Tracing the Evolution of Psychiatric Institutions in the U.S.

Abstract

Institutional Affiliation: Abstract The development of psychiatric care has been closely associated with the improvements in general health services in the United States. However, lack of understanding and knowledge on the experiences of mentally ill persons had hindered the care of patients prior to the 18th century. While communities and families were tasked with meeting the needs of the mentally ill, they were hardly able to provide adequate care. In most cases, the mentally ill were exposed to abuse and neglect since their families were unable to meet their needs. Initial institutions were private facilities that cared for the wealthy in return for donations used to expand the care for physically ill patients. Mental health asylums managed by the public sectors originated in the 18th century and were facilitated by the lobbying of researchers in the field. A key prominent figure was Dorothea Dix who conducted extensive research on the experiences of mentally ill individuals particularly in incarceration. Her work led to revelations on the level of abuse faced by these persons during care. Additionally, lobbyists presented the proposals for improvement based on the experiences in other countries. Expanding the access to mental health services led to challenges as the institutions were overwhelmed with the number of patients especially after the 1930s. The early 20th century led to the understaffing of institutions and lack of quality care for the mentally ill persons in the United States. The late 20th century was a critical period that saw the increase in funding for these facilities and improved training for the nurses offering care to the patients. With the 21st century, the experiences of healthcare professionals working with the mentally ill persons has been a key driver to the improvements in the care of the mentally ill. Table of Contents Abstract 2 Table of Contents 3 Introduction 4 History of Psychiatric Care 4 Moral Treatment for Patients 5 Mental Asylums 6 Dorothea Dix 7 Decline in the Late 19th Century 9 The Economic and Personnel Crisis 10 Conclusion 12 References 13 Introduction Psychiatric care plays a critical role in meeting the needs of patients and offering a hospitable environment for the persons in need of these services. Through extensive research and the application of findings in psychiatry in care, there has been a significant improvement in the experiences of mentally ill persons. The development of psychiatric care demonstrates the origin of the sector and how it has experienced changes over the years. Prior to the introduction of formal institutions to meet the people in need of these services, family members and communities were responsible for the care of mentally ill individuals. Eventually towns established programs to care for the patients but the individuals offering these services lacked the experience and training to provide these services (Giacco et al., 2017). The influence of individuals such as Dorothea Dix led to the advocacy and pollical lobbying that gradually led to the modern mental health care facilities in the country. Research on the experiences of mentally ill persons was fundamental in the improvement of care for individuals requiring psychiatric services. History of Psychiatric Care The history of psychiatric care is closely related to that of hospitals in the United States. The public support for healthcare facilities led to the development of institutions meant to care for the mentally ill patients. In the 18th century, mentally ill persons, like the physically ill, remained at home where they were offered the care that they needed by their close family members. For most families, the closest people to mentally ill persons were tolerant to the behaviors that others would view as strange (Apolinário-Hagen, Kemper, & Stürmer, 2017). However, some viewed the mentally ill persons as too violent and intolerable leading to their prolonged stays in hospitals. Public and private institutions in the 19th century provided special facilities and wards for the mentally ill men and women admitted in these institutions. One of the goals was to separate these individuals from the rest of the community while providing them with the care they needed (Modak, Sarkar, & Sagar, 2016). However, private institutions use depended on the funding from the wealthier families who wanted the institutions to offer care to their family members. Such findings were used to construct the facilities that the hospitals used to treat the physically ill persons in the institutions. Moral Treatment for Patients The European ideas introduced to the United States in the 19th century focused more on humane treatment that would place the mentally ill persons on a path of recovery. Rather than restraining the ill persons in methods that appeared punitive, the hospitals focused on a safe and better environment for sick individuals (Forrester et al., 2018). It was critical that people in hospitals were treated humanely and harsh restraints were replaced with moral support for the mentally ill. The hospitals placed individuals in secluded, quiet, and peaceful country settings that would provide opportunities for mentally ill persons to do meaningful work and have access to recreation. Additionally, the care for ill persons changed with health institutions using gentler restraints to control the destructive behavior of the patients. The 19th century led to the development of care facilities called asylums that focused on the improvement of the welfare of mentally ill persons while ensuring better treatment (Metcalfe et al., 2017). The hospitals promised rewards for patients who demonstrated rational behaviors and led to a significant decrease in punitive treatment for mentally ill patients. The European care for the mentally ill persons introduced into the United States in the 19th century focused on the potential for recovery of people from mental illness. The first half of the 19th century led to significant changes in the structure and organization of mental health asylums across the United States. Hospitals created better wards meant to provide comfort to mentally ill patients across the country (Houston, 2019). The goal of these changes was to improve the care of patients through the introduction of moral treatment in hospitals accommodating these individuals. However, Friends Asylum established in 1814 in Philadelphia was the first institution specifically meant for the care of mentally ill individuals in the United States. The organization was administered by lay persons with no medical training and was meant to offer moral and accommodative care for mentally ill persons (Druss & Goldman, 2018). Organizations that followed were ran by medical staff and attached to major hospitals in the United States. However, their structure was the same to the Friends Asylum in that they were located in secluded sites meant to provide a quite environment for people with mental illnesses in the United States. They were separate from the facilities offering care for patients with physical illnesses and focused on the recovery of the ill individuals. Mental Asylums Mental health facilities were developed across the United States and were attached to hospitals. The administration of care to ill patients was managed by trained medical professionals in these institutions (Weston, 2022). In 1811, the Massachusetts General Hospitals established the McLean Hospital just outside the city of Boston. Bloomingdale Insane Asylum was developed by the New York Hospital in 1816 while Institute of the Pennsylvania Hospital was developed in 1841 by Pennsylvania Hospital outside the city (Stanwell-Smith, 2019). Thomas Kirkbride was a medical superintendent working at the Institute of Pennsylvania Hospital who developed a plan to structure the mental health asylums in the 19th century. Known as the Kirkbride plan, its goal was to improve the comfort of patients in the mental health asylums to improve the care offered to patients (Ghahramanlou-Holloway et al., 2019). According to the plan, the asylums would have a central core and rambling wings that ensured the privacy, comfort, and high-quality care for patients. The institutions would have a maximum of 250 patients to ensure they met the needs of the individuals they accommodated. In spite of the developments in the care for mentally ill patients, a key challenge persisted in that health institutions limited the expensive care to patients from wealthy families. Dorothea Dix While the mentally ill persons from wealthy families were placed in comfortable asylums and offered quality services, the experiences of the poor held dark secrets. Individuals living in poverty were unable to pay for the care needed by their family members in asylums. Consequently, the mentally ill patients languished in inhospitable living conditions in spite of the efforts to address the challenges faced by these individuals. Strickler & Farmer (2019) demonstrated that from the mid-19th century, there were increased calls for healthcare facilities to accommodate poor mentally ill patients. Dorothea Dix was one of the most critical individuals demanding for the fair treatment of individuals with mental illnesses in public hospitals (DeRubeis, 2019). She was responsible for the sustainable lobbying of the United States legislature to allocate resources and funding to care for the mentally ill individuals. While these services were readily available for mentally ill persons from wealthy backgrounds, they were inaccessible for the poor patients in the United States. Dorothea Dix’s efforts were motivated by her work with prisoners and mentally ill persons in Massachusetts. Between 1840 and 1841, Dix worked as a teacher in women’s prisons and she frequently interacted with mentally ill individuals in incarceration. Their cells were dark and foul since they were isolated from the rest of the prison population. Additionally, mentally ill individuals were placed together with violent criminals where they were subject to abuse while serving time in prison (Strickler & Farmer, 2019). During this period, moreover, the mentally ill individuals relied on their families and the community for support. Those who lacked such support from their families depended on individuals, mostly volunteers, who partnered with community programs to assist mentally ill individuals. Nelson (2021) noted the Dix conducted statewide research on the experiences of mentally ill poor persons to support her lobbying for better services. She lobbied for the creation of improved and funded government programs that would offer care for mentally ill persons at state levels. Additionally, Dix demonstrated the disparity between the care provided to the wealthy mentally ill persons compared to the poor in the United States (King, 2019). Research on the experiences of poor mentally ill people and inmates demonstrated the need for a more elaborated and funded public healthcare system for patients. Dix lobbied for stat involvement in the care of mentally ill patients as well as the provision of moral care to poor patients....