The History of Mental Illness in America: A Journey From Despair to Hope & Recovery Ms. Manzo.

The History of Mental Illness The History of Mental Illness in America: A Journey From in America: A Journey From Despair to Hope & RecoveryDespair to Hope & Recovery

Ms. Manzo

Former First Lady Rosalynn Former First Lady Rosalynn CarterCarter

““We have been given many gifts as a nation; we are We have been given many gifts as a nation; we are rich beyond measure. We Americans think of rich beyond measure. We Americans think of ourselves as decent, generous, and compassionate ourselves as decent, generous, and compassionate people, & for the most part we are; yet we treat a large people, & for the most part we are; yet we treat a large proportion of our own population as though they are proportion of our own population as though they are second class citizens undeserving of our help, our second class citizens undeserving of our help, our resources, & our understanding.”resources, & our understanding.”

20102010

Colonial AmericaColonial America

Society believed insanity was caused Society believed insanity was caused by a full moon at the time of a baby’s by a full moon at the time of a baby’s birthbirth

These “lunatics”- (lunar) were thought to These “lunatics”- (lunar) were thought to be possessed by the devilbe possessed by the devil

Treatments: ice baths, bloodlettingTreatments: ice baths, bloodletting

Colonial TreatmentColonial Treatment

Barbaric Demon-possessed Senseless animals “It was believed that patients chose to

behave irrationally, and doctors tried to help them adopt a more normal manner.”

Care?????Care?????

FamilyParish ChurchThose without family-

– placed in prisons- chained to walls, unclothed

– poorhouses

1770s1770s

First hospitalsFirst hospitals1773- Williamsburg, Virginia1773- Williamsburg, VirginiaDesigned to keep those with mental Designed to keep those with mental

illness away from society- not treat illness away from society- not treat them.them.

The Public Hospital, Va.The Public Hospital, Va.

1717thth-18-18thth Centuries Centuries

Dorothea DixDorothea Dix

Dorothea DixDorothea DixSchoolteacherDiscovered many people with mental

illness were in jails.Crusaded for the establishment or

enlargement of 32 mental hospitals, & transfer of those with mental illness from almshouses and jails.

18401840

US CensusUS Census– Includes its 1Includes its 1stst

question on “insanity”question on “insanity”

Thomas KirkbrideThomas KirkbrideDesigner of AsylumsDesigner of Asylums

Athens Asylum for the Insane-1874Athens Asylum for the Insane-1874

• 544 rooms- self-sufficient with dairy barns, greenhouses, transportation system, recreational activities• But others soon went there for food & shelter• Populations skyrocketed – patient care suffered.• Now old ways returned…ice baths- shock machines…..

An Asylum For Every StateAn Asylum For Every State

The Civil WarThe Civil War

Many servicemen- postwar traumaMany servicemen- postwar traumaState hospitals and asylums State hospitals and asylums

overcrowdedovercrowdedRestraints, shock therapy, opiumRestraints, shock therapy, opium

Soldier’s Heart- or “PTSD”Soldier’s Heart- or “PTSD”

Post Civil WarPost Civil War

Asylums – now underfunded – Asylums – now underfunded – overcrowdedovercrowded

Quality of care deterioratesQuality of care deterioratesNewspapers expose inhumane Newspapers expose inhumane

conditionsconditions

1900- Clifford Beers1900- Clifford Beers

““A Mind That Found Itself”A Mind That Found Itself”

1908- changed mental health care1908- changed mental health careBeers’ autobiography –chronicles his Beers’ autobiography –chronicles his

struggle with mental illness and struggle with mental illness and healthcarehealthcare

Mental Health Screening BeginsMental Health Screening Begins

Ellis IslandEllis Island

Dr. Thomas Salmon in 1905: “Justice to the immigrant requires a carefully considered diagnosis; while on the other hand, the interests of this country demand an unremitting search for the insane persons among the hundreds of thousands of immigrants who present themselves annually at our ports of entry.”

The National Committee For The National Committee For Mental HygieneMental Hygiene

Founded in 1909- in NY by psychiatrists and Founded in 1909- in NY by psychiatrists and BeersBeers

GoalsGoals– To improve attitudes toward mental illness and To improve attitudes toward mental illness and

those with mental illnessthose with mental illness– To improve servicesTo improve services– To work for the prevention of To work for the prevention of

mental illness & promote mental mental illness & promote mental

healthhealth

1930s- The Lobotomy1930s- The LobotomyMental Health’s Darkest HourMental Health’s Darkest Hour

Surgically separated the neural Surgically separated the neural passages from the back of the brainpassages from the back of the brain

Over 20,000 performedOver 20,000 performedAbuse and neglect soaredAbuse and neglect soared

Asylums Renamed Mental Asylums Renamed Mental HospitalsHospitals

Psychiatric units opened in general hospitalsPsychiatric units opened in general hospitalsTreatments ineffectiveTreatments ineffectiveHospitals provided humane custodial care at Hospitals provided humane custodial care at

bestbest– At worst- neglect or abuseAt worst- neglect or abuse

Great Depression=overcrowding…….Great Depression=overcrowding…….

1946- National Mental Health Act1946- National Mental Health Act

President Truman - National Mental Health Act

Creates for the first time in US history a significant amount of funding for psychiatric education and research

Led to the creation in 1949 of the National Institute of Mental Health (NIMH).

1947-19511947-1951

11stst community based health treatment community based health treatment for patients in state institutionsfor patients in state institutions

1949- Lithium1949- Lithium

New hopeNew hope

19541954

Antipsychotic drugs introducedAntipsychotic drugs introducedThorazine- improves hallucinations and Thorazine- improves hallucinations and

delusionsdelusionsOther medications now become Other medications now become

availableavailable

19561956

Congress allocates- $12 million for Congress allocates- $12 million for psychopharmacologypsychopharmacology

Number of consumers decline in mental Number of consumers decline in mental institutionsinstitutions

1961- 1961- Action for Mental Health Action for Mental Health Report to Congress based on 5 years of Report to Congress based on 5 years of

researchresearch– Task- arrive at a national program to meet the Task- arrive at a national program to meet the

needs of those with mental illnessneeds of those with mental illness– Recommends improved research, Recommends improved research, trainingtraining and and

treatment in the field of mental health.treatment in the field of mental health.– Attempts to answer:Attempts to answer:

“ “Why has Why has carecare of the mentally ill lagged?” of the mentally ill lagged?” ““How can we catch up?”How can we catch up?”

1960s1960s

Community health movementCommunity health movement– Outpatient servicesOutpatient services– More researchMore research– Less state mental hospitalsLess state mental hospitals– More general hospitals with psychiatric More general hospitals with psychiatric

wingswings– More community health centersMore community health centers

1980s1980s

President Jimmy CarterPresident Jimmy CarterMental Health Systems ActMental Health Systems Act

– Grant programGrant program– Involves consumer inputInvolves consumer input– Offers education and supportOffers education and support– Strengthens the links betweenStrengthens the links between

Federal and state servicesFederal and state services

1981-19851981-1985

Carter’s work haltedCarter’s work haltedMental Health Systems Act repealedMental Health Systems Act repealedFunding drops Funding drops

Behavioral Health Managed Behavioral Health Managed CareCare

19881988States now “carved out” mental care States now “carved out” mental care

from physical carefrom physical carePurpose: increase efficiencyPurpose: increase efficiencyResults: led to erosion of health careResults: led to erosion of health care

1990s- The Decade of the Brain1990s- The Decade of the Brain

President George Bush designates the President George Bush designates the 1990s as the 1990s as the Decade of the BrainDecade of the Brain: "to : "to enhance public awareness of the benefits enhance public awareness of the benefits to be derived from brain research" through to be derived from brain research" through "appropriate programs, ceremonies, and "appropriate programs, ceremonies, and activities." activities."

19941994

Behavioral Brain ImagingBehavioral Brain Imaging– Helps scientists learn more about the Helps scientists learn more about the

development of major mental illnesses.development of major mental illnesses.

19961996

HIPPA-regulation of forms, privacy and HIPPA-regulation of forms, privacy and securitysecurity

Significant impact on caregivers of Significant impact on caregivers of those with mental illnessthose with mental illness

1999- The Voice of the Supreme 1999- The Voice of the Supreme Court Court

Olmstead v. LCOlmstead v. LC– It is a violation to keep a patient in a It is a violation to keep a patient in a

restricted setting when outpatient services restricted setting when outpatient services are availableare available

The Clinton The Clinton AdministrationAdministration

Bans the use of restraints in Bans the use of restraints in

federally funded hospitalsfederally funded hospitalsReport on co-occurring disorders orderedReport on co-occurring disorders ordered

The Bush AdministrationThe Bush Administration

Increased funding for community health Increased funding for community health centerscenters

New Freedom Commission on Mental New Freedom Commission on Mental HealthHealth

The Obama AdministrationThe Obama Administration

Mental health parity states that Mental health parity states that psychological conditions must be psychological conditions must be treated equivalently to physical treated equivalently to physical illnesses. illnesses.

So why does the suffering So why does the suffering continue?continue?

Funding for research & services is Funding for research & services is scarcescarce

Screening for childhood disorders Screening for childhood disorders does not exist in most schoolsdoes not exist in most schools

Veterans are returning with few Veterans are returning with few servicesservices

Few jobs and places to liveFew jobs and places to live

And…..STIGMAAnd…..STIGMA

But…… We have come so far…But…… We have come so far…

Mental Health is our last Civil Rights Mental Health is our last Civil Rights Movement….Movement….

New advances in science are leading to New advances in science are leading to better livesbetter lives

Recovery is possible.Recovery is possible.

The Value of Hope & Hard WorkThe Value of Hope & Hard Work

““Having some hope Having some hope is crucial to recovery; is crucial to recovery; none of us would strive none of us would strive if we believed it a futile if we believed it a futile effort.”effort.” Leete ‘89Leete ‘89

And America is changing And America is changing because we are “saying what because we are “saying what

we need to say”!we need to say”!