In 1844, Dorothea Lynde Dix, who had previously lobbied the Massachusetts legislature to improve its hospital for the mentally ill, submitted a summary to the New Jersey legislature detailing her visits to the jails and almshouses in the state and the conditions she had found of how the mentally ill were confined. Perhaps her most persuasive profile was her account of how a former legislator, after suffering from mental decline, fell into destitution in old age, with Dix encountering him lying on a small bed in the basement of the Monmouth County almshouse. She wrote: "This feeble and depressed old man, a pauper, helpless, lonely, and yet conscious of surrounding circumstances, and not now wholly oblivious of the past—this feeble old man, who was he?" Many members of the legislature knew her pauper jurist. Joseph S. Dodd introduced her report to the Senate on January 23, 1845 in which she urged the legislature to act and appropriate funds to construct a facility for the care and treatment of the mentally ill. Dix continued to lobby for a facility, writing letters and editorials to build support. During the session, she met with legislators and held group meetings in the evening at home.
The Trenton Psychiatric Hospital, originally named as the New Jersey State Lunatic Asylum, opened on May 15, 1848, as the first public mental hospital in the state of New Jersey, located on the boundary of Trenton and Ewing. It was the first mental hospital designed on the principle of the Kirkbride Plan, a system of mental facility design in which environment and exposure to natural light and air circulation were emphasized. on behalf of the indigent mentally ill who, through a vigorous and sustained program of lobbying state legislatures and the United States Congress, created the first generation of American mental asylums. During the Civil War, she served as a Superintendent of Army Nurses.
In 1881, Dix moved into the New Jersey State Hospital, formerly known as Trenton State Hospital, that she built years prior The state legislature had designated a suite for her private use as long as she lived. Although in poor health, she carried on correspondence with people from England, Japan, and elsewhere. Dix died on July 17, 1887. She was buried in Mount Auburn Cemetery in Cambridge, Massachusetts. Before the 1850s, few people knew the causes of mental illnesses, even less how to treat them. It was even widely believed that evil spirits caused the illnesses, or that God punished sinners by making them mentally ill. Even so, there was beginning to be a support for establishing institutions designed to care for the ill, but very few of these institutions actually existed in the United States in the early 1800s.
Oftentimes, the people suffering from mental illnesses were kept in prisons and poorhouses, in which they were treated terribly. Prisons were unregulated and unhygienic, and the mentally ill resided amongst violent criminals, which was dangerous to both parties. Moreover, the jailers responsible for the inmates would beat, whip, and chain them, as well as physically and sexually abuse them. They were left naked with no heat or sanitation. Sometimes, public officials traded mentally ill people for money, and gave them to the local residents whom fed and housed them. New Jersey opened its first state hospital for those needing psychiatric care in 1848. Known as the New Jersey State Lunatic Asylum, this hospital was established in direct response to Dorothea Dix’s patient advocacy campaign and, as such, offered a revolutionary approach to patient care, one that emphasized holistic treatments and protected patient dignity. Yet over the next century, these approaches would be challenged by changing social, political, and scientific norms. She gave as an example a man formerly respected as a legislator and jurist, who, suffering from mental decline, fell into hard times in old age. Dix discovered him lying on a small bed in a basement room of the county almshouse, bereft of even necessary comforts. She wrote: "This feeble and depressed old man, a pauper, helpless, lonely, and yet conscious of surrounding circumstances, and not now wholly oblivious of the past—this feeble old man, who was he?" Many members of the legislature knew her pauper jurist. Joseph S. Dodd introduced her report to the Senate on January 23, 1845.
Dodd's resolution to authorize an asylum passed the following day. The first committee made their report February 25, appealing to the New Jersey legislature to act at once. Some politicians secretly opposed it due to taxes needed to support it. Dix continued to lobby for a facility, writing letters and editorials to build support. During the session, she met with legislators and held group meetings in the evening at home. The act of authorization was taken up March 14, 1845, and read for the last time. On March 25, 1845, the bill was passed for the establishment of a state facility.[18][19] She took up residence at the hospital she founded 35 years prior, in Trenton, New Jersey, and died there on July 17, 1887 at the age of 85.
Dix traveled from New Hampshire to Louisiana, documenting the condition of the poor mentally ill, making reports to state legislatures, Under the hospital's first superintendent, Dr. Horace A. Buttolph, the hospital admitted and treated 86 patients. In 1907, Dr. Henry Cotton became the medical director. Believing that infections were the key to mental illness, he had his staff remove teeth and various other body parts that might become infected from the hospital patients. Cotton's legacy of hundreds of fatalities and thousands of maimed and mutilated patients did not end with his leaving Trenton in 1930 or his death in 1933; in fact, removal of patients' teeth at the Trenton asylum was still the norm until 1960. The not-so-good doctor believed infections were the root cause of all mental disorders. As a result, he used surgery as treatment. He and his staff routinely maimed their patients; they cut out teeth and gallbladders, stomachs, colons, testicles, and ovaries. Cotton reportedly paid particular attention to the right side of the hindgut, which he believed was the source of depraved impulses.
Cotton claimed to have achieved cure rates near 90 percent during his tenure – yet his death numbers were disturbingly high. What’s worse, many of his victims were dragged against their will into the operating room. He and his staff practiced experimental surgical bacteriology on patients, including the routine removal of some or all of patients' teeth, their tonsils, and frequently spleens, colons, ovaries, and other organs. These practices continued long after careful statistical reviews falsified Cotton's claims of extraordinarily high cure rates, and demonstrated very high mortality and morbidity as a result of these aggressive and dangerous measures. As well as the medical horrors he forced upon the patient/victims, Cotton still instituted many progressive ideas after becoming medical director of the Trenton State Hospital at the age of 30. These included abolishing mechanical restraints and implementing meetings of daily staff to thrash out patient care
His enthusiasm for the scientific medicine that was taking hold at the opening of the 20th century led him to an unshakable belief that mental illness of all kinds was the result of untreated infections in the body. Based on the observation that patients with high fever often turn delusional or begin hallucinating, * Pulling Teeth to Treat Mental Illness, 10/22/2014, The Atlantic While he died in 1933, remnants of Dr. Cotton’s practices continued well into the second half of the twentieth century. Eventually, the Trenton Psychiatric Hospital forsook his brutal methods and certain wings of the campus fell into abandonment. In 1881, Dix moved into the New Jersey State Hospital, formerly known as Trenton State Hospital, that she built years prior The state legislature had designated a suite for her private use as long as she lived. Although in poor health, she carried on correspondence with people from England, Japan, and elsewhere. Dix died on July 17, 1887. She was buried in Mount Auburn Cemetery in Cambridge, Massachusetts.
As the hospital in Trenton became overcowded, in 1876 the state built Greystone Park Psychiatric Hospital, renovating a facility formerly known asthe State Asylum for the Insane at Morristown. Originally built to accommodate 350 people, the facility, after several expansions, reached a high of over 7,700 patients. Its most prominent patient was the folksinger and composer Woodie Guthrie, who wrote "This Land Is Your Land" and more than 3,000 other folk songs, was suffering from Huntington's disease, a degenerative neurological disorder that at the time was completely misunderstood by the public. He was soon hospitalized at Greystone Park State Hospital in Morris Plains, N.J. And though his family, friends and acolytes, including a 19-year-old Bob Dylan, visited him there, a cone of silence descended on the five years he spent at Greystone and subsequent stays at other hospitals until his death at the age of 55.n 2008, the facility was ordered to be closed as a result of deteriorating conditions and overcrowding. Despite considerable public opposition and media attention, demolition of the main Kirkbride building began in April 2014 and was completed by October 2015.
All patients in our mental hospitals are either voluntary or involuntary commitments. As to voluntaries, there is no problem. As to involuntaries, the rules now require judicial reviews at the time of initial commitment, and periodically thereafter. The criterion for the commitment is whether the person is "a [probable] danger to himself or the community". R. 4:74-7(f). If so, he is confined to a mental hospital. Thus, all patients who have been involuntarily committed, whether in maximum security at Vroom or with little or no security at other hospitals for the mentally ill, have been judicially determined to be "dangerous." N.J.S.A. 30:4-24 declares that
The provisions of this Title [30] shall govern the admission and commitment of the mentally ill * * * and mentally retarded to the several institutions designated therefor and govern and control all phases of the relationship between such patients and such institutions.
State v. Krol, 68 N.J. 236 (1975), that https://www.leagle.com/decision/197530468nj236131 standard for commitment be cast in terms of continuing mental illness and dangerousness to self or others, not in terms of continuing insanity alone, and that some trier of fact make a meaningful determination as to whether defendant is actually within these standards * * * the fact that the person to be committed has previously engaged in criminal acts is not a constitutionally acceptable basis for imposing upon him a substantially different standard or procedure for involuntary commitment. The labels "criminal commitment" and "civil commitment" are of no constitutional significance.
"Mental illness" is defined in N.J.S.A. 30:4-23:
"Mental illness" shall mean disease to such an extent that a person so afflicted requires care and treatment for his own welfare, or the welfare of others, or of the community.
State v. Caralluzzo,49 N.J. 152, 156 n. 1 (1967), to continue to mean "dangerous to self or to society" and we understand that to be the proper construction of the civil commitment statute, N.J.S.A. 30:4-44. Hence, if equal protection requires the standard for involuntary commitment of persons acquitted by reason of insanity to be identical to that applicable to civil commitment proceedings [68 N.J. 253] generally, defendant may be committed only if he has been determined to be both mentally ill and dangerous to himself or to society.
According to the National Institute of Mental Health (NIMH), 6.3 percent of the population suffers from severe mental illness, defined as longstanding mental illnesses, typically psychosis, that cause moderate-to-severe disability of prolonged duration. Given that the number of adults 18 and over in the United States in 2010 was estimated to be roughly 234,564,000, approximately 14.8 million people have severe mental illness. Experts polled by the Treatment Advocacy Center estimated that about 50 beds per 100,000 people would meet needs for acute and long-term care, but in some states the number of available beds is as low as 5 per 100,000 people. Thus, many who need residential treatment cannot obtain it.
einstitutionalization as a policy for state hospitals began in the period of the civil rights movement when many groups were being incorporated into mainstream society. Three forces drove the movement of people with severe mental illness from hospitals into the community: the belief that mental hospitals were cruel and inhumane; the hope that new antipsychotic medications offered a cure; and the desire to save money [8]. It has not worked out as well as expected on any of the three fronts. People with severe mental illness can still be found in deplorable environments, medications have not successfully improved function in all patients even when they improve symptoms, and the institutional closings have deluged underfunded community services with new populations they were ill-equipped to handle. The passage of the 1963 Community Mental Health Construction Act, which made federal grants available to states for establishing local community mental health centers, was intended to provide treatment in the community in anticipation of the release of patients from state hospitals. Laws providing income subsidies through the Aid to the Disabled Program (latter called Supplemental Security Income or SSI), food stamps, and housing subsidies has made it ostensibly possible for people with SMI to live in the community, although many still cannot survive in any dignified or independent manner given that the subsidies are below the poverty level of $11,490 for an individual (current 2013 federal SSI payment is $8,529.32 per year for an individual).
Perhaps the most important change in federal law was the introduction of Medicaid, which shifted funding for people with SMI in state hospitals from the states’ responsibility to a shared partnership with the federal government. This created an incentive for states to close the facilities they funded on their own and move patients into community hospitals and nursing homes partially paid for by Medicaid and the federal government. With the Omnibus Budget Reconciliation Act of 1981, the federal government ended direct federal funding for community-based nursing homes that primarily treated patients with mental health problems and required the screening of patients entering nursing homes to assure they had legitimate medical illness
Perhaps the most significant ethical concern with outpatient civil commitment is the violation of autonomy and civil rights based on the possibility of future dangerousness. Many consumer groups, some mental health professionals, civil-liberties groups, and the Bazelon Center for Mental Health Law oppose outpatient civil commitment on the premise that a person who is competent and not currently dangerous has the right to determine the course of his or her treatment
Mental health conditions, such as depression or anxiety, are real, common and treatable. And recovery is possible.
The Mental Health Association in New Jersey’s NJMentalHealthCares Helpline offers free, anonymous online mental health screenings in cooperation with Mental Health America. Self-assessments are available for depression, anxiety, substance abuse, PTSD and bipolar disorder, as well as screens for youth and parents. The NJ MentalHealthCares Help Line staff offers telephone counseling, information and referral and assistance in helping to get the behavioral health services needed by you or a loved one. For assistance or more information, please call our toll-free, confidential number: 866-202-HELP (4357) (TTY 877-294-4356).
The New Jersey MentalHealthCares Helpline is funded by the New Jersey Division of Mental Health and Addiction Services. Assistance is available in many languages. A TTY line is available for the deaf and hearing impaired at (877) 294-4356 Hours of operation are Monday thru Friday 8 a.m. to 8 a.m.
The New Jersey Division of Mental Health and Addiction Services serves individuals and with mental illnesses and/or substance abuse problems and assists their family members. The New Jersey Department of Children and Families is the state’s first comprehensive agency dedicated to ensuring the safety, well-being and success of children, youth, families and communities. The Mental Health Association in New Jersey strives for mental health for children and adults through advocacy, education, training, and services. Psychiatric Emergency Crisis Centerssometimes an individual is in emotional crisis and cannot wait for a regular appointment to receive services. To provide services in such situations, Screening/Crisis Centers were established in each County. Emergency services are provided 24-hours a day, seven-days a week, and are typically located in General Hospitals. Veterans Counseling Hotline The new toll free number will provide immediate assistance to veterans suffering from psychological or emotional distress as well as those having difficulty re-assimilating back into civilian life following the conclusion of their mobilization for active duty service. NJ Self-Help Group Clearinghouse Self-help groups are member-run support groups, where people facing the same stressful situation come together regularly to help one another. Most of the self-help groups listed on our Clearinghouse database can better be described as mutual aid support groups because they derive their energy from members helping one another. NJ Disaster Mental Health ServicesEmotional support for people affected by disasters or other overwhelming events is available by calling New Jersey MentalHealthCares’ Disaster Mental Health Helpline toll free at (877) 294-HELP (4357) Register Ready – New Jersey’s Special Needs Registry for Disasters allows NJ residents with access and functional needs and their families, friends and associates an opportunity to provide information to emergency response agencies, so emergency responders can better plan to serve them in a disaster or other emergency.
Post Partum Depression Perinatal mood disorders (PMD) are treatable, but many people do not know the facts. They wait too long to get help, or never seek treatment.
The American Foundation for Suicide Prevention (AFSP) is exclusively dedicated to understanding and preventing suicide through research and education, and to reaching out to people with mood disorders and those impacted by suicide. The Center for Mental Health Services (CMHS) is the Federal agency within the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) that leads national efforts to improve prevention and mental health treatment services for all Americans. Child and Adolescent Mental Health is a section of the National Insititue of Mental Health’s website which provides a great deal of information on the mental health issues and concerns of childhood and adolescence. National Alliance on Mental Illness (NAMI) is dedicated to the eradication of mental illnesses and to the improvement of the quality of life for persons of all ages who are affected by mental illnesses. The National Institute of Mental Health (NIMH) is the largest scientific organization in the world dedicated to research focused on the understanding, treatment, and prevention of mental disorders and the promotion of mental health. The Substance Abuse and Mental Health Services Administration (SAMHSA) has established a clear vision for its work — a life in the community for everyone. To realize this vision, the Agency has sharply focused its mission on building resilience and facilitating recovery for people with or at risk for mental or substance use disorders. SAMHSA is gearing all of its resources — programs, policies and grants — toward that outcome. The New Jersey Division of Mental Health and Addiction Services serves individuals and with mental illnesses and/or substance abuse problems and assists their family members. The New Jersey Department of Children and Families is the state’s first comprehensive agency dedicated to ensuring the safety, well-being and success of children, youth, families and communities. The Mental Health Association in New Jersey strives for mental health for children and adults through advocacy, education, training, and services. Psychiatric Emergency Crisis Centerssometimes an individual is in emotional crisis and cannot wait for a regular appointment to receive services. To provide services in such situations, Screening/Crisis Centers were established in each County. Emergency services are provided 24-hours a day, seven-days a week, and are typically located in General Hospitals. Veterans Counseling Hotline The new toll free number will provide immediate assistance to veterans suffering from psychological or emotional distress as well as those having difficulty re-assimilating back into civilian life following the conclusion of their mobilization for active duty service. NJ Self-Help Group Clearinghouse Self-help groups are member-run support groups, where people facing the same stressful situation come together regularly to help one another. Most of the self-help groups listed on our Clearinghouse database can better be described as mutual aid support groups because they derive their energy from members helping one another. NJ Disaster Mental Health ServicesEmotional support for people affected by disasters or other overwhelming events is available by calling New Jersey MentalHealthCares’ Disaster Mental Health Helpline toll free at (877) 294-HELP (4357) Register Ready – New Jersey’s Special Needs Registry for Disasters allows NJ residents with access and functional needs and their families, friends and associates an opportunity to provide information to emergency response agencies, so emergency responders can better plan to serve them in a disaster or other emergency.
Post Partum Depression Perinatal mood disorders (PMD) are treatable, but many people do not know the facts. They wait too long to get help, or never seek treatment.
The American Foundation for Suicide Prevention (AFSP) is exclusively dedicated to understanding and preventing suicide through research and education, and to reaching out to people with mood disorders and those impacted by suicide. The Center for Mental Health Services (CMHS) is the Federal agency within the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) that leads national efforts to improve prevention and mental health treatment services for all Americans. Child and Adolescent Mental Health is a section of the National Insititue of Mental Health’s website which provides a great deal of information on the mental health issues and concerns of childhood and adolescence. National Alliance on Mental Illness (NAMI) is dedicated to the eradication of mental illnesses and to the improvement of the quality of life for persons of all ages who are affected by mental illnesses. * NAMI County Affiliates and Support Groups
Consisting of fifty two pages, this "Memorial" was written by Dix for the legislature of New Jersey in Dorothea Dix 52-page report published January 1845, upon opening of NJ first public mental hospital in Trenton.
