A Brief History of the Care of Those with Mental Disorders and Developmental Disabilities in the United States

Over the course of more than 250 years in the United States, approaches to the treatment of those with severe mental disorders and developmental disabilities have undergone significant changes. These shifts have sometimes been driven by public will, sometimes by financial constraints, and sometimes by legal interventions; occasionally the changes have reflected clinically sound considerations. In brief overview this paper will examine the evolution of the role of asylums, the reliance on and eventual turning away from long-stay institutions as key custodial and treatment facilities, and the benefits and failures of deinstitutionalization. The documentation of abuses in many institutions, the reallocation of resources through cost shifting, and the transfer of sometimes vulnerable persons to community settings will be discussed. The impact of legislation and judicial rulings, scientific advances in the understanding of mental and developmental disorders, and the current funding uncertainties facing those with chronic conditions will be explored. Finally, examining the development of the patients? rights and recovery movements, the strategic focus on advocacy and anti-stigma campaigns, and the building of alliances in the context of inclusion will highlight the centrality of the persons affected by the many legal, economic, medical, educational, and quality of life concerns to be discussed.