TRANSFORMATION IN 20th CENTURY CUCKOO’S NEST PUBLIC MENTAL HOSPITALS CENTRAL LONG INPATIENT STAYS REPRESSIVE SOCIAL CONTROL NO PATIENT RIGHTS VOLUNTARIES INSTITUTIONALISM

NO PLACE ON EARTH FOR ME SYLVIA FRUMKIN SHORT HOSPITAL STAYS LONG STAYS IN COMMUNITY LITTLE SOCIAL CONTROL MANY PATIENT RIGHTS NO VOLUNTARIES ANTI-INSTITUTIONALISM

TRANSFORMATION INCREDIBLY SHORT PERIOD - CUCKOO’S NEST IN 1963 (1975); FRUMKIN IN 1978 (1982) WHAT WAS TRANSFORMATION? REASONS FOR TRANSFORMATION.

I AROSE IN U.S. ABOUT 1800 PREVIOUSLY PEOPLE CARED FOR IN FAMILIES, ROAMED COUNTRY, JAILS INITIALLY HUMANE REFORM PHILOSOPHY OF THE ENLIGHTENMENT

PHILOSOPHY REMOVE PEOPLE FROM STRESSFUL ENVIRONMENT COUNTRY SETTINGS - ISOLATED FROM FAMILIES AND COMMUNITIES PROVIDE MORAL TREATMENT IN CALM AND RESTFUL ENVIRONMENT MAINLY MIDDLE AND UPPER CLASS CLIENTS

II GROWTH OF POPULATION HUGE BUREAUCRACIES FROM TREATMENT TO MANAGEMENT AND CONTROL NO EFFECTIVE TREATMENTS

PATIENTS LOWER SES, IMMIGRANT, ELDERLY LONG STAYS, HIGH DEATH RATES CHRONIC CONDITIONS - SCHIZ., SYPHILUS, ALCOHOLISM INSTITUTIONALISM: APATHY, ADJUST, DON’T WANT TO LEAVE

SUMMARY AS OF 1955 LARGE ISOLATED INSTITUTIONS CUSTODIAL WITH LITTLE TREATMENT LONG STAYS, FEW RELEASES, MANY ELDERLY PATIENTS

III. DI ( PRESENT) REMOVE PATIENTS FROM HOSPITAL, ADMIT FEWER PATIENTS, USE OF COMMUNITY TREATMENT BEGINS IN REVERSAL OF 150 YEAR OLD TREND HIGHLY CONTROVERSIAL - CRIME, HOMELESSNESS, NEGLECT

PUBLIC INPATIENT

RESIDENTS OF PUBLIC MENTAL HOSPITALS DRASTIC DECLINE IN RESIDENTS, (“OPENING BACK DOOR”) ,000; ,000; ,000; ,000; ,000 INCREASE IN ADMISSIONS , DECREASE SINCE THEN (“CLOSING FRONT DOOR”)

PUBLIC MENTAL HOSPITALS NOW NO LONGER THE MAJOR PART OF SYSTEM PLACE OF LAST RESORT - VIOLENT, DIFFICULT TO TREAT (FRUMKINS) OR NOWHERE ELSE TO GO STILL 2/3 OF STATE EXPENSE FIXED COSTS, UNIONS, COMMUNITIES

CHANGE IN PATIENTS FROM ELDERLY, LONG-TERM, SCHIZ. AND BRAIN DISEASE TO YOUNG, SHORT-TERM, DRUG USERS (MICA) SAME: POOR, MINORITIES, MALES

INPATIENT TREATMENT NOW MOST IN GENERAL HOSPITALS GROWTH OF PRIVATE, SPECIALIZED HOSPITALS SHORT STAYS – 1 TO 2 WEEKS OR AS LONG AS HAVE INSURANCE FOR WHITE, FEMALE, DEPRESSION, ALCOHOL ELDERLY NOW IN NURSING HOMES

SUMMARY OF CHANGES DRASTIC DECLINE IN NATURE AND CENTRALITY OF PUBLIC MENTAL HOSPITALS NOT LONG STAYS BUT SHORT STAYS WITH LONG SPELLS IN COMMUNITY MOST INPATIENT TREATMENT IN GENERAL OR PRIVATE HOSPITALS RISE OF NURSING HOMES

PATIENTS PATIENTS IN PUBLIC MENTAL HOSPITALS STILL POOR/ MINORITY NOW YOUNG, DRUG USING, HARD TO HANDLE; NOT OLD, COMPLIANT, AND INSTITUTIONALIZED