Mental Health

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The Decline of Mental Hospitals, 1950s

April 27, 2012 in Mental Health, Mental Illness, Nursing Home, Nursing Homes | No comments

The movement of mental health care from mental hospitals to treatment in outpatient settings and nursing homes  began in the 1950s.  Here is how it happened.

“The field of medicine where the ‘rediscovery of community’ found an immediately welcome reception was mental health services.  A movement away from mental hospitals had already begun in the mid-1950s.  The national census of mental hospitals declined from a peak of 634,000 in 1954 to 579,000 by 1963.  The predominant, though contested, explanation for the drop is that the discover and introduction of major tranquilizers (e.g., Thorazine) was the decisive event.  Patients who were previously hospitalized could now be safely treated, or at least more safely ignored, on an outpatient basis.  Another interpretation points to the adoption by Congress in 1956 of amendments to Social Security that provided greater aid to states to support the aged in nursing homes. Mental hospitals had been filled with unwanted older people suffering only from a harmless senility.  By transferring such patients from mental hospitals to nursing homes, the states could transfer part of the cost of upkeep to the federal government.  Probably both drugs and nursing homes had some effect on the decline of mental hospitalization.”

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Mental Health and Substance Abuse Spending

October 7, 2010 in Mental Health, Supply of Medical Services | 2 comments

Although somewhat outdated, this report by Mark et al. (2007) provides a glimpse at trends in mental health and substance abuse (MHSA) spending.

National expenditures for the treatment of MHSA disorders amounted to $121 billion in 2003, up from $70 billion in 1993.  The average annual rate of (5.6%) was somewhat slower than spending growth for all medical services (6.5 %).  As a result, MHSA spending as a share of all health spending fell to 7.5 percent of the $1.6 trillion spent on all health services in 2003, from 8.2 percent in 1993.

From 1993 to 1998, a period of rapid expansion of managed care, the growth rate for MHSA expenditures was only 3.4% compared to 5.4% for all health services.  From 1998 to 2003 MHSA spending grew by 7.9 percent similar to the 7.7 percent for all health.

Of all MHSA spending, $100 billion was for mental health and $21 billion was for substance abuse.  The pie chart below gives the breakdown of payers for MHSA spending in 2003.

The next chart shows the distribution of MHSA expenditures by provider in the same year.

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