Table of Contents

Series Foreword xiii

Preface xv

Part I Overview 1

1 Background and Definitions 3

What Is Mental Health, Mental Illness, and Discrimination? 3

What Is Mental Health? 3

What Is Mental Illness? 5

What Is Discrimination? 7

How Many People Are Affected by Mental Illness and Discrimination? 10

Early Documentation Efforts 10

Current Challenges in Documenting Mental Illness 11

Current Data on Mental Illness 13

Gender Concerns 14

2 Changing Belief Systems and Historical Treatment of the Mentally Ill 17

Ancient Beliefs 17

Medieval Beliefs 20

Modern Beliefs 23

The Renaissance 23

The Reformation 24

Beliefs in the Age of Reason 26

Early American Beliefs 26

Moving toward Scientific Causes of Mental Illness 32

3 Discrimination and the Formation of a Modern System of Care for the Mentally Ill 35

The Madhouses 36

The Elizabethan Poor Law of 1601 36

The Madhouse Act of 1774 38

The County Asylum Act of 1808 39

The Poor Law Amendment Act of 1834 40

The County Asylum Act of 1845 and the Lunacy Act of 1845 41

The Lunatic Amendment and County Asylum Amendment Acts of 1853 and 1862 44

Metropolitan Poor Act of 1867 46

The Lunatics Law Amendment Act of 1889 and the Lunacy Act of 1890 48

4 Early American Society and Discrimination against the Mentally Ill 51

Almshouses, Poorhouses, and Workhouses in the United Slates 52

Dorothea Dix 53

Early Hospitals and Asylums in the United States 56

Dr. Benjamin Rush and the Pennsylvania Hospital 57

Francis Fauquier and the Eastern State Hospital 59

The New York Hospital and the Bloomingdale Asylum 60

The Public Hospital of Baltimore (Spring Grove) 61

Thomas Scatlergood and the Friends Hospital 61

Reverend Louis Dwight, the Massachusetts General Hospital, and the Worcester Lunatic Asylum 62

Thomas Story Kirkbride and the Pennsylvania Hospital for the Insane 63

5 How Treatment Movements Influenced Discrimination against the Mentally III 67

The Movement toward Physical Treatments 67

The Medication Management Movement 69

Approaching Mental Illness as Public Health 72

What Is the Public Health Approach, and How Does It Relate to the Mentally Ill? 72

How the Public Health Approach Affects Discrimination 74

Deinstitutionalization and Community Mental Health Centers 77

Persistent Overcrowding 78

The Costs of Treating Mental Illness 79

The United Kingdom and Other Developed Nations 81

Approaching Mental Illness as a Disability 82

What Is the Disability Movement? 82

The Connection between the Disability Movement and Mental Health Advocacy 82

Approaching Mental Illness as a Behavioral Health Issue 85

What Is Behavioral Health? 87

How a Behavioral Health Approach Can Affect Treatment and Discrimination 88

6 Forms of Discrimination against the Mentally Ill and the Influence of Diversity 89

Basic Human Rights of the Mentally Ill 89

How Federal and State Laws Affect the Rights of the Mentally Ill 93

Limits of Confidentiality and Privacy 93

Educational Discrimination 97

Lack of Educational Supports for the Mentally Ill 97

Elementary and Secondary Education Act (ESEA) 98

Restrictive Policies Adopted by Educational Institutions 99

Cultural Discrimination 100

Social and Religious Beliefs about the Causes of Mental Illness 100

How the Mentally Ill Are Portrayed in the Media 100

Political Discrimination 102

Political Attitudes toward the Mentally Ill 102

Their Participation in the Political Process 103

How Diversity and Discrimination Affect the Mentally Ill 104

Gender Differences 105

Age Differences 105

Differences in Racial/Cultural/Ethnic Identity 105

Sexual Identity Differences 106

Part III Controversies 109

7 How Comorbidity Affects Discrimination 111

Mental Illness and Substance Use Disorders 111

Nicotine Use Disorder 112

Medication-Assisted Treatment 113

Other Issues and Controversies 114

Mental Illness and Other Chronic Health Disorders 118

Mental Illness and Gambling 120

Mental Illness and Neuro-Developmental Disorders 123

Defining Neuro-Developmental Disorders 123

How Many Children Are Affected? 124

Potential Causes and Outcomes 124

Treating Co-Occurring Disorders 127

Who Provides Treatment and Where? 127

Medical Staff 127

Nonmedical Staff 128

Treatment Locations 129

Mental Illness and PTSD-The Veteran Connection 132

What Is Stress? 132

The Stress Response 133

Trauma 134

Responding to Veterans 135

Suicide 136

PTSD Indicators 137

Suicide Indicators 138

Issues Contributing to Ongoing Discrimination 138

8 Mental Illness and the Criminal Justice System 141

Who Are the Criminally Insane? 141

Historical Treatment of the Criminally Insane 141

Current Estimates of the Criminally Insane 143

Problem-Solving Court Model 144

Training of Correctional Personnel 146

Civil Rights of Institutionalized Peoples Act (CRIPA) of 1980 147

Approaches to Public Safety 147

Scarce Resources 149

Legal Representation 149

Rehabilitation versus Punishment 151

Post-Incarceration Resources 152

Voluntary and Involuntary Commitment 154

2-PC or Two Physicians Certify 154

Mandatory Medication Management 157

Voluntary 157

Involuntary 158

9 Preventing Discrimination against the Mentally Ill 161

Is Discrimination Preventable? 163

What Are the Ways to Prevent Discrimination? 163

Focusing on Prevention 163

Changing Societal Attitudes 164

Ensuring Access to Quality Medical and Psychiatric Health Care 166

Part III Resources 171

Sources for Further Information 173

Important Documents 177

Glossary 203

Timeline 207

Index 217

About the Author 237