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History of Mental Health

History of Mental Health. 1840’s-Dorthea Dix championed need for mental health institutions on a federal level By the 1920’s, State Hospitals were warehousing individuals who utilized them due to lack of social programs. Mental Health Reform. Early 1900’s, Mental Health Reform was started

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History of Mental Health

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  1. History of Mental Health • 1840’s-Dorthea Dix championed need for mental health institutions on a federal level • By the 1920’s, State Hospitals were warehousing individuals who utilized them due to lack of social programs

  2. Mental Health Reform • Early 1900’s, Mental Health Reform was started • Critical of State Hospitals run by the state governments • WWII-Focused attention on Mental Health Issues, due to 1 out of 4 draftees being rejected from duty because of mental health or neurological issues • Mental Health Act of 1946-established the National Institute of Mental Health that focused on modernizing treatment approaches to psychiatric care

  3. Community Health Centers Acts of 1963 & 1965 • Act of 1963-Appropriated funds only for construction of Community Health Centers • Act of 1965-Staffing-Governmental proposals to institute federal programs for the aged and the poor • Focused on mental health prevention-a concept that was borrowed from the Public Health concept of prevention

  4. Deinstitutionalization • Nixon Administration impounded funds for mental health programs • Reagan Administration collapsed all mental health funding to block grants • Between 1970-73, 14 state hospitals had closed, with Reagan promising to close all by 1980 • Judicial decisions impacted treatment-increased civil rights of patients, while requiring the states to provide treatment • States provided narrow interpretation of Donaldson decision • Illusory legal decisions for the mentally ill-enhancing human rights and freedoms without any corresponding improvement in services to be provided

  5. Revolving Door • High incidence of readmissions to the state hospitals and less money for treatment-medication management • Hospital related deaths • Mental health clients increase involvement to petty crime • By 2000, reforms change judicial policy and establish specialized courts to deal with mentally ill, non-violent offenders

  6. Community Mental Health Centers under siege • Chronically, mentally ill population that were discharged from state hospitals prove to be a burden for the service providers • CMHC’s receive cut in federal funding • Reagan provides block grants to states, but with a 21% cut • Reliance on government assistance programs • Reorganization-increase of case loads and target of chronic mentally ill treatment

  7. Preventative Committment • Out-patient programs have lack of follow thru by chronically mentally ill patients, but continue with increased hospitalization • Utilizes preventative commitment as a treatment modality to prevent decompensation of the chronically, mentally ill • Statue provides for mentally ill people who are unable to voluntarily comply with treatment and need treatment to prevent decompensation to be a danger to self, others, or a grave disability

  8. Mental Health Service Delivery • SAMSHA-Substance Abuse and Mental Health Services Administration-oversees block grants • Block grants administered since 1981 • New Approaches to treatment delivery-Capitation Method • Predetermined amount of money to be provided per client that insist on a wide range of services to be delivered

  9. Integrated Mental Health Concept • Categorical grants-Medicaid, Supplemental Security Income, Food Stamp Program. Local funding would be allocated to a common fund • Non-Profit Planning Committee-Would oversee planning and coordination, monitor performance, and evolve innovative programs • High-usage clients would be targeted for provision of less costly services in order to generate surpluses for less intensive programs

  10. Parity for Mental Health Care • 1996-Established parity form mental health treatment • Employers with more than 50 employees who offer any mental health coverage, must include mental health coverage comparable to physical health coverage • In 2000, survey found a resulting decrease in employee benefits

  11. Substance Abuse • High cost to society has provided much focus in social policy • Increase in block grants to fund programs • Public intolerance has escalated due to highway fatalities, HIV transmission between IV drug users, and Fetal Alcohol Syndrome and drug abuse affects among newborn infants • Drug-Free Schools Act of 1990-Provided $500 million for drug abuse prevention • Focus of treatment is mainly directed at intervention strategies and rehabilitation since there are not any major prevention initiatives

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