T H E DEINSTITUTIONALIZATION OF MENTAL PATIENTS |0 America’s Mental HealthThe Effects of the Deinstitutionalization of Mental Patients in the 1960s on my Life and Society Jennifer Kitchen 4/1/2011
T H E DEINSTITUTIONALIZATION OF MENTAL PATIENTS |1 The history of psychology is long and the trek to understanding and helping theWorld’s mentally ill has been a lengthy and challenging journey through scientifichistory. Over half a million years ago, ancient healers used trephining, chipping away atthe skull to release the evil spirits within, to “cure” the mentally ill. By 430 BC, the greatfather of modern medicine, Hippocrates, argued for the four temperaments ofpersonality, which he associated with the four humors of the body which he felt, affectedthe personality. In the early 1800s, phrenology, the study of the bumps on one’s head,is used by physicians as a means to discern intelligence, moral character, and otherpersonality characteristics of an individual. By the early 1900s,psychology gained thepsychodynamic perspective of Sigmund Freud and then the fundamental principles oflearning from Ivan Pavlov. Due to the misunderstanding of mental illness throughoutthis history many people were institutionalized in asylums. Today there are five major perspectives used in psychology to help explain andunderstand human behavior and the causes of mental illness. These are the biological,psychodynamic, cognitive, behavioral, and humanistic perspectives of psychology(Feldman, 2002). Each of these psychological perspectives focuses on differentaspects of behavior and mental processes. Using these perspectives, psychologists andsocial scientists have learned much of how individuals learn, how the personality isdeveloped, and why they react the ways they do and many psychotropic medicationshave been developed to assist in managing the symptoms of mental illness.With thisunderstanding a cure to mental illness seems more a possibility than ever before and inthe 1960s mental institutions began releasing or deinstitutionalizing mental healthpatients. This single event, which happened over four decades ago, has had an effect
T H E DEINSTITUTIONALIZATION OF MENTAL PATIENTS |2on society, on my personal life, and on my course of study and future career. Mental illness must first be defined to be able to understand the impact thatdeinstitutionalization has had in the World and in my life. Mental illness can be definedas any of the various disorders in which a persons thoughts, emotions, or behaviors areabnormal and may cause suffering to himself, herself, or other people.Therefore,mental health is psychological well-being and satisfactory adjustment,emotionally and behaviorally, to society and to the ordinary demands of life.TheNational Institute of Mental Health (NIMH) a branch of the National Institute of Health(NIH) defines Serious Mental Illness (SMI) as: “A mental, behavioral, or emotional disorder (excluding developmental and substance use disorders), diagnosable currently or within the past year, of sufficient duration to meet diagnostic criteria specified within the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities” (2010).How prevalent is mental illness in the United States? A quarter of American adults canbe diagnosed with one or more disorders in any given year. Although mental disordersseem commonplace only about 6% of the population (that is 1 in 17 people) suffers fromdebilitating serious mental illness (NIHM, 2010). This seems such a small number butwhen we look at the affect that mental illness has on not only those suffering but thefamily of these people it affects more than just that 1 out of 17 people. Living with amental disorder can be hard but there are methods of treatment and information that is
T H E DEINSTITUTIONALIZATION OF MENTAL PATIENTS |3available to assist all persons involved. In the late 1960s, a majority of mentally ill patients were moved from institutionsand into the community. It all started with the new psychotropic medications that wereavailable and the Community Mental Health Center Act in 1963.Psychoactive drugsdeveloped in the preceding decades enabled the discharge of large numbers of patientsinto the community. In1935 Amphetamines were used for depression and in1949Lithium was used being used to treat manic states. By the 1960s drugs, such asThorazine (the first antipsychotic) and a variety of antidepressants and antianxietymedications, were being used regularly in the psychiatric practice (Department of HealthServices, n.d.). Initially these drugs were only used for managing patients within theinstitutions, and then became a part of outpatient treatment.This outpatient treatmentwas the basis for the Community Mental Health Centers Act. This act put each state incharge of providing community based mental health careand the development offacilities to provide the services of prevention, diagnosis, care, treatment, and therehabilitation of the mentally ill and if a patient was unable to pay for the servicesprovided the state was obligated to pay for the services (NIH,1963). With theimplementation of these community mental health care centers and the use of out-patient psychotropic drug therapy, many of the mental institutions and asylums wereable to release patients that were considered not a danger to themselves, others, orsociety. The mentally ill were deinstitutionalized and given prescription medication toassist them in managing the symptoms of their illness.The deinstitutionalization ofmental patients has affected American society in many ways.
T H E DEINSTITUTIONALIZATION OF MENTAL PATIENTS |4 There are many agencies that have been developed to study the effects ofmental illness on persons and society and the outcome of this deinstitutionalization isstill in the process of being determined. NIMH informs us that about two-thirds of theinmates in America prisons suffer with mental illness (2010) and according to Harrisonand Dye one-fourth to one-third of America’s homeless population suffer from mentalillness (2008). Why is this? The Substance Abuse and Mental Health ServicesAdministration (SAMHSA) reported that in 2008, 13.4% of adults in the United Statesreceived treatment for a mental health issues, this included all adults who used in-patient or out-patient care or used prescription medication for mental or emotionalissues (NIMH, 2010). This means that even though there is treatment available onlyabout half everyone who suffers with a mental disorder receives help. Some people justare not aware that help is out there, some people do not look for help due to the stigmathat still goes along with mental illness, and some people simply do not feel they havethe access or the money to afford mental health care. The Agency for HealthcareResearch and Qualitys (AHRQs) Medical Expenditure Panel Survey (MEPS) in 2006shows that 36.2 million people paid for mental health services totaling $57.5 billion.This means $1,591 was spent on average by those who paid (NIMH, 2010). The yearbefore, a study by SAMHSA found that the U.S. total spending on behavioral health was$135 billion which is 7.3 percent of the $1.85 trillion spent on health care (SAMHSA,2010). Community mental health programs are available and the government does pickup most of the mental health tab here in the U.S. I, personally, have taken part in theservices provided by these community programs and know that they do work whenused properly by patients and care providers.
T H E DEINSTITUTIONALIZATION OF MENTAL PATIENTS |5 I suffer from compound mental disorders; this means I have more than onedisorder. I was diagnosed with bi-polar disorder when I was 13 and then borderlinepersonality disorder and anti-social disorder when I was 28. I have used the communitymental health care centers to receive counseling and I have been prescribed a varietyof psychotropic medications in my life. I have also been admitted to the psychiatricward in hospitals on two separate occasions. The first time I was ordered by the stateof Arizona to be treated as an in-patient and the second time I chose to enter aninstitution in Illinois of my free will because I knew I needed special care. I have onlyhad to pay for the services and medications provides when I was working and able.The 1960s event of deinstitutionalization means that even if I do enter a mental healthinstitution I am not going to have to live the remainder of my life in such an institution. Ihave the rights and freedoms that other citizens enjoy. I am not restricted from living anormal and healthy life and am actually given every opportunity to do so. I even havethe choice of refusing treatment, which was not the case beforedeinstitutionalization. Iexercise this right by not taking medications to treat my mental illness because I do notbelieve in the efficacy of some these drugs due to my personal experiences. This has influenced my course of study and my career path. In my opinionpsychotropic drugs are over-prescribed. I am not saying that none of these drugs workbut that they are not always used properly by providers or patients. Today psychotropicmedications are one of the most commonly prescribed classes of drugs and widespreadusage has increased concerns about if these drugs are being used appropriately (Mark,2010). I have had medications pushed on me by psychiatrists and have had somesevere adverse reactions that I was told was not the medication. This has caused me
T H E DEINSTITUTIONALIZATION OF MENTAL PATIENTS |6much stress and I have changed my lifestyle in order to live healthy with fewer sideeffects from the symptoms of my disorders. I have also seen other mentally ill patientsmisuse the drugs they were given. Hippocrates once made the comment “Keep watchalso on the faults of the patients, which often make them lie about the taking of thingsprescribed.”I have seen a problem with the over-use and misuse of these medicationsand have decided that I can help make a change by going into research. I am inuniversity to gain my Bachelors in Science for Health and Wellness to learn about howall people can live healthy lives. After I graduate I would like to do research onComplementary and Alternative Medicine (CAM). Why? Well, I have seen firsthand thatnutrition and traditional therapies, like yoga and meditation, can make living with mentaldisorders easier. I am not naïve enough to say that my methods can work for everyonewho suffers from the same disorders I do but it may be better for certain individualssuffering with certain mental disorders. I want to find out what works best and pass thisknowledge on to those who need it. Alternative therapies are not always used aloneeither. They can be used in a complimentary or integrative manner, which makes useof conventional and traditional therapies. This may be the best way to go about treatingmental illness. Deinstitutionalization has had a major effect on society, my personal life, and myplans for the future. The U.S. has seen more opportunity for the people suffering withmental illness. We have also seen the effects of not all of these people takingadvantage of mental health care available. Deinstitutionalization has allowed me to livelike any other American, without the fear that I could lose all my freedoms and rights. Ican strive to be a meaningful member of society, to receive an education and to vote.It
T H E DEINSTITUTIONALIZATION OF MENTAL PATIENTS |7has allowed me to decide what I need and do not need and given me the opportunity tohelp change the World. The study of how our minds work is still in progress, the mind isa complicated thing, and it may be a very long time before we fully understand humanbehavior and personality.We came a long way in the past few centuries and evenfurther in the past few decades.
T H E DEINSTITUTIONALIZATION OF MENTAL PATIENTS |8 ReferencesDepartment of Health Services, (n.d.). History of psychotropic medication use for consumers with developmental disabilities. Retrieved from http://www.dhs.state.mn.us/main/groups/licensing/documents/pub/dhs16_15767 4.pdfFeldman, R., (2002). Understanding Psychology. New York; McGraw-Hill.Harrison, B. and Dye, D., (2008). Powerand Society. Ohio: Cengage Learning.Mark, T., (2010). For what diagnoses are psychotropic medications being prescribed? [Electronic version].Retrieved fromhttp://www.samhsa.gov/Financing/file.axd?file=2011%2F1%2FMark+CNS+ Drugs+2010+24(4)+319-326+508.pdfNational Institute of Health. (1963). Community Mental Health Centers Act [electronic archive]. Retrieved from http://history.nih.gov/research/downloads/PL88-164.pdfNational Institute of Mental Health, (2010). Statistics. Retrieved from http://www.nimh.nih.gov/statistics/SMI_AASR.shtmlSubstance Abuse and Mental Health Services Administration. (2011). National expenditures for mental health services & substance abuse treatment, 1986- 2005 [electronic version]. Retrieved from http://www.samhsa.gov/Financing/post/National-Expenditures-for-Mental-Health- Services-Substance-Abuse-Treatment-1986-2005.aspx