For persons with severe mental illness, hospitalization has been the treatment of choice in the United States for the past 150 years. Several different kinds of hospitals offer such care. General hospitals admit many affected people, usually for short-term stays until they can be released to their families or to other institutional care. Private hospitals—some non- profit and some for profit—offer services to people with adequate insurance. Veterans Administration hospitals admit veterans with psychological disorders.
When most people think of “mental hospitals,”however, large, state-run institutions come to mind. These public hospitals, many with beds for thousands of patients, were often built in rural areas in the 19th century. The idea was that a country setting would calm patients and help to restore their mental health. Despite the good intentions behind the establishment of these hospitals, in general they have not provided adequate care or therapy for their residents, as they are perpetually underfunded and understaffed. Except for new arrivals, who were often intensively treated in the hope of quickly discharging them, patients received little therapy besides drugs; and most spent their days watching television or staring into space. Under these conditions, many patients became completely apathetic and accepted a permanent “sick role.”
The development of effective drug therapies starting in the 1950s led to a number of changes in state hospitals (Shorter, 1997). First, people who were agitated could now be sedated with drugs, which was considered an improvement over the use of physical restraints. The second major, and more lasting, result of the new drug therapies was the widespread release of people with severe psychological disorders back into the community—a policy called deinstitutionalization.