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MENTAL HOSPITALS

MENTAL HOSPITALS. US PUBLIC INPATIENT 1830-1955. PUBLIC INPATIENT 1955-2006. TRANSFORMATION IN 20th CENTURY. CUCKOO’S NEST PUBLIC MENTAL HOSPITALS CENTRAL LONG INPATIENT STAYS – “CHRONICS” MORE SOCIAL CONTROL THAN TREATMENT NO PATIENT RIGHTS VOLUNTARIES INSTITUTIONALISM.

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MENTAL HOSPITALS

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  1. MENTAL HOSPITALS

  2. US PUBLIC INPATIENT 1830-1955

  3. PUBLIC INPATIENT 1955-2006

  4. TRANSFORMATION IN 20th CENTURY • CUCKOO’S NEST • PUBLIC MENTAL HOSPITALS CENTRAL • LONG INPATIENT STAYS – “CHRONICS” • MORE SOCIAL CONTROL THAN TREATMENT • NO PATIENT RIGHTS • VOLUNTARIES • INSTITUTIONALISM

  5. NO PLACE ON EARTH FOR ME • SYLVIA FRUMKIN • SHORT HOSPITAL STAYS • LONG STAYS IN COMMUNITY • MUCH LESS SOCIAL CONTROL • MORE PATIENT RIGHTS • HARD TO ENTER VOLUNTARILY • ANTI-INSTITUTIONALISM

  6. TRANSFORMATION • INCREDIBLY SHORT PERIOD - CUCKOO’S NEST IN 1963 (1975); FRUMKIN IN 1978 (1982) • WHAT WAS TRANSFORMATION? • REASONS FOR TRANSFORMATION.

  7. HISTORY OF MENTAL HOSPITAL

  8. I. 1800-1850 • AROSE IN U.S. ABOUT 1800 • PREVIOUSLY FAMILY RESPONSIBILITY • IF NO FAMILY EXILED OR JAILED • MENTAL HOSPITALS INITIALLY HUMANE REFORM

  9. ENLIGHTENMENT PHILOSOPHY • REMOVE PEOPLE FROM STRESSFUL ENVIRONMENT • COUNTRY SETTINGS - ISOLATED FROM FAMILIES AND COMMUNITIES • PROVIDE MORAL TREATMENT IN CALM AND RESTFUL ENVIRONMENT • MAINLY MIDDLE AND UPPER CLASS CLIENTS

  10. 1850 - 1955

  11. II. TRANSFORMATION • GROWTH OF POPULATION • HUGE BUREAUCRACIES

  12. NO EFFECTIVE TREATMENTS • MANAGEMENT AND CONTROL

  13. PATIENTS 1850-1955 • LOWER SES, IMMIGRANT, ELDERLY • LONG STAYS, HIGH DEATH RATES • CHRONIC CONDITIONS - SCHIZ., SYPHILUS, ALCOHOLISM • INSTITUTIONALISM: APATHY, ADJUST, DON’T WANT TO LEAVE

  14. SUMMARY AS OF 1955 • LARGE ISOLATED INSTITUTIONS • CUSTODIAL WITH LITTLE TREATMENT • LONG STAYS, FEW RELEASES, MANY ELDERLY PATIENTS • NO ALTERNATIVES

  15. DEINSTITUTIONALIZATION (DI)

  16. III. DI (1955 - PRESENT) • REMOVE PATIENTS FROM HOSPITAL, ADMIT FEWER PATIENTS, USE OF COMMUNITY TREATMENT • BEGINS IN 1955 - REVERSAL OF 150 YEAR OLD TREND • HIGHLY CONTROVERSIAL - CRIME, HOMELESSNESS, NEGLECT

  17. PUBLIC INPATIENT 1955-2006

  18. RESIDENTS OF PUBLIC MENTAL HOSPITALS • DRASTIC DECLINE IN RESIDENTS, 1955-2006 (“OPENING BACK DOOR”) • 1955 - 560,000; 1970 - 450,000; 1980 - 140,000; 1990 - 100,000; 2006 - 80,000 • INCREASE IN ADMISSIONS 1955-1970, DECREASE SINCE THEN (“CLOSING FRONT DOOR”)

  19. PUBLIC MENTAL HOSPITALS NOW • NO LONGER THE MAJOR PART OF SYSTEM • PLACE OF LAST RESORT - VIOLENT, DIFFICULT TO TREAT (FRUMKINS) OR NOWHERE ELSE TO GO • STILL 2/3 OF STATE EXPENSE • FIXED COSTS, UNIONS, COMMUNITIES

  20. CHANGE IN PATIENTS • FROM ELDERLY, LONG-TERM, SCHIZ. AND BRAIN DISEASE • TO YOUNG, SHORT-TERM, DRUG USERS (MICA) • SAME: POOR, MINORITIES, MALES

  21. INPATIENT TREATMENT NOW • MOST IN GENERAL HOSPITALS • GROWTH OF PRIVATE, SPECIALIZED HOSPITALS • SHORT STAYS – 1 TO 2 WEEKS OR AS LONG AS HAVE INSURANCE • WHITE, FEMALE, DEPRESSION, ALCOHOL, EATING DISORDERS • ELDERLY NOW IN NURSING HOMES

  22. SUMMARY OF CHANGES • DRASTIC DECLINE IN NATURE AND CENTRALITY OF PUBLIC MENTAL HOSPITALS • NOT LONG STAYS BUT SHORT STAYS WITH LONG SPELLS IN COMMUNITY • MOST INPATIENT TREATMENT IN GENERAL OR PRIVATE HOSPITALS • RISE OF NURSING HOMES

  23. PATIENTS • PATIENTS IN PUBLIC MENTAL HOSPITALS STILL POOR/ MINORITY • NOW YOUNG, DRUG USING, HARD TO HANDLE; NOT OLD, COMPLIANT, AND INSTITUTIONALIZED

  24. Grade distribution – 2nd Hourly Exam GradeRangeN A 90-100 77 B+ 88 12 B 80-86 65 C+ 78 20 C 60-76 63 D 50-58 8 F <50 3

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