Lecture 17: Mental Health Treatment & Policy Flashcards
the history of mental health treatment
- Societies have always recognized deviant behaviour
- Some behaviours were deemed mad (mentally ill), while others were deemed bad (worthy of punishment)
- In the 17th century, mentally ill people were thrown into madhouses, which had the same conditions as prisons
- In the late 18th century, the concept of moral treatment was introduced in Britain and France
- The institutions that grew in North America followed this principle
- Early in the 19th century, people assumed that people who had acute mental illnesses could be treated through moral treatment. Those who had chronic mental illness were taken care of in their home communities
- After WWll, deinstitutionalization began
moral treatment
you can rehabilitate people from their mental illness by treating them humanely and exposing them to “normal” habits, like working
Deinstitutionalization
the collapse of the asylum system
Reasons for deinstitutionalization
- A shift in population dynamics
People started to live longer, so there were more chronic mental illnesses like Alzheimer’s
Institutions became overrun, preventing doctors from using moral treatment) - The development of “societal cures” (eugenics)
- A shift in technology
Ex. electroshock therapy, lobotomies - The Great Depression
The quality of care that people received in institutions decreased
mental health treatment post WWll
- Post WWll, antipsychotic drugs enabled hospitals to send people home
- Governments started forming federal-level mental health commissions
- Legislation shifted mental health care to communities to provide funding to outpatient clinics
- Community care worked well for people who had mild conditions and social support, but it didn’t work as well for people with severe or chronic conditions
- The shift from hospitalization to deinstitutionalization created a cycle of underfunding community treatment facilities, causing treatment to decline even further
Responses to mental health
individual and social responses to mental illness and how they impact their pathways to care
illness career
- The social experience of having an illness
- Exploration of illness
- Progression through stages of social meaning that are given to mental health problems
who is most likely to seek care?
- Women
- White people
- Middle-aged adults
- Those of higher SES, especially those with higher levels of education
- The influence of income is less clear
Parsons and the sick role
implicit model of illness career:
onset of symptoms -> sick role -> patient role -> recovery
Clausen & Yarrow
- The process of treatment is more complex
- Highlights the role of others
- Mental health problems are poorly understood by most
- Others are generally the first to recognize behaviour as a mental health problem
- Voluntary entry into or seeking of treatment is not accurate
- Process is not an orderly, linear progression
onset of the problem -> adjustment of expectations -> shifting definitions -> adaptation of deviance -> threshold of intolerance -> hospital
complicating responses to mental health
- Influences
- Modes of entry into care
- Systems of care
- Types of pathways and gateways
influences on pathways to care
- Lay attributions: how an everyday person might interpret behaviours and view them as problems that may require treatment
- Culture: provides a framework for reasonable methods to solve a problem
modes of entry
- Voluntary: individual’s choice
- Informal coercion: social pressures from family and friends
- Legal coercion: forced into treatment
systems of care
- Lay system: family and friends
- Folk system: traditional healers
- Formal system: psychiatrists
variety of pathways and importance of gateways
- Acknowledgement of multiple pathways to care
- Initial contact reflects the range of possible attributes and descriptions of the nature of mental health problems
- The first to identify a mental health problem starts the illness career
