Transcript History of Mental Health

History of Mental Health
1840’s-Dorthea Dix championed
need for mental health institutions
on a federal level
 By the 1920’s, State Hospitals were
warehousing individuals who utilized
them due to lack of social programs
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Mental Health Reform
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Early 1900’s, Mental Health Reform was
started
Critical of State Hospitals run by the state
governments
WWII-Focused attention on Mental Health
Issues, due to 1 out of 4 draftees being
rejected from duty because of mental
health or neurological issues
Mental Health Act of 1946-established the
National Institute of Mental Health that
focused on modernizing treatment
approaches to psychiatric care
Community Health Centers
Acts of 1963 & 1965
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Act of 1963-Appropriated funds only for
construction of Community Health
Centers
Act of 1965-Staffing-Governmental
proposals to institute federal programs for
the aged and the poor
Focused on mental health prevention-a
concept that was borrowed from the
Public Health concept of prevention
Deinstitutionalization
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Nixon Administration impounded funds for
mental health programs
Reagan Administration collapsed all
mental health funding to block grants
Between 1970-73, 14 state hospitals had
closed, with Reagan promising to close all
by 1980
Judicial decisions impacted treatmentincreased civil rights of patients, while
requiring the states to provide treatment
States provided narrow interpretation of
Donaldson decision
Revolving Door
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High incidence of readmissions to the
state hospitals and less money for
treatment-medication management
Hospital related deaths
Mental health clients increase
involvement to petty crime
By 2000, reforms change judicial policy
and establish specialized courts to deal
with mentally ill, non-violent offenders
Community Mental Health
Centers under siege
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Chronically, mentally ill population that
were discharged from state hospitals
prove to be a burden for the service
providers
CMHC’s receive cut in federal funding
Reagan provides block grants to states,
but with a 21% cut
Reliance on government assistance
programs
Reorganization-increase of case loads and
target of chronic mentally ill treatment
Preventative Committment
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Out-patient programs have lack of follow
thru by chronically mentally ill patients,
but continue with increased
hospitalization
Utilizes preventative commitment as a
treatment modality to prevent
decompensation of the chronically,
mentally ill
Statue provides for mentally ill people
who are unable to voluntarily comply with
treatment and need treatment to prevent
decompensation to be a danger to self,
Mental Health Service
Delivery
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SAMSHA-Substance Abuse and Mental
Health Services Administration-oversees
block grants
Block grants administered since 1981
New Approaches to treatment deliveryCapitation Method
Predetermined amount of money to be
provided per client that insist on a wide
range of services to be delivered
Integrated Mental Health
Concept
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Categorical grants-Medicaid,
Supplemental Security Income, Food
Stamp Program. Local funding would be
allocated to a common fund
Non-Profit Planning Committee-Would
oversee planning and coordination,
monitor performance, and evolve
innovative programs
High-usage clients would be targeted for
provision of less costly services in order
to generate surpluses for less intensive
programs
Parity for Mental Health
Care
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1996-Established parity form mental
health treatment
Employers with more than 50 employees
who offer any mental health coverage,
must include mental health coverage
comparable to physical health coverage
In 2000, survey found a resulting
decrease in employee benefits
Substance Abuse
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High cost to society has provided much
focus in social policy
Increase in block grants to fund programs
Public intolerance has escalated due to
highway fatalities, HIV transmission
between IV drug users, and Fetal Alcohol
Syndrome and drug abuse affects among
newborn infants
Drug-Free Schools Act of 1990-Provided
$500 million for drug abuse prevention
Focus of treatment is mainly directed at
intervention strategies and rehabilitation