The first psychiatric hospital was established in the United States in the late 18th century, and its establishment did not initially make a significant mark in terms of mental health care. Since mental health was still a mysterious anomaly, there were few mental institutions opened. Psychiatric facilities were established and funded by the families of individuals receiving care, but for the general population, there was little care.
This all changed in 1841. Dorathea Dix entered a prison with the intent of teaching about the Bible, and she noticed the amount of people who were suffering from a mental illness within the prison. She was appalled by the inhumane treatment, and she sought out to establish facilities for people who were suffering with severe disabilities. She went on to establish 30 more facilities across the United States. This number would increase quickly, and by 1955, there were over 500,000 people living in state hospital institutions.
The initial design of these institutions was to provide a safe space for individuals to heal and thrive in an environment that would allow them to thrive and live a life of productivity. This mission became difficult to maintain, as the number of beds within the hospitals increased, and the staffing decreased. This caused the conditions to decrease, and by the 1950’s the state of psychiatric facilities became eerily like prisons, with mistreatment and poor conditions abound.
This would inevitably change with John F. Kennedy signing the Mental Retardation Facilities and Community Health Centers Construction Act in 1963, which kickstarted a trend of moving mental health facilities into the community rather than a more isolated approach to treatment. Presidential advocacy for mental health was foundational for the establishment of outpatient care, which was further established with the implementation of Medicaid. However, Medicaid decreased funding for inpatient care, including state hospitals, and with few community-based centers being made, available care became limited. There has since been a drastic decrease in mental health facilities, and many state hospitals across the country have closed their doors.
“History of Psychiatric Hospitals.” • Nursing, History, and Health Care • Penn Nursing, https://www.nursing.upenn.edu/nhhc/nurses-institutions-caring/history-of-psychiatric-hospitals/.
Roth, Alisa. “The Truth about Deinstitutionalization.” The Atlantic, Atlantic Media Company, 25 May 2021, https://www.theatlantic.com/health/archive/2021/05/truth-about-deinstitutionalization/618986/.