The movement from institutionalized care to community and home care is evident in all aspects of health care. This shift began in the 1950's in the United States changing the inpatient and outpatient treatment of the chronically mentally ill. The nature of psychiatric illness, however, differs significantly from other ailments. The stigma of mental illness, combined with the cardinal symptom of lack of self-care, often leaves the patient vulnerable impacting safe discharge to the family and community. Advances in mental health care, increased pressure from the public, and changing federal policies over the last six decades have contributed to the American shift towards a more community-centered care model. This review of the literature will examine three defining periods reflecting shifts in care paradigms (1950-1975, 1976-1995, and 1996-2015), and the subsequent changes in treatment provision for the seriously, chronically mentally ill in the United States.

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