Mental Health Care: Past, Present and Future

MiKayla Pennings

Michigan Technological University

PSY2400 Health Psychology

Catherine Tislar

11/18/2021
 Dating back to the 1840’s, the compassionate heart of Dorothea Dix revolutionized the

future of mental health. The mental health field would not be where it is today if it were not for

her advocating for better facilities. Over the span of four decades, she assisted 32 psychiatric

hospitals with government funding. Though she lived in a time much different from the current,

she sparked the conversation for years to come as humans learned more about mental illnesses

and disorders. Mental health facilities now are heavenly in comparison but as with anything,

there is always room for improvement (“A Brief History of Mental Illness and the U.S. Mental

Health Care System.”).

A study done 2007 analyzed the data of mental health patients from 1990 to 2000. Per the

Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project, children and

adolescents under 18 years old who were clinically diagnosed with a mental health disorder

made up the data set. Between 1990 and 2000, the number of inpatient admissions was cut in

half. What would normally take professionals twelve days was now taking them only four and a

half. These routine evaluations, treatments, and discharges were being performed much quicker

and relied much less on transfers to intermediate levels of institutionalization. This decade is

solely responsible for the emergence of current mental health care and medications. Medical

professionals saw different results when looking at adult data though. Many believe that this is

because there was a shift to private institutions as opposed to state and county care. With a 48%

decrease in public facilities, there was an increase of 90% of adults admitted to private

institutions. Though this data sample has its limitations, the results indicate the change in

procedure over the years and the effectiveness of those changes. Professionals are now able to

get ahead of symptoms before they present themselves and before the response of selective

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serotonin reuptake inhibitors (Case, Brady G.). Using this data, looking at years that followed

can be better understood.

The routines implemented between 1990 and 2000 were later criticized. Brenda Happell’s

article Determining the effectiveness of mental health services from a consumer perspective, was

exactly what was needed to keep the snowball rolling towards better care. Consumers felt as

though they were not given the opportunity to voice their opinions about the instruments and

practices. In Australia, the Department of Health and Aged Care determined a way to measure

routine outcomes of mental health services. Currently, the Health of Nations Scale, Life Skills

Profile, and Behavior Symptom Identification Scale are being used. The Health of Nations Scale

uses 12 subcategories to measure behavior, impairment, symptoms and social functioning of

those diagnosed (“Health of the Nation Outcome Scale.”). The Life Skills Profile assesses a

person's ability, focusing on functioning rather than clinical symptoms (“Life Skills Profile

(LSP-16).”). Lastly, the Behavior Symptoms Identification Scale combs through a diagnosis and

looks specifically at depression and functioning, relationships, self-harm, emotional ability

psychosis, and substance use or abuse (Marcus, Ruthanne.). Although these scales cover a

variety of topics, they have been criticized for not including what patients care about most when

it comes to their mental health care. Recovery is just as important as the disorder itself to keep

from a vicious cycle beginning.

This article was designed to build off of what is already known and add in the voices of

patients who have experienced going through recovery. Results found that medication was a

major concern for patients. They felt more comfortable when they were listened to about their

wishes and concerns. Countless patients specifically mentioned the use of cigarettes to help calm

anxiety and panic ridden people. Professionals view cigarettes as a form of self-medication or

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coping mechanism, though it is not a healthy option. Finding support in others is crucial to

recovery, even though it is not seen nor recognized as a therapeutic technique. Brenda Happell’s

findings can be applied to more than just Australia’s medical field. Professionals globally can

have the opportunity to learn from others and model these changes with patients of their own. If

the rest of the world were to follow suit perhaps there would be more policies like Australia’s

that clearly dictates that patients must play an active role in their care and treatment (Happell,

Brenda).

Looking deeper into recovery, a study was conducted to better determine what the agreed

upon definition was and what it meant to those who have been through it before. The participants

of this data collection must have experienced problems for at least two years and consider

themselves to be improving. The interviews found that personal definitions of recovery followed

the same two trends. The common themes involved the ability to get rid of negative feelings and

acquiring positive feelings. Researchers took this to mean that most people struggle in one of two

directions. Some responses indicated valid turning points in people’s recovery such as finally

being listened to, accepted, making the conscious decision to be better, or even changing their

medication. Quotes directly from patients mentioned seeing negative examples in those who did

not want to recover and then using that as fuel to be better themselves. Because most responses

fell into one category or the other, it was concluded that there are more similarities in the

personal definition of recovery than there are differences. Those who never wanted to reach that

point were considered to be fighting. Those who continued to fight were striving for peace of

mind, no worries, and the ability to function normally in society by going to work and socializing

with others. Giving up meant accepting the disorder, handing over control of care to others, and

accepting their new identity where the disorder has overwhelmed their personality. Though this

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study was done with a relatively small sample size, the information is valid and should be

considered across the globe (Kartalova-O'Doherty, Yulia, and Donna Tedstone Doherty.).

For those who find themselves repeatedly in psychiatric care, there have been studies

done in attempt to predict the signs and symptoms of recurring visitors. Psychiatric Services used

patients who had visited emergency psychiatric care at least three times in the past year. Medical

records were pulled for over 4,000 patients and around 5% of that sample had visited three or

more times in 2008. Of that 5%, 22% of these patients also visited at least three times in the

following years. It was determined that sociodemographic factors such as age, gender, marital

status, professional activity, and citizenship were not able to be used as predictors. However, the

specific diagnosis and recurrent use proved to be significant. Patients with personality disorders

were found to use emergency psychiatric care more frequently than those dealing with mood,

substance use, anxiety, and psychotic disorders. Two percent of adult patients using the

University Hospital of Geneva were repeat visitors and typically generated anywhere from 21%

to 65% of clinical activity. Due to the nature of these visits, they have since become a significant

financial burden. Some patients experienced negative attitudes from professionals and negative

reactions due to the fact that their conditions are not seen as urgent.

This study was the first of its kind to focus on prevalence, sociodemographic categories,

and clinical aspects. The results concluded that borderline personality disorder was the leading

diagnosis of those who were frequent fliers. This could be for a number of reasons including the

continuation of misdiagnoses and underdiagnosis of the disorder. Borderline personality disorder

is often conjoined with other disorders and makes it difficult to establish a therapeutic technique.

Researchers suggest professionals look into the pattern of visits when dealing with a patient and

including some sort of on-site follow up procedure (Richard-Lepouriel, Hélène, et al.). Those

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who are frequent visitors may benefit from having outpatient facilities that ensure better access

to care than emergency settings.

One of the biggest conversations surrounding mental health is suicide. Many suicide

attempts lead to hospitalization or institutionlization. The American Journal of Psychiatry

published an article back in 2005 that evaluated the role that mental health facilities and the care

they provide played in the rates of suicide. Previous literature implies suicide rates after being

discharged from a facility are directly linked to the quality of care. Not only are suicides

commonly seen immediately following discharge but the lack of adequate medication, contact

with health professionals, and follow-up care may be putting them at a greater risk of success in

their attempts. The participants of this sample included in this study were diagnosed with major

affective disorder, bipolar affective disorder, posttraumatic stress disorder, or schizophrenia.

The Veterans Affair health care system is one of the largest in the world, tending to poor

and disabled military veterans. Roughly 60% of stays at the VA are patients with schizophrenia,

psychoses, and PTSD. Using the National Death Index and social security numbers, researchers

were able to merge the data and determine the number of patients who were deceased within a

year of being discharged. Of the 121,933 patients in this study, 3,588 were deceased within a

year and 481 died by suicide. Forty-six percent of patients were deceased within the first three

months, 18.3% between four to six months post-discharge, 20.4% between six to nine months,

and 15.4% between nine to twelve months. Data from 128 VA hospitals across the nation

indicated that there were 44.53 suicide deaths per 10,000 people each year. It also suggests that

there is a discernable variation from facility to facility and that some aspects of service delivery

are associated with suicide risk. This tells researchers that there is not necessarily a problem in

the delivery of service but a problem with lack of individualized care. Those who find

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themselves having suicidal ideations or attempting suicide are at their highest level of risk within

the first year of being discharged. Cases of suicide should not be investigated under the intention

of finding out what could have prevented it. Instead, cases of such should be looked at towards

the future. With post-discharge being the time of greater risk, the intervention of predischarge

assessment, follow-up procedures and rehospitalization when needed have the ability to change

the future predicted statistics (Desai, Rani A., et al.).

The future of mental health is in the hands of medical professionals, researchers, and

scientists. It is up to them to reevaluate their procedures and methods when dealing with mental

health patients. The diagnoses today may not be the same as they were in years past nor is it clear

if they will stand the test of time. Until the future becomes the present, looking at how to

improve the mental health field within the near future is the next best thing. Suicides are still

occuring every day. Patients are still being ignored and pushed to the side due to other more

urgent patients.

In order to better understand what mental health facilities and treatments are like, I spoke

with several people about their own experiences as a patient at an inpatient mental health facility.

Though I heard a number of positive responses to the care and environment they experienced,

there were also several negatives that presented themselves. I created a questionnaire to use as a

template when speaking with each person. I asked their age at the time they were admitted, how

long their stay was, what the conditions were, and if they would do it all over again if they had

to. Those who responded negatively had very valid reasons as to why they would encourage their

younger self to take a completely different route to avoid being admitted. Everyone who took

part in my research gave me permission to disclose the information in hopes it would spark more

conversation.

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 Ginny was admitted three times over the course of her life. The first time she was only 12

years old and spent 3 months as an inpatient. The second time she was 16 years old and was

admitted for only a week. The last time she was admitted, she was only put on a 72 hour hold.

She spoke very highly of the care she received as a child and adolescent but was disgusted by the

way she was treated as an adult. Her and her friends, who have also been through similar things,

all agreed that the care they received in their younger years surpassed the way they felt later on

in life. She was given little to no interaction with medical professionals even though she was

admitted to have her stomach pumped. The nurses she did speak with told her what to do to get

her out of there quicker, leaving her to feel as if she was wasting their time. While this may have

just been the nurses she did come in contact with, there are other people who have had similar

experiences.

Another young man I spoke with felt the same way. Skyler was admitted to a facility at

only 13 years old due to his anger issues and suicidal ideations. What was supposed to be a two

week stay, ended short after only three days when he begged his mother to take him home. He

did not want to stay in a place where he felt disrespected, was isolated when he expressed

feelings of sadness, and got woken up by a flashlight in the middle of the night as they checked

rooms. He was admitted before COVID had reached the United States and yet at the time he was

forced to stay at least 6 feet away from any and all other patients.

Natalie experienced something close to the same. Like Ginny, she was admitted three

different times. However, all three times were within a year and a half. The first two times she

was admitted to the same place and each experience was just as awful. She was given only one

snack throughout the day, was kept in her room for hours at a time while being told it was for the

shift change, and when the air conditioner broke in the hospital she was forced to stay in a long

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sleeved shirt. The balmy temperatures made it unbearable but patients were told to keep their

sleeves down to cover any self harm scars as they may be triggering to others.

Though a close friend of mine was never fully admitted, at only 10 years old she was

given the option to. She did not even fully understand what her diagnosis was at the time so the

idea of leaving home to be surrounded by sterile equipment and strangers was terrifying.

Through her years of dealing with mental health she went through countless doctors, therapists,

and psychologists just trying to find one that would sit, listen and not judge her. Some of those

professionals along the line even went as far as to write her a prescription without hearing her

out about her concerns and questions. She was handed the medication and told to take it. She

often felt as though she was being accused rather than having the problem be addressed. These

people are friends, parents, and siblings of regular people. They are living, breathing proof that

mental health does not discriminate and there is always room for improvement.

Though humans have learned throughout the years, it should not stop there. Across the

globe people struggle with mental health. The efforts of research do not go unnoticed but

sometimes what goes on behind the curtains does go unnoticed. Patients every day are reaching

out in an attempt to get help and should not be ignored for their efforts. Everyone deserves the

resources and help that they need to live a long, happy, satisfying life. Recovery is a vital part of

mental health and is not reserved just for those who are getting over an event. There is more that

can be done to improve the lives of people with mental health disorders. Professionals are the

head of the revolution and should be held up to higher standards when dealing with mental health

patients. Although some may speak highly of their experience, the ones that need to be heard the

most are the ones who did not have an enjoyable experience. Until everyone receives the care

they deserve and need, the mental health field should continue to push forward towards better.

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Resources:

“A Brief History of Mental Illness and the U.S. Mental Health Care System.” Unite for

Sight, https://www.uniteforsight.org/mental-health/module2.

Case, Brady G., et al. “Trends in the Inpatient Mental Health Treatment of Children and

Adolescents in US Community Hospitals between 1990 and 2000.” Archives of General

Psychiatry, JAMA Network, 1 Jan. 2007,

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/209961.

Desai, Rani A., et al. “Mental Health Service Delivery and Suicide Risk: The Role of

Individual Patient and Facility Factors.” American Journal of Psychiatry, Psychiatry

Online, 1 Feb. 2005, https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.162.2.311.

Happell, Brenda. “Determining the Effectiveness of Mental Health Services from a

Consumer Perspective: Part 1: Enhancing Recovery.” Wiley Online Library, John Wiley &

Sons, Ltd, 28 Feb. 2008,

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1447-0349.2008.00519.x.

“Health of the Nation Outcome Scale.” Physiopedia,

https://www.physio-pedia.com/Health_of_the_Nation_Outcome_Scale#:~:text=The%20He

alth%20of%20the%20Nation,64%20years%20old%20age%20group.&text=Rate%20items

%20in%20order%20from,information%20in%20making%20your%20rating.

Kartalova-O'Doherty, Yulia, and Donna Tedstone Doherty. “Recovering from Recurrent

Mental Health Problems: Giving up and Fighting to Get Better.” Wiley Online Library,

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John Wiley & Sons, Ltd, 6 Jan. 2010,

https://onlinelibrary.wiley.com/doi/full/10.1111/j.1447-0349.2009.00636.x.

“Life Skills Profile (LSP-16).” AMHOCN, 15 Aug. 2016,

https://www.amhocn.org/publications/life-skills-profile-lsp-16.

Marcus, Ruthanne. “Use of Behavior and Symptom Identification Scale-24 Measurements

for Opioid Agonist Treatment Self-Assessments in Ukraine.” National Institute on Drug

Abuse, 15 Aug. 2018,

https://www.drugabuse.gov/international/abstracts/use-behavior-symptom-identification-sc

ale-24-measurements-opioid-agonist-treatment-self-assessments#:~:text=Background%3A

%20The%2024%2Ditem%20Behavior,%2C%20psychosis%2C%20and%20substance%20

use.

Richard-Lepouriel, Hélène, et al. “Predictors of Recurrent Use of Psychiatric Emergency

Services.” Psychiatric Services, Psychiatry Online, 2 Feb. 2015,

https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201400097.

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