Date of Award


Document Type



College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Lauren Valk Lawson


This policy evaluation project evaluated how federal mental health policy changes impact individuals diagnosed with severe mental illness through analyzing how institutionalization and deinstitutionalization policies impact persons with severe mental illness (SMI). In order to determine how federal policy changes impact outcomes for people diagnosed with SMI, psychiatric hospitalization rates per 100,000 from 1850 to 2015 are compared to the life expectancy, incarceration rates per 100,000, and percentage of unhoused population with SMIs in the United States (U.S.) during the same years. Research compiled for this paper found that decreasing the numbers of psychiatric beds correlates within creased rates of homelessness (R-0.71), increased rates of incarceration (R-0.53), and decreased life expectancy (R-0.78) for persons with SMI. From 1980 to 2015, for every time the psychiatric population goes down by 1 person per 100,000, there are 0.8 people with SMI who are incarcerated.

There is a scarcity of psychiatric beds and an overabundance of prison cells. This project demonstrates that periods of increased centralization of mental health policy correlate with improved outcomes for people with SMI. Transinstitutionalization and homelessness are more expensive than providing comprehensive community treatment and housing for people living with SMI. Increased federal funding in programs that provide supportive housing and psychiatric care reduce taxpayer cost and improve outcomes for people living with SMI. Fixing this crisis will involve more than simply changing the locus of care away from incarceration. America needs legislation supporting increased federal financial and programmatic support to improve outcomes for people with SMI.

Included in

Nursing Commons