Question

How have things changed since the beginning of the mental health system in the United States? How would you improve the current mental health system?

Answer 1

Beginning of the mental health system in the United States

In ancient Egyptian, Indian, Greek, and Roman writings, mental illness was categorized as a religious or personal problem.

In the 5th century B.C., Hippocrates was a pioneer in treating mentally ill people with techniques not rooted in religion or superstition; instead, he focused on changing a mentally ill patient’s environment or occupation, or administering certain substances as medications.

During the Middle Ages, the mentally ill were believed to be possessed or in need of religion.

Negative attitudes towards mental illness persisted into the 18th century in the United States, leading to stigmatization of mental illness, and unhygienic (and often degrading) confinement of mentally ill individuals.

History of mental health system in the united states

In the 1840s, activist Dorothea Dix lobbied for better living conditions for the mentally ill after witnessing the dangerous and unhealthy conditions in which many patients lived . Over a 40-year period, Dix successfully persuaded the U.S. government to fund the building of 32 state psychiatric hospitals.

This institutional inpatient care model, in which many patients lived in hospitals and were treated by professional staff, was considered the most effective way to care for the mentally ill. Institutionalization was also welcomed by families and communities struggling to care for mentally ill relatives.

Although institutionalized care increased patient access to mental health services, the state hospitals were often underfunded and understaffed, and the institutional care system drew harsh criticism following a number of high-profile reports of poor living conditions and human rights violations.

By the mid-1950s, a push for deinstitutionalization and outpatient treatment began in many countries, facilitated by the development of a variety of antipsychotic drugs.

Deinstitutionalization efforts have reflected a largely international movement to reform the “asylum-based” mental health care system and move toward community-oriented care, based on the belief that psychiatric patients would have a higher quality of life if treated in their communities rather than in “large, undifferentiated, and isolated mental hospitals”.

The closure of state psychiatric hospitals in the United States was codified by the Community Mental Health Centers Act of 1963, and strict standards were passed so that only individuals “who posed an imminent danger to themselves or someone else” could be committed to state psychiatric hospitals.

By the mid-1960s in the U.S., many severely mentally ill people had been moved from psychiatric institutions to local mental health homes or similar facilities. The number of institutionalized mentally ill patients fell from its peak of 560,000 in the 1950s to 130,000 by 1980.

By 2000, the number of state psychiatric hospital beds per 100,000 people was 22, down from 339 in 1955.

In place of institutionalized care, community-based mental health care was developed to include a range of treatment facilities, from community mental health centers and smaller supervised residential homes to community-based psychiatric teams.

Though the deinstitutionalization debate continues, many health professionals, families, and advocates for the mentally ill have called for a combination of more high-quality community treatment programs (like intensive case management) and increased availability of intermediate and long-term psychiatric inpatient care for patients in need of a more structured care environment.

Many experts hope that by improving community-based programs and expanding inpatient care to fulfill the needs of severely mentally ill patients, the United States will achieve improved treatment outcomes, increased access to mental health care, and better quality of life for the mentally ill.

U.S. Mental Health Policy

Mental Health America (MHA), originally founded by Clifford Beers in 1909 as the National Committee for Mental Hygiene, works to improve the lives of the mentally ill in the United States through research and lobbying efforts.

In 1946, Harry Truman passed the National Mental Health Act, which created the National Institute of Mental Health and allocated government funds towards research into the causes of and treatments for mental illness.

In 1963, Congress passed the Mental Retardation Facilities and Community Health Centers Construction Act, which provided federal funding for the development of community-based mental health services.

The National Alliance for the Mentally Ill was founded in 1979 to provide “support, education, advocacy, and research services for people with serious psychiatric illnesses”.

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How would you improve the current mental health system?

We should discuss about challenges with improvements in mental health system

I) Lack of support

Providing adequate support such as counselling, access and awareness to me medical and therapy facilities.

2) Unawareness about the mental health facilities

Creating awareness about the available resources, insurance schemes and etc

3) Unreach of funding to rural outreach.

Should reduce the gap between the funding between rural and urban mental health facilities.

4) No minimum standards

Educate the care provides with updated informations and technology.

5) Making sure patients have access to needed medications.

6) Dealing with policy changes on federal, state, and local levels.

7) Advocating integrated care.

8) Preventing mental illnesses.