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  Chapter Eight:

  Health of Children
  Health of Adults
  STDs and AIDS
  Illegal Drugs
  Accidental Deaths
  Hospital Patients
  Health Care Costs
  Mental Patients
  Disabled Persons



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Mental Patients

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The population institutionalized for mental disorders increased from early in the century to the 1950s and then declined sharply. The number of people institutionalized for mental retardation, however, continued to grow throughout the century.
During the first half of the century, an increasing number of people with severe mental disorders were confined involuntarily for long or permanent stays in certain state and county hospitals, popularly known as insane asylums. Lacking effective methods of treatment, the behavior of inmates was controlled by straitjackets, ice baths, beatings, and isolation. 

The advent of phenothiazine tranquilizers in the late 1950s, followed by other reliable chemical therapies, coincided with a shift in attitudes toward mental illness and revulsion against the inhumane conditions of the typical asylum. A new psychiatric consensus held that most mental patients could be safely accommodated in community facilities with follow-up care. As the upper chart indicates, the asylums began to empty out, but community facilities were often inadequate or absent, and many de-institutionalized mental patients were soon homeless or in prison. 

In the early years of the century, most people with mental retardation lived at home in the care of their families. Only a handful of residential facilities provided care for the “feeble-minded.” In 1931, the earliest year in which people with mental retardation were counted, they constituted only a small fraction of the institutionalized population. Their numbers grew steadily in the decades thereafter. 

As the availability of health insurance and third-party payments for care increased, so too did the number of patients in private facilities. As shown in the lower chart, many patients with mental illness and mental retardation moved from decaying public institutions into private institutions of generally higher quality.

Chapter 8 chart 11

Source Notes
Source Abbreviations

HS series B 423–427 and B 428–443; SA 1959, table 93; SA 1979, table 184; SA 1987, tables 158 and 159; and SA 1997, tables 204 and 205. For the number of patients in institutions, see Philip Bean, ed., Mental Illness: Changes and Trends (New York: John Wiley, 1983).


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