2. US PUBLIC INPATIENT 1830- 1955

3. PUBLIC INPATIENT 1955-2000

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

5. NO PLACE ON EARTH FOR ME SYLVIA FRUMKIN SHORT HOSPITAL STAYS LONG STAYS IN COMMUNITY MUCH LESS SOCIAL CONTROL MORE PATIENT RIGHTS HARD TO ENTER VOLUNTARILY ANTI-INSTITUTIONALISM

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

8. I. 1800-1850 AROSE IN U.S. ABOUT 1800 PREVIOUSLY PEOPLE EXILED OR JAILED; CARED FOR IN FAMILIES MENTAL HOSPITALS INITIALLY HUMANE REFORM

10. 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

12. II. 1850-1960 GROWTH OF POPULATION HUGE BUREAUCRACIES FROM TREATMENT TO MANAGEMENT AND CONTROL NO EFFECTIVE TREATMENTS

15. PATIENTS 1850-1960 LOWER SES, IMMIGRANT, ELDERLY LONG STAYS, HIGH DEATH RATES CHRONIC CONDITIONS - SCHIZ., SYPHILUS, ALCOHOLISM INSTITUTIONALISM: APATHY, ADJUST, DON’T WANT TO LEAVE

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

18. III. DI (1955 - PRESENT) REMOVE PATIENTS FROM HOSPITAL, ADMIT FEWER PATIENTS, USE OF COMMUNITY TREATMENT BEGINS IN 1955 - REVERSAL OF 150 YEAR OLD TREND HIGHLY CONTROVERSIAL - CRIME, HOMELESSNESS, NEGLECT

19. PUBLIC INPATIENT 1955-2000

20. RESIDENTS OF PUBLIC MENTAL HOSPITALS DRASTIC DECLINE IN RESIDENTS, 1955-2000 (“OPENING BACK DOOR”) 1955 - 560,000; 1970 - 450,000; 1980 - 140,000; 1990 - 100,000; 2000 - 90,000 INCREASE IN ADMISSIONS 1955-1970, DECREASE SINCE THEN (“CLOSING FRONT DOOR”)

21. 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

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

23. 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

24. 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

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