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Unfortunately mental health services were gutted in the 1980s with little objection. There are few options for patients that require long term care. The communi

Unfortunately mental health services were gutted in the 1980s with little objection. There are few options for patients that require long term care. The community health services that were supposed to replace the asylums of old never materialized.

everybodyknows 4y ago
> community health services Was that Reagan's campaign line, to rationalize the money grab? Can anyone fill in the history here?
- derbOac 4y ago
  The community mental health services movement actually started in the 60s, and coincided with a deinstitutionalization movement that you can tie to general social progressive policies during that time (civil rights etc). The idea (rightly so imho) was to destigmatize mental health, and to move to a model of reintegration, and not route people into institutionalization where they couldn't get out. This model declined during the 80s, and to a lesser extent 90s, for many many reasons. One is defunding, so you ended up in a situation where the institutions closed, but then as part of general government defunding (ala Reagan and post-Reagan trends), the community mental health services closed. Another issue that's probably less apparent is the neo-Kraepelinian movement in psychiatry that started in the 70s and accelerated during the 80s kind of was at odds with with the community services model. It allowed for treatments (think antipsychotics) that allowed people to leave institutions, but I think boxed in thinking about psychiatric care during subsequent decades. "Psychopathology as a medical illness" when it works in extreme cases is good at getting people out of residential institutions, but then is bound to a hospital-patient model that the US isn't very good at getting out of. So at the same time psychiatry was succeeding at getting people out of institutions through a biomedical model of psychiatry, it was kind of failing by neglecting the sociocultural side of psychiatry. So people get out of institutions because of effective medications, but then when they're out there, they're tied to hospitals for care and not community centers as they were originally envisioned. Basically, community-based care works, but requires a certain amount of infrastructure like anything, and it's been neglected to some extent because of biases in the healthcare system. It's also difficult once you recognize that psychiatric difficulties are bound up in very big socioeconomic structural issues that require a lot of political will to change, and if you don't, it incentivizes a head-in-the-sand kind of reaction. I wouldn't be surprised if there was a return to interest in these kinds of decentralized care models for various reasons in the coming decades, but it's hard to say. I think it's unfair to tie community mental health service trends to Reagan in particular, but I do think to the extent you attribute certain trends in public and government service funding to Reagan, it's accurate to say that Reagan-era trends were one contributor to problems. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266763/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266763/
- mixmastamyk 4y ago
  It was the opposite of a "money grab" and liberals walked hand-in-hand to close mental health facilities, encouraged by the "One Flew Over the Cuckoo's Nest" film. Didn't think though the consequences however.
- ROTMetro 4y ago
  Mental health institutions were nightmares. They were the places that in the 1950/60s did lobotomies and were still doing electro shock treatment into the 80s. People were sold on a more humane community treatment model instead of holdover 1800s insane asylum style treatment but unfortunately the community side never happened.
jstarfish 4y ago
> The community health services that were supposed to replace the asylums of old never materialized. They did, but it was doublespeak. "Community health services" took the form of privatized prisons.

everybodyknows 4y ago

> community health services Was that Reagan's campaign line, to rationalize the money grab? Can anyone fill in the history here?

derbOac 4y ago
The community mental health services movement actually started in the 60s, and coincided with a deinstitutionalization movement that you can tie to general social progressive policies during that time (civil rights etc). The idea (rightly so imho) was to destigmatize mental health, and to move to a model of reintegration, and not route people into institutionalization where they couldn't get out. This model declined during the 80s, and to a lesser extent 90s, for many many reasons. One is defunding, so you ended up in a situation where the institutions closed, but then as part of general government defunding (ala Reagan and post-Reagan trends), the community mental health services closed. Another issue that's probably less apparent is the neo-Kraepelinian movement in psychiatry that started in the 70s and accelerated during the 80s kind of was at odds with with the community services model. It allowed for treatments (think antipsychotics) that allowed people to leave institutions, but I think boxed in thinking about psychiatric care during subsequent decades. "Psychopathology as a medical illness" when it works in extreme cases is good at getting people out of residential institutions, but then is bound to a hospital-patient model that the US isn't very good at getting out of. So at the same time psychiatry was succeeding at getting people out of institutions through a biomedical model of psychiatry, it was kind of failing by neglecting the sociocultural side of psychiatry. So people get out of institutions because of effective medications, but then when they're out there, they're tied to hospitals for care and not community centers as they were originally envisioned. Basically, community-based care works, but requires a certain amount of infrastructure like anything, and it's been neglected to some extent because of biases in the healthcare system. It's also difficult once you recognize that psychiatric difficulties are bound up in very big socioeconomic structural issues that require a lot of political will to change, and if you don't, it incentivizes a head-in-the-sand kind of reaction. I wouldn't be surprised if there was a return to interest in these kinds of decentralized care models for various reasons in the coming decades, but it's hard to say. I think it's unfair to tie community mental health service trends to Reagan in particular, but I do think to the extent you attribute certain trends in public and government service funding to Reagan, it's accurate to say that Reagan-era trends were one contributor to problems. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266763/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266763/
mixmastamyk 4y ago
It was the opposite of a "money grab" and liberals walked hand-in-hand to close mental health facilities, encouraged by the "One Flew Over the Cuckoo's Nest" film. Didn't think though the consequences however.
ROTMetro 4y ago
Mental health institutions were nightmares. They were the places that in the 1950/60s did lobotomies and were still doing electro shock treatment into the 80s. People were sold on a more humane community treatment model instead of holdover 1800s insane asylum style treatment but unfortunately the community side never happened.

jstarfish 4y ago

> The community health services that were supposed to replace the asylums of old never materialized. They did, but it was doublespeak. "Community health services" took the form of privatized prisons.