Flying the Cuckoo’s Nest

This chapter charts the multiple factors that spurred the deinstitutionalization of mental hospitals in the 1960s. In 1963, Congress passed the Community Mental Health Act, which funded the creation of community mental health centers and provided inpatient and outpatient care, partial hospitalization, emergency services, and public education. The creation of Medicare and Medicaid also caused many states to reduce their reliance on custodial mental hospitals. Meanwhile, anti-psychiatry texts like Ken Kesey’s One Flew over the Cuckoo’s Nest spurred anti-institutionalism and advocates filed successful lawsuits against involuntary commitment laws. Institutionalized people gained a plethora of civil liberties, further reducing the mental hospital population. The chapter explores these national changes at the local level at places such as the Philadelphia State Hospital. That institution released large numbers of people, many of whom faced hardship when they left the hospital. That trend reflected how changes in mental health law and policy did not guarantee that people could access medical and social services in their home communities.