We Didn't Know Any BetterLists about the pre-historic, ancient, medieval, olden, and not-that-long-ago days of medicine, when doctors made bizarre assumptions and prescribed totally insane treatments that made sense at the time...
From the 1850s to the 1980s, large state-run psychiatric facilities housed most of America's citizens with mental illness. This practice began to change in the 1960s, when legislation dismantled the state-run asylum system, replacing it with a community-based care policy that ultimately failed as well.
Support for closing asylums and transitioning to community-based care facilities or outpatient treatment centers began to grow in the 1950s. By then, the public was aware of the issues with asylums: they were frequently overcrowded, and many patients experienced deplorable conditions. At the same time, several new psychiatric drugs became available. Doctors were able to sell politicians on the idea that these drugs would make it possible for previously institutionalized patients to live in the community. The research that led to deinstitutionalization began in the 1950s, but it wasn't until the 1960s that the federal and state governments passed laws which closed asylums en masse.
The asylums were far from perfect - there were many cases of systemic mistreatment. One of the most horrifying examples was the Willowbrook State School in New York. Some institutions also practiced eugenics and sterilized patients. However, the facilities kept many people with mental illness off the streets, out of jail and in relatively safe housing with access to treatment.
The consequences of deinstitutionalization were not immediate. Many politicians were eager to save money by placing the responsibility of care onto communities and the federal government instead of the states.
Systemic Patient Abuse Was Partly Why The Public Wanted Asylums Closed
In the middle of the 20th century, people across the United States called for the closure of mental asylums. Stories of horrific abuse emerged from asylums nationwide, from the infamous Willowbrook State School in New York to the Topeka Insane Asylum in Kansas.
Patients at certain asylums endured various forms of torture, including extended confinement and waterboarding, which was considered a "cure" at the time. Asylum administrators also often denied adequate food and clothing to their patients, and many facilities were understaffed. Though not every asylum mistreated patients, tragic stories upset the public, causing progressive groups to rail against the facilities.
When mental institutions closed, many patients were unable to find work to support themselves and became homeless. Mental illness also frequently coincides with substance dependency, such as addictions to drugs, alcohol or both. When patients were no longer looked after by a staff of nurses and doctors at a mental institution, they often turned to drugs and alcohol to self-medicate, which only worsened the effects of their mental illnesses and made it even more difficult to find a stable income and lifestyle.
The problem, unfortunately, has not gotten much better. Today, about 20-25% of the homeless population suffers from a severe mental illness, and mental illness is the third largest cause of homelessness for single adults.
Some Individuals With Destructive Or Criminal Tendencies Landed In Prison
When large mental asylums were still in use, the population of prisoners with mental illness was only about 1% in 1880. Once institutions began closing in the 1960s, the number started rising significantly.
By the 1980s, around 10% of the imprisoned population suffered from severe mental illness. In 2012, New York Daily News dubbed the Los Angeles County Jail "the largest de facto psychiatric inpatient facility in the US," with New York City's Rikers Island coming in second.
The issue is that, for individuals with severe mental illness, prison is not the right solution. Placing them there puts an undue burden on law enforcement, who are not trained to handle patients with mental illness.
The Rights of Severely Mentally Ill Individuals May Be Infringed Upon
Though the majority of people with mental illness are nonviolent, some incidents led to legislation requiring they get treatment. In 1999, a man named Andrew Goldstein pushed Kendra Webdale in front of a New York City subway train, killing her. He had failed to take his medication for diagnosed schizophrenia.
After the incident, Kendra's Law went into effect, which, according to New York Daily News, "gave courts the power to compel the mentally ill to accept treatment as a condition of living in society." The law lets judges order the mental health system to treat those with severe mental illness - this potentially gives people access to mental health treatments.
However, groups like the American Civil Liberties Union oppose Kendra's Law and similar laws because this law "unconstitutionally expands the circumstance under which the State may compel persons with neurobiological disorders to undergo treatment against his or her will."
The Federal Government Failed To Enforce Mental Health Legislation After Kennedy's Assassination
In 1963, John F. Kennedy signed the Community Mental Health Act. It essentially shifted the responsibility of caring for people with mental illness from the states to the federal government, which began to rely on community centers for patient care. The intention was to allow patients to remain at home and continue participating in society with community-based care, rather than via large institutions.
It was an idealistic plan requiring a lot of follow-through by the federal government. Kennedy's assassination occurred less than a month after he signed the bill. The community programs never received stable funding, and people widely deemed the legislation a failure.
In the 1950s and '60s, psychiatrists pushed community care for people with mental illness. Many psychiatrists realized moving away from or reforming the existing systems could prove too difficult, so a community-based option seemed practical.
Decades later, those who composed the legislation readily admitted the plan had numerous flaws. According to Dr. John A. Talbott, president of the American Psychiatric Association:
The psychiatrists involved in the policymaking at that time certainly oversold community treatment, and our credibility today is probably damaged because of it.
The legislation ordered the opening of community-run mental health centers, but psychiatrists recognized the lack of local resources to assume this responsibility, especially when state hospitals discharged patients quickly and unexpectedly. However, despite a lack of faith in the program, officials passed the Community Mental Health Act in 1963.
