The History of Deinstitutionalisation of the Mentally Ill in America

　
Deinstitutionalisation is the process of replacing long-stay psychiatric hospitals with less isolated community living mental health services with mentally ill or developmentally challenged patients Deinstitutionalisation is aimed at reducing the population size of mental institutions shortening the length of stays, and reducing both admissions and readmission
Deinstitutionalisation is the practice of transferring homeless, involuntarily hospitalized mental patients from state mental hospitals into different kinds of psychiatric institutions funded by the federal government The plan is striving to combat mental illness in the United State.
In many cases, the mass deinstitutionalisation of the mentally ill from the 1960s onwards has translated into a mass release of patients into the community. Individuals who previously would have been in mental institutions are no longer supervised by health care workers.
The 19th century saw a large expansion in the number and size of asylums Although initially were thought to be moral and humane confinement they became o non-therapeutic, isolated in location, and neglected in the care require
By the beginning of the 20th century, the admissions had resulted in serious overcrowding. inadquate funding especially during periods of economic decline, and war, many patients starved to death. Asylums became institutions with poor living conditions, lack of hygiene, overcrowding, ill-treatment, and abusive
The first community-based alternatives started in the 1920s and 1930s, asylum numbers continued to increase up to the 1950s deinstitutionalisation began strongly in various countries in the 1950s and 1960s.
Public outrage helped expose the poor conditions and treatment. Sociologists argued that these institutions created dependency, passivity, exclusion and disability and caused people to be instistutionalized much like prison
Community services were thought to be cheaper and new psychiatric medications made it more feasible to release people into the communit
Community services began with supported housing with full or partial supervision within the public community Costs have been said to be lower in some ca
Although deinstitutionalisation has been positive for the majority of patients for some it has severe repurcussions
Hopes that ommunity care would lead to fuller social integration are not achieved; many remain without work, have limited social contacts and often live in sheltered environments.
Community services are often unable to meet complex needs. Services in the community sometimes isolate the mentally ill where clients meet each other but have little contact with the rest of the community. Instead of community living reforms established an Open air Institution
Often there is insufficient preparation or support. A greater proportion of people with mental disorders became homeless or are imprisoned Homelessness has increased in some states in the USA Families can often play a crucial role in the care of those who would be placed in long-term treatment centers; however, many mentally ill people are resistant to such help because of the mental condition The majority of those who would be under continuous care in long-stay psychiatric hospitals are paranoid and delusional to the point that they refuse help and do not believe they need it, which makes it difficult to treat them.
Moves to community living and services leads to various concerns and fears, from both the individuals themselves and other members of the community
In every category of crime, including rape/sexual assault, other violent assaults, and personal and property theft the incident rates have increased The rates are similar in those with developmental disabilities
The unfounded idea that people with mental disorders released into the community are more likely to be dangerous and violent, a large study indicated that they were no more likely to commit violence than those in the neighborhoods usually economically deprived and high in substance abuse and crime where they are typically placed in
Findings on violence committed by those with mental disorders in the community have been inconsistent a higher rate of the most serious offenses such as homicide has sometimes been found but, despite high-profile homicide cases, the evidence suggests this has not increased ofdeinstitutionalisatio Aggression and violence that does occur is usually within the families
Deinstitutionalisation began in the USA IN 1950s and targeted people with mental illness. 15 years after individuals who had been diagnosed with a developmental disability were being placed in the community Although these movement began over 50 years ago, deinstitutionalisation continues today
The social forces that have led to a move for deinstitutionalisationpublic opinion of those with mental disabilities, and state's desire to reduce facilities for the mentally ill
Public awareness of the conditions of mental institutions began to increase during World War II Following WWII, articles and exposes about the mental hospital conditions would bombard popular and scholarly magazines and periodicals. These findings led to increased knowledge that mental illness was moderately prevalent. More importantly, people began to realize that cost that would be associated with more individuals being admitted to mental institutions (i
This time period was the beginning in the change of public and congressional attitudes toward the mentally ill. Since many individuals suffering from mental illness had served in the military, many began to think that more knowledge about mental illness and better services could benefit the men that served as well as the nation as a whole. that would be essential in developing the mental health field.
During the 1950s many new drugs became available and incorporated into therapy for the mentally ill. These new drugs were effective in reducing severe symptoms, which would allow people with mental illnesses to live in communities Drug therapy not onlyt depopulated the mental institutions, but it also opened opportunities for employment of the mentally
In general, professionals, civil rights leaders, and humanitarians saw deinstitutional confinement to local care as the appropriate approach.The Movement started off slowly but when it adopted the philosophy of the Civil Rights Movement It took off During the 1960s, deinstitutionalisation decreased dramatically as the average length of stay decreased by more than half. Instead of placing people with mental illnesses in long term institutions, many began to be placed in community care facilities where they could get care for their mental health needs. The deinstitutionalisation that took place in the United States was a transition from a mental institution to a more community centered facility
As hospitalisation costs increased due to improvements advocated by civic groups, both the federal and state governments desired to find less expensive alternatives to hospitalisation With the government on the side of deinstitutionalisation, getting legislation passed proved less difficult
Observers of the homeless issue also saw a change related to deinstitutionalisation Studies from the late 1980s indicated that one-third to one-half of homeless people had severe psychiatric disorders, often occurring with substance abuse
　
While the original idea of deinstitutionalization as it was in the beginning as a more humane way of living for the mentally ill There are still flaws which continue to make Community Living an alternative that needs to be restructuted to the individual eeds of each person with a mental disorder
Grouping and labeling of people continues to be a form of predjudice which still thrives with the stigma of Mental Illness

THE CHANGES OF MEDICAL TREATMENT IN BIPOLARS SINCE 1950 IN AMERICA

　
　
Bipolar affective disorder has been a mystery since the 16th century. History has shown that this affliction can appear in almost anyone. Even the great painter Vincent Van Gogh is believed to have had bipolar disorder. It is clear that in our society many people live with bipolar disorder; however, despite the abundance of people suffering from it, we are still waiting for explanations for the causes and cure. The one fact of which we do know is that bipolar disorder severely disables its ones ability to obtain and maintain social and occupational success.
Affective disorders are characterized by symptoms that can be broken into manic and depressive episodes. The depressive episodes are characterized by intense feelings of sadness and despair that can become feelings of hopelessness and helplessness. Some of the symptoms of a depressive episode include disturbances in sleep and appetite, psycomoter retardation, loss of energy, feelings of worthlessness, guilt, difficulty thinking, indecision, and recurrent thoughts of death and suicide The manic episodes are characterized by elevated or irritable mood, increased energy, decreased need for sleep, poor judgment and insight, and often reckless or irresponsible behavior Bipolar affective disorder affects approximately three million people in the United States. It occurs in both males and females. Bipolar disorder involves episodes of mania and depression. These episodes may alternate with profound depressions with persistant sadness, almost inability to move, hopelessness, and disturbances in appetite, sleep, in concentration
Bipolar disorder is diagnosed if an episode of mania occurs whether depression has been diagnosed or not Most commonly, individuals with manic episodes experience a period of depression. Symptoms include elated, expansive, or irritable mood, hyperactivity, pressure of speech, flight of ideas, inflated self esteem, decreased need for sleep, distractibility, and excessive involvement in reckless activities (H.
Bipolar disorder can create substantial developmental delays, marital and family disruptions, occupational setbacks, and financial disasters. This devastating disease causes loss of jobs and millions of dollars in cost to society. Many times bipolar patients report that the depressions are longer and increase in frequency as the individual ages. Many times bipolar states and psychotic states are misdiagnosed as schizophrenia. Speech patterns help distinguish between the two disorders
The onset of Bipolar disorder usually occurs between the ages of 20 and 30 years of age, with a second peak in the mid-forties for women. A typical bipolar patient may experience eight to ten episodes in their lifetime. However, those who have rapid cycling may experience more episodes of mania and depression that succeed each other without a period of remission
The three stages of mania begin with hypomania, in which patients report that they are energetic, extroverted and assertive Doctors believe that the hypomania stateshows that bipolar patients are «addicted» to their mania. Hypomania progresses into mania and the transition is marked by loss of judgment Often, euphoric grandiose characteristics are displayed, and paranoid or irritable characteristics progress The third stage of mania is evident when the patient experiences delusions with often paranoid themes. Speech is generally rapid and hyperactive behavior manifests sometimes associated with violence
When both manic and depressive symptoms occur at the same time it is called a mixed episode. Because there is a combination of hopelessness, agitation, and anxiety that makes them feel like they «could jump out of their skin they are a higher risk patients. Patients report feeling dysphoric, depressed, and unhappy; yet, they exhibit the energy associated with mania. Rapid cycling mania is another of the bipolar disorder. Mania may be present with four or more distinct episodes within a 12 month period This form of the disease exhibits more episodes of mania and depression than bipolar.
Lithium has been the primary treatment of bipolar disorder since its introduction in the 1960’s. It is main function is to stabilize the cycling characteristic of bipolar disorder. The overall response rate for bipolar subjects treated with Lithium was is more than 3/4 of patients Lithium is also the primary drug used for long – term maintenance of bipolar disorder. In a majority of bipolar patients, it lessens the duration, frequency, and severity of the episodes of both mania and depression.
Unfortunately,the other 1/4 of bipolar patients are either unresponsive to lithium or can not tolerate the side effects. Some of the side effects include thirst, weight gain, nausea, diarrhea, and edema. Patients who are unresponsive to lithium treatment are often those who experience dysphoric mania, mixed states, or rapid cycling bipolar disorder.
One of the problems associated with lithium is the fact the long-term lithium treatment has been associated with decreased thyroid functioning in patients with bipolar disorder. Another problem associated with the use of lithium is experienced by pregnant women. Its use during pregnancy has been associated with birth defects
There are other effective treatments for bipolar disorder that are used in cases where the patients cannot tolerate lithium or have been unresponsive to it in the past. The next line of treatment to be Anticonvulsant drugs such as valproate and carbamazepine. These drugs are useful as antimanic agents, especially in those patients with mixed states. Both of these medications can be used in combination with lithium or in combination with each other. Valproate is especially helpful for patients who are lithium noncompliant, experience rapid-cycling, or have alcohol or drug abuse.
Neuroleptics such as haloperidol or chlorpromazine have also been used to help stabilize manic patients who are highly agitated or psychotic. Use of these drugs is often necessary because the response to them are rapid, but there are risks involved in their use. Because of the often severe side effects, Benzodiazepines are often used in their place. Benzodiazepines can achieve the same results as Neuroleptics for most patients in terms of rapid control of agitation and excitement, without the severe side effects.
Antidepressants such as fluovamine and amitriptyline have also been used by some doctors as treatment for bipolar disorder. A study showed that fluvoxamine and amitriptyline are highly effect Conflicting research shows that antidepressants can actually precipitate manic episodes. Most doctors can see the usefulness of antidepressants when used in conjunction with mood stabilizing medications such as lithium.
In addition to the mentioned medical treatments of bipolar disorder, there are several other options available to bipolar patients, most of which are used in conjunction with medicine. One such treatment is light therapy. . Bipolar patients in one study showed a improvement in their depressive symptoms, with no incidence of mania or hypomania. They all continued to use light therapy, and all showed a sustained positive response Hypomanic symptoms were experienced by some of bipolar patients in this study. Predominant hypomanic symptoms included racing thoughts, deceased sleep and irritability. it is evident from this study that light treatment may be associated with the symptoms. Careful professional monitoring during light treatment is necessary, even for those without a history of major mood disorders.
Another treatment for bipolar disorder is electro-convulsive shock therapy. ECT is the preferred treatment for severely manic pregnant patients and patients who are homicidal, psychotic, catatonic, medically compromised, or severely suicidal. In one study, researchers found marked improvement in patients treated with ECT, compared to patients treated only with lithium and of patients who received neither, ECT or lithium
A final type of therapy is outpatient group psychotherapy. The value of support groups influenced mental health professionals to take a more serious look at group therapy for the bipolar population.
Research shows that group participation may help increase lithium compliance, decrease denial regarding the illness, and increase awareness of both external and internal stress factors leading to manic and depressive episodes. Group therapy for patients with bipolar disorders responds to the need for support and reinforcement of medication management, and the need for education and support for the interpersonal difficulties that arise .