Congress enacted legislation to extend grants to aid construction of facilities for research and treatment of people with mental disabilities and illnesses, the first such disability rights legislation in the United States.
In the 1960’s, there were an estimated 5.4 million people in the United States who were mentally ill or mentally disabled in varying degrees. Developmentally disabled individuals for many years were not assured the basic rights afforded nondisabled people. People with mental disabilities and illnesses were relegated to the status of second-class citizens, and therefore few services were provided to aid in improving their daily lives. Nonetheless, many families of mentally disabled children continued to raise them in their own homes.
Still, many children who were mentally ill or disabled were assigned to “special” schools because they were identified as being unable to learn. It was hoped that they could be “trained,” rather than educated, to become functioning adults. They were also presumed to need teaching in morals and ethics, since this was not considered inherent in their natural abilities. Many special schools were located far from children’s homes, thus removing them from concerned family and friends.
Usually, adults who were mentally ill or disabled were involuntarily placed in institutions, where they could be “hidden” from public view. These institutions, on the whole, had very poor conditions. Most were overcrowded, unsanitary, and extremely unpleasant. There was little in the way of education or training for the residents. School programs designed to teach turned into rote exercises administered by drill masters; the training programs, which focused on farm and garden activities and laundry and kitchen skills, became unpaid institutional maintenance assignments instead of programs teaching skills to help patients integrate into the community. Many residents of these institutions spent their days on drugs that were intended to calm, and pacify, them. Some states spent as little as two dollars per person per day on care for people who were mentally disabled; the average was only four dollars.
Charges of mistreatment and neglect by these institutions became more and more frequent. Part of the problem was that the specific causes of mental illness and disability were unknown. Often, mentally ill persons were neglected because their illnesses were misunderstood and clouded by superstitions and irrational fears. Developmentally disabled people were stereotyped as unstable, temperamental, and morally deficient. Furthermore, because mental illness was believed to be uncontrollable and also unchangeable, it was thought that medicine would be ineffective as a treatment. The only “cure” was to perform surgery, induce physical pain and “compliant” behavior through electric shock, or prescribe medications, for example.
As more scientific research was completed in the area of mental illness, people began to realize that mental disease was often the result of chemical imbalances in the brain rather than of uncontrollable factors. As more of the causes of mental illness began to come to light, the population of needy people received more attention. It was recognized that, in many ways, the mentally disabled and ill simply needed more help than others throughout their entire lives. Their needs included special education, health maintenance, legal protection, daily care, and sometimes community services. It was also recognized that their needs, to a great extent, depended on their age and degree of mental illness.
During the 1950’s and 1960’s, mental disease and illness in the United States began to get more recognition. Individual states would soon be involved. New York passed the first state-county mental health law, which provided state financing to county programs. The law’s goal was to spend as much money outside state hospitals as inside state hospitals. The federal government also began to get involved. President Dwight D. Eisenhower
The final report was given to then-President John F. Kennedy. Kennedy, a major supporter of the rights of the mentally ill, had a sister, Rose, who was mentally disabled. Kennedy’s father, Joseph P. Kennedy
Kennedy believed the nation could save money by helping the mentally ill learn how to work in society and lead productive lives outside institutions. He appointed a special panel to study mental disability. The panel examined many facets of mental illness, including questions of program development. It found, among other things, that only a small percentage of the mentally ill in the United States were so severely disabled that they required constant care or supervision. This and other specific recommendations formed the primary basis of Kennedy’s message to Congress, which in turn formed the basis of the Community Mental Health Centers Construction Act.
On February 5, 1963, Kennedy spoke to Congress on mental illness and disability. In his speech, he called for a “bold new approach” to the issue by federal, state, and local governments. In the message, he requested that federal funds be transmitted to states so that they could detect, treat, and rehabilitate those identified as mentally ill. He said he wanted to get away from simply institutionalizing those who were mentally ill, and he soon made a series of recommendations about mental illness. He recommended that a matching-grant program be instituted to allow states to build community health centers. He requested federal grants for maternity and child health services to combat the problem of mental disability. He supported special education programs for mentally disabled children and increased teacher training, including improved vocational training. Finally, he supported federally financed research into the causes and prevention of mental illnesses.
After the message of February 5, hearings were held in the Senate on two separate bills directly relating to the recommendations proposed by Kennedy. The bill’s floor manager was Senator Abraham A. Ribicoff, a Democrat from Connecticut. A few weeks later, similar hearings began in the House of Representatives. The floor manager was Representative Wilbur Mills, a Democrat from Arkansas. The bill had tremendous support in both the House and the Senate. Supporters of the bill believed that the concept of community health centers could lead to the treatment of many in their homes and decrease the populations of state mental hospitals. The bill became law on October 31, 1963, on Kennedy’s signature.
The Mental Retardation Facilities and Community Mental Health Centers Construction Act authorized construction of research centers. Between 1965 and 1967, $27 million was expended to establish twelve centers. A Mental Retardation Branch and the National Institute of Child Health and Human Development were developed to administer the research centers’ policies. University Affiliated Facilities, or UAFs, were built as part of the act. Between 1965 and 1971, $38.5 million was allocated to eighteen UAF sites. A Community Facilities Construction Program was also part of the act. This helped individual states build specially designed facilities for the diagnosis, treatment, education, training, and personal care of the mentally ill. The program received $90.2 million between 1965 and 1970.
The centers were small, centrally located buildings that provided a wide range of psychiatric programs. These included inpatient and outpatient facilities, day- and night-care services, emergency services, precare and aftercare follow-up, rehabilitation clinics, halfway houses, and foster care. There were facilities for training and research and for the evaluation of programs. These programs were located within communities, thereby increasing the availability of psychiatric services to community residents. In this way, mental illness could be diagnosed and treated before hospitalization was necessary. If hospitalization became necessary, separation from family and community would be minimized. This was the first time the federal government took a leadership role in the field of mental illness.
In his speech of February 5, Kennedy had recognized that the United States had not seen much progress in understanding, treating, and preventing mental disabilities. Kennedy also recognized the importance of the role of the federal government in assisting, stimulating, and channeling public energies to help address the issue. Kennedy wanted to return a large proportion of the mentally ill to useful lives and, through research, cut the number of new cases.
After Kennedy’s assassination, President Lyndon B. Johnson and Congress continued to support the initial goals set forth by Kennedy. The first federal grant to finance on-the-job training for mentally disabled youth was given to a New York company. The money was used to train ninety mentally disabled youths for a variety of jobs. These jobs included key-punching, typing, and glass etching. It was expected that, after the training, the youths could obtain private employment.
The Johnson administration continued to fund research programs associated with the new law. Money was allocated for many research grants to qualified personnel to investigate the causes and treatments of mental illness. Other groups also became involved in seeking appropriate solutions to the issues surrounding mental health. For example, the American Medical Association held a series of conferences to seek ways to prevent, address, and treat mental illness.
Mental health institutions changed as well. They began to include private institutions with cottages containing social rooms, classrooms, extensive playgrounds, and arts and crafts centers built to meet current recommended standards in the field. The goal was to encourage students to participate actively in the community. On a broader level, those who had sponsored the act hoped the act would change the way Americans thought about mental disease and disability; it has, to a great degree.
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Noll, Steven, and James W. Trent, Jr., eds. Mental Retardation in America: A Historical Reader. New York: New York University Press, 2004. A comprehensive collection addressing the history of mental disabilities in the United States, covering the early nineteenth century to 2002. -
Parry, John. Handbook on Disability Discrimination Law. Washington, D.C.: American Bar Association, Commission on Mental and Physical Disability Law, 2003. Contents of this handbook include an “overview” of the “history, basic elements, and limits” of disability law and chapters covering employment, public services at the state and local government level, public accommodations, housing, education, and “telecommunications and the Internet.” -
Stroud, Marion, and Evelyn Sutton. Expanding Options for Older Adults with Developmental Disabilities. Baltimore: Paul H. Brookes, 1988. Focuses on the needs of elderly persons with mental disabilities. A “hands-on” source that is useful in helping provide mentally ill older adults with the same opportunities that are available to others. -
Summers, J. A. The Right to Grow Up. Baltimore: Paul H. Brookes, 1986. Summers presents a comprehensive introduction to topics related to adults with mental illness. Some nontraditional issues are addressed, including the need for sexual expression, friendship, and self-choice. -
U.S. Department of Justice. Civil Rights Division. A Guide to Disability Rights Law. September, 2005. http://www.usdoj.gov/crt/ada/cguide.htm. Provides brief summaries of federal civil rights laws for disabled persons and links to relevant government sites. -
Whitaker, Robert. Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill. Reading, Mass.: Perseus, 2001. A critical examination of the psychiatric profession and its history of attempting to treat the mentally ill and disabled. A provocative work.
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