Mental Health

History

In the Western world, criminal (and civil) confinement of persons with mental disorders dates back many centuries. Historically, different cultures have had an uneasy relationship with how best simultaneously to address the needs of mentally ill citizens who engaged in criminal wrongdoing while also protecting the public from the likelihood of future harm. Within the United States, four progressive reform strategies can be identified, dating back to the colonial period.

The first reform occurred during the period of colonial jurisprudence. It was termed the “moral treatment movement.” It emphasized hard work and penitence in the asylum rather than confinement in the correctional setting. During the moral treatment era, the conviction was that with enough religion, prayer, and labor, persons with mental disorders would be saved, and, therefore, would eventually refrain from criminal and delinquent transgressions.

The second reform emerged in the mid-1800s. It was termed the “mental hygiene movement.” Discoveries in science, advances in psychopharmacological therapies, and a commitment to curing mental disease or defect meant that the promise of treatment was the source of change. Psychopathic hospitals displaced the asylums of the past, and mentally ill offenders were subjected to various experimental drug regimens and other unproven procedures (including lobotomies).

The third reform movement surfaced in the 1950s. It was termed the period of “deinstitutionalization.” Disappointed by the failings of the mental hygiene era and outraged by the deteriorating, debilitating, and prison-like conditions in which persons with psychiatric disorders lived in psychopathic hospitals, progressive-minded politicians and social activists sought to validate the identity and affirm the (constitutional) liberties of persons with mental illness. This was the period of patients' rights. As such, during the 1950s and 1960s there was a massive deinstitutionalization movement, and psychiatric patients were placed in less restrictive community-based environments.

The fourth reform movement emerged in the 1980s and continues into the early 21st century.

Some researchers refer to this period as a time of “abandonment” in the care and treatment of persons with mental disorders. Others regard this period as a time during which various community mental health practices have been implemented with varying degrees of success. Deinstitutionalization produced a massive exodus from many state psychiatric facilities. This exodus raised a host of practical questions about how best to address the needs of persons with mental illness in community settings. Most critics agree that the limits of the fourth reform movement include cyclical or “revolving door” psychiatric treatment, homelessness, incarceration, and even death for some street dwellers with acute and/or chronic psychiatric disorders. Current efforts at progressive reform attempt to respond to each of these social problems.

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