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America started a grand experiment in the 1960s: deinstitutionalization of the mentally ill. The consequences were very destructive: homelessness; a degradation of urban life; increases in violent crime rates; increasing death rates for the mentally ill. My Brother Ron tells the story of deinstitutionalization from two points of view: what happened to the author's older brother, part of the first generation of those who became mentally ill after deinstitutionalization, and a detailed history of how and why America went down this path. My Brother Ron examines the multiple strands that came together to create the perfect storm that was deinstitutionalization: a well-meaning concern about the poor conditions of many state mental hospitals; a giddy optimism by the psychiatric profession in the ability of new drugs to cure the mentally ill; a rigid ideological approach to due process that ignored that the beneficiaries would end up starving to death or dying of exposure.
One of the most significant medical and social initiatives of the twentieth century was the demolition of the traditional state hospitals that housed most of the mentally ill, and the placement of the patients out into the community. The causes of this deinstitutionalization included both idealism and legal pressures, newly effective medications, the establishment of nursing and group homes, the woeful inadequacy of the aging giant hospitals, and an attitudinal change that emphasized environmental and social factors, not organic ones, as primarily responsible for mental illness. Though closing the asylums promised more freedom for many, encouraged community acceptance and enhanced outpatient opportunities, there were unintended consequences: increased homelessness, significant prison incarcerations of the mentally ill, inadequate community support or governmental funding. This book is written from the point of view of an academic neurologist who has served 60 years as an employee or consultant in typical state mental institutions in North Carolina and Ohio.
Both the scope and effects of deinstitutionalization have been dramatic. This volume examines both positive and negative effects of this mass movement of persons with severe mental illness out of the state hospitals and into the community. The chapters address the following issues: the use of community alternatives to state hospitalization; the very large numbers of persons with severe mental illness who have found their way into the criminal justice system, why this has happened, and what to do about it; the community treatment of mentally ill offenders; how to prevent inappropriate entry of mentally ill persons into the criminal justice system; the value of mental health consultation in courtroom settings; the therapeutic use of mental health conservatorship; and finally, psychiatric rehabilitation. Although deinstitutionalization for the most part can result in a much richer life experience in the community, much more needs to be done to make that occur. This is the 90th issue of the Jossey-Bass series New Directions for Mental Health Services.
Mind, State and Society examines the reforms in psychiatry and mental health services in Britain during 1960–2010, when de-institutionalisation and community care coincided with the increasing dominance of ideologies of social liberalism, identity politics and neoliberal economics. Featuring contributions from leading academics, policymakers, mental health clinicians, service users and carers, it offers a rich and integrated picture of mental health, covering experiences from children to older people; employment to homelessness; women to LGBTQ+; refugees to black and minority ethnic groups; and faith communities and the military. It asks important questions such as: what happened to peoples' mental health? What was it like to receive mental health services? And how was it to work in or lead clinical care? Seeking answers to questions within the broader social-political context, this book considers the implications for modern society and future policy. This title is also available as Open Access on Cambridge Core.
Psychiatric rehabilitation refers to community treatment of people with mental disorders. Community treatment has recently become far more widespread due to deinstitutionalization at government facilities. This book is an update of the first edition's discussion of types of mental disorders, including etiology, symptoms, course, and outcome, types of community treatment programs, case management strategies, and vocational and educational rehabilitation. Providing a comprehensive overview of this rapidly growing field, this book is suitable both as a textbook for undergraduate and graduate courses, a training tool for mental health workers, and a reference for academic researchers studying mental health. The book is written in an easy to read, engaging style. Each chapter contains highlighted and defined key terms, focus questions and key topics, a case study example, special sections on controversial issues of treatment or ethics, and other special features.*New chapters on supported education and integrated dual diagnosis treatment services*Comprehensive overview of all models and approaches of psychiatric rehabilitation*Special inserts on Evidence-Based Practices*New content on Wellness and Recovery*Class exercises for each chapter*Profiles of leaders in the field*Case study examples illustrate chapter points
The author is a social worker who writes with experience, authority, and compassion about what really happened when thousands of mental patients were discharged from state hospitals--and what to do about it. Annotation copyrighted by Book News, Inc., Portland, OR
The author "reveals how we have failed our mentally ill and offers a viable, provocative blueprint for change."--Jacket.
Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.
In 1963, President John F. Kennedy delivered an historic speech on mental illness and retardation. He described sweeping new programs to replace "the shabby treatment of the many millions of the mentally disabled in custodial institutions" with treatment in community mental health centers. This movement, later referred to as "deinstitutionalization," continues to impact mental health care. Though he never publicly acknowledged it, the program was a tribute to Kennedy's sister Rosemary, who was born mildly retarded and developed a schizophrenia-like illness. Terrified she'd become pregnant, Joseph Kennedy arranged for his daughter to receive a lobotomy, which was a disaster and left her severely retarded. Fifty years after Kennedy's speech, E. Fuller Torrey's book provides an inside perspective on the birth of the federal mental health program. On staff at the National Institute of Mental Health when the program was being developed and implemented, Torrey draws on his own first-hand account of the creation and launch of the program, extensive research, one-on-one interviews with people involved, and recently unearthed audiotapes of interviews with major figures involved in the legislation. As such, this book provides historical material previously unavailable to the public. Torrey examines the Kennedys' involvement in the policy, the role of major players, the responsibility of the state versus the federal government in caring for the mentally ill, the political maneuverings required to pass the legislation, and how closing institutions resulted not in better care - as was the aim - but in underfunded programs, neglect, and higher rates of community violence. Many now wonder why public mental illness services are so ineffective. At least one-third of the homeless are seriously mentally ill, jails and prisons are grossly overcrowded, largely because the seriously mentally ill constitute 20 percent of prisoners, and public facilities are overrun by untreated individuals. As Torrey argues, it is imperative to understand how we got here in order to move forward towards providing better care for the most vulnerable.