The Last Half-Century of Psychiatric Services as Reflected in Psychiatric Services

Abstract

The last half-century of psychiatric services in the United States is examined through developments and trends reported in the 50 years of publication of Psychiatric Services. The journal, earlier named Mental Hospitals and then Hospital and Community Psychiatry, was launched by the American Psychiatric Association in January 1950 and marks its 50th anniversary this year. The author organizes his review of psychiatric services largely around the locus of care and treatment because the location of treatment--institution versus community--has been the battleground for the ideology of care and for the crystallization of policy and legal reform. He uses "dehospitalization" to describe the movement of patients out of state hospitals, rejecting the widely used term "deinstitutionalization" as inappropriate; one reason is that the term wrongly implies that many settings where patients ended up were not institutional. Also covered in detail, as reflected in the journal, are community care and treatment, economics, patient empowerment, and the interface issues of general hospitals, outpatient commitment, and psychosocial rehabilitation. The author notes that some concepts, such as outpatient commitment and patient empowerment, emerged earlier than now assumed, and that others, like psychosocial rehabilitation, recurred in slightly different forms over time. He concludes that even after 50 years of moving patients out of state hospitals and putting them somewhere else, mental health policymakers and practitioners remain too myopically focused on the locus of care and treatment instead of on the humaneness, effectiveness, and quality of care.

How Evidence-Based Practices Contribute to Community Integration

“…Some estimates are that less than onethird are living independently, while about one-third of the homeless population have mental illness (Torrey, 2001). Many have been ''transinstitutionalized,'' from psychiatric hospitals to nursing homes and other supervised residences (Geller, 2000). Among those consumers counted as ''living in the community'' are many who are leading lonely, isolated, barren lives, often without social or recreational outlets (Carling, 1995;Segal & Aviram, 1978;Wong & Solomon, 2002).…”

De-institutionalisation in psychiatry – both sides of the coin

“…By the end of the 20th century, particularly in the USA and Europe, the number of inpatients in psychiatric hospitals had been radically reduced -in the USA the population of state and county psychiatric hospitals fell from 553 979 in 1954 to 61 722 in 1996, and 120 hospitals were closed. [2] The reasons for this precipitous change in the practice of psychiatry are complex, but a number of factors have been cited: [3] • the advent of effective antipsychotic medication • the growing wave of public antipathy towards psychiatric institutions as the abuses and poor conditions became more widely known • the growth of mental healthcare user/survivor groups and the development of disability activism • an assumption that community-based care would be more humane • a variety of political arguments that span the spectrum -from concerns about the human rights of the mentally ill to financial imperatives driven by growing costs and the perception that community care would be cheaper.…”

Factors Influencing Risk of Premature Mortality in Community Cases of Depression: A Meta-Analytic Review

“…Deinstitutionalization of individuals with chronic mental disorders has been continuing over the past 50 years [12], with only a small proportion of those with depression now hospitalized, and then for short periods. Due to both increased reliance on community care [13] and low treatment-seeking rates for depression [14], those hospitalised are more likely to be presenting with severe symptomatology and not representative of depressive disorder in the community.…”