Per 100,000 population
Some mentally ill persons were housed in almshouses and private asylums, but many ended up in prisons and jails.
Dorothea Dix and other reformers actively crusade for housing and more humane treatment of the mentally ill. Her efforts lead to the establishment of 110 psychiatric hospitals by 1880.
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With a growing population comes a recognition of the national scope of mental illness. State hospitals and a smaller number of private facilities such as sanitariums are constructed to treat it.
In his best seller A Mind That Found Itself, Clifford Beers recounts his mistreatment in both private and state mental institutions. Beers sparks the “mental hygiene” reform movement.
The U.S. Census Bureau issues a report on the increase in the number of patients in institutions for mental diseases, which is nearly three times higher than the rate reported 43 years earlier.
The Granger Collection, NYC
The concept of a national psychiatric institute is introduced. World War II reveals the tremendous toll of mental illness, with more men receiving medical discharges from the armed forces for neuropsychiatric disorders than for any other reason.
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Chlorpromazine is developed as the first antipsychotic drug, now described as the single greatest advance in psychiatric care. For the first time, a drug could control the symptoms of schizophrenia and allow some institutionalized patients to be discharged.
The Community Mental Health Act, a major initiative by President John F. Kennedy, begins a new national program to fund construction of community mental health centers as an incentive to deinstitutionalize patients.
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The FDA approves the use of lithium as an antimanic and Dr Julius Axelrod, Ph.D., of the NIMH is awarded the Nobel Prize for his research into brain chemistry that lays the groundwork for later development of selective serotonin reuptake inhibitors (SSRIs), such as Prozac.
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The Omnibus Reconciliation Act of 1981 radically diminishes the federal government’s role in providing services to the mentally ill by favoring block grants to states instead. Federal mental health spending decreases by 30%.
Capacity for the mentally ill in U.S. hospitals continues to decline. Most private facilities refuse to admit patients who have no insurance, even if beds are available.
A slow economy forces states to cut approximately $4.35 billion in public mental health spending, the largest combined reduction since deinstitutionalization. This trend will likely continue for several years, according to the National Association of State Mental Health Program Directors.
Solutions for the Shortfall
The North Carolina state legislature is funding a statewide telepsychiatry program, linking rural ERs to five larger hospital “hubs,” where psychiatrists provide 24/7 evaluations via videoconferencing.
Mental Health Courts
The Michigan state legislature is spending $5.8 million to expand its system of 16 mental health courts. Here, nonviolent mentally ill offenders are sentenced to probation that includes treatment coordinated with community mental health departments.
The state of Virginia launched an online statewide psychiatric bed registry in March. It lists real-time psychiatric bed availability, with required participation from private and public hospitals. Similar tracking databases are in place in roughly half of the states, though some only track beds in public hospitals.
Assisted Outpatient Treatment (AOT)
Outpatient programs are in use by 45 states. A court- ordered treatment plan is created by an evaluating psychiatrist, and patients receive case management, medication management, and individual or group therapy. Congress will fund 200 AOT start-up grants over the next four years, for a total of $60 million.