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Mental illness often viewed as supernatural—caused by demons, curses, or displeasure of gods. Treatments focused on religious and magical rituals, including incantations, prayers, and offerings (Parys, 2014).

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700 BCE - 500 CE - Ancient Greece and Rome

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700 BCE - 500 CE - Ancient Greece and Rome

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Hippocrates treatment focused on the imbalances of the four humors (blood, phlegm, yellow bile, black bile) by diet, exercise, and regulating (Kleisiaris et. al, 2014).

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During the middle ages those with mental illness was regarded as a punishment from God: sufferers were thought to be possessed by the devil and were burned at the stake, or thrown in penitentiaries and madhouses where they were chained to the walls or their beds. This didn't change until enlightenment when they were provided institutions for support (Rossler, 2016).

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middle ages mental health demon possessed

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Before the 1700s, drilling holes in the head (trephination/trepanning) was practiced globally from prehistoric times for head trauma, epilepsy, migraines, and mental issues, believed to release evil spirits or pressure

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Salem Witch Trials - persecution and execution of individuals, who were mostly women, being accused of witchcraft. Many were believed to be mentally ill, neurological conditions or neurodivergent (Quintanilla, 2010).

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In the 1700s, London’s Bethlem Royal Hospital (known as Bedlam) was notorious for treating mental illness through, and often inhumane, physical coercion rather than therapeutic care. Treatments included cold water immersion, bloodletting, purgatives, and heavy restraints (chains/handcuffs), while patients were notoriously exhibited to the public for amusement until 1770 (Bostridge, n.d.)

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Treatment of mental illness as something from evil spirits or witchcraft; individuals can be considered as witches or persecuted often treated within asylum using inhumane approaches such as being beat, chained, starved, or bled to keep them in control (Roberts & Farris Kurtz, 1987)

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Quakers aimed to care for mentally ill. They created a newly-opened Pennsylvania Hospital in Philadelphia provided rooms in the basement complete with shackles attached to the walls to house a small number of mentally ill patients (National Institutes of Health, n.d).

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1773: First State Hospital for Mentally Ill

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1773: First State Hospital for Mentally Ill

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First state hospital named the Public Hospital for Persons of Insane & Disordered Minds in Williamsburg, Virginia in 1773 where treatments included restraint, drugs, electric-shock treatment, "shock" water treatment, bleeding, and blistering salves (Strunk, 2014)

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In 1793, Philippe Pinel, a French physician, initiated a significant change in the care of the mentally ill at the Bicêtre Hospital in Paris. He removed the chains of patients, arguing for a more humane treatment based on compassion and understanding. This approach, known as moral treatment, laid the groundwork for modern occupational therapy by emphasizing the importance of environment and activity in healing (Weiner, 1992).

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Asylums implementing moral treatment, as reformed by Dorothea Dix, which promoted every state had at least 1 publicly supported asylum focusing on scall caseloads to promote improved relationships, patients of recent onset of illness, and public funding (George et al, 2023)

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Parrish medical officers in the United Kingdom were required to visit all paupers in their areas four times a year (National Archives, n.d).

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Their structural characteristics were subordinated to a certain approach to moral management: exposure to natural light, beautiful views and good air circulation. These hospitals used several architectural styles, but they all had a similar general plan with no more than 250 patients and included occupational tasks (laundry, farming, carpentry) as a form of treatment (Carlson, 2016).

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By the late 1800s, the United States had more than 150 mental hospitals, many of which became severely overcrowded as patient populations rapidly increased beyond available space and resources, leading to criticism of asylum conditions and treatment practices (George, 2023; National Library of Medicine, n.d.)

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Shift from suffering and restraint to promoting the use of engaging in occupations to help them potentially reduce or even remove restraints (Friedland, 2003).

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Patient population in state mental hospitals radically changed from serving primarily acute cases to also serving senile patients, those with chronic mental illness, and other diseases that required long-term or permanent custodial care, such as tertiary syphilis. Resulted in a 240 percent increase in the number of patients admitted to state mental hospitals from 1903 to the mid-20th century. The state mental hospitals again became largely custodial care facilities (George et al, 2023)

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The primary treatment for mental disorders was psychoanalytical therapy, also known as the "talking cure" along with custodia care (Thomason, 2005).

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1900s - Start of Mental Hygiene Movement

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1900s - Start of Mental Hygiene Movement

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Focus on reforming institutions to promote change to returning individuals back into the community instead of just being trapped in state hospitals for the insane (Bridges, 1928; Toms, 2015)

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1917: Founding of the Occupational Therapy Profession

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1917: Founding of the Occupational Therapy Profession

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The National Society for the Promotion of Occupational Therapy, now known as the American Occupational Therapy Association (AOTA), was founded on March 15, 1917. This marked the official beginning of the occupational therapy profession. The founders recognized the therapeutic value of occupation and aimed to improve mental health through purposeful activity, highlighting the vital connection between occupation and mental well-being (Anderson & Reed, 2024).

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Introduced in the 1930s and known collectively as "shock" therapies, these treatments consisted of three distinct, albeit overlapping, remedies: insulin, Metrazol, and electroconvlusive therapy (ECT). Insulin differed the most from the other two treatments in that it actually produced a state of physiologic shock but no seizures, while Metrazol and electricity produced grand mal seizures or convulsions but no physiologic shock (Braslow, 1999)

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The 1940s marked the beginning of deinstitutionalization in the United States, a movement aimed at treating mentally ill patients in community-based settings rather than large psychiatric hospitals. This shift emphasized the importance of social integration and occupational therapy's role in helping individuals develop the skills they need for daily living and work, promoting mental health recovery in a community context (George et al, 2023).

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President Harry S. Truman signed the National Mental Health Act. In addition to its broad purpose of improving “the mental health of the people of the United States,” the act enabled the founding, three years later, of the National Institute of Mental Health (National Institute of Mental Health, n.d.)

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Start of medication for treatment of mental illness, with the first antipsychotic starting in 1952, and anxiety and antidepressant medications emerging in 1950s such as benzodiazepines, tricyclic antidepressant, MAOIs

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1963: Community Mental Health Centers Act

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1963: Community Mental Health Centers Act

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Signed into law by President John F. Kennedy, the Community Mental Health Centers Act of 1963 was a landmark in mental health policy. It led to the establishment of community mental health centers across the country, providing a boost to the field of occupational therapy. Occupational therapists became key players in these settings, using their expertise to assist individuals with mental health issues in improving their quality of life through meaningful activities (Erickson, 2021).

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1980: Introduction of the Biopsychosocial Model

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1980: Introduction of the Biopsychosocial Model

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The introduction of the biopsychosocial model in the 1980s marked a paradigm shift in mental health care. This model emphasizes the importance of considering biological, psychological, and social factors in the treatment of mental illnesses. Occupational therapy aligns with this approach by assessing and addressing the comprehensive needs of individuals, thereby offering a holistic approach to mental health care (George & Engel, 1980).

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2008: The Mental Health Parity and Addiction Equity Act

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2008: The Mental Health Parity and Addiction Equity Act

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The Mental Health Parity and Addiction Equity Act of 2008 (enacted in 2010) requires insurance plans to provide the same level of benefits for mental health and substance use treatment and services that they do for medical and surgical care. This legislation has significant implications for the field of occupational therapy, by increasing access to occupational therapy services for individuals with mental health conditions (Friedman et al, 2018).

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The passage of the Affordable Care Act (ACA) expanded access to mental health and substance use disorder services by requiring many health insurance plans to include mental health coverage as an essential health benefit and strengthening mental health parity protections (U.S. Department of Health & Human Services, n.d.).

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2018: Occupational Therapy's Role in Mental Health Advocacy

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2018: Occupational Therapy's Role in Mental Health Advocacy

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Occupational therapists have increasingly taken on roles as advocates for mental health care reform. In 2017, the AOTA emphasized the profession's commitment to mental health, outlining the significant contributions of occupational therapy to mental health services. These include promoting mental health awareness, advocating for policy changes, and providing holistic care that addresses the psychosocial needs of individuals (Reitz et al, 2020).

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2024: Future Trends in Occupational Therapy and Mental Health

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2024: Future Trends in Occupational Therapy and Mental Health

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The field of occupational therapy continues to evolve, with emerging trends focusing on digital health technology, holistic and integrated care models, and increased recognition of occupational therapy's role in mental health globally. As we move towards 2024, these developments are expected to further solidify the importance of occupational therapy in promoting mental health, demonstrating the profession's adaptability and commitment to meeting societal needs (AOTA, 2024).

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References