How Far We've Come...and How Far We've Stepped Back

By mackenzieccrow

  • The first psychiatric patient is admitted to Public Hospital for Persons of Insane and Disordered Minds in Williamsburg, Virginia.

  • Dorothea Dix visits the East Cambridge Jail, where she first sees the horrible living conditions of the mentally ill.

    By 1880, she had established 110 psychatric hospitals.

  • Nellie Bly forces her way into the the Women’s Lunatic Asylum on New York’s Blackwell’s Island as a patient.

    After writing about the living conditions in the asylum following her stay, there was a grand jury investigation on the asylum.

  • Indiana became the first of more than 30 states to enact a law to surgically sterilize the mentally ill, keeping them from procreating.

  • Dr. Walter Freeman and his colleague James Watt perform the first prefrontal lobotomy.

  • Italian neurologist Ugo Cerletti introduces electroshock therapy for treatment for extreme mental illness.

  • President Harry Truman signs the National Mental Health Act, calling for the establishment of the National Institute of Mental Health to conduct research into neuropsychiatric problems.

  • Substance abuse was included in the Diagnostic and Statistical Manual of Mental Disorders.

    ...But it was added to the category of Sociopathic Personality Disturbances, which was a blanket term for serious mental health disorders and character weaknesses.

  • Marketed as Thorazine by Smith-Kline and French, chlorpromazine is the first antipsychotic drug approved by the Food and Drug Administration.

  • The number of mentally ill people in public psychiatric hospitals peaks at 560,000.

  • President John F. Kennedy signs the Community Mental Health Act to provide federal funding for the construction of community-based preventive care and treatment facilities.

    Between the Vietnam War and an economic crisis, the program was never adequately funded.

  • Medicaid excludes insurance coverage for "institutions for mental diseases."

    The elderly who were presently treated in psychiatric facilities were moved to nursing homes for insurance to cover their stay.

  • The California Legislature passes the Lanterman-Petris-Short Act, which makes involuntary hospitalization of mentally ill people vastly more difficult.

    One year after the law goes into effect, the number of mentally ill people in the criminal-justice system doubles.

  • There are 650 community health facilities serving 1.9 million mentally ill patients a year.

  • President Jimmy Carter signs the Mental Health Systems Act, which aims to restructure the community mental-health-center program and improve services for people with chronic mental illness.

  • Under President Ronald Reagan, the Omnibus Budget Reconciliation Act repeals Carter’s community health legislation and establishes block grants for the states, ending the federal government’s role in providing services to the mentally ill.

    Federal mental-health spending decreases by 30 percent.

  • Federal funding drops to 11 percent of community mental-health agency budgets.

  • Clozapine, the first “atypical” antipsychotic drug to be developed, is approved by the FDA as a treatment for schizophrenia.

  • The Mental Health Parity Act is passed.

    The Mental Health Parity Act of 1996 prohibited large group health plans from putting annual or lifetime dollar limits on mental health benefits that are less than those put on medical/surgical benefits.

  • Studies suggest approximately 16 percent of prison and jail inmates are seriously mentally ill, roughly 320,000 people.

    This year, there are about 100,000 psychiatric beds in public and private hospitals. That means there are more three times as many seriously mentally ill people in jails and prisons than in hospitals.

  • The Mental Health Parity and Addiction Equity Act is updated.

    The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) added new protections, such as requiring that substance use disorders also have comparable coverage. However, MHPAEA does not require health insurance plans to include mental health/substance use disorders benefits; its requirements apply only to insurers that include mental health/substance use disorders in their existing benefit packages.2

  • In the aftermath of the Great Recession, states are forced to cut $4.35 billion in public mental-health spending over the next three years, the largest reduction in funding since deinstitutionalization.

  • There are 43,000 psychiatric beds in the United States, or about 14 beds per 100,000 people—the same ratio as in 1850.

  • The Affordable Care Act is passed.

    The Affordable Care Act of 2010 (ACA) builds on the earlier parity legislation by requiring that most individual and small-employer health insurance plans—including all plans offered through the Health Insurance Marketplace—cover mental health and substance use disorders services. The ACA also requires coverage of rehabilitative services that support people with behavioral health challenges.

  • The Mental Healthcare Reform Act is passed.

    This act is aimed to ensure the programs that are treating patients for mental illness or doing so effectively, help states financially to meet these needs for patients, ensure all practices used to treat mentally ill patients are the newest and most effective and increase access to mental health care for all people.