Transcript April 7, Mental Hospitals

TRANSFORMATION IN 20th
CENTURY
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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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SYLVIA FRUMKIN
SHORT HOSPITAL STAYS
LONG STAYS IN COMMUNITY
LITTLE SOCIAL CONTROL
MANY PATIENT RIGHTS
NO VOLUNTARIES
ANTI-INSTITUTIONALISM
TRANSFORMATION
• INCREDIBLY SHORT PERIOD CUCKOO’S NEST IN 1963 (1975);
FRUMKIN IN 1978 (1982)
• WHAT WAS TRANSFORMATION?
• REASONS FOR TRANSFORMATION.
I. 1800-1850
• AROSE IN U.S. ABOUT 1800
• PREVIOUSLY PEOPLE CARED FOR IN
FAMILIES, ROAMED COUNTRY, JAILS
• INITIALLY HUMANE REFORM
• PHILOSOPHY OF THE
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
II. 1850-1960
• GROWTH OF POPULATION
• HUGE BUREAUCRACIES
• FROM TREATMENT TO
MANAGEMENT AND CONTROL
• NO EFFECTIVE TREATMENTS
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
SUMMARY AS OF 1955
• LARGE ISOLATED INSTITUTIONS
• CUSTODIAL WITH LITTLE
TREATMENT
• LONG STAYS, FEW RELEASES, MANY
ELDERLY PATIENTS
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
PUBLIC INPATIENT 1955-2000
600
500
400
residents
admit
300
200
100
0
1955
1970
1990
2000
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”)
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
CHANGE IN PATIENTS
• FROM ELDERLY, LONG-TERM, SCHIZ.
AND BRAIN DISEASE
• TO YOUNG, SHORT-TERM, DRUG
USERS (MICA)
• SAME: POOR, MINORITIES, MALES
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
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
PATIENTS
• PATIENTS IN PUBLIC MENTAL
HOSPITALS STILL POOR/ MINORITY
• NOW YOUNG, DRUG USING, HARD TO
HANDLE; NOT OLD, COMPLIANT,
AND INSTITUTIONALIZED