Abstract
Societal views on the care of those living with mental illness respond to historical and sociopolitical factors and fluctuate throughout time. Deinstitutionalization was the largest single change to occur in mental health care in the U.S. after World War II. Currently, the U.S. is struggling with the outcomes of deinstitutionalization and the need to make significant decisions about new directions for mental health policy. The purpose of this historical study was to examine the intersection between a significant federal policy of deinstitutionalization (the Community Mental Health Centers Act of 1963), the critical actors charged with implementing it, and a representative progressive community based institution (Massachusetts Mental Health Center) as a case study to determine placement of deinstitutionalization in the context of social history during the period between 1955 and 1967. Using a social history framework, primary and secondary sources from the Massachusetts Mental Health Center (MMHC) private archive in Boston, Massachusetts were studied to explore and clarify complex interactions, relationships, and influences of the health center and its actors, and their relevance to a groundbreaking piece of legislation that formed a pillar of the deinstitutionalization movement. Sources and data were critically analyzed and interpreted in historical context. MMHC provided a case study of post-World War II innovative psychiatric treatment, prevention, and care delivery, that displayed its vital role in the shift to community-based psychiatry, and ultimately influenced mental health policy. It provided an alternative to institutionalization through its revolutionary community-oriented services and innovative practices. Three psychiatrists from MMHC – Harry C. Solomon, Jack R. Ewalt, and Bertram S. Brown – had an influence in the development of the Community Mental Health Centers Act of 1963 (CMHCA). Their experiences at MMHC influenced the CMHCA. Through MMHC’s visibility, history of innovative treatment, training programs, groundbreaking research, and actors, the center played a direct role in the formulation of the CMHCA. The study findings elucidated the social and political processes that led to deinstitutionalization, and informed a deeper understanding of how decisions were made regarding care and treatment for people living with serious mental illness. This understanding may be incorporated into future decisions surrounding the care and treatment of people living with serious mental illness.