The State of Mental Health in America

The history of mental illness in the United States illustrates how our understanding of mental illness and trends in treating mental health influence both our attitude toward mentally illness and national policy policy governing mental healthcare.

For centuries many cultures viewed serious mental illnesses as a religious problem, religious punishment, or even demonic possession. Hippocrates was an early pioneer in treating mental illness in the 5th century B.C. Rather than pointing to religious and paranormal causes, Hippocrates directed his attention toward changing the patient's environment or occupation and administering oral treatments as medication. Despite his work, the belief that the mentally ill were demonically possessed continued into the 18th century in the U.S. The belief surrounding possession and mental illness led to unhygienic and degrading confinement of people with serious mental illnesses until the early 19th century.

The work of activist/lobbyist, Dorothea Dix was instrumental in improving the conditions and care of those suffering from mental illnesses by arguing for the institutional inpatient care model. After a 40 year fight, the U.S. Government was persuaded to fund the building of 32 state psychiatric hospitals. The institutional inpatient care model allowed patients to live in hospitals and receive treatment rendered by professional staff. Institutionalized care also increased access to mental health care and was welcomed by families and communities who struggled to provide care for family members who were mentally ill.

The rise and growth of asylums and mental health hospitals in the United States was slow because the burden of costs was deferred to state governments, who were leery of accepting the financial responsibility. Despite the financial burden, hospitals proliferated and continued to grow. By 1915, New York’s inpatient population had grown to 33,124 and by 1930, it was 47,775; an astounding growth rate of 977 patients per year over a 15-year period. However, the rapid growth was not met with increased funding. Eventually, the state hospitals became under-funded and under-staffed; giving way to worsening living conditions and human rights violations.

In the mid 19th century, the advent of a variety of psychotropic medications gave rise to the international trend toward deinstitutionalization and a move toward community-oriented care, based on the belief that psychiatric patients would have a higher quality of life if treated in their communities rather than in “large, undifferentiated, and isolated mental hospitals” (Novella et. al, 2010). In the United States, the closure of state psychiatric hospitals was codified by the establishment of the Community Mental Health Centers Act of 1963 which stated that only persons who posed imminent danger to themselves or someone else could be committed to psychiatric hospitals.

While well intentioned, the major shift in deinstitutionalization that occurred in the late 1960s left the most seriously mentally ill patients without needed treatments and families without the resources needed to care for them (Mental Illness Policy.org, n.d.). Deinstitutionalization along with cost-shifting by the states to the federal government, after the advent of Medicare and Medicaid, has led to one of the most significant problems defining today’s health crisis, the criminalization of Americans with the severest brain diseases. Mental illness is the underlying root cause of criminality; substance abuse disorder; and loss of life, both intentional and unintentional. Incarceration in state penitentiaries have become the surrogate for mental healthcare in America.