amounted to 15 percent of federal expenditures, the third largest single category in the federal budget, trailing only Social Security (22 percent) and defense (18 percent) ( OMB 1996, p. 7). In the 1960s and 1970s net interest payments consumed about 7 percent of federal spending, less than half of current levels. While the federal government can afford this level of deficit, some observers worry that this level of interest payment has shifted money away from programs and frozen the will of government and its ability to come up with progressive policies and carry them out; they suggest that the U.S. is beginning to resemble developing countries where citizens labor to pay for past consumption and serve their creditors rather than invest in their future and the futures of their children. Others argue that the deficit debate has led to a much needed reexamination of the appropriate role and size of government in society.
Budget of the U.S. Government, FY 1997: Historical Trends. Washington, D.C.: U.S. Government Printing Office.
Mufson, Steven, 1991. "The Thing That Wouldn't Die". The Washington Post National Weekly Edition (February 11-17) 6.
Office of Management and Budget (OMB), 1995. A Citizen's Guide to the Federal Budget. FY 1996. Washington, D.C.: U.S. Government Printing Office.
Wildavsky Aaron, 1988. The New Politics of the Budgetary Process. Boston: Scott, Foresman and Co.
DEINSTITUTIONALIZATION. The policy and practice of transferring incarcerated people from large, dense, homogeneous, restrictive environments to less restrictive, less crowded, heterogeneous environments. Outpatient mental health care and intermediate sentencing represent deinstitutionalization in the fields of mental health and criminal justice.
Institutionalization by the state was a nineteenthcentury reform to care for society's outcasts, who had previously been cared for at home, by local governments, or not at all. The ninteenth-century vision of progress motivated reformers to assemble into a modern facility those people who exhibited behaviors that were unwanted of feared. Juveniles and adults who break the law, the mentally ill, the mentally retarded, and the aged are the categories of people usually institutionalized. Institutionalization was justified as a humane practice in caring for people who are unable or unwilling to conduct themselves in a societally approved manner, and whose roaming freely constitutes a risk to themselves or others. "Penitents" (hence the term "penitentiary") were to be given time alone, to reflect on and to improve their behavior.
Institutionalization is currently being described as an ineffective and/or inefficient way to deal with people who have difficulty caring for themselves or who exhibit socially inappropriate behavior. Issues of institutionalization versus deinstitutionalization face citizens and governments of all Western nations. Since criminal and statutory offenders differ from the mentally disabled and aged, these two categories will be discussed separately.
According to the supporters of institutionalization, an isolated, supportive environment protects the mentally ill, mentally retarded, and the aged from abuse or neglect, and provides these people with caring, professional treatment. Perhaps some can be cured. Mental health and retardation institutions grew to meet societal demand, and as a result, people who were unruly, obstinate, or addicted to drugs and alcohol found themselves committed to these institutions, thereby turning these intended havens for rest and rehabilitation into the dumping ground for society's unwanted.
A large client population, coupled with deteriorating budgets to support caring and treatment, meant that harried mental health workers could do little more than act as warehouse custodians. By the 1960s cries for change came from across the ideological spectrum. Critics such as psychiatrist R. D. Laing ( 1969) and sociologist Erving Goffman ( 1961) considered incarceration inhumane. Institutionalization labeled the individual with a stigma, which the individual internalized into a self-concept, thereby inhibiting intellectual and emotional growth, and causing the client to become psychologically trapped in a dependency relationship with powerful caregivers. Incarcerated clients, kept in a restrained and dependent condition, were coerced to display acquiescent behavior to ease the task of the custodians. For critics such as Goffman and Laing, the institution was the problem, and the first step for improving mental health care was to close these places of confinement and to substitute an environment where the patient could gain self-respect and be challenged to grow.
Cost-conscious legislators attacked from a different direction, criticizing institutions as inefficient, a waste of taxpayers' money. The discovery (or rediscovery) of psychotropic drugs in the 1950s demonstrated that mood shifts and violent outbursts could be minimized by medication, so patients were less likely to be a danger to themselves or others, which undercut one argument for longterm incarceration. After undergoing crisis intervention and becoming stabilized on medication, the client could live with family, in a group home, or alone, without the need of highly trained professionals in attendance 24 hours daily. A professional case manager could serve as liaison and advocate for the client, connecting the client with the appropriate medical or social service. With emotional outbursts controlled through drug therapy, the mentally ill could not be readily distinguished from "normal" people. Community care would eliminate the labeling stigma,