Deinstitutionalization Through Optimism: The Community Mental Health Act of 1963

Abstract

One Flew Over the Cuckoo's Nest, The Snake Pit, The Shame of the States, "Titicut Follies," and Life Magazine's "Bedlam 1946": these articles, films, and books-and books that were made into films-are cultural touchstones of the state mental hospital era.They epitomize a negativism-regarding insanity, imprisonment, terror, chaos, and disgrace-associated with life in American psychiatric institutions in the first half of the 20th century (1, 2).Although critical attention has been paid to the relationship between publicized atrocities and the movement for state hospital deinstitutionalization, fewer efforts have highlighted the federal idealism underlying deinstitutionalization.The Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963more commonly known as the Community Mental Health Act (CMHA) (3)-provides a critical historical lesson on the roles of optimism and structure in outpatient care for serious mental illness.In 1946, the federal government entered mental health policy with the passage of the National Mental Health Act.In 1949, it established the National Institute of Mental Health (NIMH).With both, the government promoted visions of progress and community in mental health care-a stark contrast to stagnant connotations of state hospital institutionalization (2).By the 1960s, in terms of policies from the environment to education, the public largely believed in the federal government's ability to meet society's needs (4).In this political context, the Joint Commission on Mental Illness and Health, a federal organization charged with surveying the resources and diagnostic and treatment methods for mental illness, published its findings as Action for Mental Health.This document detailed inadequacies in national mental health services and called for improvements in both state mental hospitals and community mental health care (2).In 1963, Congress then passed and President Kennedy signed the CMHA.With the CMHA, Kennedy and Congress sought to decrease the number of institutionalized individuals by incubating self-sufficient and local mental health care centers.Kennedy's personal motivations illustrate the federal idealism in community mental health care.With his New Frontier platform, Kennedy sought improvements in the nation's mental and physical health.He also aimed to unburden society of chronically dependent persons.In particular, he hoped to liberate the population of confined mentally ill patients through advancements in psychopharmacology and supportive housing.He was emotionally drawn to issues of mental illness and intellectual disability because of his sister Rosemary, who underwent a lobotomy that significantly worsened her quality of life (2).Politically, Kennedy grasped the negative public sentiment around an increasing institutionalized

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