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America’s Mental Health

The Effects of the Deinstitutionalization of Mental Patients in the 1960s on my Life and Society

Jennifer Kitchen

4/1/2011

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The history of psychology is long and the trek to understanding and helping the

World’s mentally ill has been a lengthy and challenging journey through scientific

history. Over half a million years ago, ancient healers used trephining, chipping away at

the skull to release the evil spirits within, to “cure” the mentally ill. By 430 BC, the great

father of modern medicine, Hippocrates, argued for the four temperaments of

personality, which he associated with the four humors of the body which he felt, affected

the 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 other

personality characteristics of an individual. By the early 1900s, psychology gained the

psychodynamic perspective of Sigmund Freud and then the fundamental principles of

learning from Ivan Pavlov. Due to the misunderstanding of mental illness throughout

this history many people were institutionalized in asylums.

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Today there are five major perspectives used in psychology to help explain and

understand 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 different

aspects of behavior and mental processes. Using these perspectives, psychologists and

social scientists have learned much of how individuals learn, how the personality is

developed, and why they react the ways they do and many psychotropic medications

have been developed to assist in managing the symptoms of mental illness. With this

understanding a cure to mental illness seems more a possibility than ever before and in

the 1960s mental institutions began releasing or deinstitutionalizing mental health

patients. This single event, which happened over four decades ago, has had an effect

on 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 that

deinstitutionalization has had in the World and in my life. Mental illness can be defined

as any of the various disorders in which a person's thoughts, emotions, or behaviors are

abnormal 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. The National Institute of

Mental Health (NIMH) a branch of the National Institute of Health (NIH) defines Serious

Mental Illness (SMI) as:

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“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 can

be diagnosed with one or more disorders in any given year. Although mental disorders

seem commonplace only about 6% of the population (that is 1 in 17 people) suffers from

debilitating serious mental illness (NIHM, 2010). This seems such a small number but

when we look at the affect that mental illness has on not only those suffering but the

family of these people it affects more than just that 1 out of 17 people. Living with a

mental disorder can be hard but there are methods of treatment and information that is

available to assist all persons involved.

In the late 1960s, a majority of mentally ill patients were moved from institutions

and into the community. It all started with the new psychotropic medications that were

available and the Community Mental Health Center Act in 1963. Psychoactive drugs

developed in the preceding decades enabled the discharge of large numbers of patients

into the community. In1935 Amphetamines were used for depression and in 1949

Lithium was used being used to treat manic states. By the 1960s drugs, such as

Thorazine (the first antipsychotic) and a variety of antidepressants and antianxiety

medications, were being used regularly in the psychiatric practice (Department of Health

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Services, n.d.). Initially these drugs were only used for managing patients within the

institutions, and then became a part of outpatient treatment. This outpatient treatment

was the basis for the Community Mental Health Centers Act. This act put each state in

charge of providing community based mental health care and the development of

facilities to provide the services of prevention, diagnosis, care, treatment, and the

rehabilitation of the mentally ill and if a patient was unable to pay for the services

provided the state was obligated to pay for the services (NIH,1963). With the

implementation of these community mental health care centers and the use of out-

patient psychotropic drug therapy, many of the mental institutions and asylums were

able to release patients that were considered not a danger to themselves, others, or

society. The mentally ill were deinstitutionalized and given prescription medication to

assist them in managing the symptoms of their illness. The deinstitutionalization of

mental patients has affected American society in many ways.

There are many agencies that have been developed to study the effects of

mental illness on persons and society and the outcome of this deinstitutionalization is

still in the process of being determined. NIMH informs us that about two-thirds of the

inmates in America prisons suffer with mental illness (2010) and according to Harrison

and Dye one-fourth to one-third of America’s homeless population suffer from mental

illness (2008). Why is this? The Substance Abuse and Mental Health Services

Administration (SAMHSA) reported that in 2008, 13.4% of adults in the United States

received 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 emotional

issues (NIMH, 2010). This means that even though there is treatment available only

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about half everyone who suffers with a mental disorder receives help. Some people just

are not aware that help is out there, some people do not look for help due to the stigma

that still goes along with mental illness, and some people simply do not feel they have

the access or the money to afford mental health care. The Agency for Healthcare

Research and Quality's (AHRQ's) Medical Expenditure Panel Survey (MEPS) in 2006

shows 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 year

before, 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 pick

up most of the mental health tab here in the U.S. I, personally, have taken part in the

services provided by these community programs and know that they do work when

used properly by patients and care providers.

I suffer from compound mental disorders; this means I have more than one

disorder. I was diagnosed with bi-polar disorder when I was 13 and then borderline

personality disorder and anti-social disorder when I was 28. I have used the community

mental health care centers to receive counseling and I have been prescribed a variety

of psychotropic medications in my life. I have also been admitted to the psychiatric

ward in hospitals on two separate occasions. The first time I was ordered by the state

of Arizona to be treated as an in-patient and the second time I chose to enter an

institution in Illinois of my free will because I knew I needed special care. I have only

had 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 health

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institution I am not going to have to live the remainder of my life in such an institution. I

have the rights and freedoms that other citizens enjoy. I am not restricted from living a

normal and healthy life and am actually given every opportunity to do so. I even have

the choice of refusing treatment, which was not the case before deinstitutionalization. I

exercise this right by not taking medications to treat my mental illness because I do not

believe 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 opinion

psychotropic drugs are over-prescribed. I am not saying that none of these drugs work

but that they are not always used properly by providers or patients. Today psychotropic

medications are one of the most commonly prescribed classes of drugs and widespread

usage 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 some

severe adverse reactions that I was told was not the medication. This has caused me

much stress and I have changed my lifestyle in order to live healthy with fewer side

effects from the symptoms of my disorders. I have also seen other mentally ill patients

misuse the drugs they were given. Hippocrates once made the comment “Keep watch

also on the faults of the patients, which often make them lie about the taking of things

prescribed.” I have seen a problem with the over-use and misuse of these medications

and have decided that I can help make a change by going into research. I am in

university to gain my Bachelors in Science for Health and Wellness to learn about how

all people can live healthy lives. After I graduate I would like to do research on

Complementary and Alternative Medicine (CAM). Why? Well, I have seen firsthand that

nutrition and traditional therapies, like yoga and meditation, can make living with mental

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disorders easier. I am not naïve enough to say that my methods can work for everyone

who suffers from the same disorders I do but it may be better for certain individuals

suffering with certain mental disorders. I want to find out what works best and pass this

knowledge on to those who need it. Alternative therapies are not always used alone

either. They can be used in a complimentary or integrative manner, which makes use

of conventional and traditional therapies. This may be the best way to go about treating

mental illness.

Deinstitutionalization has had a major effect on society, my personal life, and my

plans for the future. The U.S. has seen more opportunity for the people suffering with

mental illness. We have also seen the effects of not all of these people taking

advantage of mental health care available. Deinstitutionalization has allowed me to live

like any other American, without the fear that I could lose all my freedoms and rights. I

can strive to be a meaningful member of society, to receive an education and to vote. It

has allowed me to decide what I need and do not need and given me the opportunity to

help change the World. The study of how our minds work is still in progress, the mind is

a complicated thing, and it may be a very long time before we fully understand human

behavior and personality. We came a long way in the past few centuries and even

further in the past few decades.

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References

Department 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.pdf

Feldman, R., (2002). Understanding Psychology. New York; McGraw-Hill.

Harrison, B. and Dye, D., (2008). Power and Society. Ohio: Cengage Learning.

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Mark, T., (2010). For what diagnoses are psychotropic medications being prescribed?

[Electronic version]. Retrieved from http://www.samhsa.gov/Financing/file.axd?

file=2011%2F1%2FMark+CNS+Drugs+2010+24(4)+319-326+508.pdf

National Institute of Health. (1963). Community Mental Health Centers Act [electronic

archive]. Retrieved from http://history.nih.gov/research/downloads/PL88-164.pdf

National Institute of Mental Health, (2010). Statistics. Retrieved from

http://www.nimh.nih.gov/statistics/SMI_AASR.shtml

Substance 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