But this is not a new issue, in 1841, Dorothea Dix brought to the Massachusetts Legislature attention that the sick and insane were "confined in this Commonwealth in cages, closets, cellars, stalls, pens! Chained, beaten with rods, lashed into obedience." After touring prisons, workhouses, almshouses, and private homes to gather evidence of appalling abuses, she made her case for state-supported care. Ultimately, she not only helped establish five hospitals in America, but also went to Europe where she successfully pleaded for human rights to Queen Victoria and the Pope.
In 1841 Dr. John Galt took over the superintendence of the Eastern State Hospital in Williamsburg, Virginia, the first publicly supported mental state hospital. It was a triumph for the time because it was the first publicly supported hospital dedicated to the sole treatment of the mentally ill. Dr. Galt, a pioneer in his time in the treatment and the rehabilitation of those suffering from psychological disorders introduced Moral Management Therapy This taught, as Dr. Galt said, that the mentally ill "differ from us in degree, but not in kind" and are entitled to human dignity. Dr. Galt introduced therapeutic activities and talk therapy. He was probably alone among contemporary asylum superintendents to advocate that the psychiatric hospital undertake in-house research and claimed to treat African-American patients on an equal footing with whites. Dr. Galt used restraint very sparingly (one year restraining none) and sought a calming medication to replace restraint. He dispensed opium liberally to patients in a foreshadowing of our twentieth century neuroleptics. In 1857, Dr. Galt was the first to advocate deinstitutionalization and community-based mental health care. Dr. Galt and Eastern State Hospital introduced all the components of the modern psychiatric hospital -human dignity for the mentally ill, therapeutic activities, talk therapy, calming medication, in-house research, deinstitutionalization, and community-based mental health care.
With these great advances in the care of those with mental illnesses seen almost 141 years ago, the United States and Idaho have regressed greatly due to simply put money. In the 1970 and 1980’s Ronald Reagan was governor of California he systematically began closing down mental hospitals, later as president he would cut aid for federally-funded community mental health programs. It is not a coincidence that the homeless populations in the state of California grew in the seventies and eighties. The people were put out on the street when mental hospitals started to close all over the state.
Perspectives & Analysis of Policy:
Idaho currently has two psychiatric hospitals State Hospital South in Blackfoot which provides inpatient treatment for adults and children. The hospital works in partnership with families and communities to enable clients to return to community living. The second state hospital is State Hospital North located in Orofino which is a 55-bed psychiatric hospital that provides treatment for adults in psychiatric crisis. The hospital is intended to be of short to intermediate duration with the objective of stabilizing presenting symptoms and returning the patient to community living in the shortest reasonable period of time. The commonality of these hospitals is to provide treatment for short durations of time and get them back into the community, a Band-Aid to the real problem, consistent care and consistent treatment.
The economic downturn has made an impact on the state of Idaho and the mass unemployment has exacerbated and caused deep cuts in the economic support of public money to the care and treatment of those with mental health issues. Gov. C.L. "Butch" Otter recommended budget for the Idaho Department of Health and Welfare's mental health services division during the next fiscal year, which begins July 1, is about $32.4 million. That's down 4.6 percent from the current fiscal year and a full 19 percent less than in 2008 two years after he took office. The division of Health and Welfare has laid off or left unfilled 35 full-time positions to assist adults with mental health problems, and another 14 positions to help Idaho youth. About 450 people in the past year have been referred to out of state mental health programs or to private providers amid the staffing cuts and budget holdbacks in 2009 and 2010.
Impact of Policy & Analysis:
Currently, Idaho has no published policy on the treatment of those with mental illnesses. Idaho uses many out of state resources to minimize the cost of dealing with the mentally ill. An example can be drawn from the use of the Oregon’s suicide hotline. Since Idaho does not currently have a hotline, people in crisis are directed to call the Oregon help center. Why? Simply put the state government does not have any financial obligation nor does it need to provide trained counselors or professionals to staff a state center. The State of Idaho provides state funded and operated community based mental health care services through Regional Mental Health Centers (RMHC) located in each of the seven geographical regions of the state.
The idea of deinstitutionalizing mental health care and the treatment of those who suffer from mental disorders was a well-intentioned idea, the failure to provide outpatient care that revolved around the idea of recovery and the ability to return and function in society is easily one of the biggest failures of the 20th century. Today, in many states including Idaho, the continuation of closing hospitals or limiting the number of beds by administrators and politicians are creating a problem that they either do not want to face or chose not to care. In many cases it is easy to point out problems but a harder task to offer suggestions that will change the direction social services will provide those who need the help. There are many possibilities that politicians and administrators can look at. Some of these are: