Due to the advent of psychotropic drugs in the last half of the 20th century, many patients were able to live normal lives outside of a hospital setting. Also, state hospitals began to receive negative press for their deteriorating conditions. Conceptions of mental illness were changing and rates of recovery were rising. Privitization of health care brought less patients to hospitals. State and federal funds began focusing on alternative methods of treatment and out-patient care, which tended to be less expensive than long hospital stays.

All of changing attitudes and practices effected Northampton State Hospital. The number of patients at the hospital fell, and the length of patients stays dwindled. For the first time since 1961, more patients were being discharged than admitted. A placement program was started in 1962, with the goal of sending patients back to their families, or into smaller group or nursing homes for care.

Patients had the opportunity to be discharged from the hospital if they were deemed able at a hearing. However, many patients were proven able to live outside of a hospital setting, yet no community programs were existant to fit their needs. In 1976, a class-action lawsuit was brought by the Center for Public Representation on behalf of patients at Northampton State Hospital who felt that the state had the duty to provide treatment in the least restrictive setting possible for each patient. Brewster vs. Dukakis (David Brewster, a patient at NSH, versus Michael Dukakis, the then governor of Massachusetts) was settled in 1978 with the "consent decree." The decree required the development, funding, and execution of dozens of community service programs designed to aid the mentally ill. A timetable was established for reducing Northampton State Hospital's population and placing clients in the community.

Advocacy and support programs, such as "The Mental Health Advocacy Project," funded by the National Institute of Mental Health, provided patients with free legal advice and represented them at hearings in which the need to keep the patient in the hospital was determined.

The original timetable called for three years during which over 400 patients would be deinstitutionalized, bringing the hospital population down to the 50 most severely ill patients. In reality, the process took almost 14 years, yet in that time, the number of community programs developed exceeded the original goals of the decree.

Deinstitutionalization was a very controversial issue. Many employees of the state hospital system lost their jobs, as there were less patients to care for. Therapy at the hospital became more living-skills based. Occupational therapy and residental and work rehabilitation programs, like the Incentive Community Program, gave work to social workers, while professional psychiatrists and psychologists left the hospital to find new jobs opening in the community. Also, some were skeptical about forcing patients to leave life at the hospital, which was more beneficial to some than others.

On Thursday, August 26, 1993, the last eleven patients left Northampton State Hospital for a new psychiatric unit at a Springfield Hospital.

To learn about what has happened since, click on Memorialization, or explore the Revdevelopment section.