May is Mental Health Awareness Month
*content warning: discussion of suicide and abuse
The history of mental health care is anything but pretty, and often unknown to the public. So, how did we get to the point where we now dedicate an entire month to mental health awareness? For centuries, mental health has been cloaked in stigma and misunderstanding, often leaving those struggling with mental illness to suffer in silence or endure inhumane treatment in the name of care.
Mental Health Awareness Month began in 1949 and was launched by Mental Health America (MHA) after one of their founding individuals was placed at inpatient treatment for over 3 years. The movement for change and reform started long before the creation of MHA. The mistreatment of people with mental illness goes back centuries. As early as the 1700s, institutionalizing care of mentally ill people became common, but these early asylums were far from therapeutic. People were admitted to places that resembled more like warehouses than treatment spaces. Individuals who did not fit societal norms were often subjected to cruel practices that were wrapped in the thought of "curing" people of their mental illness. As psychiatrist named Jeffrey A. Lieberman states in Shrinks: The Untold Story of Psychiatry, “The mentally ill were considered social deviants or moral misfits suffering divine punishment for some inexcusable transgression” (Mental Health America, 2025). With this kind of belief system, nearly any behavior outside of the social norm could lead to someone being admitted to asylums against their will, to be forgotten.
Mental illness was not recognized as an illness at all in the 19th century. It was labeled as madness or insanity. People who suffered from mental illness were hidden away at asylums, resulting in a spike of asylum population during the middle of the 19th century. Society often viewed individuals with mental illness as monsters, demonic, or creatures and asylums were chaotic and unsanitary. It was believed the best treatment for these individuals was isolation (Challons-Lipton, 2023).
As we know today, mental health has an affect on every family, with some being able to identify a close family member struggling with their mental health. Due to this large web of connection, there has always been someone seeking more information for helpful treatment in our history. Still, progress has been extremely slow. For decades, people with mental illness were more likely to end up in jail than get treatment, and this issues continues still today, with 44% of people in locally run jails living with a mental illness (U.S. Department of Justice et al., 2017). Treatment for mental health has often been a separate issue from medical treatment. Much of mental health was treated through private and public hospitals and was not covered under insurance plans. Resulting in no coverage made it so there was not place for individuals who could not afford mental health out of pocket to end up in the prison system. Even as institutions were created to offer hope, the care provided often remained harsh and deeply rooted in religious beliefs and moral judgment. People continued to be seen as demonic or evil rather than ill.
Since the creation of mental health institutes and asylums, there have been brave individuals who fought for positive change in care. Nellie Bly, an investigative journalist, famously went undercover in an asylum to expose the horrific conditions. Clifford W. Beers, a former patient, spent three brutal years in hospitals and used his experiences to spark a movement. Dorothea Dix led reform efforts in the 1800s, pushing for more humane treatment of patients. Judi Chamberlin became a powerful voice in the mental patients' liberation movement. These were just a few figures that were instrumental in shifting public perception and policy around mental health care.
Dorothea Dix, another major reformer, began her work in the 1840s. She fought to eliminate abusive practices like shackling patients and the wearing of straitjackets. She was able to successfully lobby Congress and increase funding for more public hospitals. However, problems like overcrowding and lack of proper care persisted (PBS Newshour Extra, n.d.).
Journalist Nellie Bly went even further in exposing the conditions within mental health institutions. In 1887, she was admitted to Blackwell’s Island Insane Asylum under false pretenses to document what really happened inside. She recounts that her admittance was quickly, with not many questions being asked to determine her mental status. Once admitted, she began to see how often and extreme inhumane treatment of patients was happening. During this time, it was common for patients to be subjected to hydrotherapy as a main form of treatment. This practice involved placing patients in large soaking tubs filled with water, sometimes warm, but more commonly cold. They would be placed in these tubs for extended amounts of time. Individuals would also be wrapped up like a mummy and dosed in freezing cold showers. Much of these practices were completed without consent to these patients (Fabian, 2023).
The founding of Mental Health America was sparked by the personal experience of Clifford W. Beers. After graduating from Yale and being a new Wall Street financier, Beers experienced his first episode of bipolar disorder following the death of his brother. From 1900 to 1903, he spent time in both public and private mental hospitals after a suicide attempt where he jumped from a 3rd story building. While in the care of these hospitals, Beers witnessed and endured poor treatment, including being restrained in a straitjacket for 21 nights in a row. He later published A Mind That Found Itself in 1908, an autobiography that helped reignite the mental health reform movement once again (Mental Health America, 2025).
The secrecy surrounding mental health institutions meant much of this abuse remained hidden for years. It took investigative journalists, whistleblowers, and former patients to pull back the curtain. Unfortunately, challenges continue to remain high. Issues for proper care, reimbursement from insurances to mental health providers, and accessible means continue to this day. Insurance providers have a long history of not covering mental health care coverage. It wasn't until 1996 that U.S. federal law required some parity in cost limits for mental health care but it did not require coverage at all. This continued to allow employers and insurers to ignore the need and issue. In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) required group insurance plans that did offer mental health coverage to treat it at the same level of physical health, but again, still did not mandate coverage. Finally, in 2010 with the Affordable Care Act (ACA), or more commonly known as Obamacare, made mental health and substance use disorder services an "essential health benefit" for many plans. Some plans still find workarounds to avoid paying for costs. They do so by providing low reimbursement rates, require more documentation for mental health claims, and limit the amount of providers allowed to be credentialed with the insurance.
Mental health care is still often underfunded and has unequal access, especially for marginalized communities. Despite this, the push for awareness and reform continues to move forward thanks to organizations like Mental Health America, the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Alliance on Mental Illness (NAMI). Through advocacy, education, research, and funding, these programs continue to pave the way for a future where mental health is treated with the care and respect it deserves.
A Call To Action
There is an understanding that the world of therapy has inherently focused on social justice (a topic for a later date) and care for patients. With this new knowledge, a call to action comes to mind for those who are able to engage. MentalSoup hopes to encourage reflection, calls to action, and increase empathy through many means, potentially starting with the following:
- Encourage an understand that not one-size-fits-all treatment is the best treatment and that there should be personalized treatment approaches for individuals
- Engage in active collaboration with community organizations such as schools and local government
- Advocate for policy changes to address systemic inequities in care
- Urge policymakers to prioritize mental health funding on a state and federal level
- Engage in reform work for marginalized groups to help receive adequate care
- Build your own well-being by prioritizing self-care practices
References:
Challons-Lipton, S. (2023, February 8). Goya’s Black Paintings: Mental Illness & 19th-Century Art — Inclination: An Art History Blog. Inclination: An Art History Blog. https://inclinationarthistory.com/blog/goyas-black-paintings-mental-illness-amp-19th-century-art
Fabian, R. (2023, March 9). The history of inhumane mental health treatments. Talkspace. https://www.talkspace.com/blog/history-inhumane-mental-health-treatments/
Mental Health America. (2025, April 10). Our History | Mental Health America. https://mhanational.org/our-history/
PBS Newshour Extra. (n.d.). https://www.journalisminaction.org/case/nellie-bly
U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, Bronson, J., Ph. D., & Berzofsky, M., Dr. P. H. (2017). Indicators of mental health problems reported by prisoners and jail inmates, 2011-12. In Special Report (Report NCJ 250612). https://bjs.ojp.gov/content/pub/pdf/imhprpji1112.pdf
Vine, P. (2022, December 6). Mental health reform activists played the long game. Here’s what that can teach us today. - Ms. Magazine. Ms. Magazine. https://msmagazine.com/2022/12/06/mental-health-reform-history-biden-american-rescue-plan/
