The Mental Health
Movement
U.S. and Alabama
Dorothea Dix
 Stimulated creation of state facilities for
specialized treatment of mentally ill (insane)
 1852 Alabama passed bill to create Alabama
Insane Hospital
 April 1861 hospital opened in Tuscaloosa
under direction of 27 year old Dr. Peter Bryce
Bryce’s Principles of Treatment
 Early treatment (many got there too late after
hard trips and could not be helped)
 Tender loving care
 Occupational therapy (moral treatment)
 Non-restraint
Shoestring budget
 Counties paid $3/week/patient (remained at
this rate until 1940)
 Patients did all sewing, raising vegetables,
farm animals, fishing
 Despite low pay, strict rules for staff: fined if
discourteous or inattentive to patients
Model Hospital
 Non-restraint policy distinctive
 “If there is one thing more than another
calculated to destroy the peace and
tranquility of the patients, and the orderly
quiet of the wards in which they reside it is a
life of enforced idleness.”
 Bryce died in 1892, by which time about
1,000 patients at the hospital
Mental Health 1900s
 1902 a separate hospital for African
Americans established at Mt. Vernon.
 Nationally, beginning work in aftercare
 1908 Clifford Beers founded organized
mental health movement
 Mental hygiene focused on causes, early
diagnosis, prevention and treatment
1920s – 1950s
 Child guidance clinics, outpatient centers
 Psychiatric social work developed in 1920s
 In Alabama, institutions became larger and
increasingly more crowded
 Superintendent Partlow purchased 3,000
more acres on $3/week reimbursement rate
 From 1925 to 1950 patients at Bryce and
Searcy grew from 3162 to 6045
 Overcrowding continued and little real
treatment
 Bryce would have been shocked with
idleness, which had become the norm
 Commitment had become easy and life-long
 25% of draftees rejected for mental problems
& 40% of medical discharges in US were for
MH reasons in WW II
Post WW II Activity
 VA took leadership role in treatment
 National Mental Health Act 1946—study
authorized
 1961 “Action for Mental Health” - -utopian
vision of mental health care
 Led to creation of Community Mental Health
Centers
Stimuli for CMHC Movement
 Postwar budget surplus
 New generation of psychotropic medications,
which stabilized many
 View that community care was better than
institutional care
 Support of President Kennedy
CMHC Acts of 1963 and 1965
 Idea to eliminate the need for state mental
hospitals
 Move to community care & prevention
 Divide the US into catchment areas
 CMHC to provide inpatient hospitalization,
partial hospitalization, outpatient services,
emergency services, consultation, and
education for those in area
 Case manager role defined to follow patient
through system
 Rise of CMHC coincided with
deinstitutionalization for cost savings
(California) and to meet court orders
(Alabama)
 Not enough $$ appropriated to fulfill promise
Revolving Door
 Frequent readmissions, often due to
difficulties with remaining on medications
when out of hospital
 Side effects, paying for meds, getting meds at
all
 Many homeless are former hospital patients
 Crimes committed to get help??
Alabama Role
 Wyatt v. Stickney 1974 Right to treatment
 Judge Frank Johnson “To deprive any citizen
of his or her liberty upon the altruistic theory
that the confinement is for humane
therapeutic reasons and then fail to provide
adequate treatment violates the very
fundamentals of due process.”
Changes with Wyatt
 5,000 patients (and 1 psychiatrist) at Bryce
when suit filed
 Less than 500 now
 Also changes in commitment proceedings
make involuntary commitment difficult
“danger to self or others”
Mental Retardation in Early 1900s
 Bryce concerned about “mentally deficient”
 No law to allow admission to Alabama Insane
Hospital, but 2,223 in state in 1875
 Concern arose in US that retarded were
criminal, anti- social, and a menace to rest of
society
 Eugenics – segregation/sterilization
Sterilization Laws
 Intended to prevent “feeblemindedness”
 Racist and anti-immigrant views coincided
with rise of miscegenation laws
 1907 Indiana passed first law, and many
states followed. Alabama passed in 1919.
 Ruled constitutional in 1927 “Society can
prevent those who are manifestly unfit from
continuing their kind” (Holmes)
Special Institutions
 1923 Alabama Home for Mental defectives
opened with 80 white girls and 80 white boys
 No provisions for African Americans until
1944
 By 1950 there were 1,188 at Partlow
1970s and Mental Retardation
 “Least restrictive environment”
 Education for All Handicapped Children Act
(1974)
 Continuing movement toward community
care/responsibility and normalization
Wyatt v. Stickney conclusion
 Court requirements were met, per the judicial
decision, and the state of AL was removed
from official oversight in 200?
 Current population at Bryce:
 Current staff ration at Bryce: