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MENTAL HOSPITALS

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us public inpatient 1830-1955 - PowerPoint PPT Presentation


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MENTAL HOSPITALS. US PUBLIC INPATIENT 1830-1955. PUBLIC INPATIENT 1955-2000. TRANSFORMATION IN 20th CENTURY. CUCKOO’S NEST PUBLIC MENTAL HOSPITALS CENTRAL LONG INPATIENT STAYS REPRESSIVE SOCIAL CONTROL NO PATIENT RIGHTS VOLUNTARIES INSTITUTIONALISM. NO PLACE ON EARTH FOR ME.

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Presentation Transcript
transformation in 20th century
TRANSFORMATION IN 20th CENTURY
  • CUCKOO’S NEST
  • PUBLIC MENTAL HOSPITALS CENTRAL
  • LONG INPATIENT STAYS
  • REPRESSIVE SOCIAL CONTROL
  • NO PATIENT RIGHTS
  • VOLUNTARIES
  • INSTITUTIONALISM
no place on earth for me
NO PLACE ON EARTH FOR ME
  • SYLVIA FRUMKIN
  • SHORT HOSPITAL STAYS
  • LONG STAYS IN COMMUNITY
  • MUCH LESS SOCIAL CONTROL
  • MORE PATIENT RIGHTS
  • HARD TO ENTER VOLUNTARILY
  • ANTI-INSTITUTIONALISM
transformation
TRANSFORMATION
  • INCREDIBLY SHORT PERIOD - CUCKOO’S NEST IN 1963 (1975); FRUMKIN IN 1978 (1982)
  • WHAT WAS TRANSFORMATION?
  • REASONS FOR TRANSFORMATION.
i 1800 1850
I. 1800-1850
  • AROSE IN U.S. ABOUT 1800
  • PREVIOUSLY PEOPLE EXILED OR JAILED; CARED FOR IN FAMILIES
  • MENTAL HOSPITALS INITIALLY HUMANE REFORM
enlightenment philosophy
ENLIGHTENMENT PHILOSOPHY
  • REMOVE PEOPLE FROM STRESSFUL ENVIRONMENT
  • COUNTRY SETTINGS - ISOLATED FROM FAMILIES AND COMMUNITIES
  • PROVIDE MORAL TREATMENT IN CALM AND RESTFUL ENVIRONMENT
  • MAINLY MIDDLE AND UPPER CLASS CLIENTS
ii 1850 1960
II. 1850-1960
  • GROWTH OF POPULATION
  • HUGE BUREAUCRACIES
  • FROM TREATMENT TO MANAGEMENT AND CONTROL
  • NO EFFECTIVE TREATMENTS
patients 1850 1960
PATIENTS 1850-1960
  • LOWER SES, IMMIGRANT, ELDERLY
  • LONG STAYS, HIGH DEATH RATES
  • CHRONIC CONDITIONS - SCHIZ., SYPHILUS, ALCOHOLISM
  • INSTITUTIONALISM: APATHY, ADJUST, DON’T WANT TO LEAVE
summary as of 1955
SUMMARY AS OF 1955
  • LARGE ISOLATED INSTITUTIONS
  • CUSTODIAL WITH LITTLE TREATMENT
  • LONG STAYS, FEW RELEASES, MANY ELDERLY PATIENTS
iii di 1955 present
III. DI (1955 - PRESENT)
  • REMOVE PATIENTS FROM HOSPITAL, ADMIT FEWER PATIENTS, USE OF COMMUNITY TREATMENT
  • BEGINS IN 1955 - REVERSAL OF 150 YEAR OLD TREND
  • HIGHLY CONTROVERSIAL - CRIME, HOMELESSNESS, NEGLECT
residents of public mental hospitals
RESIDENTS OF PUBLIC MENTAL HOSPITALS
  • DRASTIC DECLINE IN RESIDENTS, 1955-2000 (“OPENING BACK DOOR”)
  • 1955 - 560,000; 1970 - 450,000; 1980 - 140,000; 1990 - 100,000; 2000 - 90,000
  • INCREASE IN ADMISSIONS 1955-1970, DECREASE SINCE THEN (“CLOSING FRONT DOOR”)
public mental hospitals now
PUBLIC MENTAL HOSPITALS NOW
  • NO LONGER THE MAJOR PART OF SYSTEM
  • PLACE OF LAST RESORT - VIOLENT, DIFFICULT TO TREAT (FRUMKINS) OR NOWHERE ELSE TO GO
  • STILL 2/3 OF STATE EXPENSE
  • FIXED COSTS, UNIONS, COMMUNITIES
change in patients
CHANGE IN PATIENTS
  • FROM ELDERLY, LONG-TERM, SCHIZ. AND BRAIN DISEASE
  • TO YOUNG, SHORT-TERM, DRUG USERS (MICA)
  • SAME: POOR, MINORITIES, MALES
inpatient treatment now
INPATIENT TREATMENT NOW
  • MOST IN GENERAL HOSPITALS
  • GROWTH OF PRIVATE, SPECIALIZED HOSPITALS
  • SHORT STAYS – 1 TO 2 WEEKS OR AS LONG AS HAVE INSURANCE FOR
  • WHITE, FEMALE, DEPRESSION, ALCOHOL
  • ELDERLY NOW IN NURSING HOMES
summary of changes
SUMMARY OF CHANGES
  • DRASTIC DECLINE IN NATURE AND CENTRALITY OF PUBLIC MENTAL HOSPITALS
  • NOT LONG STAYS BUT SHORT STAYS WITH LONG SPELLS IN COMMUNITY
  • MOST INPATIENT TREATMENT IN GENERAL OR PRIVATE HOSPITALS
  • RISE OF NURSING HOMES
patients
PATIENTS
  • PATIENTS IN PUBLIC MENTAL HOSPITALS STILL POOR/ MINORITY
  • NOW YOUNG, DRUG USING, HARD TO HANDLE; NOT OLD, COMPLIANT, AND INSTITUTIONALIZED
ad