Treatment of Psychological Disorders

Institutional Treatment

The discovery of antipsychotics along with the rise of the community mental health movement led to deinstitutionalization of mental patients, which has had mixed results.

Until the reform movements of the 1800s, people with mental illness had few rights. They were often held indefinitely in asylums or poorhouses, where they suffered in brutal conditions. Dorothea Dix, an American reformer, helped spearhead a national network of state-funded hospitals. These hospitals, built in the 1840s, were intended to provide humane treatment in a rural environment. Unfortunately, these hospitals became overcrowded and underfunded. Patients continued to endure inhumane treatment far from their families and communities.

The care of individuals with mental illness did not change significantly until the 1950s following the discovery of effective antipsychotic medications. Antipsychotic medication can reduce symptoms of schizophrenia, such as delusions and hallucinations. This allowed people with schizophrenia to cope better outside a controlled environment. People previously considered permanently disabled were able to stay safe and regain independence.

This change in treatment options sparked the rise of the community mental health movement in the 1960s. This movement emphasized locally based care so the mentally ill could lead more independent lives. These developments led to massive deinstitutionalization, the release of long-term patients with mental illness back into the community. In 1955 there were about 558,000 patients living in mental hospitals. Adjusting for population growth, that would translate to about 750,000 people in 2018. However, as of 2014, there are only about 170,000 people in 24-hour residential treatment facilities on any given night.

This significant decrease in the number of inpatients was not met with a corresponding increase in outpatient facilities. Plans to pair deinstitutionalization with funding for large numbers of community mental health centers did not materialize. Many people with serious mental illness have great difficulty finding access to care. As a result deinstitutionalization has led to an increase in incarceration and homelessness for people with mental illness. According to the Center for Prisoner Health and Human Rights, the percentage of people with serious mental health problems in prisons rose from 0.7% in 1880 to 21% in 2005. The Treatment Advocacy Center reports that a third of people without stable housing have serious, untreated mental illnesses, such as schizophrenia, schizoaffective disorder, bipolar disorder, and major depression. Many other people living on the streets have untreated substance abuse problems.

Institutionalization

Since the 1950s a decline in use of inpatient mental health hospitals has been balanced by an increase in the prison population. In 2012 there were about 35,000 people with mental illness living in state mental hospitals. In contrast there were over 350,000 people with mental illness held in jails or prisons that year.