There often comes a time in our lives when we ask ourselves: how did we get here? How did we arrive at the place we’re at today? I often find myself contemplating: who or what is responsible for the inadequate policies and procedures we continuously endorse as efficient mental health treatment? More importantly, what steps can we take to enhance services for the mental health population moving forward? And lastly, how can we safely and effectively re-introduce the option for asylum to one of the most vulnerable populations in society? 

Maybe it wasn’t the doings of one person per se, but an age-old mindset that helped to pave the way here; maybe it’s always been about saving a pretty penny; or perhaps, neglecting to provide adequate care to those with a severe mental illness stems from one of our nations’ most memorable political campaigns to date. Quite possibly, it’s a culmination of the above…

In order to pave the way towards a more comprehensive mental health system, we must first address how we arrived here. Individuals with severe mental illness have faced improper management of their diagnoses as far back in time as records can show. Throughout the middle ages—when mental illness was understood as a religious punishment or result of demonic possession, it was common to observe acts of neglect, abuse, and a lifetime of torturous imprisonment as suitable measures of addressing the alleged “problem” (Unite for Sight, n.d.). 

During the 1800’s, when the institutional model of mental health was deemed quite controversial, it took persistent efforts from several activists to encourage the U.S. government to initiate funding towards the development of state psychiatric facilities. Although institutionalization would provide individuals with better access to the mental health services they required—helping families breathe a sigh of relief knowing their loved one was under the care of a capable multidisciplinary team—it soon became evident that most facilities lacked the appropriate funding and staffing to ensure best care practices. As a result, it was common for state facilities to be overcrowded, unkempt, and in violation of patients’ rights (Unite for Sight, n.d.). 

By the 1950’s, the fight for deinstitutionalization was successful. The focus of mental health treatment quickly shifted towards a community-based approach in combination with the implementation of several new psychotropic medications, like Thorazine (UShistory, n.d.). For many, deinstitutionalization felt like a step towards a more ‘”humanized” approach for treating the severely mentally ill. 

In 1963, The Community Mental Health Centers Act was signed into law by John F. Kennedy and significantly changed the delivery of mental health services nationwide (UShistory, n.d.). Under this law, many patients were discharged back to their communities and began services on an outpatient basis. At this time, it was determined that individuals would no longer be committed against their will unless they posed imminent danger to themselves or someone else (Placzek, 2016). As you could imagine there were both pros and cons to this. 

Yes, deinstitutionalization would link many individuals to mental health services in the comfort and convenience of their own communities, while also preventing any future incidences of a person being wrongly held against their will; though at the same time, those who were in need of more intensive treatment no longer met criteria for such programs and were left to fend for themselves with little to no guidance. One of the goals of deinstitutionalization (besides saving money of course) was to increase the quality of life for the mentally ill population; instead, it seemed to place a large number of the mentally ill population at a disadvantaged position (Placzek, 2016). 

This brings us back to where we first started: the political campaign that changed a lot more than we ever anticipated. After winning the 1980 election, Ronald Reagan promised an array of new policies that would increase life satisfaction for all. Not only did Reagan’s message of hope greatly appeal to the American people after such a vulnerable time when unemployment and inflation were on the rise, but his confidence and charm only helped to seal his position further (UShistory, n.d.). After winning re-election with his 1984 campaign: “Morning in America,” Reagan became a leader of promise for a better future—a future that would be sure to benefit some, though not all. A future that would leave many generations having to pick up the pieces. 

At this time, the severely mentally ill were suffering. Due to increased budget cuts and the responsibility of mental health being turned back to the state, community-based mental health programs lacked the necessary financial and social support they needed to succeed (Guerra, 2017). As a result, many argued that rates of crime, imprisonment, homelessness, and substance abuse among the mentally ill were somehow related to inadequate support from the community and society at large. Many began to question if deinstitutionalization was doing more harm than good. 

Today in the United States, the lack of institutional care, inpatient care, and long-term services available to the mental health population is extremely concerning. For this reason, we continue to see increased rates of stigmatization and victimization, unemployment, homelessness, and incarceration among individuals who have a severe mental illness. We question the efforts of our current governing system and what is being done to facilitate a true comprehensive treatment model for this vulnerable population. We continue to see our loved ones struggle, fighting to survive in a world that does not accommodate their needs. 

It’s difficult to ignore the political involvement, or lack thereof, which led us here today. It’s time we re-define mental health in America—opening our minds to a much improved governing system and implementing a movement for change. We call this movement: Morning in Mental Health.

References

Guerra, E. C. (2017, February 8). Ronald Reagan and the Federal Deinstitutionalization of Mentally Ill Patients. PSY 833 Ethics and Leadership Wheeler. https://sites.psu.edu/psy533wheeler/2017/02/08/u01-ronald-reagan-and-the-federal-deinstitutionalization-of-mentally-ill-patients/comment-page-1/. 

Placzek, J. (2016, December 8). Did the Emptying of Mental Hospitals Contribute to Homelessness? KQED. https://www.kqed.org/news/11209729/did-the-emptying-of-mental-hospitals-contribute-to-homelessness-here. 

Unite For Sight. A Brief History of Mental Illness and the U.S. Mental Health Care System. (n.d.). https://www.uniteforsight.org/mental-health/module2. 

UShistory.org. (n.d.). Reaganomics. ushistory.org. https://www.ushistory.org/US/59b.asp.