Care and Treatment of the Mentally Ill in the United States: Historical Developments and Reforms

Abstract

Three major cycles of reform in public mental health care in the United States--the moral treatment, mental hygiene, and community mental health movements--are described as a basis for assessing the shifting boundaries between the mental health, social welfare, and criminal justice systems. Historical forces that led to the transinstitutionalization of the mentally ill from almshouses to the state mental hospitals in the nineteenth and twentieth centuries have now been reversed in the aftermath of recent deinstitutionalization policies. Evidence is suggestive that the mentally ill are also being caught up in the criminal justice system, a circumstance reminiscent of pre-asylum conditions in the early nineteenth century. These trends shape the current mental health service delivery system and the agenda for policy-relevant research on issues involving the legal and mental health fields.