Abstract
Prior to the 1960s, most people suffering from severe mental illness were housed in state mental hospitals. Although asylums for the insane evolved from a caring, therapeutic approach of the moral treatment, a century later these institutions had become overcrowded, underfunded, and hardly reflective of the humane values upon which they were originally based. With the passage of the Community Mental Health Centers Act of 1963, a new chapter was announced in the care and treatment of people suffering from mental illness; they should be able to live in society like everyone else. Deinstitutionalization was one of the largest social experiments in American history in which close to one-half million people moved out of these institutions and back into their communities (Grob 1994). This occurred, however, without sufficient social supports in place, and with even less understanding of the impact that the resulting homelessness, unemployment, and drug addiction would have in the lives of people struggling with mental illness. Furthermore, former patients were expected to live in communities where the stigma associated with mental illness caused them to be viewed with both fear and suspicion. Torrey (1997) has described the result as a psychiatric “Titanic.” Others commenting on the current challenges facing community mental health (Rosenberg and Rosenberg 2006) found the current shape of mental health practice as a “fragmented system of care” (p. 3). More pointedly, the President’s New Freedom Commission on Mental Health (2003) characterized it as “in disarray” (Executive Summary, p. 4). There are no consistent theories of treatment and the funding system is ill-suited to the demands of those in need. In effect, the goal of deinstitutionalization—namely, that people suffering from mental illness can live and function in society—is a book whose final chapter has yet to be written.
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- 1.
Traitement morale, or the moral treatment, was a psychological treatment for people suffering from mental illness developed by the renowned French physician Philippe Pinel in the late-eighteenth-century. It emphasized therapeutic observations and discussions, and an environment conducive to a humane, caring approach to mental illness.
- 2.
The term working community™ is used by Fountain House to describe its signature approach to supporting its members in recovery from mental illness.
- 3.
Mandiberg (2010) notes the importance of such relationships, which are currently overlooked in hospital discharge planning for psychiatric patients.
- 4.
May 3, 1949 minutes of the Professional Advisory Committee, Fountain House, New York.
- 5.
This episode is explored in Anderson’s (1998) history of Fountain House We Are Not Alone. It is of note that the same dichotomy exists today over who should be in charge of recovery in mental illness—the patient or the professional. John Beard resolved this conflict in a manner that empowered both the patients and the professionals in a collaborative process.
- 6.
A similar movement was taking place in England with the therapeutic community of Jones (1953) that involved the entire hospital community in contributing to the recovery process.
- 7.
Additionally, Fountain House operates an international training institute, a professional art gallery for member artists to sell their paintings, and a rural farm in northern New Jersey.
- 8.
Figures do not include the number of staff separately employed in the Fountain House housing program.
- 9.
Transitional employment was an innovation wherein Fountain House partnered with employers in establishing a temporary position for its members to test out their abilities and establish a work history.
- 10.
http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=189. The generic term “ICCD Clubhouse,” with Fountain House as its originator, is the actual listing to reflect the partnership of many strong clubhouses in the United States and around the world in achieving this goal.
- 11.
Now featured in Section 2703 of Public Law 111-148, the Affordable Care Act of 2010.
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Doyle, A. (2012). Fountain House and Community Psychiatry. In: McQuistion, H., Sowers, W., Ranz, J., Feldman, J. (eds) Handbook of Community Psychiatry. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3149-7_30
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