The mental health movement in the United States began with a period of considerable enlightenment. Dorothea Dix was shocked to find the mentally ill in jails and almshouses and crusaded for the establishment of asylums in which people could receive human care in hospital-like environments and treatment which might help restore them to sanity. By the mid 1800s, 20 states had established asylums, but during the late 1800s and early 1900s, in the face of economic depression, legislatures were unable to appropriate sufficient funds for decent care. Asylums became overcrowded and prison-like. Additionally, patients were more resistant to treatment than the pioneers in the mental health field had anticipated, and security and restraint were needed to protect .patients and others. Mental institutions became frightening and depressing places in which the rights of patients were all but forgotten. These conditions continued until after World War Ⅱ. At that time, new treatments were discovered for some major mental illnesses theretofore considered untreatable (penicillin for syphilis of the brain and insulin treatment for schizophrenia and depressions), and a succession of books, motion pictures, and newspaper exposés called attention to the plight of the mentally ill. Improvements were made and Dr. David Vail’s Humane Practices Program is a beacon for today. But changes were slow in coming until the early 1960s. At that time, the Civil Rights movement led lawyers to investigate America’s prisons, which were disproportionately populated by blacks, and they in turn followed prisoners into the only institutions that were worse than the prisons the hospitals for the criminally insane. The prisons were filled with angry young men who, encouraged by legal support, were quick to demand their rights. The hospitals for the criminally insane, by contrast, were populated with people who were considered "crazy" and who were often kept obediently in their place through the use of severe bodily restraints and large doses of major tranquilizers. The young cadre of public interest lawyers liked their role in the mental hospitals. The lawyers found a population that was both passive and easy to champion. These were, after all, people who, unlike criminals, had done nothing wrong. And in many states, they were being kept in horrendous institutions, an injustice, which once exposed, was bound to shock the public and, particularly, the judicial conscience. Patients’ rights groups successfully encouraged reform by lobbying in state legislatures. Judicial interventions have had some definite positive effects, but there is growing awareness that courts cannot provide the standards and the review mechanisms that assure good patient care. The details of providing day-to-day care simply cannot be mandated by a court, so it is time to take from the courts the responsibility for delivery of mental health care and assurance of patient rights and return it to the state mental healty administrators to whom the mandate was originally given. Though it is a difficult task, administrators must undertake to write rules and standards and to provide the training and surveillance to assure that treatment is given and patient rights are respected.
A．overly emotionalB．cleverly deceptiveC．cautiously optimisticD．fiercely independent
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