MENTAL HEALTH

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MENTAL ILLNESS
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MENTAL ILLNESS

• Brief History and Statistics
• Labeling of people
• Key People
• Legal Actions and Movements
• Treatments

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A BRIEF HISTORY OF MENTAL ILLNESS

• During the 1700s people were locked away by
  their families
• The first mental asylum was built in 1769 and was
  headed by Benjamin Rush
• In the 18th and 19th century asylums and
  hospitals were built
• After World War II, people began to realize that
  soldiers were having abnormal behavior

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More History

• In 1940s and 1950s medication was actually
  prescribed to some patients
• Many laws were passed to help with regulations of
  institutions
• In the 1960s around 500,000 people were
  institutionalized and by 1986 the number had
  reduced to 100,000

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STATISTICS

• From 1880 to 1920 the number of insane patients
  had increased from 40,942 to 232,680!! And as
  mentioned before 500,000 by 1960
• Some statistics from 1923

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Mental Illness Statistics Today

• Panic Disorders 6 million Americans
• Obsessive-Compulsive Disorder (OCD) 2.2 million
  Americans
• Schizophrenia 2.4 million Americans
• Bipolar Disorder 5.7 million Americans
• Mood Disorders 20.9 million Americans
• Post-Traumatic Stress Disorder 7.7 million
  Americans

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MENTAL ILLNESS

• Labels
• Mythical causes
• Types of people who were in mental hospitals
• Places

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LABELS GIVEN TO MENTALLY ILL

• Lunatics
• Crazy
• Insane
• Idiots
• Feeble-minded
• Brain-sickness
• Beast
• Animals

• Witches
• Sorcerers
• Werewolves
• Madness
• Possessed
• Disturbed
• Maniac
• Unbalanced

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Mythical causes of Mental Illness

• Post-partum depression
• Old-age
• Evil spirits
• blessed by God
• Masturbation

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Who were in Mental Hospitals?

• Wives daughters who disobeyed their husbands
  fathers
• Depressed
• Menopausal women
• Those caught masturbating
• Those who didnt fit the status quo
• Alcoholics

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Places

• All people with brain sickness were placed here
  for peoples amusement.
• Cages
• Cellars
• Closets
• Stalls
• Pens

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Important People In Mental Health

• Benjamin Rush
• Dorthea Dix

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Benjamin Rush (1745-1826)

• He was one of the
• founding fathers of
• the United States
• He was a staff member
• at the Pennsylvania
• hospital
• He was also a professor of
• medical theory and clinical
• practice at the university of
• Pennsylvania
• After he began to practice
• medicine he realized that his
• primary interest was the
• treatment of mentally ill

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Father of American Psychiatry

• He advocated bleeding for almost any illness long
  after its practice had declined
• His favorite method was to tie patients to a
  board and spin them until all the blood went to
  their head
• Rush was far ahead of his time in the treatment
  of mental illness
• He invented the tranquilizing chair and the
  gyrator

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Father of American Psychiatry

• Rush was an advocate for the insane asylums,
  believing that with proper treatment mental
  disease can be cured
• He worked toward a more human housing for
  psychiatric patients. He encouraged hygiene for
  patients and forms of occupational therapy
• Rush disapproved completely of restraints of any
  kind, for long periods of time
• He outlawed the use of whips, chains, and
  straitjackets and developed his own method for
  keeping control
• Some of his methods we feel he was quite harsh,
  but in his day his methods were considered
  exceedingly humane

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Dorthea Dix (1802-1887)

• In 1841, began her moral
• treatment crusade
• She was a teacher and ended
• up working herself to exhaustion
• Took a break and traveled
• to Europe. While there she met
• Dr. Samuel Tuke, he was
• concerned about problems of all
• people, the sick, poor, and insane
• She learned from him that
• in an environment of compassion
• and genuine care, mental
• disease could be more effectively
• treated

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Dorothea Dix

• Her second job started when she was 39. In 1842
  she entered the East Cambridge Jail. She
  volunteered to teach the inmates Sunday school.
  When she got there she witnessed horrible images
  of prostitution, drunks, criminals, mentally ill.
  The people were chained to the wall in the
  basement they were under fed and filthy. They
  were all housed together in a unheated,
  unfurnished, and foul smelling quarters
• When she asked the jailer why they lived in such
  conditions they said the insane cant feel heat
  or cold.
• After seeing these conditions she took matters to
  the court

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Dorothea Dix

• Dorthea was devoted to the right of the sick and
  insane. She traveled all over the U.S to visit
  hospitals
• She would visit these hospitals repeatedly over
  time to document the current conditions and the
  treatment of the patients

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Dorothea Dix

• Because of her status as a female, she was not
  powerful enough to promote action to help the
  people in these institutions
• In 1848, she attacked the federal government. She
  made an appeal for 5 million acres to be used for
  and by the insane, deaf, and the dumb
• In 1854, the bill was sent to the senate and
  house and was passed by a large majority, but was
  vetoed by president Franklin Pierce

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Dorothea Dix

• As an educator, Dorthea educated the nurses
  because most of them were often uneducated,
  crude, and cruel. She taught them ethics and
  every aspect of hospital care, including
  exercises
• Dorthea believed that the mentally ill would
  never be cured living in those dreadful
  conditions by betting the conditions of the
  inmates, sowed people that mental illness wasnt
  all incurable
• She played a major role in founding 32 mental
  hospitals, 15 schools for the feeble minded, a
  school for the blind, and numerous training
  facilities for nurses
• She also established libraries in prisons, mental
  hospitals and other institutions

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Dorothea Dix

• Many believed that she was the most useful and
  distinguished women American has yet produced
• She was also known as the most effective
  advocate of humanitarian reform in American
  Mental Institutions during the 19th century

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Mental Illness

• Asylum Movement
• Eugenics
• Mental Hygiene Movement
• Deinstitutionalization
• Psychiatric Survivor Movement
• Today

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Asylum Movement

• 1843 Memorial to Massachusetts legislature asking
  for better conditions and treatment for the
  mentally ill
• 1894 State Care Act
• Placed financial responsibility on state
  government instead of local government
• By mid 19th century the asylums had deteriorated
  to horrible conditions like that originally found
  in the jails

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Eugenics

• The study of improving human genetic qualities
• 1865 Sir Francis Galton developed the idea of
  eugenics for social control of the weak. It would
  help control the natural selection process
• 20th centurylaws written to prohibit marriage
  and force sterilization of the mentally ill

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Eugenics

• Laws were abolished in 1967
• By 194545,000 mentally ill patients had been
  forcibly sterilized
• Many people were told they were having other
  surgical procedures and then were sterilied
• Nazis were most famous for the use of eugenics
  for racial cleansing

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Mental Hygiene Movement

• Clifford Beers
• Yale educated
• Went mad
• Wrote A Mind that Found Itself 1908
• His journey through many asylums
• Created the National Committee for Mental Hygiene
• Today it is called the National Mental Health
  Association, NMHA

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Mental Health Movement

• Goals
• To improve attitudes toward mental illness and
  the mentally ill
• Improve treatment, services and care
• Prevention of mental illness and promote mental
  health
• 1920 created model laws for states
• Conducted many studies and research

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Mental Hygiene Movement

• Didnt like asylums, renamed them mental
  hospitals
• Began psychiatric care of patients with drugs and
  patient centered care
• Wanted early treatment and preventative measures
• Believed in outpatient care for discharged
  patients

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Deinstitutionalization Movement

• Called a social experiment
• Removing patients from hospitals and placing them
  within the community
• Problems
• Forgotten relatives returned to family members
  homes
• Community not receptive
• Psychotropic drugs failed

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Deinstitutionalization Movement

• Pressure to make changes from
• Civil Rights Movement
• Professionals in the asylums
• Discovery of psychotropic drugs
• Cheaper care alternatives were available
• The number of psychiatric hospitals decreased
• 277 hospitals in 1977
• 231 hospitals in 1996

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Deinstitutionalization Movement

• The shift in care was placed on community
  organizations
• 92 of people living in psychiatric hospitals in
  1955 were not there in 1994

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Who was deinstitutionalized?

• 50-60 schizophrenic
• 10-15 manic depressive or severe depressive
• 10-15 brain disease
• Alzheimers, TBI
• The restpsychosis, mental retardation and brain
  damage from alcohol and/or drug use

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Where did they go?

• Jailapproximately 10 are mentally ill
• Streets
• Family
• Community based programs
• Many were untreated in any capacity

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"Cast from shackles which bound them, this bell
shall ring out hope for the mentally ill and
victory over mental illness."
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Psychiatric Survivor Movement

• Initiated by patients
• Two types of involvement
• Consumersindividuals working to change mental
  health system from withinreform
• Survivorsindividuals have fought and survived
  and overcame oppressive situations with mental
  health care and fight to be completely free of
  mental health services

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Psychiatric Survivor Movement

• Goals
• They want real change in the mental health system
• Partnership with professionals
• Employ ex-patients
• Expose imbalance of power within the mental
  health system
• Individual change
• October 1974 People First Convention
• We are tired of being seen first as handicapped
  or retarded or disabled. We want to be seen as
  people first

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Today

• President Bush created the commission on Mental
  Health in 2002
• Purpose
• To project mental health services for the next 25
  years
• Criticism
• The past commissions, 1960 and 1977, failed to
  reach their goals
• Project for the future
• Only provided simple solutions
• Lack of implementation system has changed but not
  the care

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What does the commission need to do different?

• Serve various populations
• Focus on people and not on the system
• 1993 approximately 15 of the adult population
  use mental health services

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Treatments Techniques

• Cleansing the body
• Hydrotherapy
• Motion and Spinning
• Terrorizing and Scaring
• Restraints
• Institutions in North Dakota

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Cleansing The Body

• Bloodletting
• Usually by applying leaches to the skin or by
  incision.
• So much blood was taken from the patient that
  they would become anemic, depleted, exhausted and
  their blood pressure would drop significantly
• Purging
• Induced vomiting
• Expelled toxic elements
• Rational Calm mentally ill and rid the toxins
  from the body

Leeches? Dont Worry Mate. The little bit of
Blood they do take wont hurt you.
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Hydrotherapy

• Needle Cabinets
• Steele boxes, designed for patients to stand
  upright high pressure water was then sprayed
  directing onto the skin
• Hermann Boerhaave (1668-1738)
• Renowned medical teacher
• The greatest Remedy for it mental illness is
  to throw the Patient unwarily into the Sea, and
  to keep him under Water as long as he can
  possibly bear without being quite stifled.
• Running cool water over patients wrists and
  ankles to reduce metabolic rate
• Restraining them in cold baths

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Motion and Spinning

• Hollow Wheel
• Would create goal-directed behavior
• Hoped that would bring patient out of
  hallucination and back to relaity
• Generally patients spent 36-48 hrs in the wheel
• Came out obedient or so fatigued by the constant
  pace that there was no problems with managing
  patient

• Gyrator (Rush)
• OHallorans Swing
• Immobile Patients were strapped down and rotated
  about 100XMinThought to
• Stimulate blood circulation of the nervous system
• Separate the humors of the brain

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Terrorizing or Scaring

• One of the earliest psychiatric treatment
  approaches was terrorizing patients back to
  sanity
• Reils Immersion Method
• Dunking patients underwater while firing cannons

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Restraints

• Chains
• Straight Jackets
• Waist Restraints
• Utica crib
• Tranquilizer Chair
• Calm Patient by restricting High sensory input

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Institution Of North Dakota

• Authorized by legislation in 1883
• Opened its doors May 1, 1885
• North Dakota 163/100,000 of the population was
  institutionalized National average 58/100,000
• National Average spent per person was 68 per day
  North Dakota was only 24.42 dollars a day

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Grafton Developmental Center

• Originally known as the Institution for the
  Feeble-Minded, then name change in the 1930s to
  Grafton State School
• In 1904, 12 people from the North Dakota State
  Hospital were transferred to the new facility in
  Grafton, N.D.
• In recent years, the Developmental Center's
  population has ranged from 140 to 160 people with
  developmental disabilities
• Lawsuit in 1982
• ARC vs. State of ND

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Social Welfare and Mental Illness

• In the late 1950s social workers helped clients
  get and maintain food, clothing and housing
• Continuing Day Treatment Programs were created,
  led and staffed with social workers
• Create quality of life for mentally ill