DEVELOPMENT OF PSYCHIATRIC IN 20TH

CENTURYNURUL HUDA NORKASANI

STUDENT OF OCCUPATIONAL THERAPYNATIONAL UNIVERSITY OF MALAYSIA

CONTENT History of development

institutionalization in 20th century

History of development deinstitutionalization in 20th century

Institutionalization

Deinstitutionalization

DEVELOPMENT OF INSTITUTIONALIZATION

IN 20TH CENTURY

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).

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. 

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).

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.

DEVELOPMENT OF DEINSTITUTIONALIZATI

ON IN 20TH CENTURY

Development~How it is begins?

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.

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

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.

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.

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.

Definition of Institutionalization

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 .

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).

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.

Definition of Deinstitutionalization

DEFINITION: • 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).

Who is the FOUNDERand HOW it’s work?

I. National Institutes of Mental Health (NIMH)

New psychiatric medications Chlorpromazine New hope, and helped address some of

the symptoms of mental disorders.

2. HOW? First focuses• reducing the population size of mental

institutions. Second focuses • reforming mental hospitals' institutional

processes.

Factors that lead to Deinstitutionalization

Community mental health services

Open hospitals

Psychotropic drugs

Financial

Consequences More humane and liberal treatment

Change in the scope of mental health care

Homelessness

Regain freedom

Adjustment to everyday life

Thank You