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   The Great Social Experiment

To anyone familiar with the history of mental illness treatment in our country, this article may be a restatement of some topics that are recognizable, but there are some good reasons to review where we have been as respects how we view mental illness as a society.

Recently I participated in an anniversary celebration for a local NAMI organization.  That fact by itself is no reason to research additional history, but in the process of creating display materials and a video production the occasion offered the opportunity to review just why the organization came to exist.  To find the answer to that question required a bit of research into past public policy issues.

Like many issues, the care and treatment of those with mental illness goes through cycles.  We have all recently experienced the shifting sands of political fortune and watched and participated in elections that yet again shifted the political fortunes of our two major parties.  This has happened before and will certainly happen again.  Each time, pundits express how difficult it will be for the opposing side to recover from their electoral setbacks.

In the mental health world, the changes have been more seismic in nature and less frequent.  In 1955, the treatment world was primarily based in the concept of residential treatment.  There were large scale institutions that housed in excess of 550,000 residents across the country.  There were, to be certain, many problems with this arrangement.  First and foremost, medical treatments were in a considerably less sophisticated state and the institutions were in many cases, overcrowded and there were abuses of residents and lack of funds to promote decent living standards.  What once were supposed to be havens of relaxed and humane treatment had degraded into many instances of abuse and mistreatment.  That is not to imply that all treatment facilities were in terrible condition, but there is ample evidence to suggest that there were plenty of problematic facilities.

A second and very important factor was the introduction into the treatment model of psychiatric medications to relieve symptoms of illness.  This is a place where modern psychiatric treatment has made considerable progress, but if looked at in total, is where much is yet to be accomplished.  Early medications, and to a great extent, those in use today, are a promise and yet a curse.  Because the exact chemical nature of mental illnesses is not yet identified, all medications function in a bit of a magical fashion.  While some chemical properties are well known, there are not exacting standards like those that exist for diabetes and blood glucose levels which make identification of the illnesses more concrete.

The effect of the medications on some patients was considered to be in many ways, miraculous.  Some who had suffered from terrible psychotic symptoms were able to recover and continue on with their lives.  However; just like serious traditional illness, the treatments were neither perfect nor without consequences.  The effect on public policy, however, was without question dramatic.  Congress passed the Community Mental Heath Treatment Act just prior to the assassination of president John F. Kennedy and in the following years the treatment of mentally ill persons has undergone massive transformation.

In a perfect world, the process called deinstitutionalization would have gone smoothly and benefit the release of those with illness.  Citizens would have found supportive services and been successful in their transformation from institution to community.

In reality, there was a rush to "release" those in institutions into the community because of the savings of massive amounts of tax dollars, and only the promise of community treatment.  True to form, the release went very well, the creation of community treatment centers and housing and job supports were left as dreams without adequate funding.  In reality those charged with creating public policy had no idea of the necessary public services necessary to support deinstitutionalization.  By 1980 there were less that 100,000 still in institutions yet only 750 of 1,500 suggested community mental health treatment centers were opened.

Sadly, the people who suffered the most were those that suffered from disease as well as their families.  In the 1970's hundreds of thousands were denied access to treatment facilities and suffered from the lack of treatment options available.  It was the family members of those who suffered that began to band together in communities across the country in small independent groups.

In September 1979, a professor at the University of Wisconsin was granted funds to convene a convention of 58 groups from 29 States.  At that meeting, NAMI, the National Alliance for the Mentally Ill was formed.  In the intervening years, affiliates and state organizations of NAMI spread throughout the country and today are recognized for their leadership on the issues of mental health treatment and community services.

In the meantime, the efforts to create effective community mental health care have suffered and the process that was supposed to reunite those that suffered from disease saw many of them suffer lack of services, become homeless, be institutionalized in prisons, and die prematurely.  Based upon the latest statistics that those with mental illness die on average nearly 25 years earlier than their peers, the failure of the system to provide adequate care is clear.

There is little question that creating a network of care that is responsive to those with serious mental illness and provides care that is effective and appropriate to the patients condition is far from complete.  The rush to deinstitutionalize was highly successful in its ability to remove people from institutions.  What they were rushed to is, unfortunately no better that what they were rushed from.

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Last modified: 11/30/08