At the time of the commission’s report a trend had already begun to develop for treatment of mental illness, even the most serious mental illness, right in the community. By 1962 more than 20% of the general hospitals in the United States had already established psychiatric units where they treated patients with psychoses. These patients were admitted to these general hospitals just like medical and surgical patients and without the necessity of legal commitment. In many hospitals they were treated in separate psychiatric wards, but in some they were treated in the same wards as the other patients.
In June, 1962, the American Medical Association declared mental illness to be America’s most pressing and complex health problem and voted to involve its entire membership, as professional people and as citizens, in action to deal with this vast problem. The American Psychiatric Association had been active in this work for half a century.
These two major professional organizations and the National Association for Mental Health emphasized four main lines of action:(1) Continued Improvement in the State Mental Hospitals
In the early 1960′s these hospitals housed 85% of the nation’s 800,000 mental hospital patients. Most state hospitals were able to give intensive treatment only to the new patients, being forced to neglect those who were “chronic patients.” It was found that some patients who had been in hospitals 10, 20, and even 30 years could achieve partial or total recovery with intensive treatment. The goal set was intensive treatment for all.
(2) Increased Community Facilities
Since it had been shown that even the most seriously sick mental patients could be treated in the general hospitals in the community, efforts were made to get most or all general hospitals to set up psychiatric sections. Some doctors hoped that in 10 or 20 years all mental patients would first get treatment in a general hospital and that only those who did not respond to intensive treatment there would be sent to specialized mental hospitals for treatment as chronic cases.
Efforts were also made to increase the number of psychiatric clinics and all-purpose mental health centers. These mental health centers provide inpatient care as well as outpatient care, and their services include diagnosis, treatment, and rehabilitation. Emphasis was also given to the establishment of 24-hour emergency psychiatric services in general hospitals, similar to the emergency services for medical and surgical cases.
Many patients discharged from mental hospitals were found to need help in finding a place to live, finding a job, and obtaining follow-up medical care. Research showed that the relapse rate for discharged mental hospital patients could be cut from 35% to 10% through rehabilitation services.
As treatment of mental illness improved, the number of patients discharged increased. In 1956, for the first time in 50 years, mental hospital rolls stopped climbing and began to drop. The decline, while still very small, continued into the 1960′s. This did not mean that fewer people were in need of help. As a matter of fact, mental hospital admissions increased sharply, but improved treatment permitted a greater turnover, with the resultant decline in the total number in hospitals. The large number treated and released make the need for rehabilitation services more urgent.
(4) Treatment of Mentally III Children
Surveys in the early 1960′s indicated that there were at least 500,000 children with serious mental illness (psychosis) in the United States. About 4,000 of these, ranging in age from 5 to 16, were in the state mental hospitals. An additional 2,000 were being cared for in small residential treatment centers and day care centers in the communities. In 1963 the National Association for Mental Health absorbed the smaller National Organization for Mentally 111 Children. As a result of the consolidation, intensified efforts were made to assure separate and special treatment for children in the state mental hospitals and to increase vastly the treatment services in local communities.World-wide Mental Health Programs
Canada. The mental health movement in Canada followed a pattern similar to that in the United States. The first leader in the movement, a physician named Clarence Meredith Hincks, was influenced by Clifford Beers’ program. Hincks established the first mental health clinic in Canada. In 1918 he founded the Canadian National Committee for Mental Hygiene, with assistance from Beers. This committee worked to reform and expand treatment of mental illness throughout Canada. After World War II the name was changed to the Canadian Mental Health Association.
By the 1950′s mental illness had come to be regarded as Canada’s top priority health problem. Public interest and government actions resulted in improved programs of treatment. Canada experienced the same problems— such as a lack of doctors and nurses—as the United States. Canadian programs stressed such services as increasing the number of mental health clinics and giving treatment locally rather than in large asylum like institutions.The World Federation for Mental Health
The pioneers in the mental hygiene movement in Canada and the United States hoped to extend their programs to all nations. Hincks and Beers established the International Committee for Mental Hygiene in 1920. In the next 10 years mental health associations were formed in many countries, and the first International Congress on Mental Hygiene was held in 1930.
In 1948 the International Committee adopted a new name, the World Federation for Mental Health. The U.S. and Canadian associations are charter members, and total membership is more than 140 organizations in 46 nations and 2 dependencies. The U.N. World Health Organization works with the World Federation on problems of mental health.