Author: Sarah

An Early Response to Mental Illness

The United States has been struggling since its founding to care for its mentally ill. The earliest response to mental illness were to chain inmates to damp underground cells where they were hidden from the public.

Often families were responsible for finding their own solution and would lock their loved ones in a room in their house where they received absolutely no treatment whatsoever.

When the public learned about how many sick people were being mistreated, they were shocked and outraged. Those in charge of their care were limited in their means and ignorant to illness. The government needed to step in and take responsibility.

As we began to see the sick as patients instead of inmates, they were removed from attics, jails, almshouses, etc. and admitted to small hospitals that became overcrowded faster than expected. Professionals drafted treatment plans instead of punishments, and newer, better, bigger institutions designed specifically for the housing and treatment of the mentally ill were constructed.

Given Credit for Trying

By the early twentieth century, although legislation had made some positive changes, terrifying treatments such as lobotomies, sterilization, electro-shock therapy (without the use of a sedative), and tooth extraction (without the use of a sedative) were unnecessarily performed. Fact: Trenton State Hospital’s Superintendent, Dr. Cotton, pulled almost all of his patient’s teeth because cavities were believed to be the cause of their psychosis. Let’s just say, cavities weren’t the only infection unnecessarily removed and most of the patients died after their operation. (This article will tell you all you need to know).

Oddly enough, one of the very first patients this procedure was tried on, was made completely sane after the removal of her front teeth; even though she murdered her own child.

Esther Miller Blake, a Philadelphia real estate operator, was sent to the State Hospital at Trenton after she threw her son, Buddy, from the Ventnor pier. With the removal of her teeth and an injection of a “special serum,” (possibly the antistreptococcous serum) she was healthy enough to go back into society. The newspaper reads that the unknown physicians were “confident a permanent cure would be effected.” The unknown physicians were probably none other than Dr. Cotton and his colleagues.

If you can’t tell, there’s some subtext of criticism and mockery. I mean, come on – how can a woman who commits a crime so horrendous, suddenly become sane over night with the removal of a few bad teeth? It’s not possible. Of course, we know this now. But, back in the 1920s, even though absolutely no scientific data was extracted from these procedures, they made it seem like it was a cure to insanity and forced it upon maybe of their patients with great praise from the public. Similarly, the lobotomy emerged like this and was given the same praise and push.

By the time psychiatric medication was discovered (chlorpromazine), a noticeable change in the demeanor of patients was seen. Pharmaceuticals were on the rise and barbaric treatments lessened. (a timeline of psychiatric medication). But there was a stigma to mental illness that never went away, and the large institutions were once again overcrowded, under-funded and poorly staffed.

Terrible Conditions Re-emerge

Most of the patients never communicated with their families and were treated terribly by the staff. Patients were neglected, abused, experimented upon, etc. The hospitals once built to resolve the over-population were once again heavily populated and under-staffed. No one knew how to properly care for this many people, let alone one single person. The staff was usually poorly trained, underpaid, and overworked. Patients would sit naked in their own filth, were strapped to beds and chairs, and/or walked in circles with nothing to occupy themselves with. Roland Johnson, a former patient at Pennhurst State School and Hospital, was forced to do the work of the staff because he was able-bodied, and they were short staffed. He also claimed that at night, he would be sexually abused. “They did awful things to me,” he said. Johnson eventually discovered that he was HIV positive (Rifkin, 2020).

There’s always more to learn, but the following is a basic timeline of major events that impacted the evolution of mental health care in the United States.

18th Century

• 1713 – The Friends Almshouse was constructed in Philadelphia.
• 1732 – The Philadelphia Almshouse was constructed. This would later be known as the Philadelphia General Hospital.
• 1751 – The Pennsylvania Hospital in Philadelphia was constructed. They admitted a small population of patients with mental illness, but this population was greater than most hospitals and almshouses.
• 1767 – The Philadelphia Bettering House was constructed.
• 1773 – The first patient is admitted to the Public Hospital for Persons of Insane and Disordered Minds in Williamsburg, Virginia.

19th Century

• 1827 – Louis Dwight, a congregationalist minister in Massachusetts, was shocked by the conditions of mentally ill prisoners when he began taking bibles to prisoners in jails.
• 1827 – the state investigated and said the confinement of mentally ill persons in jails in to be made illegal and to transfer current inmates to hospitals.
• 1835 – The patients from the Philadelphia Almshouse were moved to the Blockley neighborhood of Philadelphia where a four-building “hospital” was built. One of those buildings was an insane asylum. It was later named Philadelphia Almshouse and Hospital, then just simply known as Blockley. In 1919, it was renamed the Philadelphia General Hospital.
• 1841 to 1842 – Dorothea Dix visited every jail in Massachusetts and documented the mistreatment of mentally ill prisoners. She presented her findings to the state legislature.
• 1847 – Dorothea Dix had visited 300 county jails and 18 state prisoners. Her efforts are why we began building State Hospitals.
• 1850 – There was 1 psychiatric bed available for every 5,000 people.
• 1864 – The female building at Blockley burns down.
• 1880 – Less than 1% of mentally ill persons were incarcerated.
• 1887 – On assignment for New York World, Nellie Bly feigns lunacy in order to be admitted to the Women’s Lunatic Asylum on New York’s Blackwell’s Island. Her exposé, “Ten Days in a Mad-house,” detailing the appalling living conditions at the asylum, leads to a grand jury investigation and needed reforms at the institution.

20th Century

• 1907 – Indiana is the first of more than 30 states to enact a compulsory sterilization law, allowing the state to “prevent procreation of confirmed criminals, idiots, imbeciles and rapists.” By 1940, 18,552 mentally ill people are surgically sterilized.
• 1936 – Dr. Walter Freeman and his colleague James Watt perform the first prefrontal lobotomy. By the late 1950s, an estimated 50,000 lobotomies are performed in the United States.
• 1938 – Italian neurologist Ugo Cerletti introduces electroshock therapy as a treatment for people with schizophrenia and other chronic mental illnesses.
• 1939 – Lionel Penrose called the relationship between jails and hospitals the “balloon theory” – push in on one side and the other side bulges out.
• 1942 – George Elder was taken to Byberry for hitchhiking and an expired draft card. He was released 26 years later and 5 months later, he checked himself back into Byberry because he felt he was too institutionalized to cope with the world.
• 1946 – President Harry Truman signs the National Mental Health Act, calling for the establishment of the National Institute of Mental Health to conduct research into neuropsychiatric problems.
• 1947 – Joseph P. Kennedy Jr. Foundation.
• 1950 – State and county mental hospitals housed approximately 48,000 people with developmental disabilities.
• 1954 – Marketed as Thorazine by Smith-Kline and French, chlorpromazine is the first antipsychotic drug approved by the Food and Drug Administration. It quickly becomes a staple in asylums.
• 1955 – There are 560,000 people in state hospitals.
• mid 1950s – Governor Goodwin Knight began the emptying of State Hospitals.
• 1957 – Eunice Kennedy Shriver directs the foundation.
• 1958 – The Special Olympics was founded.
• 1960 – Governor Edmund “Pat” Brown continued the emptying of State Hospitals.
• 1962 – JFK establishes the National Institute of Child Health and Human Development to research intellectual disabilities
• 1962 – The decision of the United States Department of Health, Education, and Welfare (DHEW) made financial aid available to former state hospital patients under the Aid to the Permanently and Totally Disabled program, which is now known as a Social Security Income under the Social Security Act. It was intended to support patients in community settings and offered a stimulus to private business owners who offered room and board to the mentally ill.
• 1963 – President John F. Kennedy signs the Community Mental Health Act to provide federal funding for the construction of community-based preventive care and treatment facilities. Between the Vietnam War and an economic crisis, the program was never adequately funded.
• 1965 – With the passage of Medicaid, states are incentivized to move patients out of state mental hospitals and into nursing homes and general hospitals because the program excludes coverage for people in “institutions for mental diseases.” Nursing homes were less expensive, and they often underreported psychiatric conditions.
• 1967 – The California Legislature passes the Lanterman-Petris-Short Act, which makes involuntary hospitalization of mentally ill people vastly more difficult. One year after the law goes into effect, the number of mentally ill people in the criminal-justice system doubles.
• 1970 – It had become evident that deinstitutionalization resulted in an increase in the number of mentally ill in jails and prisons.
• 1972 – Marc F. Abramson, a jail Psychiatrist from San Mateo County, California, published a study reporting a 36% increase in mentally ill prisoners in county jails and a 100% increase in mentally ill persons judged incompetent to stand trial.
• 1972 – Marc F. Abramson published The Criminalization of Mentally Disordered Behavior: Possible Side-Effects of a New Mental Health Law.
• people with serious mental illnesses being criminalized.
• 1973 – San Joaquin county Sheriff said, “a good deal of mental illness is now being interpreted as criminality.”
• 1975 – The Education for All Handicapped Children Act (EAHCA) allocates federal money to states for the education of children with disabilities in the “least restrictive environment,” and preferably integrated into a public school. The act is renamed the Individuals with Disabilities Education Act (IDEA) in 1990.
• 1977 – There are 650 community health facilities serving 1.9 million mentally ill patients a year.
• 1980 – President Jimmy Carter signs the Mental Health Systems Act, which aims to restructure the community mental-health-center program and improve services for people with chronic mental illness.
• 1980 – Gary Whitmer, a San Franciscan social worker, published a study of “500 defendants in need of psychiatric treatment.”
• 1980 – a Philadelphia newspaper headline read, “Keeping the Maniacs off the Streets.” It told the story of James Jimbo Willis, whose story fueled anxiety about mental illness, especially at a time when crime was the city’s number one priority.
• 1981 – Under President Ronald Reagan, the Omnibus Budget Reconciliation Act repeals Carter’s community health legislation and establishes block grants for the states, ending the federal government’s role in providing services to the mentally ill. Federal mental-health spending decreases by 30 percent.
• 1982 to 1983 – Dr. Richard Lamb and his colleagues published 2 studies of mentally ill inmates in the Los Angeles county jail and cited multiple other studies indicating that the problem of mentally ill patients in jails and prisons was getting worse.
• 1983 to 1984 – Dr. Linda Teplin from Chicago’s Cook County Jail cited that 6.4% of her the inmates had a mental illness.
• 1984 – An Ohio-based study finds that up to 30 percent of homeless people are thought to suffer from serious mental illness.
• 1985 – Federal funding drops to 11 percent of community mental-health agency budgets.
• 1989 – The number of persons with development disabilities living in state hospitals declined by 97% to only 1,605 persons.
• 1990 – Clozapine, the first “atypical” antipsychotic drug to be developed, is approved by the FDA as a treatment for schizophrenia.
• 1992 – Based on a jail survey sent to 3,353 institutions in the United States, the average number of mentally ill was 7.2% (based on usable data from 1.391 replies).
• 1994 – There are 71,619 mentally ill patients.
• 1996 – the United States has spent more on corrections than it did on social welfare programs like food stamps and welfare grants.
• 1998 – the United States Department of Justice issued a study reporting 16.3% of inmates in jails are mentally ill and 16.2% in state prisons.

21st Century

• 2000 – the American Psychiatric Association estimated that roughly 20% of prisoners were mentally ill.
• 2002 – the National Commission on Correctional Health Care said 17.5% of inmates in state prisoners were severely mentally ill and are placed in isolation.
• 2004 – Studies suggest approximately 16 percent of prison and jail inmates are seriously mentally ill, roughly 320,000 people. This year, there are about 100,000 psychiatric beds in public and private hospitals. That means there are more three times as many seriously mentally ill people in jails and prisons than in hospitals.
• 2005 – There is 1 psychiatric bed for every 3,000 persons.
• 2006 – the Department of Justice issued a survey reporting that 24% of jail inmates were mentally ill and 15% of prison inmates were mentally ill.
• 2008 – 1.6% of persons with developmental disabilities are living in state hospitals.
• 2009 – a survey among 822 jail inmates determined 16.6% of prisoners met the criteria for mental illness.
• 2009 – In the aftermath of the Great Recession, states are forced to cut $4.35 billion in public mental-health spending over the next three years, the largest reduction in funding since deinstitutionalization.
• 2009 – President Obama declared 2009 as the “Year of Community Living”, which also celebrated the ten year anniversary of the Olmstead Act in 1999.
• 2010 – There are 43,000 psychiatric beds in the United States, or about 14 beds per 100,000 people – the same ratio as in 1850.
• 2015 – 3 bioethicists from the University of Pennsylvania published a paper saying how deinstitutionalization shifted people from hospitals to carceral institutions such as prisons. They called for the return of rehabilitative institutions like asylums to treat people. It was highly controversial and received a lot of criticism. They said the older institutions are in need for a revival. They were looking for a solution to the prison problem.

Reference

_{Rifkin, G. (2020). Overlooked No More: Roland Johnson, Who Fought to Shut Down Institutions for the Disabled. The New York Times. Retrieved from https://www.nytimes.com/2020/07/31/obituaries/roland-johnson-overlooked.html}