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.
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