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"Deinstitutionalization history."
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Deinstitutionalization and the rise of violence
The deinstitutionalization of individuals with serious mental illness was driven by 4 factors: public revelations regarding the state of public mental hospitals, the introduction of antipsychotic medications, the introduction of federal programs to fund patients who had been discharged, and civil libertarian lawyers. The result is approximately 3.2 million individuals with untreated serious mental illness living in the community. Beginning in the 1970s in the United States, there began to be reported increasing incidents of violent behavior, including homicides, committed by these untreated individuals. Such incidents became more numerous in the 1980s and 1990s, and have further increased since the turn of the century. Existing studies suggest that individuals with untreated severe mental illness are responsible for at least 10% of all homicides and approximately half of all mass killings. Studies have also shown that when these individuals are treated, the incidence of violent behavior decreases significantly. Examples of treatment mechanisms that have proven effective include assisted outpatient treatment (AOT), conditional release, and mental health courts.
Journal Article
Creating a Science of Homelessness During the Reagan Era
Context: A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda. Methods: Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness. Findings: Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding \"social research,\" together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services. Conclusions: The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways.
Journal Article
The Final Years of Central State Hospital
There is a rich literature on the deinstitutionalization movement in the US but few, if any, parallel histories of state mental hospitals. Under attack from the 1950s on, state hospitals dwindled in size and importance. Yet, their budgets remained large. This paper offers a case study of one such facility, Indiana’s Central State Hospital, between 1968 and 1994. During these years, local newspapers published multiple stories of patient abuse and neglect. Internal hospital materials also acknowledged problems but offered few solutions. In 1984, the US Department of Justice intervened, charging Central State with having violated patients’ civil rights, the first such action filed under the 1980 Civil Rights of Institutionalized Persons Act. Although Indiana signed a consent decree promising major reform, long-lasting change proved elusive. Civil and criminal lawsuits proliferated. In 1992, as Central State continued to attract negative attention, Indiana Governor Evan Bayh ordered the troubled hospital closed. His decision promised to save the state millions of dollars and won plaudits from many, but not all, mental health advocates. Even as the last patients left in 1994, some families continued to challenge the wisdom of eliminating Indiana’s only large urban mental hospital, but to no effect.
Journal Article
Management of psychiatric patients before deinstitutionalization: an inquiry into the years 1907-1913 in Pisa
Asylums comprises the main focus of historical research on early 20th century psychiatry. To assess the characteristic of asylum transfers in a clinical population, we analyzed newly found clinical records from University of Pisa Clinic for Mental and Nervous Illness.
We focused on the early years of this structure’s activities considering all admissions from 24th April 1907 to 31st January 1913.
We collected demographic and clinical data from 1,068 patients performing Chi-Square Tests to study correlation between asylum transfer and diagnosis and gender difference; independent sample Student’s t-tests were also performed to compare mean Age, mean number of Days of Hospitalization and mean number of Subsequent Admissions to the Clinic observed in patients transferred to an asylum versus those who had been discharged. Multiple logistic regression model was employed to identify the best predictors of asylum transfers.
Most patient were discharged, and only a third of the hospitalization led to asylum confinement. Our data outlines a peculiar discharge rationale, suggesting that the Clinic acted like a “sieve-institution” to prevent asylum overcrowding from treatable, non-chronic conditions.
These data suggest that our historical view of psychiatric care is probably not complete, and that a different approach to source materials could provide new research paradigms.
Journal Article
\Should the staff's attitude towards the patients remain unchanged, I will not guarantee anything.\ Protest masculinity and coping of \rebellious patients\ at the Heidelberg University Psychiatric Hospital on the eve of deinstitutionalization
This article analyses the illness experiences of male patients from the Heidelberg University Psychiatric Hospital during the protests against Psychiatry in the year 1973. Protest is one of the most important expressions of masculinity in socially disadvantaged men, such as men with mental disorders. The analysis of 100 medical records shows that some patients tried to construct themselves as men in a way that was explicitly motivated by antipsychiatric ideas: They questioned psychiatric authority, behaved \"sexually inappropriate\", or used drugs. On the eve of psychiatric reform in West Germany those patients were well aware that the alternative--complying with the treatment--would put them at considerable risk. In addition to the usual inference of hegemonic or normative masculinities as risk-factors, the behavior of those ,,rebellious patients\" has to be interpreted as individual coping strategies.
Journal Article
The Ghosts of Institutionalization at Pennhurst's Haunted Asylum
In the woods of Spring City, Pennsylvania, lies Pennhurst, a school for people with developmental and physical disabilities from 1908 to 1987. Like many institutions, Pennhurst eventually became a place of abuse and neglect. Pennhurst was finally shut down, and the residents were relocated into group homes. Two years ago, a group well educated about Pennhurst's past formed the Pennhurst Memorial and Preservation Alliance, a nonprofit dedicated to making Pennhurst into a national museum. Standing in the way of PM&PA's vision was a businessman named Richard Chakejian, who purchased Pennhurst from the state for $2 million and has now converted it to a haunted house. The result is a bizarre hybrid of history and legend, and of criminality and commercialism, that simultaneously evokes and erases Pennhurst's troubled past.
Journal Article
Community Mental Health Nursing in Alberta, Canada: An Oral History
Community mental health nurses had a central role in the construction of new rehabilitative practices and community mental health services in the 1960s and 1970s. The purpose of this article is, first, to explore how nurses understood and created their new role and identity in the turbulent context of deinstitutionalization. The development of after care services for patients discharged from Alberta Hospital in Ponoka (AH-Ponoka), a large mental institution in Calgary, in the Canadian province of Alberta, will be used as a case study. I specifically focus on the establishment of outpatient services in a new psychiatric department at Foothills General Hospital in Calgary. Second, I examine how deinstitutionalization itself shaped community mental health nurses' work. Oral history interviews with nurses and other mental health professionals, who had a central role in this transformation process, provide a unique lens through which to explore this social change. The article concludes that new rehabilitative, community-based mental health services can better be understood as a transformation of former institutional practices rather than as a definite break with them.
Journal Article
Freeing the Insane
In fact, however, Pinel unchained the female patients at Paris's Salpêtrière hospital in 1800.2 He did not entirely abandon physical restraints, but when necessary, he confined the more agitated and potentially dangerous patients to the gentler control of the recently popularized straitjacket This was part of a widespread asylum reform movement that began during the late 18th century and continued well into the 19th.3 Lay asylum superintendents and early medical \"alienists\" (psychiatrists) in Italy, England, France, and the United States contributed to humanizing the treatment of the insane by making confinement less brutal and treatment more gentle and interactive.
Journal Article