Community Mental Health Centers

Historical Antecedents

In the eighteenth and nineteenth centuries, the mentally ill were subjected to an extraordinary variety of treatments. Exorcisms, eugenics, chains, and jails were all elements of the treatment package in the past. There were those who championed a more humane approach, including Philippe Pinel (1745–1826) in France, Dorothea Dix (1802–1887) in the United States, and William Tuke (1782–1822) in England. Despite their efforts, however, most mentally ill patients were confined to custodial care until the 1930s and 1940s.

The late eighteenth and early nineteenth centuries brought the development of the medical model in psychiatry, including the one-to-one relationship of doctor and patient. Such treatment was, however, available only to the wealthy. Care for most people included placement in a twenty-four-hour facility, a psychiatric ward typically run by poorly trained county, state, or federal government staff. By the 1930s, these institutions were bursting at the seams. Urbanization, economic depression, and the pressures of daily life contributed to increased admissions to these warehousestyle facilities, typically located in quieter rural areas whose distance from towns protected the patient from the family and community and the society from the patient. Few patients were discharged. Large sums were spent to provide care and seclusion from the world. Such treatments as electroconvulsive therapy, insulin coma therapy, lobotomies, and hydrotherapy (all pioneered in the 1930s) were of little value and did not encourage the patient's return to family and community.

A variety of new treatment approaches and medical interventions developed in the 1950s to 1960s, within and outside the hospital, encouraged the development of the CMHCs. These included group psychotherapy, family therapy, and the therapeutic social club (a precursor to the current psychosocial rehabilitation programs), all of which encouraged independence and redirection toward home and community. The therapeutic community, a term popularized by Doctor Maxwell Jones in the early 1950s, offered a group approach, redirecting patients toward the outside world, with the doctor acting as facilitator and other patients offering communal support. Former mental patient Clifford Beers pioneered the mental hygiene clinics, and some cities created child guidance clinics. However, perhaps the single most important development was the introduction in the mid-1950s to mid1960s of medications known as phenothiazines (examples include Thorazine and Mellaril), which helped to calm the patient and to control the psychiatric symptoms. Patients and staff could be hopeful as mental illness became more controllable. Open-door policies began in hospitals, and some halfway houses were established. Mental health professionals now had some new tools for helping the patients to return home.

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