I’m not going to go really in depth, because a simple google search will tell you a lot about the controversies surrounding Deinstitutionalization. Here I’m giving a very simple summary:
This was the process by which asylums were replaced with community care programs. It had it’s roots in the late 1920’s but it wasn’t until the 1950’s that it became a popular idea for the mental health care standard.
Basically, as psychological drugs were developed, rates of recovery rose. Health care was becoming privatized and less patients were entering hospitals. There was a very large public push to get as many patients out as possible, especially since outpatient care was much less expensive than staying in a hospital, and the public opinion was that almost anyone could be cured with the right drug.
In 1963, JFK passed the Community Mental Health Act. The act provided federal funds to community based health centers. The idea was to provide the mentally ill with options in regards to care, but it had the opposite of intended effect—many of the state hospitals were shut down by states due to their high cost—and because there were supposed to be federal funds, never replaced the hospitals with state programs leaving many patients with nowhere to go for care.
In Northampton, many of the patients complained and brought a class-action suit against the governor of Massachusetts, which resulted in the “consent decree” which required that the centers be built. The plan took 14 years to implement and by the time it was finished the hospital was down to the 50 most affected patients.
Some good links for more info include:
http://www.smith.edu/nsh/dein.html
http://en.wikipedia.org/wiki/Deinstitutionalisation
And for my fellow students in Psychology 380, the first chapter of the book describes much of this.
Now that we’ve gone through the history and know that things weren’t always as they are today…how does it apply to the current issue of homelessness, of which this blog is supposed to address?
Deinstitutionalization was supposed to address some of the inhumanity experienced in the overcrowded state hospitals. It was to release the states of the expense of caring for patients who, with the help of modern medicine, were capable of life outside the institutions. It was intended to create an environment where hospitalization was temporary and hope for recovery was high. Unfortunately, this ideal depended very heavily on community health centers—many of which were not built and the ones that exist do not meet current demands. Combined with the privatization of healthcare, many people cannot afford to be treated for mental illness.
Sources differ widely on the percent of homeless who suffer from mental illness, but estimates range from 17-60% with 30% being the number most often cited. It seems to depend on the area studied. Regardless of which statistic is used, the number of homeless with mental illness is much greater than the general population. An individual on the poverty like with an illness is much more likely to become homeless than one who is not.
This is not to say that deinstitutionalization was responsible for these statistics—in fact, the number of homeless rose sharply long after much of the plan had already gone into effect. However, the lack of funding for projects and the closing of state hospitals has led to fewer options in treatment. There is some debate as to it's effects, but that is more than I can cover. I will explore more of the statistics, causes and concerns regarding homelessness and mental illness in my next post.
Monday, August 10, 2009
Sunday, August 2, 2009
History part Deux--Moral Treatment
Northampton State hospital was created during the rise in the “Moral Treatment” movement of mental health care. This philosophy was defined by the idea that ill people were still people, and by treating them the way humans ought to be treated and also giving them work to help them be productive. In short, words often used to describe the movement: “sympathy, kindness, authority and control.” Religion was often a central theme. Due to campaigning in the US after a woman was horrified at the state of inmates at a prison and then generalized her complaints to include the poor and mentally ill; the US set aside a great deal of funding towards the mentally ill that lasted in a period from 1841-1881. Most states required the building of asylums to help treat the mentally ill. Many state asylums were created that followed the Kirkbride Plan, a common form of moral treatment.
The whole design was to keep people comfortable. The building let in lots of lights and air. The people moved about freely and therapists often lived on site, developing strong personal relationships with their patients. Many, like Northampton State Hospital started with names like the “Northampton Lunatic Asylum” which at the time had positive connotations. They were a restructuring of the past and the era of a new, humane view of the ill. The plan was for small curative setups and dreams that most people, given time, will get better.
Unfortunately, due to the stigma of the “locked away” aspect of care, the public views on State Hospitals and the mentally ill began to shift. Also, there started to show that for many patients, “Moral treatment” was not enough. Little consideration had been taken into account that it could be permanent. Lastly, many of the asylums became so overcrowded that they did not have the resources to follow the philosophy of care needed to make even mild cases succeed. The asylums also became a place to house the poor and elderly, furthering the overcrowding problem. Eventually public funding diminished, but the patients remained in the care, resulting in much of the tragic stigma and dark history associated with this time-period of mental healthcare.
Even in its glory days, the moral treatment philosophy had critics, especially among many of the mildly ill who were insulted and angered by the insinuation that their illness was the result of them not being moral enough, not being strong enough, etc. Many were angry at the fact that they were not given any say in their treatment, and felt that the hospitals were a form of social repression made to teach the ill that they must follow the rules like children. One such dissent group formed in the UK was the Alleged Lunatic’s Friend Society (ALFS)
Some consider moral treatment to be the “glory days” of mental health care. Supposedly, it was a time period where the mentally ill were treated like people and were cared for and tended to. It was a time when states allocated funds to ensuring that the ill had somewhere to go to be treated, and the treatment was humane and focused on the patient feeling useful. For some patients the style did indeed work; but that may be influenced by how diseases that affected the mind were diagnosed at the time--after all one might wind up there for being poor or in a hysterical state. Also, many relapses were found later to have been recorded as new patients, thus inflating the numbers of "cured" and disregarding the ones released too soon.
Next post will be up shortly and will cover the deinstitutionalization. That will not be so long as this and will be followed by a post with statistics about homelessness and how it relates to the above program. I thought I'd provide some context for some of the things I will say first, and wanted to stress that the NoHo Assylum wasn't meant to be a bad place.
The whole design was to keep people comfortable. The building let in lots of lights and air. The people moved about freely and therapists often lived on site, developing strong personal relationships with their patients. Many, like Northampton State Hospital started with names like the “Northampton Lunatic Asylum” which at the time had positive connotations. They were a restructuring of the past and the era of a new, humane view of the ill. The plan was for small curative setups and dreams that most people, given time, will get better.
Unfortunately, due to the stigma of the “locked away” aspect of care, the public views on State Hospitals and the mentally ill began to shift. Also, there started to show that for many patients, “Moral treatment” was not enough. Little consideration had been taken into account that it could be permanent. Lastly, many of the asylums became so overcrowded that they did not have the resources to follow the philosophy of care needed to make even mild cases succeed. The asylums also became a place to house the poor and elderly, furthering the overcrowding problem. Eventually public funding diminished, but the patients remained in the care, resulting in much of the tragic stigma and dark history associated with this time-period of mental healthcare.
Even in its glory days, the moral treatment philosophy had critics, especially among many of the mildly ill who were insulted and angered by the insinuation that their illness was the result of them not being moral enough, not being strong enough, etc. Many were angry at the fact that they were not given any say in their treatment, and felt that the hospitals were a form of social repression made to teach the ill that they must follow the rules like children. One such dissent group formed in the UK was the Alleged Lunatic’s Friend Society (ALFS)
Some consider moral treatment to be the “glory days” of mental health care. Supposedly, it was a time period where the mentally ill were treated like people and were cared for and tended to. It was a time when states allocated funds to ensuring that the ill had somewhere to go to be treated, and the treatment was humane and focused on the patient feeling useful. For some patients the style did indeed work; but that may be influenced by how diseases that affected the mind were diagnosed at the time--after all one might wind up there for being poor or in a hysterical state. Also, many relapses were found later to have been recorded as new patients, thus inflating the numbers of "cured" and disregarding the ones released too soon.
Next post will be up shortly and will cover the deinstitutionalization. That will not be so long as this and will be followed by a post with statistics about homelessness and how it relates to the above program. I thought I'd provide some context for some of the things I will say first, and wanted to stress that the NoHo Assylum wasn't meant to be a bad place.
Sunday, July 26, 2009
ServiceNet and Roger's Orders
I'm currently working on a post about the history of mental health and how it relates to the opening of state hospitals, however I ended up participating in a fundraiser for a mental health service center in Northampton this weekend, and wanted to share the information.
Their website
This is a fantastic example of programs that I feel would be helpful throughout the US. They provide affordable mental health care, counciling and other services to those most in need. They also act as a homeless shelter among other things. Great work.
But now to my segway:
While exploring their site, I came across a term I had never heard of, "Roger's Orders." in this article on forced medication
The only real concrete information I could get right away by googling the subject was at this link
It describes that the term came from a legal case regarding the forced medication of an institutionalized patient. It currently describes a government issued mandate requiring a patient takes his or her medication during outpatient treatment. It was supposed to only be applied to extreme cases, but of late has become more commonly used with little need basis.
There are many people that feel this violates basic human rights, and also demonstrates a gross misunderstanding of drugs in general. Too many people see the drugs as a miricle cure, forgetting that the side-effects can be debilitating and life-altering. When representing patients, or when judging cases, many enter with the idea that "if medicated, the patient would know it was best for him." and therefore the patient isn't treated seriously.
While such laws can be deemed necessary on some level, the practice of these laws leaves something to be desired.
A question that one must ask is, at what point can someone no longer give consent to what happens to their body? At what point is someone too ill to have a say? If someone is living on the streets, does the government have the right to step in and force-medicate on the presumption that they are making the person "less dangerous?" (Especially since, there really isn't an impartial party that can make a good argument as to what constitutes "dangerous enough" to trump the human right of judging what's best for their body?)
I thought it was an interesting tangent.
Their website
This is a fantastic example of programs that I feel would be helpful throughout the US. They provide affordable mental health care, counciling and other services to those most in need. They also act as a homeless shelter among other things. Great work.
But now to my segway:
While exploring their site, I came across a term I had never heard of, "Roger's Orders." in this article on forced medication
The only real concrete information I could get right away by googling the subject was at this link
It describes that the term came from a legal case regarding the forced medication of an institutionalized patient. It currently describes a government issued mandate requiring a patient takes his or her medication during outpatient treatment. It was supposed to only be applied to extreme cases, but of late has become more commonly used with little need basis.
There are many people that feel this violates basic human rights, and also demonstrates a gross misunderstanding of drugs in general. Too many people see the drugs as a miricle cure, forgetting that the side-effects can be debilitating and life-altering. When representing patients, or when judging cases, many enter with the idea that "if medicated, the patient would know it was best for him." and therefore the patient isn't treated seriously.
While such laws can be deemed necessary on some level, the practice of these laws leaves something to be desired.
A question that one must ask is, at what point can someone no longer give consent to what happens to their body? At what point is someone too ill to have a say? If someone is living on the streets, does the government have the right to step in and force-medicate on the presumption that they are making the person "less dangerous?" (Especially since, there really isn't an impartial party that can make a good argument as to what constitutes "dangerous enough" to trump the human right of judging what's best for their body?)
I thought it was an interesting tangent.
Tuesday, July 21, 2009
Comments/Questions/Concerns
Just to note, comments, discussion, questions, etc. are welcome. There is a space for comments at the bottom of each entry. At the moment, all comments are public, so please don't post anything you don't want read or commented on by others. Please keep things respectful and courteous, especially since the topics within can be sensitive to some folk.
I may not answer every question addressed within the comments. Sometimes I either don't know the answer or it doesn't fit within the scope of my project and I'm not sure what to say. Other times I'm very busy and don't have time. Also 0thers may also answer your question within the comments.
Quick Disclaimer:
If I feel something could be percieved as offensive I may moderate comments, only if I find the results to be deconstructive.
I may not answer every question addressed within the comments. Sometimes I either don't know the answer or it doesn't fit within the scope of my project and I'm not sure what to say. Other times I'm very busy and don't have time. Also 0thers may also answer your question within the comments.
Quick Disclaimer:
If I feel something could be percieved as offensive I may moderate comments, only if I find the results to be deconstructive.
Monday, July 20, 2009
The Project (and a little History)
Northampton MA is a quiet little town not far from the University of MA Amherst. It is famous for its arts, among other things, and is considered "quintessential New England" by many books.
However, outside of the sunny streets and the artistic atmosphere downtown there lies the ruins of what was once one of the largest assylums on the East Coast. Opened in 1856, it was originally built to house 250 patients. Wings, and additions were made over the years, and at its peak it held over 2500 people.
Like most assylums of it's time, the people brought there were subjected to all sorts of "treatments," however it cleaned up as standards of psychological practice became for stringent. After a number of legal battles, etc. the hospital closed in 1993. According to rumor, they opened the doors and just let the patients go.
As of 2005 the buildings were demolished.
Interestingly enough, even though this hospitol was very large and important in its own right, it's not even mentioned in the brief history of Northampton on their website:
http://www.noho.com/townhistory.html
This project is a discussion about the effects of the asylum on the community, how mental health treatment relates to homelessness and what you can do to help. I am not an expert and have a lot to learn myself, so my goal is to educate other people as I educate myself. Aside from the above, which is easily found while googling for info, I want to learn about how the public has felt about the hospitol through the years. How it shut down, why it was shut down, what went on there, and how it affected the local community. I am also going to discuss the public image of mental health and it's treatment and why a disproportionate number of homeless are affected. Lastly: What can be done? How can we make treatment, safe, effective, and affordable with a realiable source available for those in need who can't afford insurance?
I feel strongly that by looking at our history we can identify where some current problems have stemmed from.
In the end, by my studying my own community I hope that someone will walk away with an appreciation that these issues are not just something in a book, taught in a class or that these things just affect "other people." This is real, and we can not only see it with our own eyes, but if we take it upon ourselves to educate each other than we may even be able to make a difference.
NOTES:
Both photos © www.opacity.us (allowed under their license for non-profit, educational use)
However, outside of the sunny streets and the artistic atmosphere downtown there lies the ruins of what was once one of the largest assylums on the East Coast. Opened in 1856, it was originally built to house 250 patients. Wings, and additions were made over the years, and at its peak it held over 2500 people.
Like most assylums of it's time, the people brought there were subjected to all sorts of "treatments," however it cleaned up as standards of psychological practice became for stringent. After a number of legal battles, etc. the hospital closed in 1993. According to rumor, they opened the doors and just let the patients go.
As of 2005 the buildings were demolished.
Interestingly enough, even though this hospitol was very large and important in its own right, it's not even mentioned in the brief history of Northampton on their website:
http://www.noho.com/townhistory.html
This project is a discussion about the effects of the asylum on the community, how mental health treatment relates to homelessness and what you can do to help. I am not an expert and have a lot to learn myself, so my goal is to educate other people as I educate myself. Aside from the above, which is easily found while googling for info, I want to learn about how the public has felt about the hospitol through the years. How it shut down, why it was shut down, what went on there, and how it affected the local community. I am also going to discuss the public image of mental health and it's treatment and why a disproportionate number of homeless are affected. Lastly: What can be done? How can we make treatment, safe, effective, and affordable with a realiable source available for those in need who can't afford insurance?
I feel strongly that by looking at our history we can identify where some current problems have stemmed from.
In the end, by my studying my own community I hope that someone will walk away with an appreciation that these issues are not just something in a book, taught in a class or that these things just affect "other people." This is real, and we can not only see it with our own eyes, but if we take it upon ourselves to educate each other than we may even be able to make a difference.
NOTES:
Both photos © www.opacity.us (allowed under their license for non-profit, educational use)
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