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Hippocrates was a pioneer in treating mental ill people with techniques not rooted in religion or superstition.

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Believed to be used by Hippocrates

The imbalance of humors, or dyscrasia, was thought to be the direct cause of all diseases.

The qualities of the humors influence the nature of the diseases they caused. Yellow bile caused warm diseases and phlegm caused cold diseases.

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Mentally ill were believed to be possessed or in need of religion.

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Bellevue Hospital, founded on March 31, 1736, is the oldest public hospital in the United States. Located on First Avenue in the Kips Bay neighborhood of ...Location‎: ‎462 First Avenue, ‎New York, NY

But it wasn't until he read David Oshinsky's book Bellevue: Three Centuries of Medicine and Mayhem at America's Most Storied Hospital, that he realized the hospital was a pioneering institution for all of American medicine.

Bellevue in the 18th century was really both a poorhouse and a pest house. It was a place you came to die. It really began with the great yellow fever epidemics of the 1790s. At that time the Bel-Vue estate, which became the hospital, was located on the East River, about two miles away from where most of New York was located down by the Battery. And you would send people who really had no chance of recovering.

Despite the early history, The hospital, has been in the forefront of many innovations in medicine in the U.S. Advances that started at Bellevue included ambulances, a maternity ward, nursing school, a children's clinic and forensic pathology.

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Pennsylvania Hospital, co-founded by Ben Franklin, and America’s oldest hospital

Pennsylvania Hospital was founded in 1751 by Dr. Thomas Bond and Benjamin Franklin "to care for the sick-poor and insane who were wandering the streets of Philadelphia.

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“Father of American Psychiatry,“

First to believe that mental illness is a disease of the mind and not a "possession of demons.“

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Negative attitudes towards mental illness persisted during this time and leading to stigmatization of mental illness. Moreover, unhygienic and degrading confinement of mentally ill individuals.

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McLean Hospital was first known as the “Asylum for the Insane,” a division of the Massachusetts General Hospital. The Asylum opened on Oct. 1, 1818

Note the oncoming train at the left side of the image. The expanding rail service brought about the end of the canal and river trade, and also helped prompt McLean to relocate to more a peaceful location.

In the 1840s, 1850s and early 1860s, the McLean Asylum in Somerville slowly lost its tranquil environment, deemed so important in the treatment of mentally ill patients. The Asylum had grown in size, including its number of patients, buildings and acreage. The railroads encroached on the land adjacent to the Asylum and by 1872, two tracks cut through the grounds.

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Was successful in lobbying for the establishment of state hospitals for the mentally ill.

Introduced the idea of state hospitals

Appointed as Superintendent of Women Nurses during Civil War

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Nellie Bly went undercover to expose abuse of the mentally ill

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Journey Into the Madhouse: Nellie Bly's Ten Days of Insanity

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Considered to be the first American Psychiatric nurse.

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In the early part of the 1900s

Experts began to try to understand what might make a person behave in an erratic way, and what kinds of thoughts and opinions might be attached to what outsiders would deem “madness.”

Innovative Therapies in the 1930s

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Developed by Egas Moniz, Portugal

It was a runaway hit with US physicians

This treatment had a firmer theoretical justification than the shock therapies

A simple surgical procedure that involved severing the nerve fibers of the frontal lobe

Between 1936 and 1951, at least 19,000 lobotomies were performed in the US

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Developed by Ugo Cerletti (Italian physician who believed in shock treatment but found insulin and metrozol too dangerous)

Was shown to work effectively, particularly with affective disorders and psychotic mood states

The problem was that diagnoses themselves was so shotty that it was hard to apply this treatment to the “right” patient

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Psychologist and father of psychoanalysis

Most influential and authoritative thinkers of the twentieth century.

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Based upon his observation that diabetic drug addicts treated with insulin in 1928 had a decrease in psychotic symptoms

By the mid-1930s he was routinely using this treatment in psychotic illness's

The hypoglycemic state resulted in a coma relieved by administration of sugar

Lacked a rationale theory and didn't’t work

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Based upon the observation that epileptics are rarely schizophrenic, he employed metrazol to induce convulsions

Many potential side effects to insulin and metrazol

Insulin comas were sometimes fatal and could induce seizures, pulmonary edema, and respiratory distress (mortality rate of 1 – 5%)

Metrazol was safer but could lead to fractures and respiratory distress

Still, these treatments became quickly in vogue and were to be found in every asylum and psychiatric hospital by 1940

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After 1945, the nation’s healthcare system underwent major changes as a result of:

Federal initiatives

The development of 3rd party insurance

A commitment to medical technology and specialization

The NIMH was established and so ended a long period of federal passivity in mental health policy

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Aka “therapeutic community”

Proposed that the environment of an asylum or hospital could assist in the treatment of the mentally ill by organizing a community or social organization which itself would be healing and toward which everyone is expected to make a contribution

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It helped to bring together biological and psychodynamic modalities found to be useful

Many effective drugs followed and helped move patients into the community

Necessitated all sorts of new practitioners (psych nurses, social workers, clinical psychologists)

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Community Mental Health Centers Construction Act (1963)

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Community Mental Health Centers Construction Act (1963)

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Medicaid provided a better reimbursement for nursing home care than for mental hospitals

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American physician who specialized in lobotomy.

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Social Security Disability Insurance (1972)

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Social Security Disability Insurance (1972)

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Social Security Disability Insurance (SSDI) was expanded to include the mentally disabled

The Social Security Act was amended to provide coverage for people who didn't qualify for benefits

SSDI and SSI made it still easier for the mentally ill to leave hospitals since federal payments would allow them to live in the community

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1981 with the Omnibus Budget Reconciliation Act

Reagan reversed 3 decades of federal involvement in the care of the mentally ill

Funding was shifted away from the federal government and to states and communities

Billions of dollars were eventually cut

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US Congress stated the 1990s would be the "Decade of the Brain"

U.S. president George H. W. Bush as part of a larger effort involving the Library of Congress and the National Institute of Mental Health of the National Institutes of Health "to enhance public awareness of the benefits to be derived from brain research".

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American Red Cross and Mental Health America published and distributed more than 250,000 copies of When the Yellow Ribbons Come Down. This was a book to help veterans form Operation Desert Storm and families to cope with readjusting to life at home.

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The first comprehensive conference on The State of Mental Health and Mental Illness in Black America.

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The first federal legislation to bring more equity to healthy insurance coverage of mental health care was secured, Mental Health Parity Act.

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President Bill Clinton enacted the Mental Health Insurance parity for federal workers to end discrimination in Mental Health insurance coverage.

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Landmark Supreme Court ruling declaring the death penalty for juvenile offenders unconstitutional. (Removed 73 individuals from death row)

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Mental Health Parity Act signed into law. This made it so insurers who did provide mental health coverage could not put limitations on benefits that are not equal to limits on other medical care coverage.

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DSM5 eliminated the term “gender identity disorder” which was considered stigmatizing, changed to “gender dysphoria: which focuses attention only o those who feel distressed by their gender identify.

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American Psychiatric Association changed the DSM5 definition of mental health to: A syndrome characterized by clinically significant disturbance in an individual’s cognitions, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associating with significant distress or disability in social, occupation, or other important activities. An expected or culturally approved response to a common stressor or loss such as the death of a loved one is not a mental disorder.

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Bipartisian support to prioritize hospitalization and court ordered treatment, focusing on integrating mental health into primary care and addressing mental health needs across the life span was added as a provision of the 21st Century Cures Act.