A nurse at St. Elizabeths Hospital for the mentally ill in Washington, D.C., monitors patients in continuously flowing baths, circa 1950.
National Library of Medicine
origin story / justice

The Discovery of the Mental Institution

Mental health care has never been adequate in the U.S.
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For historians, it is not surprising that jails and prisons are currently the largest providers of mental health care in this country. As long as the United States has been a country, state governments have been using jail or prison as a solution to the potential for violent acts committed by the mentally ill. In 1798, Massachusetts passed a regulatory act that read as follows: “That when it shall be made to appear to any two justices … that any person … is lunatick and so furiously mad as to render it dangerous to the peace or the safety of the good people for such lunatick person to go at large; the said justices shall have full power … to commit such person to the house of correction.”

The stress was on providing incarceration rather than mental health care. As legislators encountered the mentally ill and saw the ways such men and women could disrupt the workings of society, they responded with legal attempts to remove those disruptions. Care for the mentally ill figured into the equation but was secondary to protecting the community and working toward order and stability.

Reformers, of course, had other ideas. The eighteenth-century hospital movement and the nineteenth-century asylum movement were well-intentioned movements to provide quality care for the mentally ill. The Pennsylvania Hospital opened in 1751 with a mission to restore “the distempered poor” to “health and comfort,” so that they could “become useful to themselves, their families, and the publick.” The Virginia legislature funded a small hospital for the care of the mentally ill in 1773. A century later, every state had at least one publicly-funded hospital for the treatment of the mentally ill.

While reformers had success in getting asylums and hospitals built, they had less success when it came to quality care in those institutions. By the 1950s, a new generation of reformers began to argue for deinstitutionalization, shining a light on the abuses in many of the mental hospitals that had been endemic for a century or more. By the 1960s, the federal government had passed laws to transfer the care of the mentally ill from long-term residency in mental health hospitals to community mental health centers.
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