Institutional Progress and Reform

Seven Challenges: A Report on Conditions in the State Hospitals of Texas

A 1950 report on the poor conditions at Austin State Hospital.

Various individuals and groups recognized the wrongs being perpetuated against the mentally ill within mental health institutional systems, and advocated for the betterment of the process for admitting patients and their treatment plans. Concerned doctors, inquisitive reporters, and compassionate civilians became involved in the movement, revolutionizing mental health care and fighting stigma. Their work was undeniably critical in the progress that has been made within institutions and the public discourse about mental illness. 

Beginning in the 1840s and largely due to Dorothea Dix’s exposé on the maltreatment of the mentally ill, the asylum movement was an attempt to rectify the unjust treatment experienced by mentally ill individuals who were locked away in the prison system or on the streets. “Asylum” meant a place of safety, and the movement advocated for much more humane and dignified treatment of the mentally ill in addition to the necessity of pleasant surroundings for their recovery. Thus, states began establishing asylums to provide care. Before long, however, reports began emerging of maltreatment within these “safe havens.”

After the mental hygiene movement (~1909 - 1960) encouraged the establishment of mental health organizations in the U.S., these organizations, as well as determined reporters, investigated injustices in the asylum system and pushed to reform them. Groups such as the Mental Health Association in Texas and the Hogg Foundation took it upon themselves to publish reports on the inadequacy of care in mental hospitals. These efforts gained widespread attention and many reforms were undertaken to mitigate the harsh reality of medical paternalism: overcrowding, and non-consensual procedures.

Ultimately, these controversial practices ended, and the 1980s saw a trend towards deinstitutionalization, ensuring the rehabilitation and discharge of patients instead of commitment for life. This movement arose partially as a result of the civil rights movement of the 1960s, which stressed personal freedom, giving rise to a favoring of community-based care over state institutionalization.

Before this movement, improvements within the system in the 1950s included the development of new treatments, new ways of classifying and organizing patients, and the idea that trauma is a probable cause of "delinquency.” The newspaper titled “A Break for Johnny Doe” below describes a case of a heavily traumatized boy who was institutionalized after committing a crime, and his improvements after receiving rehabilitative, non-punitive treatment in a specialized children’s ward.