The Mental Health Movement

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
Bryces 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 1946study 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)

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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