HISTORY OF MENTAL INSTITUTIONS

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MENTAL HEALTH SYSTEMS
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TRANSFORMATION IN 20th CENTURY

• CUCKOOS NEST
• MENTAL HOSPITALS CENTRAL
• LONG INPATIENT STAYS
• REPRESSIVE SOCIAL CONTROL
• NO PATIENT RIGHTS
• VOLUNTARIES
• INSTITUTIONALISM

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NO PLACE ON EARTH FOR ME

• SYLVIA FRUMKIN
• SHORT HOSPITAL STAYS
• LONG STAYS IN COMMUNITY
• LITTLE SOCIAL CONTROL
• MANY PATIENT RIGHTS
• NO VOLUNTARIES
• ANTI-INSTITUTIONALISM

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TRANSFORMATION

• INCREDIBLY SHORT PERIOD - CUCKOOS NEST IN 1963
  (1975) FRUMKIN IN 1978 (1982)
• FROM TOO MUCH TO TOO LITTLE CONTROL
• WHAT WAS TRANSFORMATION?
• REASONS FOR TRANSFORMATION.

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HISTORY OF MENTAL HOSPITAL
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I. 1800-1850

• AROSE IN U.S. ABOUT 1800
• PREVIOUSLY PEOPLE CARED FOR IN FAMILIES, ROAMED
  COUNTRY, JAILS
• INITIALLY HUMANE REFORM
• PHILOSOPHY OF THE ENLIGHTENMENT

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PHILOSOPHY

• REMOVE PEOPLE FROM STRESSFUL ENVIRONMENT
• COUNTRY SETTINGS - ISOLATED FROM FAMILIES AND
  COMMUNITIES
• PROVIDE MORAL TREATMENT IN CALM AND RESTFUL
  ENVIRONMENT
• MAINLY MIDDLE AND UPPER CLASS CLIENTS

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II. 1850-1960

• GROWTH OF POPULATION
• HUGE BUREAUCRACIES
• FROM TREATMENT TO MANAGEMENT AND CONTROL
• NO EFFECTIVE TREATMENTS

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(No Transcript)
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PATIENTS 1850-1960

• LOWER SES, IMMIGRANT, ELDERLY
• LONG STAYS, HIGH DEATH RATES
• CHRONIC CONDITIONS - SCHIZ., SYPHILUS, ALCOHOLISM
• INSTITUTIONALISM APATHY, ADJUST, DONT WANT TO
  LEAVE

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SUMMARY AS OF 1955

• LARGE ISOLATED INSTITUTIONS
• CUSTODIAL WITH LITTLE TREATMENT
• LONG STAYS, FEW RELEASES, MANY ELDERLY PATIENTS

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DEINSTITUTIONALIZATION (DI)
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III. DI (1955 - PRESENT)

• REMOVE PATIENTS FROM HOSPITAL, ADMIT FEWER
  PATIENTS, USE OF COMMUNITY TREATMENT
• BEGINS IN 1955 - REVERSAL OF 150 YEAR OLD TREND
• HIGHLY CONTROVERSIAL - CRIME, HOMELESSNESS, POOR
  TREATMENT, NEGLECT

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INPATIENT 1955-2000
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RESIDENTS OF PUBLIC MENTAL HOSPITALS

• DRASTIC DECLINE IN RESIDENTS, 1955-2000 (OPENING
  BACK DOOR)
• 1955 - 560,000 1970 - 450,000 1980 - 140,000
  1990 - 100,000 2000 - 90,000
• INCREASE IN ADMISSIONS 1955-1970, DECREASE SINCE
  THEN (CLOSING FRONT DOOR)

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PUBLIC MENTAL HOSPITALS NOW

• NO LONGER THE MAJOR PART OF SYSTEM
• PLACE OF LAST RESORT - VIOLENT, DIFFICULT TO
  TREAT (FRUMKINS) OR NOWHERE ELSE TO GO
• STILL 2/3 OF STATE EXPENSE
• FIXED COSTS, UNIONS, COMMUNITIES

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CHANGE IN PATIENTS

• FROM ELDERLY, LONG-TERM, SCHIZ. AND BRAIN DISEASE
• TO YOUNG, SHORT-TERM, DRUG USERS (MICA)
• SAME POOR, MINORITIES, MALES

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INPATIENT TREATMENT NOW

• MOST IN GENERAL HOSPITALS
• GROWTH OF PRIVATE, SPECIALIZED HOSPITALS
• SHORT STAYS 1 TO 2 WEEKS OR AS LONG AS HAVE
  INSURANCE FOR
• WHITE, FEMALE, DEPRESSION, ALCOHOL
• ELDERLY NOW IN NURSING HOMES

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SUMMARY OF CHANGES

• DRASTIC DECLINE IN PUBLIC MENTAL HOSPITALS
• NOT LONG TERM STAYS BUT SHORT STAYS WITH LONG
  SPELLS IN COMMUNITY

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LOCATION

• STATE HOSPITALS NOT CENTRAL
• MOST INPATIENT TREATMENT IN GENERAL OR PRIVATE
  HOSPITALS
• NURSING HOMES

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PATIENTS

• PATIENTS IN PUBLIC MENTAL HOSPITALS STILL POOR/
  MINORITY
• NOW YOUNG, NOT OLD
• NOW DRUG USING AND HARD TO HANDLE NOT COMPLIANT
  AND INSTITUTIONALIZED