1 / 21

Evolution of Mental Healthcare: 1955-2000

Explore the causes of changes in inpatient mental healthcare from 1955 to 2000, driven by drugs, ideology, legal reforms, and economic factors, including developments in drug treatments, ideological shifts towards community care, legal adjustments in commitment and release processes, and economic influences on funding and treatment locations.

tiana
Download Presentation

Evolution of Mental Healthcare: 1955-2000

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CAUSES OF DI

  2. INPATIENT 1955-2000

  3. CAUSES OF DI • 1. DRUGS • 2. IDEOLOGICAL CHANGES • 3. LEGAL CHANGES • 4. ECONOMIC CHANGES

  4. I. DRUG TREATMENT • ANTI-PSYCHOTICS THORAZINE AND LITHIUM IN MID-1950’S • IMMEDIATE SUCCESS • DON’T CURE BUT CONTROL • EASY TO ADMINISTER • NEW HOPE AND OPTIMISM • BUT MAJOR CHANGES 1970 -

  5. II. IDEOLOGY • 1. ANTI-MENTAL HOSPITALS - E.G. CUCKOO’S NEST • 2. PRO-COMMUNITY TREATMENT - 1960’S • LIBERAL PHILOSOPHY OF GOVERNMENT • STRONG FEDERAL ROLE – BYPASS STATE MENTAL HOSPITALS

  6. CMHC • BUILD LARGE NETWORK OF OUTPATIENT COMMUNITY MENTAL HEALTH CENTERS (CMHC) • SERVED DIFFERENT POPULATION THAN STATE MENTAL HOSPITALS - LESS SERIOUS, EASIER TO TREAT

  7. CMHC • NOT INTEGRATED WITH STATE HOSPITALS - FEW PROGRAMS FOR S.M.I. • CREATED GREAT GAP IN CARE – HOW FILL OLD ROLE OF STATE HOSPITAL?

  8. III. LEGAL • JUDICIAL AND LEGISLATIVE CHANGES • 3 ASPECTS - COMMITMENT TO HOSPITAL, CONDITIONS IN HOSPITAL, RELEASE TO COMMUNITY • MOVE FROM MEDICAL TO LEGAL MODEL

  9. PRIMACY OF HEALTH PATERNALISM BETTER SAFE THAN SORRY PRIMACY OF LIBERTY ADVERSARIAL NO TREATMENT UNLESS NECESSARY MEDICAL AND LEGAL

  10. 1. COMMITMENT • UP TO 1970 PRIMACY OF MEDICAL MODEL • ANYONE CAN BRING PETITION ASSERTING MENTAL ILLNESS • M.D. MUST SIGN • ROUTINE EXAM BY COURT PSYCH. • BRIEF HEARING

  11. 1970-2003 • EXPANSION OF LEGAL MODEL FOR COMMITMENT • HAD BEEN “MENTAL ILLNESS” • NOW - DANGER TO SELF OR OTHERS • SOMETIMES GRAVELY DISABLED • SPECIFIC AND OVERT ACTIONS • PROCEDURAL PROTECTIONS

  12. COMMITMENT • EMERGENCY COMMITMENTS FOR BRIEF PERIODS - 2 WKS OR MONTH • LEAST RESTRICTIVE ALTERNATIVE • AFTER THAT UP TO STATE TO PROVE NEED FOR COMMITMENT

  13. 2. WITHIN HOSPITAL • MANDATED STANDARDS OF CARE WITHIN HOSPITAL – TREATMENT, STAFF RATIO, LIVING CONDITIONS • RESTRICTIONS ON SOCIAL CONTROL FRUMKIN • HITS PT., BLINDS ATTENDANT GETS 2 HOURS OF SECLUSION

  14. 3. RELEASE FROM HOSPITAL • BURDEN OF PROOF ON STATE FOR WHY SHOULD KEEP IN HOSPITAL • HEARINGS AT REGULAR PERIODS – EVERY SIX MONTHS OR SO

  15. COMPARE CUCKOO’S NEST • MORE TRUE PRE-1970’S THAN NOW • NOW MORE LEGAL THAN MEDICAL • “VOLUNTARIES” WOULDN’T BE THERE – PRIVATE OR OUTPATIENT • HEARING WHERE STATE MUST JUSTIFY KEEPING IN HOSPITAL • PROBLEM NOW IS LACK OF INPATIENT FACILITIES

  16. REASONS FOR LEGAL CHANGES • CIVIL RIGHTS MOVEMENT • ECONOMIC PRESSURE TO REDUCE HOSPITAL POPULATIONS

  17. IV. ECONOMIC • STATE HOSPITALS VERY EXPENSIVE • DI CLAIMED TO SAVE MONEY • IN FACT, SHIFTS ECONOMIC BURDEN FROM STATES TO FEDERAL GOV. • FEDERAL WON’T PAY INPATIENT TREATMENT IN SMH BUT WILL FOR TREATMENT OUTSIDE HOSPITALS

  18. FUNDING FOR TREATMENT • MEDICAID – POOR; FEDERAL/STATE • MEDICARE - ELDERLY; FEDERAL PROGRAM • BOTH GO TO PROGRAMS NOT TO INDIVIDUALS • NEITHER PAYS FOR TREATMENT IN MENTAL HOSPITALS

  19. SSI • SUPPLEMENTAL SECURITY INCOME • FEDERAL PROGRAM • TO INDIVIDUALS FOR LIVING EXPENSES • NEED DISABILITY, LOSS OF FUNCTION, DURATION

  20. SSI • NOW MAJOR FUNDING FOR SERIOUSLY MENTALLY ILL • ABOUT $600/MONTH • GOOD – PROVIDES SUPPORT • BAD – FOSTERS DEPENDENCY AND DISINCENTIVE TO WORK

  21. RESULTS OF ECONOMIC CHANGES • NO FEDERAL FUNDING FOR STATE HOSPITAL TREATMENT • MORE TREATMENT IN GENERAL HOSPITALS • MORE TREATMENT OF ELDERLY IN NURSING HOMES

More Related