Madness and insanity challenge people at different times in their lives. Early civilisations did not have enough knowledge about mental health but related these disorders with something supernatural. Mental health services in England and Wales are determined by many social, cultural, political, and medical events between the 18th and 20th centuries. At the end of the 19th century, the Lunacy Act was introduced to legalise asylums for the insane. In the middle of the 20th century, legalism was replaced with medicalism (the Mental Health Act). The struggle between legalism and medicalism of mental health services defines their legalisation in England and Wales today.
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The Historical Development of Mental Health Practice
In the first half of the 18th century, the first social concerns about mental health were noticed in the countries. Trade expanded, and the desire to increase estates and solve agricultural issues, taking into account the achievements of science, intensified. The Industrial Revolution was accompanied by changes in the structure of society through self-consciousness growth. People experienced negative emotions associated with planning and motivation and the intentions to achieve success. Transformations were associated with social problems, human behaviours, and health complications’ explanations. One of the first laws to meet the interests of English society was the Vagrancy Act 1714 and 1774 to punish vagrants who begged on streets. The Madhouses Act 1774 was created to address mental health specifically, protect wealthy patients, and underline asylum importance. In 1845, the Lunacy Act was signed to create the necessary local funds for asylums in England.
Each act had its specific restrictions, goals, benefits, and shortages. The purposes of most legislation processes were the same –to regulate madhouses and manage care and employment. The conditions for madness diagnosis were private for rich or paupers for poor, and the admission depended on the Lunacy Commission. In the middle of the 1800s, the Commission was responsible for new institutions and controlling the work of asylums. The regulations were based on information offered by the current philosophers, economists, and politicians.
Societal Perceptions of the Mentally Disordered in Media
The socio-economic formation of capitalism in England and Wales was accompanied by the gradual growth of society’s culture. Localising the person’s spiritual capabilities and brain abilities, a materialistic standpoint of mental disorders was developed. In 1751, St. Luke’s Hospital was opened in London, where regular medical rounds and occupational therapy were introduced. However, in 1774, according to the new act, inspections were required to check the conditions for services and the staff qualification. Mental health services legalism was slowly replaced with medicalism to enhance responsibility of the medical employees.
New donations favouring well-maintained boarding houses for the mentally ill were offered. Sensualist ideas were removed from definitions in the mental health sector, and insanity was interpreted as an incorrect connection of ideas caused by disturbances of perception, sensation, and representation. This phenomenon determined social priorities in the development of English psychiatry. Then, the diagnosis was free from ideological layers of spirits and approached the materialistic interpretation. Depression, self-destruction, anxiety, alcohol or substance abuse were revealed as additional elements of mentally disabled people. Mental disability was no longer just a personal problem but a public health concern.
People received treatment under the regulations of the Lunacy Act. In 1930, the Mental Treatment Act was signed to define mental illness as any other illness with voluntary admission and temporary treatment. Compared to previous legislations, this act lacked clarity and enough administrative decisions. Thus, it could be defined as a transition between legalism and medicalism in mental health practice, associated with the anti-psychiatry movement and the Mental Health Act implementation.
Boundaries and norms in mental health practice were discussed by Thomas Szasz and Michel Foucault in the 20th century. Szasz explored the symbolic nature of the concepts of “disease” and “patient” as applied to the human mind and incorrect interpretation consequences. Mental illness is not diagnosed using studies of cells, tissues, or organs but identified as conditional. Although people behaved inadequately, it did not mean they had a disease. Illness and disease were only medical metaphors for describing some behavioural disorders. Szasz was not against people being treated for mental problems that bothered them. He was against coercion to force people into treatment but fully supported voluntary treatment. Thus, he claimed that mental illness was a myth, but he did not mean that people could experience disorders in their emotional and cognitive systems.
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The purpose was to underline that the mental health treatment system was designed for patients, which proved legalism. It was a method of controlling the population, which was politics. Although some mental health treatments were acceptable and patient-oriented, most mental health treatments were politically related. If a person is educated, they can access patient-centred therapy. If the patient has a lower socioeconomic status, they will most likely access only compulsory treatment organised to control the population.
Compared to Szasz, Foucault relied on the historical examination and ideas to be accepted as true. His goal was not to explain why madness did not exist but how it should be encountered in society. He did not introduce psychiatry as something wrong – its development shows that some elements of this practice were unnecessary. During the 1800s, the attitudes toward mental wellbeing and behavioural habits underwent many changes, and Foucault’s ideas helped to differentiate treatment from power and control.
Policy Issues and Mental Health Services: Legalism vs. Medicalism
Mental well-being is a state when a person is aware of capabilities, solves problems, and works productively to benefit society. Mental health practice represents a powerful potential for social development and prosperity. The attitude towards the mentally ill reflects the low cognitive level of public consciousness. People suffer from mental disorders and live in their unique world with a subtle sense of others, pronounced intuition, and insecurity. Social maladaptation, negativism and unwillingness to communicate emerge during an exacerbation, severe course, and disease progression. While about a quarter of all patients with schizophrenic disorders recover entirely and return to their previous lifestyle, others had mild defects of social functioning. Social support and communication are necessary for people to become full-fledged members of the community. Thus, society with a favourable and reasonable attitude towards mentally ill members can reduce the negative manifestations and consequences of the epidemic of mental disorders.
Mental health involves public, private and public sectors in solving behavioural problems. One of the first countries to build shelters, the United Kingdom was also the first one to abandon them as the primary method of treating the mentally ill. Currently, most mental health services are provided by the National Health Service with the support of the private and voluntary sectors. In 1959, the Mental Health Act was introduced with its major amendment in 1983 to define suitable care for mentally disordered people. According to this Act and the Mental Capacity Act 2005, mental disorder is any disability of mind that requires psychiatric care. Modern mental health practice is challenged by a shortage of beds for bed, leading to long delays in accessing treatment, receiving medically inadequate care, recognising conditions like depression or anxiety or solving problems like restriction in the population. People need professional help to improve their health, and the current legislation promotes medicalism where madness is a disease to be treated.
The struggle between legalism and medicalism in mental health practice is evident from what was offered in the 18th century and what occurs today. Psychiatric problems are increased by 50% between 2011 and 2016, explained by new definitions, laws, and attitudes of the population. Some mental health services have changed because of the Mental Health Act of 1983, and inspections and control helped to remove unreliable and poorly trained institutions. The budgets of 40% of psychiatric funds have been reduced. Restrictive means in psychiatric institutions in the UK are increasing.
The first significant achievements in mental health practice were observed at the end of the 18th century. The mentally ill were treated as outcasts because they could not explain their problems. The transition from legalism to medicalism was proved through the analysis of legal acts in the 18th-20th centuries to cover the needs of sick people. This battle includes the interests and knowledge of politicians, policymakers, medical workers, and community members. Mental disorders were not created as a part of mental health practice but as human health. This practice is critical for promoting definitions and explaining situations that change human behaviours through the prism of historical development and legislation.
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