Consumer or Survivor?
The History and Fragmentation of the Mental Health Consumer and Psychiatric Survivor Movements
An examination of the differences between the mental health consumer and psychiatric survivors’ movements would not be complete without an exploration of the history of U.S. mental health policy. Last week, I briefly covered the colonial era. This week I’ll go into the history of asylums.
In 1773 the first public hospital serving the mentally ill opened in Williamsburg, Virginia. According to the text written by Amanda Smith Barusch (2006), Foundations of Social Policy, the growth of cities brought on the establishment of facilities for the mentally ill. Those who could afford it went to hospitals. The indigent went to almshouses (p.217). During the second half of the eighteenth century, public hospitals for the insane abounded. An approach called moral treatment prevailed. It was based on a structured regimen and the physician had complete control (Barusch, 2006, p.218). It was high-quality care that the public institutions could not usually afford.
Another driving force in the opening of asylums throughout the U.S. was Dorothea Dix. Appalled at the treatment of the mentally ill in jails and almshouses, she crusaded for the protection of the mentally ill from certain “predatory” forces in society (Barusch, 2006, pp.218-219). After her death, the expansion of asylums continued until 1955. Barusch (2006) explains:
Ironically, this growth destroyed the very feature that inspired it: the promise of a cure for insanity. Moral therapy and similar approaches were costly and could not be sustained in over-populated, underfunded institutions. The gap between the reality of life in asylums and the promise of effective treatment widened, even as institutional populations grew. Cures were not unheard of, but over time, intractable cases of chronic mental illness came to dominate the asylum population (p. 219).
In 1909, the National Committee for Mental Hygiene was founded “to promote the prevention of mental disorders, arguing that prevention is both easier and less expensive than treatment” (Barusch, 2006, p.220). This is the beginning of community psychiatry. Unfortunately, this movement was not based on research, but came out of the public health movement of the same time (Barusch, 2006, pp.220-221).
By the end of World War Two, the public grew more aware of the problems of quality of care in asylums. The National Mental Health Act of 1946 shifted care for the mentally ill to communities. This act had three goals: “to support research on psychiatric disorders, to train mental health personnel through fellowships and grants, and to provide grants to states to establish clinics and demonstration programs” (Barusch, 2006, p.222). This eventually caused a discharge of thousands of patients from public psychiatric facilities and onto the streets. The development of antipsychotic agents and antidepressants also fueled the discharge of patients. In 1963, the Mental Retardation and Community Mental Health Center Construction Act provided a three year grant of $150 million towards the construction of community mental health centers (Barusch, 2006, p.223). This may sound like a good start, but in reality limited funding was available to build or maintain these community mental health centers. A lot of former asylum patients wound up on the streets and without care.
Next week I’ll go into the birth of the psychiatric survivor and mental health consumers’ movements.
Barusch, A.S. (2006). Mental Illness. Foundations of Social Policy, 2nd Ed. (pp. 210-237). Belmont, CA: Thompson.