authorities now are beginning to question whether or not this deinstitutionalization, as it currently is being practiced, represents the best possible service for the patients (Bassuk & Gerson, 1978). There is an increasing awareness of the problems associated with the indiscriminate, largescale discharge of chronic psychiatric patients into communities that are unprepared to provide the multitude of services necessary to ensure an adequate quality of life. These patients often are suffering more from "social breakdown syndrome" associated with long periods of skill-depriving institutionalization than from the illness for which they originally were hospitalized.

The genesis of this large scale deinstitutionalization is complex (Gruenberg, 1974). The discovery and widespread use of powerful psychotropic drugs is one factor. Another factor is increased sensitivity to preventing the deterioration of the patient's real-life skills associated with institutionalization. Additionally, there is a policy shift by state governments toward reducing state hospital populations both as a better way of treating patients and as an effort to deal with fiscal crises brought on by excessive government spending. Concern with patients' civil rights also has been a factor.

Initial motivations notwithstanding, mental health agencies of all types now are being accused of premature discharge and poor care of patients ill prepared to manage for themselves. These accusations are coming from the lay public as well as the professional community and the government. The New York Times (Koenig, 1978, p. 14) reported that "Some 40,000 poor, chronic mental patients have been dumped in New York City. Neighborhoods feel threatened but the mentally ill are the greatest victims." The General Accounting Office of the U.S. government studied the adjustment of discharged patients and states that many patients are being released to community facilities totally inadequate for their care (U.S. Comptroller General, 1977). Critics from the professional community confirm the phenomenon. Bassuk and Gerson (1978, p. 46) conclude that "chronic patients are being discharged to a lonely existence in hostile communities without care." The prestigious multidisciplinary staff of the