2.  History of development institutionalization
in 20th century
 History of development
deinstitutionalization in 20th century
 Institutionalization
 Deinstitutionalization

4.  20th century introduced a new psychiatry into the world.
 In the first part of the twentieth century, while mental
health treatments had very limited efficacy, many patients
received custodial care in state hospitals.
 After the founding of the National Institutes of Mental
Health (NIMH), new psychiatric medications were
developed and introduced into state mental hospitals
beginning in 1955.
 The 20th century saw an advancement in treatment methods
not only for civilians but for veterans returning home
following WWII (Dickinson, 1990; Fay, 1955).

5.  Francis Galton’s stance on Eugenics may have
contributed to the belief that sterilization was the
best way to deal with the mentally ill in order to
keep them from reproducing (Galton, 1865).
 In the United States, people who had mental
disorders were forced to stay in state hospitals and
asylums where they were treated without much
kindness and respect.
 In order to prevent society from having any more
mentally ill citizens, compulsory sterilization
became the law in many states.

6.  Mentally ill patients were sterilized without their
consent, and sometimes without their knowledge,
while they were contained in hospitals so as to
prevent them from interacting or mating with
“normal” people (Whitaker, 2009).
 After the theory of eugenics lost popularity,
outpatient clinics became popular. Many people
believed that outpatient psychiatric clinics which
allowed individuals to maintain some freedom in
their lives but also be treated when necessary.
 Many of the mentally ill patients actually did
worse when placed into out-patient care (Grob,
1991).

7. The hospitalization of many individuals was
followed by a wave of deinstitutionalization
(Krieg, 2001; Porter, Kaplan, & Homeier, 2009).
Despite a greater freedom for individuals,
many problems occurred as a result.
 Beginning in the 1980s, managed care systems
began to review systematically the use of
inpatient hospital care for mental health.

9.  United States, late 20th century.
 Earlier 20th century
~ ever-increasing admissions results in serious
overcrowding.
~ funding was often cut.
~ asylums became notorious for poor living
conditions, lack of hygiene, overcrowding, and ill-
treatment and abuse of patients.

10.  prevailing argument claimed :
~ community services would be cheaper
~ new psychiatric medications made it more
feasible
 deinstitutionalization came to the fore in
various countries in the 1950s and 1960s.
 1950s, new drugs became available

11.  hospitalisation costs increased, both the federal
and state governments were motivated to find
less expensive alternatives to hospitalisation.
 1960s, introduction of Medicare and Medicaid,
~ the federal government assumed an
increasing share of responsibility for the costs
of mental health care.
 It continued into the 1970s, implementation of
the Supplemental Security Income program in
1974.

12.  According to psychiatrist and author Thomas
Szasz
~ the policy and practice of transferring homeless,
involuntarily hospitalised mental patients from
state mental hospitals into many different kinds
of de facto psychiatric institutions funded largely
by the federal government.
 These federally subsidised institutions began in
the United States and were quickly adopted by
most Western governments.

13.  The plan was set in motion by the Community
Mental Health Act as a part of John F.
Kennedy's legislation and passed by the U.S.
Congress in 1963, mandating the appointment
of a commission to make recommendations for
"combating mental illness in the United States".
 Both public concerns and private health
insurance policies generated financial
incentives to admit fewer people to hospitals
and discharge inpatients more rapidly, limit
the length of patient stays, or to transfer
responsibility to less costly forms of care.

15.  Institutionalisation is the committing of an
individual to an institution such as a mental,
medical or legal institution. It describes the
treatment, damage or adaptation that people
may experience in these organisations.
 With an emphasis on care and treatment, the
best institutions offer emotionally disturbed
people a better chance at life. They can learn
new skills, improve behavioral and
psychological problems, and develop
healthier self-esteem .

16.  People with mild emotional or behavior
problems often benefit from a short stay at an
institution and benefit from a therapy protocol
that minimizes the fact of institutionalization.
 Severely disturbed people require a longer stay
and a highly controlled environment .
 The use of state hospitals helped to protect the
mentally ill from feeling the stigma from the
outside community and from suffering another
attack if they woke to find themselves in an
insane asylum (Fay et al., 1955).

17. Benefits of institutionalization
 Patients received a medical approach for their illnesses
instead of being brushed aside.
 Clinical and laboratory tests were available in the
hospital, but were very rarely available in other care
facilities.
 Nurses and other trained professionals were on hand
when it was necessary to provide electric shock,
insulin, or other major treatments.
 Patients were seen daily by their doctors.
 Psychotherapy was available in the hospital setting.

19. • the process of replacing long-stay psychiatric
hospitals with less isolated community mental
health services for those diagnosed with a
mental disorder or developmental disability.
• Deinstitutionalization emphasized the
independent living of individuals who were
once hospitalized. This movement, as it is often
called, pushed for the mentally ill to be viewed
as members of families and communities
instead of residents in institutions and asylums
(Krieg, 2001; Porter, Kaplan, & Homeier, 2009).

20. I. National Institutes of Mental Health (NIMH)
 New psychiatric medications
 Chlorpromazine
 New hope, and helped address some of the
symptoms of mental disorders.

21. 2. HOW?
 First focuses
• reducing the population size of mental
institutions.
 Second focuses
• reforming mental hospitals' institutional
processes.

22.  Community mental health services
 Open hospitals
 Psychotropic drugs
 Financial

23.  More humane and liberal treatment
 Change in the scope of mental health care
 Homelessness
 Regain freedom
 Adjustment to everyday life