Question

s..... also i need to cite the 3 to 5 scholary sources and it need to be type in APA formatUrena

March 7 2019

ALH

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150

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Prof. Susan Maciewicz

Health System paper topic assignment

The paper topic I choose, is the History of Mental Healt Care in The U.S.

In this paper, I will be discussing the history/background of Mental Health Services,

and how quality access, cost or other factors have changed (or how they haven't). I

also, will be discussing the populations that benefit from this type of service and th

e

significant issues, problems, within the area that impact specific population. I will

interpret national policy, legislation, attitudes, political climate, and how they impact

or relate to the problems discussed

Hello i Need help to write an essay of 5 to 6 pages about the topic i attached above... Any help Welvom!! Thank you

The paper topic I choose, is the History of Mental Healt Care in The U.S. In this paper, I will be discussing the history/background of Mental Health Services, and how quality access, cost or other factors have changed (or how they haven't). I also, will be discussing the populations that benefi from this type of service and the significant issues, problems, within the area that impact specific population. I will interpret national policy, legislation, attitudes, political climate, and how they impact or relate to the problems discussed.

Also i need to provide 3 to 5 scholary source no older than 5 years thank you

Answer 1

Answer:

The History, background and policy of mental health services in U.S.

A Brief History of Mental Illness and the U.S. Mental Health Care System

The history of mental illness in the United States is a good representation of the ways in which trends in psychiatry and cultural understanding of mental illness influence national policy and attitudes towards mental health. The U.S. is considered to have a relatively progressive mental health care system, and the history of its evolution and the current state of the system will be discussed here.

Early History of Mental Illness(1)

Many cultures have viewed mental illness as a form of religious punishment or demonic possession. 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.

Mental Health Hospitals and Deinstitutionalization

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.(2)

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.(3) 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.(4) 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.(5)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”.(6)

Although large inpatient psychiatric hospitals are a fixture in certain countries, particularly in Central and Eastern Europe, the deinstitutionalization movement has been widespread, dramatically changing the nature of modern psychiatric care.(7)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.

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

(10) 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.(11)

Though the goal of deinstitutionalization – improving treatment and quality of life for the mentally ill – is not controversial, the reality of deinstitutionalization has made it a highly polarizing issue. While many studies have reported positive outcomes from community-based mental health care programs, (including improvements in adaptive behaviors, friendships, and patient satisfaction,) other studies have found that individuals living in family homes or in independent community living settings have significant deficits in important aspects of health care, including vaccinations, cancer screenings, and routine medical checks.(12)

(13) Other studies report that “loneliness, poverty, bad living conditions, and poor physical health” are prevalent among mentally ill patients living in their communities.

(14) However, some studies argue that community-based programs that have proper management and sufficient funding may deliver better patient outcomes than institutionalized care, and are “not inherently more costly than institutions”.

(15)

Critics of the deinstitutionalization movement point out that many patients have been moved from inpatient psychiatric hospitals to nursing or residential homes, which are not always staffed or equipped to meet the needs of the mentally ill. In many cases, deinstitutionalization has also shifted the burden of care to the families of mentally ill individuals, though they often lack the financial resources and medical knowledge to provide proper care.

(16) Others argue that deinstitutionalization has simply become “transinstitutionalization”, a phenomenon in which state psychiatric hospitals and criminal justice systems are “functionally interdependent”. According to this theory, deinstitutionalization, combined with inadequate and under-funded community-based mental health care programs, has forced the criminal justice system to provide the highly structured and supervised environment required by a minority of the severely mentally ill population.

(17)

Opponents of the transinstitutionalization theory contend that it applies to a small fraction of mentally ill patients, and that the majority of patients would benefit from improved access to quality community-based treatment programs, rather than from an increase in the number of inpatient state psychiatric beds. These opponents claim that the reduced availability of state hospital beds is not the cause of the high rates of incarceration among the mentally ill, arguing that deinstitutionalized patients and incarcerated individuals with serious mental illnesses are “clinically and demographically distinct populations”. Instead, they suggest that other factors such as “the high arrest rate for drug offenses, lack of affordable housing, and underfunded community treatment” are responsible for the high rates of incarceration among the mentally ill.

(18)

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.

(19) 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(20)

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.

A number of governmental initiatives have also helped improve the U.S. mental healthcare system . 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”. Other government interventions and programs, including social welfare programs, have worked to improve mental health care access.

1. Beginning in the Middle Ages and up until the mid-20th century, the mentally ill were misunderstood and treated cruelly. In the 1700s, Philippe Pinel advocated for patients to be unchained, and he was able to affect this in a Paris hospital. In the 1800s, Dorothea Dix urged the government to provide better funded and regulated care, which led to the creation of asylums, but treatment generally remained quite poor. Federally mandated deinstitutionalization in the 1960s began the elimination of asylums, but it was often inadequate in providing the infrastructure for replacement treatment.

2. Frank is severely depressed. He lost his job one year ago and has not been able to find another one. A few months after losing his job, his home was foreclosed and his wife left him. Lately, he has been thinking that he would be better off dead. He’s begun giving his possessions away and has purchased a handgun. He plans to kill himself on what would have been his 20th wedding anniversary, which is coming up in a few weeks.

GLOSSARY

asylum  institution created for the specific purpose of housing people with psychological disorders

deinstitutionalization  process of closing large asylums and integrating people back into the community where they can be treated locally

involuntary treatment  therapy that is mandated by the courts or other systems

voluntary treatment  therapy that a person chooses to attend in order to obtain relief from her symptoms

The problems in mental health care discussion:

Mental health policy and service development team
Objectives and strategies
• To strengthen mental health policies, legislation and plans through: increasing
awareness of the burden associated with mental health problems and the commitment
of governments to reduce this burden; helping to build up the technical capacity of
countries to create, review and develop mental health policies, legislation and plans;
and developing and disseminating advocacy and policy resources.
• To improve the planning and development of services for mental health through:
strengthening the technical capacity of countries to plan and develop services;
supporting demonstration projects for mental health best practices; encouraging
operational research related to service delivery; and developing and disseminating
resources related to service development and delivery.
Financial support is provided from the Eli Lilly and Company Foundation, the Johnson and
Johnson European Philanthropy Committee, the Government of Italy, the Government of
Japan, the Government of Norway, the Government of Australia and the Brocher
Foundation.

Overcoming obstacles linked to the illness
A substantial majority of persons with serious mental illness take medication.
When appropriately prescribed and monitored, these medications, especially the
newer molecules, not only control the positive symptoms of illness (agitation,
restlessness, etc.), but also have a significant impact on negative symptoms such
as apathy, passivity and social withdrawal, as well as interpersonal relationships.
All in all, 60-80% of persons with serious mental illness can be substantially
helped with a well monitored medication regime and an appropriate psychosocial
management and support programme.
It remains essential for persons with serious mental illness to have access to (and
be able to afford) both appropriate medication and a psychosocial programme
that will focus on the person’s living conditions, his/her ability to relate to oth-
ers, and his/her willingness and capacity to work. In all instances the person’s
choices must be sought and taken into account.
There is still a debate as to how much an employer should (or wants to) know
concerning an employee’s psychiatric background. In all modern legislation, dis-
ability cannot be sufficient grounds to refuse employment if otherwise the person
can do the job.
The assurance that there will be a quick and easy access to appropriate medical
and psychological help has been found to influence very positively the willingness
of employers to offer jobs to persons with mental health problems.

In the past, and still today, many persons with psychiatric backgrounds have had
to lie to a potential employer about their illness. Some of the most successful pro-
grammes are those where a mutual trusting and respectful attitude has been
developed so that issues that may arise are easier to address.

Overcoming obstacles linked to prejudice and stigma
Stigma is basically an attitude that aims
at marginalizing and ostracizing some-
one because that person has a mental
health problem. While the stigma can be
quite overt, it tends nowadays to be
more subtle. For instance, a person may
find it very difficult to obtain appropri-
ate lodging or to join a social club. It
may include fears of violent behaviour
on the part of the person with the mental health problems.
While violence attributable to mental illness exists, it is very low when compared
to other forms of violence. The risk of violence is much greater when severe men-
tal illness is associated with alcoholism and drug abuse (64) and when there is a
past history of violent behaviour.
In its most advanced forms, stigma leads to exclusion of the person from several
spheres of social functioning. Stigma may have disastrous consequences when a
person with a mental health problem starts believing that he/she deserves to be
treated in such a way. Stigma can also manifest itself in the “denial” of the per-
son’s competence, ability and potential.
The best way to fight stigma is through appropriate education and information.
This may include a public information campaign, courses, conferences, etc. It is
important to delineate very precisely what component of “general stigma” one
wants to address and to develop a specific plan of action for it.
The mass media often portray persons with mental illness in a most unfavourable
light. It has been shown (65) that nearly half of health journalists have serious
misconceptions concerning mental illness. Codes of ethics should be strength-
ened and rigorously applied to eradicate the altogether frequent “sensationalism”
with which the press treats stories involving persons with “alleged” or “real”
mental health problems. Since the media play a crucial role in filtering informa-
tion that reaches the public, it is obvious that all efforts should be made by men-
tal health professionals to work closely with them and to correct the
misconceptions which they may harbour.
Recently, advocates in the mental health/illness field have made progress with
the mass media, stirring up interest and controversy at both the international and
national levels. In general, there has been more widespread discussion in the press
and on television regarding the situation of this traditionally overlooked disability
group and more in-depth presentations about some of the political and profes-
sional issues in this field.
Today, advocates are more successful at working with the press and on the
Internet to bring mental health/illness issues both into the mainstream of the disability rights movement and to the attention of the public. At the international
level, advocates are combining three themes to attract media coverage: redefining
the bottom line as a universal human rights issue, subjecting residential institu-
tions to worldwide exposure, and building support for community based services
(66). Ultimately, this type of advocacy can ameliorate negative myths and stereo-
types and, in turn, can impact and influence work opportunities for individuals
with mental health problems.
Another important way to fight stigma is to inform the community of “good
practices” and of programmes that work.