Mental Health Outcomes Before Psychotropic Medications: A Retrospective Case Series of State Hospital Records from 1945-1954

Abstract

Background: Current outcomes for mental illness are widely regarded as poor. Since the introduction of psychotropic medications in the mid 1950's, previous psychosocial practices were minimized in favor of medication focused treatment. The majority of large U.S. state hospitals have closed with records destroyed or in storage, inaccessible to researchers. This creates barriers to studying and comparing outcomes before and after this shift in treatment practices. Aims: The study aim was to examine discharge outcomes in relation to length of stay and diagnosis in one U.S. state hospital. Methods: This case series study examined 5,618 medical records of participants admitted from 1945-1954, the decade prior to adoption of psychotropic medications. Results: Of the 3332 individuals who left the facility, over half (59.87%) of first episode hospitalizations were discharged within one year, and only 16.95% were hospitalized for more than five years. 46.17% of all admissions were discharged from hospital alive with no readmission. The most common diagnoses included schizophrenia, other forms of psychosis, and alcoholism. In the decade before the introduction of psychotropic medications, participants were often admitted for a single episode and returned to their homes within several years. Conclusions: This data challenges the erroneous assumption that prior to the introduction of psychotropic medications, participants were routinely hospitalized for years or decades and did not improve, never returning home.