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The Mental Health Movement

The Mental Health Movement. U.S. and Alabama. Dorothea Dix. Stimulated creation of state facilities for specialized treatment of mentally ill (insane) 1852 Alabama passed bill to create Alabama Insane Hospital

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The Mental Health Movement

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  1. The Mental Health Movement U.S. and Alabama

  2. Dorothea Dix • Stimulated creation of state facilities for specialized treatment of mentally ill (insane) • 1852 Alabama passed bill to create Alabama Insane Hospital • April 1861 hospital opened in Tuscaloosa under direction of 27 year old Dr. Peter Bryce

  3. Bryce’s Principles of Treatment • Early treatment (many got there too late after hard trips and could not be helped) • Tender loving care • Occupational therapy (moral treatment) • Non-restraint

  4. Shoestring budget • Counties paid $3/week/patient (remained at this rate until 1940) • Patients did all sewing, raising vegetables, farm animals, fishing • Despite low pay, strict rules for staff: fined if discourteous or inattentive to patients

  5. Model Hospital • Non-restraint policy distinctive • “If there is one thing more than another calculated to destroy the peace and tranquility of the patients, and the orderly quiet of the wards in which they reside it is a life of enforced idleness.” • Bryce died in 1892, by which time about 1,000 patients at the hospital

  6. Mental Health 1900s • 1902 a separate hospital for African Americans established at Mt. Vernon. • Nationally, beginning work in aftercare • 1908 Clifford Beers founded organized mental health movement • Mental hygiene focused on causes, early diagnosis, prevention and treatment

  7. 1920s – 1950s • Child guidance clinics, outpatient centers • Psychiatric social work developed in 1920s • In Alabama, institutions became larger and increasingly more crowded • Superintendent Partlow purchased 3,000 more acres on $3/week reimbursement rate • From 1925 to 1950 patients at Bryce and Searcy grew from 3162 to 6045

  8. Overcrowding continued and little real treatment • Bryce would have been shocked with idleness, which had become the norm • Commitment had become easy and life-long • 25% of draftees rejected for mental problems & 40% of medical discharges in US were for MH reasons in WW II

  9. Post WW II Activity • VA took leadership role in treatment • National Mental Health Act 1946—study authorized • 1961 “Action for Mental Health” - -utopian vision of mental health care • Led to creation of Community Mental Health Centers

  10. Stimuli for CMHC Movement • Postwar budget surplus • New generation of psychotropic medications, which stabilized many • View that community care was better than institutional care • Support of President Kennedy

  11. CMHC Acts of 1963 and 1965 • Idea to eliminate the need for state mental hospitals • Move to community care & prevention • Divide the US into catchment areas • CMHC to provide inpatient hospitalization, partial hospitalization, outpatient services, emergency services, consultation, and education for those in area

  12. Case manager role defined to follow patient through system • Rise of CMHC coincided with deinstitutionalization for cost savings (California) and to meet court orders (Alabama) • Not enough $$ appropriated to fulfill promise

  13. Revolving Door • Frequent readmissions, often due to difficulties with remaining on medications when out of hospital • Side effects, paying for meds, getting meds at all • Many homeless are former hospital patients • Crimes committed to get help??

  14. Alabama Role • Wyatt v. Stickney 1974 Right to treatment • Judge Frank Johnson “To deprive any citizen of his or her liberty upon the altruistic theory that the confinement is for humane therapeutic reasons and then fail to provide adequate treatment violates the very fundamentals of due process.”

  15. Changes with Wyatt • 5,000 patients (and 1 psychiatrist) at Bryce when suit filed • Less than 500 now • Also changes in commitment proceedings make involuntary commitment difficult “danger to self or others”

  16. Mental Retardation in Early 1900s • Bryce concerned about “mentally deficient” • No law to allow admission to Alabama Insane Hospital, but 2,223 in state in 1875 • Concern arose in US that retarded were criminal, anti- social, and a menace to rest of society • Eugenics – segregation/sterilization

  17. Sterilization Laws • Intended to prevent “feeblemindedness” • Racist and anti-immigrant views coincided with rise of miscegenation laws • 1907 Indiana passed first law, and many states followed. Alabama passed in 1919. • Ruled constitutional in 1927 “Society can prevent those who are manifestly unfit from continuing their kind” (Holmes)

  18. Special Institutions • 1923 Alabama Home for Mental defectives opened with 80 white girls and 80 white boys • No provisions for African Americans until 1944 • By 1950 there were 1,188 at Partlow

  19. 1970s and Mental Retardation • “Least restrictive environment” • Education for All Handicapped Children Act (1974) • Continuing movement toward community care/responsibility and normalization

  20. Wyatt v. Stickney conclusion • Court requirements were met, per the judicial decision, and the state of AL was removed from official oversight in 200? • Current population at Bryce: • Current staff ration at Bryce:

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