The Public Psychiatrist in History

Abstract

Just as the patient’s history is important to understanding his or her current situation, an understanding of the social, economic, and political forces that have shaped public psychiatry can offer insight into the public psychiatrist’s contemporary role in the United States. This chapter reviews the many historical factors that shaped the field’s development and that continue to motivate system transformation within public psychiatry today. It explores psychiatry’s shifting understanding of mental illness and treatment, alongside the rise and fall of the asylum movement and the evolution of outpatient psychiatry in the early 20th century and beyond. Then, it describes national legislation that led to the deinstitutionalization movement, the fragmentation of social services in the 1980s and 1990s, and the efforts of patient advocates that resulted in public psychiatry’s adoption of recovery-oriented services under the George W. Bush administration. Last, this chapter provides context to mental health parity laws under the Affordable Care Act.