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 MENTAL HEALTH HISTORY (Institutionalization / Transinstitutionalization) 

The shift of focus from physical health to mental health (ensuring the well being and psychological condition of the patient) has been a slow process and rather a recent development. Globally in early history, mental illness was viewed as a religious issue. In ancient Greek, Roman, Egyptian, and Indian writings, mental illness was viewed as a personal issue and religious castigation. In the 5th century B.C., Hippocrates was the first pioneer to address mental illness through medication or adjustments in a patient’s environment. Although his work was greatly influential, views on religious punishment and demonic possession persisted through the Middle Ages.

In American history, mentally ill patients were thought to be religiously punished. This response persisted through the 1700s, along with inhumane confinement and stigmatization of such individuals. Dorothea Dix was an activist who advocated for better treatment of the mentally ill. From 1840-1880, she won over the support of the federal government to set up over 30 state psychiatric hospitals; however, they were understaffed, under-resourced, and were accused of violating human rights. This issue led to the deinstitutionalization of federal mental hospitals and adoption of community mental health services. The closure of state-provisioned psychiatric hospitals was enforced by the Community Mental Health Centers Act in 1963 that laid out terms in which only patients who posed an imminent danger to others or themselves could be admitted into state facilities. This was seen as an improvement from previous conditions, however, there still remains a debate on the conditions of these community resources.

It has been proven that this transition was beneficial for many patients: there was an increase in overall satisfaction, better quality of life, more friendships between patients, and not too costly. This proved to be true only in the circumstance that treatment facilities that had enough funding for staff and equipment as well as proper management. However, this idea is a polarizing issue. Critics of deinstitutionalization argue that poor living conditions prevailed, patients were lonely, and they did not acquire proper medical care in these treatment homes. Additionally, patients that were moved from state psychiatric care to nursing and residential homes had deficits in crucial aspects of their treatment. Some cases result in the shift of care from health workers to patients’ families, where they do not have the proper funding or medical expertise to give proper care. On the other hand, patients that are treated in community mental health centers lack sufficient cancer testing, vaccinations, or otherwise regular medical check ups.

Other critics of state deinstitutionalization argue that this was simply a transition to “transinstitutionalization”, or the idea that prisons and state-provisioned hospitals are interdependent. In other words, patients become inmates. This draws on the Penrose Hypothesis of 1939, which theorized that there was an inverse relationship between prisons’ population size and number of psychiatric hospital beds. This means that populations that require psychiatric mental care will transition between institutions, which in this case, includes state psychiatric hospitals and criminal justice systems. Thus, a decrease in available psychiatric hospital beds occurred at the same time as an increase in inmates. Although some are skeptical that this is due to other external factors, others will reason this conclusion to a lack of empathy for the mentally ill. There is no argument in the social stigmatization of those with mental illnesses, they have been widely marginalized and discriminated against in society. In this source, researchers analyze how most compensation prisoners (detainees who are unable or unwilling to pay a fine for petty crimes) are unemployed, homeless, and with an extraordinarily high degree of mental illnesses and substance abuse. Compensation prisoners then lose prospective job opportunities, face social marginalization, and lack access to resocialization programs which ultimately facilitate reoffending. The research sheds light on how the mentally ill — and in this case, the poor— are further punished for certain circumstances that are beyond their control, and that this is a vicious cycle that repeats itself. Thus, prisons embody another state-provisioned mental hospital.

As the debate continues, families of patients, advocates, and mental health professionals call for the increase in more well-structured community facilities and treatment programs with a higher quality of long-term inpatient resources and care. With this more structured environment, the United States will continue with more access to mental health care and an increase in overall treatment of the mentally ill.

 MENTAL HEALTH YOUTH PREVALENCE 

According to 2020 data, mental illnesses are stagnant among adults, but rapidly deteriorated among the youth, categorized as 12 to 17 year olds. To give insight on the severity of mental health in children, 13% of youth in America reported suffering from at least one Major Depressive Episode (MDE) in the past year, with the worst being 18% in Oregon. Only 28% receive consistent treatment and 70% are left untreated. In lower income communities, it is more common to forego treatment as a result of financial resources. Being left untreated also leads to unhealthy coping mechanisms such as substance abuse, which in turn causes its own host of mental health issues.

 MENTAL HEALTH US STATE POLICIES 

Concerning U.S. state policies, only three states have approved mandatory mental health curriculums. In July 2018, New York and Virginia passed legislation that made mental health instruction mandatory in public education. This is correlated with the CDC reporting a 30% increase in US suicide numbers over the last 20 years. New York has made it mandatory for students from Kindergarten to 12th grade to undergo mental health instruction. After experiencing traumatizing suicidal behavior with his own son, the governor of Virginia thought it necessary to teach warning signs to 9th and 10th graders so they can look out for the safety of their peers and themselves. The board of education is in charge of deliberating details of the curriculum but the governor is hopeful that teachers will also receive training on warning signs. Even though investment in mental health has never been higher, the state legislature has yet to approve extra funding to implement the curriculum. In July 2019, Florida’s board of education made 5 hours of mental health education mandatory for grades 6 through 12, making it the third state to approve such instruction. There are no federal requirements in place, however, after COVID-19, a rise in mental health awareness and approval of policies is expected. This prediction is based on the increased isolation of the elderly, xenophobia against people of Asian descent, and resulting mental health effects of large-scale quarantine and business closures.

 ART THERAPY HISTORY 

Art therapy, combining studies of psychology and art, emerged much later. This type of unconventional therapy is used to cultivate self-esteem and awareness, improve cognitive and motor abilities, resolve conflicts or stress, and inspire resilience. It invites sensory, kinesthetic, perceptual, and sensory symbolization to address issues that verbal psychotherapy cannot reach. The term “art therapy” was coined in 1942 by Adrian Hill, and the practice itself began as a profession in the mid-20th century. Art had been used at the time for various reasons: communication, inducing creativity in children, and in religious contexts. Then, in 1915, Margaret Naumburg— credited as being the primary founder of American art therapy— established the Walden school in New York with the goal of bringing repressed thoughts and emotions to light. From this point forward, art therapy has continued to gain supporters as it emerges as an upcoming field today.

 ART THERAPY EFFICACY 

It is difficult to measure the efficacy of art therapy as it treats various mental illnesses to different degrees. A systematic literature review compiled and evaluated different research studies with the following seven conclusions. Among cancer patients, researchers found that relatively short-term art therapy interventions significantly improved patients’ emotional states and perceived symptoms. This was mainly among women with breast cancer and included a study on mindfulness-based art therapy. The second category included other medical conditions such as advanced heart failure, AIDS/HIV, and obesity. However, the only conclusive evidence found in this study is that they observed significant weight loss in patients with obesity. There is not enough research to draw conclusions on other medical conditions, except that it helps with a range of psychological symptoms. For mental health disorders, there is evidence that it has positive effects on all patients except those with schizophrenia, where cognitive-behavioral therapy has proven to be the most effective. The fourth category is trauma, however, there were no significant results in this field. There would need to be a longer intervention period proving that long-term art therapy has the potential to be successful in the alleviation of trauma. Geriatric group art therapy has proven to be significantly useful in helping depression for the elderly, although not particularly with dementia patients. And finally, the last category was related to people with ongoing daily challenges: art therapy helped reduce levels of stress and burnout related to patients’ professions. Overall, this survey publication revealed that both the high level of variability (such as incorporating talk therapy) and limited number of studies done with certified art therapists made it difficult to generalize over findings. Despite these limitations, art therapy has, to an extent, proved its efficacy in relieving symptoms and improving quality of life.