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MENTAL HOSPITALS

MENTAL HOSPITALS. TRANSFORMATION IN 20th CENTURY. CUCKOO’S NEST PUBLIC MENTAL HOSPITALS CENTRAL LONG INPATIENT STAYS REPRESSIVE SOCIAL CONTROL NO PATIENT RIGHTS VOLUNTARIES INSTITUTIONALISM. NO PLACE ON EARTH FOR ME. SYLVIA FRUMKIN SHORT HOSPITAL STAYS LONG STAYS IN COMMUNITY

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MENTAL HOSPITALS

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  1. MENTAL HOSPITALS

  2. TRANSFORMATION IN 20th CENTURY • CUCKOO’S NEST • PUBLIC MENTAL HOSPITALS CENTRAL • LONG INPATIENT STAYS • REPRESSIVE SOCIAL CONTROL • NO PATIENT RIGHTS • VOLUNTARIES • INSTITUTIONALISM

  3. NO PLACE ON EARTH FOR ME • SYLVIA FRUMKIN • SHORT HOSPITAL STAYS • LONG STAYS IN COMMUNITY • LITTLE SOCIAL CONTROL • MANY PATIENT RIGHTS • NO VOLUNTARIES • ANTI-INSTITUTIONALISM

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

  5. HISTORY OF MENTAL HOSPITAL

  6. I. 1800-1850 • AROSE IN U.S. ABOUT 1800 • PREVIOUSLY PEOPLE CARED FOR IN FAMILIES, ROAMED COUNTRY, JAILS • INITIALLY HUMANE REFORM • PHILOSOPHY OF THE ENLIGHTENMENT

  7. 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

  8. II. 1850-1960 • GROWTH OF POPULATION • HUGE BUREAUCRACIES • FROM TREATMENT TO MANAGEMENT AND CONTROL • NO EFFECTIVE TREATMENTS

  9. PATIENTS 1850-1960 • LOWER SES, IMMIGRANT, ELDERLY • LONG STAYS, HIGH DEATH RATES • CHRONIC CONDITIONS - SCHIZ., SYPHILUS, ALCOHOLISM • INSTITUTIONALISM: APATHY, ADJUST, DON’T WANT TO LEAVE

  10. SUMMARY AS OF 1955 • LARGE ISOLATED INSTITUTIONS • CUSTODIAL WITH LITTLE TREATMENT • LONG STAYS, FEW RELEASES, MANY ELDERLY PATIENTS

  11. DEINSTITUTIONALIZATION (DI)

  12. 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

  13. PUBLIC INPATIENT 1955-2000

  14. RESIDENTS OF PUBLIC MENTAL HOSPITALS • DRASTIC DECLINE IN RESIDENTS, 1955-2000 (“OPENING BACK DOOR”) • 1955 - 560,000; 1970 - 450,000; 1980 - 140,000; 1990 - 100,000; 2000 - 90,000 • INCREASE IN ADMISSIONS 1955-1970, DECREASE SINCE THEN (“CLOSING FRONT DOOR”)

  15. 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

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

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

  18. 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

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

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