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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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Transformation in 20th century l.jpg
TRANSFORMATION IN 20th CENTURY

  • CUCKOO’S NEST

  • PUBLIC MENTAL HOSPITALS CENTRAL

  • LONG INPATIENT STAYS

  • REPRESSIVE SOCIAL CONTROL

  • NO PATIENT RIGHTS

  • VOLUNTARIES

  • INSTITUTIONALISM


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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


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TRANSFORMATION

  • INCREDIBLY SHORT PERIOD - CUCKOO’S NEST IN 1963 (1975); FRUMKIN IN 1978 (1982)

  • WHAT WAS TRANSFORMATION?

  • REASONS FOR TRANSFORMATION.



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I. 1800-1850

  • AROSE IN U.S. ABOUT 1800

  • PREVIOUSLY PEOPLE EXILED OR JAILED; CARED FOR IN FAMILIES

  • MENTAL HOSPITALS INITIALLY HUMANE REFORM


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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


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II. 1850-1960

  • GROWTH OF POPULATION

  • HUGE BUREAUCRACIES

  • FROM TREATMENT TO MANAGEMENT AND CONTROL

  • NO EFFECTIVE TREATMENTS


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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


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SUMMARY AS OF 1955

  • LARGE ISOLATED INSTITUTIONS

  • CUSTODIAL WITH LITTLE TREATMENT

  • LONG STAYS, FEW RELEASES, MANY ELDERLY PATIENTS



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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



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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”)


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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


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CHANGE IN PATIENTS

  • FROM ELDERLY, LONG-TERM, SCHIZ. AND BRAIN DISEASE

  • TO YOUNG, SHORT-TERM, DRUG USERS (MICA)

  • SAME: POOR, MINORITIES, MALES


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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


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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


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PATIENTS

  • PATIENTS IN PUBLIC MENTAL HOSPITALS STILL POOR/ MINORITY

  • NOW YOUNG, DRUG USING, HARD TO HANDLE; NOT OLD, COMPLIANT, AND INSTITUTIONALIZED


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