PRELIMINARY LITERATURE REVIEW
A brief history of the United States’ mental health care
The United States has never had an official federal-centered approach for mental health care facilities, entrusting its responsibility to the states throughout the history. The earliest initiatives in this field took place in the 18th century, when Virginia built its first asylum and Pennsylvania Hospital reserved its basement to house individuals with mental disorders (Sundararaman, 2009). During the 19th century, other services were built, but their overall lack of quality was alarming. Even then, researchers and professionals in the mental health field attempted to implement the principles of the so-called public health, focusing on prevention and early intervention, but the funds were in the hands of the local governments, which prevented significant advances in this direction.
In 1946, President Truman signed the National Mental Health Act, allowing federal funds for education and research in mental health. By the time of the Great Depression and the World War II, asylums’ were in unsustainable conditions and traumatized veterans were returning home needing psychiatric attention. Also in a federal extent, Congress passed the Mental Health Study Act in 1955, establishing a commission to check policies and propose reforms in psychiatric treatments. Around that time the deinstitutionalization movement started changing the mental health picture.
In 1963, the Mental Health Community Act
In 1965, there was a histrionic change in the method that mental health care was delivered in the United States. The focus went from State Mental Hospitals to outpatient settings for the treatment of mental health issues. With the passing of Medicaid, States were encouraged to move patients out of the hospital setting (Pan, 2013). This process failed miserably due to under funding and understaffing for the amout of patients that were released from the State Mental Hospitals. This resulted in patients, as well as their families, who were in dire need of mental health services. This population turned to either incarceration (jails and/or prisons) or emergency departments as a primary source of care for their loved ones.
In the book, Crazy, by Pete Earley, provides a detailed overview of the mental health system in the United States, as it presents a first hand narrative of Earley’s family journey through the system. The author’s major premise and arguments, in the book, is to highlight the history of mental health, navigation through the judicial system with mental illness, the bureaucracy and policies of hospitals, society views on human rights and client safety, and the impact on the individual, family, and community. The content suggests that human service workers and public health workers should extend their professional lens to advocate for change in the mental health system in the United States.
Anyone with a mental illness knows that recovery is not a straight line. Thoughts don’t regain their rationality the second someone decides to become medication compliant, when an anorexic takes a bite of food, or even the day a depressed person decides to walk outside and see beyond their dreary perception of reality. I always wanted to get better, to be able to eat a slice of pizza without demolishing the box and punishing my throat, or to be able to not worry that the carnal impulses of mania would throw me out of the driver’s seat. However, I didn’t want to take the steps to seek help in time, then in the second semester of my sophomore year, I gave up. This led to me
In 1946 President Harry Truman enacted the National Mental Health Act which provided federal funding for mental asylums (Scott, R. A. & Marks, I. M., 1990). Military veterans were the driving force behind this law and this was the first time that mental illness was getting the spotlight it desperately needed. During the war, our soldiers suffered from traumatic events that were treated moderately by psychiatrist and then they were sent back to the field. After receiving brief treatment, the soldiers were considered healed and upon returning home, the soldiers and their families quickly realized that they were not healed at all and needed more help. Harry Truman began the National Institute of Mental Health (NIMH) to help our soldiers and other Americans who were suffering from mental illness. The NIMH was one of the founding programs of
In 1955, over 559,000 individuals resided in inpatient psychiatric hospitals. By 1995, however, the number had drastically diminished to 69,000, (National Health Policy Forum, 2000). This drastic reduction was largely due to the discovery of antipsychotic medications in the 1950s, and the deinstitutionalization movement of the 1960s, wherein several thousands of mentally ill individuals were released from psychiatric institutions to return to their communities for treatment. Mental health centers (MHCs) were conceptualized during deinstitutionalization to provide treatment to these newly-released mentally ill persons in their communities. Although efforts were well-intended, the MHCs failed to serve the
Access to mental health care is not as good as than other forms of medical services. Some Americans have reduced access to mental health care amenities because they are living in a countryside setting. Others cannot get to treatment for the reason of shortage of transportation or vast work and household tasks. In some areas, when a
In an effort to transform the public mental health system, in 1963, President Kennedy proposed the Community Mental Health Act. It was the first among several federal initiatives to create a community mental health care system. Once the act was ratified, there was an intense deterioration in institutionalization, otherwise known as “deinstitutionalization”, and by 1980 there was a 75% declined of the inpatient population at many public psychiatric hospitals. In 2000, there was less than 10% of the public institutionalized just fifty years earlier. In 2009, there was even a more dramatic shift among children and adolescence whereby there was a 98% decline in
The history of mental health in the United States show a robust movement towards the mental healthcare system we have today. Prior to the 19th century, individuals with mental health issues were widely considered to be demonically possessed, thus contributing to the stigmatization of mental illness and the proliferation of poor treatment conditions. However, in the 1800s, there was a dramatic change in mental healthcare in the U.S. The government took a proactive role in treating the mentally ill, leading to the dawn of state psychiatric facilities.
In 2009, The National Alliance on Mental Illness (NAMI) gave the United States national mental health care system a ‘D.’ This grade is based on four sections: “health promotion and measurement; financing and core treatment/recovery service; consumer and family empowerment; [and] community integration and social inclusion.” While New Jersey received a grade of a ‘C’, which is better then the national average it is still a dismal grade that needs improvement.
Do you know that between 1955 and 1998, we have about 558,000 patients dropped to 60,000 patients in our country and state mental hospital? During this time, there have a national shift between state hospitals and community-based facilities in mental health treatment, it’s called deinstitutionalization. In 1965, the Congress has created Medicaid. It is a payment for people who are in community mental health centers. In addition, President Jimmy Carter had signed the Mental Health System Act in 1980. It provided grants in a straight line to community mental health centers, but the time of fund is very short. Because when President Ronald Reagan is on the place, he cuts one third of spend to federal mental health. According to The New
There are many people in the United States that have a mental illness that is either not
In early American history, individuals with mental illnesses have been neglected and suffered inhuman treatments. Some were beaten, lobotomized, sterilized, restrained, in addition to other kinds of abuse. Mental illness was thought to be the cause of supernatural dreadful curse from the Gods or a demonic possession. Trepanning (the opening of the skull) is the earliest known treatment for individuals with mental illness. This practice was believed to release evil spirits (Kemp, 2007). Laws were passed giving power to take custody over the mentally ill including selling their possessions and properties and be imprisoned (Kofman, 2012). The first psychiatric hospital in the U.S. was the Pennsylvania Hospital where mentally ill patients were left in cold basements because they were considered not affected by cold or hot environments and restraint with iron shackles. They were put on display like zoo animals to the public for sell by the doctors (Kofmen, 2012). These individuals were punished and isolated and kept far out of the eyes of society, hidden as if they did not exist. They were either maintained by living with their families and considered a source of embarrassment or institutionalized
Senator Creigh Deeds story is just one of many that end in tragedy because of a mental health system that has failed. While the major proportion of people living with mental illness are not violent, they can become a victim of violence. According to the latest statistics from the American Psychological Association one in five adults has a diagnosable mental disorder, one in twenty-four has a serious mental disorder (SMI), and people with mental illness are no more likely to be violent that people without mental illness (Association, American Psychiatric, 2016). Untreated mental health care is characteristic of the violent crimes that we see happening today. Some of the reasons behind these untreated individuals are the unmet needs of people not having a financial means to pay for services, lack of insurance, knowledge about how to access care, embarrassment about having the need for services, and those that needed care but experienced delays in accessing care (Jones et al., 2014).
Policies have an important role in regulating and shaping the values in a society. The issues related to mental health are not only considered as personal but also affecting the relationships with significant others. The stigma and discrimination faced by people with mental health can be traced to the lack of legislation and protection of rights (Rodriguez del Barrio et al., 2014). The policy makers in mental health have a challenging task to protect the rights of individuals as well as the public (Swigger & Heinmiller, 2014). Therefore, it is essential to analyse the current mental health policies. In Canada, provinces adopt their own Mental Health Acts (MHA) to implement mental health services. As of January 15, 2016, there are 13 mental health acts in Canada (Gray, Hastings, Love, & O’Reilly, 2016). The key elements, despite the differences in laws, are “(1) involuntary admission criteria, (2) the right to refuse treatment, and (3) who has the authority to authorize treatment” (Browne, 2010). The current act in Ontario is Mental Health Act, 1990.
The mentally ill were cared for at home by their families until the state recognized that it was a problem that was not going to go away. In response, the state built asylums. These asylums were horrendous; people were chained in basements and treated with cruelty. Though it was the asylums that were to blame for the inhumane treatment of the patients, it was perceived that the mentally ill were untamed crazy beasts that needed to be isolated and dealt with accordingly. In the opinion of the average citizen, the mentally ill only had themselves to blame (Surgeon General’s Report on Mental Health, 1999). Unfortunately, that view has haunted society and left a lasting impression on the minds of Americans. In the era of "moral treatment", that view was repetitively attempted to be altered. Asylums became "mental hospitals" in hope of driving away the stigma yet nothing really changed. They still were built for the untreatable chronic patients and due to the extensive stay and seemingly failed treatments of many of the patients, the rest of the society believed that once you went away, you were gone for good. Then the era of "mental hygiene" began late in the nineteenth century. This combined new concepts of public health, scientific medicine, and social awareness. Yet despite these advancements, another change had to be made. The era was called "community mental health" and