History of Treatment for Individuals with Mental Retardation

1
History of Treatment for Individuals with Mental
Retardation
2
History of Treatment

• Perceptions of people with mental retardation and
  historical timeline of treatment
• Institutional care and de-institutionalization
• Costs of care
• Waiver funding and services

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Key points

• Perception ? behavior
• Attitudes ?discrimination
• Stereotypes ?public policy
• Models of Perception ?TREATMENT
• Cycle of Discrimination
• Lack of knowledge ?misunderstanding ?
• fear ?non-acceptance

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Perceptions of People with Mental Retardation

• As sick persons
• As subhuman organisms
• As a menace
• As objects of pity

• As holy innocents
• As burdens of charity
• As capable of educational and social development

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Historical Timeline

• Early developments up to about 1850
• Most persons with mental retardation (1-2 of
  population) stayed with their own families
• Those who were orphaned, had no one to care for
  them or were unable to work were put in community
  institutions.
• Dorothea Dix advocated for creation of special
  institutions. Several schools for deaf and blind
  started in early 1800s

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Optimistic Institution Building

• 1850 1880
• Early residential schools developed but admission
  limited
• Each state developed own institutions
• Early schools emphasized educational
  rehabilitation and excluded those seen as
  incapable of being helped.

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Optimism declines

• Some students were not rehabilitated as hoped
• Numbers of students increased so that the schools
  became more like caretaker institutions
• Many began to stay there beyond school years
• America was growing rapidly increased number of
  students substantially
• Growing pessimism by legislatures for the
  additional expansions of asylums

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Growing pessimism and institutional growth

• As large numbers collected, individuals with more
  significant disabilities stayed
• More custodial care, more work
• Work on farms for self support
• Collectively referred to as asylums
• Asylums built in remote rural locations

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Social Darwinism and Isolation

• Increasingly people believed that those with
  mental retardation were deviant, criminal, menace
• Were called inmates
• Incapable of self-support, a threat to society
• Sterilization
• Special education classes for individuals who
  were higher functioning
• AAMD defined three levels of mental retardation

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Stagnation and Slow Change1920 - 1945

• Some early intervention services developed
• Special education program expanded slowly no
  classes for children with severe disabilities
• Slow emergence of more educational and
  developmental views research
• Funding slashed during depression/war years ?
  lead to poor care in institutions

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1945 - 1960

• Great optimism after WWII developmental model
  of growth was again popular (late 1800s)
• National Mental Health Act (1946)
• Mental Health Study Act (1955)

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1960 - Present

• The Deinstitutionalization Movement
• Made possible by the Community Mental Health
  Centers Act of 1963
• Four process of deinstitutionalization
• Reducing number of residents
• Admitting no new residents
• Shortening lengths of stay
• Improvement

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Legal Rights and Greater Opportunities

• Judicial decisions about inhumane care
• 1963 CMHC Act local treatment services
• 1972 Amendments to Social Security Act
• 1973 Rehabilitation Act
• 1975 EAHCA
• 1975 Developmentally Disabled Assistance and Bill
  of Rights Act
• 1981 Wavier legislation
• 1990 ADA new definition of disability more
  rights guaranteed

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If not institutions, then where?

• In 1998, individuals with mental retardation
  lived
• 30 lived in institutions
• 13 in state hospitals
• 9 in private institutions
• 8 in nursing homes
• 70 lived in community residences
• 57 in 1-6 person homes
• 8 in 7-15 person homes
• 6 in ICF/MRs for 7-15 persons

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Costs of Care
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Waiver Funding in Pennsylvania

• 21,000 people currently benefit from waiver
  funding and services
• Medical and non-medical services designed to help
  persons with disabilities and older
  Pennsylvanians living independently in their
  homes and communities
• Various waivers examples
• Consolidated
• Person/Family Directed Support
• Attendant Care Waiver
• Infants, Toddlers, and Families Waiver