Mental health

In the mid-19th century, William Sweetser was the first to coin the term mental hygiene, which can be seen as the precursor to contemporary approaches to work on promoting positive mental health.[13][14] Isaac Ray, the fourth president[15] of the American Psychiatric Association and one of its founders, further defined mental hygiene as "the art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements".[14]

In American history, mentally ill patients were thought to be religiously punished. This response persisted through the 1700s, along with inhumane confinement and stigmatization of such individuals.[16] Dorothea Dix (1802–1887) was an important figure in the development of the "mental hygiene" movement. Dix was a school teacher who endeavored to help people with mental disorders and to expose the sub-standard conditions into which they were put.[17] This became known as the "mental hygiene movement".[17] Before this movement, it was not uncommon that people affected by mental illness would be considerably neglected, often left alone in deplorable conditions without sufficient clothing.[17] From 1840-1880, she won over the support of the federal government to set up over 30 state psychiatric hospitals; however, they were understaffed, under-resourced, and were accused of violating human rights.[16]

Emil Kraepelin in 1896 developed the taxonomy of mental disorders which has dominated the field for nearly 80 years. Later, the proposed disease model of abnormality was subjected to analysis and considered normality to be relative to the physical, geographical and cultural aspects of the defining group.[18]

At the beginning of the 20th century, Clifford Beers founded "Mental Health America – National Committee for Mental Hygiene", after publication of his accounts as a patient in several lunatic asylums, A Mind That Found Itself, in 1908[19][20][21] and opened the first outpatient mental health clinic in the United States.[22]

The mental hygiene movement, similar to the social hygiene movement, had at times been associated with advocating eugenics and sterilisation of those considered too mentally deficient to be assisted into productive work and contented family life.[23][24] In the post-WWII years, references to mental hygiene were gradually replaced by the term 'mental health' due to its positive aspect that evolves from the treatment of illness to preventive and promotive areas of healthcare.[25]

When state hospitals were accused of violating human rights, advocates pushed for deinstitutionalization: the replacement of federal mental hospitals for community mental health services. The closure of state-provisioned psychiatric hospitals was enforced by the Community Mental Health Centers Act in 1963 that laid out terms in which only patients who posed an imminent danger to others or themselves could be admitted into state facilities.[26] This was seen as an improvement from previous conditions, however, there remains a debate on the conditions of these community resources.

It has been proven that this transition was beneficial for many patients: there was an increase in overall satisfaction, a better quality of life, more friendships between patients, and not too costly. This proved to be true only in the circumstance that treatment facilities that had enough funding for staff and equipment as well as proper management.[27] However, this idea is a polarizing issue. Critics of deinstitutionalization argue that poor living conditions prevailed, patients were lonely, and they did not acquire proper medical care in these treatment homes.[28] Additionally, patients that were moved from state psychiatric care to nursing and residential homes had deficits in crucial aspects of their treatment. Some cases result in the shift of care from health workers to patients’ families, where they do not have the proper funding or medical expertise to give proper care.[28] On the other hand, patients that are treated in community mental health centers lack sufficient cancer testing, vaccinations, or otherwise regular medical check-ups.[28]

Other critics of state deinstitutionalization argue that this was simply a transition to “transinstitutionalization”, or the idea that prisons and state-provisioned hospitals are interdependent. In other words, patients become inmates. This draws on the Penrose Hypothesis of 1939, which theorized that there was an inverse relationship between prisons’ population size and the number of psychiatric hospital beds.[29] This means that populations that require psychiatric mental care will transition between institutions, which in this case, includes state psychiatric hospitals and criminal justice systems. Thus, a decrease in available psychiatric hospital beds occurred at the same time as an increase in inmates.[29] Although some are skeptical that this is due to other external factors, others will reason this conclusion to a lack of empathy for the mentally ill. There is no argument in the social stigmatization of those with mental illnesses, they have been widely marginalized and discriminated against in society.[16] In this source, researchers analyze how most compensation prisoners (detainees who are unable or unwilling to pay a fine for petty crimes) are unemployed, homeless, and with an extraordinarily high degree of mental illnesses and substance abuse.[29] Compensation prisoners then lose prospective job opportunities, face social marginalization, and lack access to resocialization programs, which ultimately facilitate reoffending.[29] The research sheds light on how the mentally ill — and in this case, the poor— are further punished for certain circumstances that are beyond their control, and that this is a vicious cycle that repeats itself. Thus, prisons embody another state-provisioned mental hospital.

Families of patients, advocates, and mental health professionals still call for the increase in more well-structured community facilities and treatment programs with a higher quality of long-term inpatient resources and care. With this more structured environment, the United States will continue with more access to mental health care and an increase in the overall treatment of the mentally ill.

However, there is still a lack of studies for MHCs( mental Health conditions) to raise awareness, knowledge development, and attitude of seeking medical treatment for MHCs in Bangladesh. People in rural areas often seek treatment from the traditional healers and these MHCs sometimes considered as a spiritual matters.[30]

Mental health can be seen as an unstable continuum, where an individual's mental health may have many different possible values.[37] Mental wellness is generally viewed as a positive attribute, even if the person does not have any diagnosed mental health condition. This definition of mental health highlights emotional well-being, the capacity to live a full and creative life, and the flexibility to deal with life's inevitable challenges. Some discussions are formulated in terms of contentment or happiness.[38] Many therapeutic systems and self-help books offer methods and philosophies espousing strategies and techniques vaunted as effective for further improving the mental wellness. Positive psychology is increasingly prominent in mental health.

A holistic model of mental health generally includes concepts based upon anthropological, educational, psychological, religious, and sociological perspectives. There are also models as theoretical perspectives from personality, social, clinical, health and developmental psychology.[39][40]

The tripartite model of mental well-being[37][41] views mental well-being as encompassing three components of emotional well-being, social well-being, and psychological well-being. Emotional well-being is defined as having high levels of positive emotions, whereas social and psychological well-being are defined as the presence of psychological and social skills and abilities that contribute to optimal functioning in daily life. The model has received empirical support across cultures.[41][42][43] The Mental Health Continuum-Short Form (MHC-SF) is the most widely used scale to measure the tripartite model of mental well-being.[44][45][46]

According to 2020 data, mental illnesses have a stagnant incidence among adults but are increasing among the youth, categorized as 12 to 17-year-olds.[47] Approximately 13% of youth in the United States reported suffering from at least one major depressive episode in 2019-20, with the greatest increase (18%) in Oregon.[47] Only 28% receive consistent treatment and 70% are left untreated.[47] In lower-income communities, it is more common to forego treatment as a result of financial resources. Being left untreated also leads to unhealthy coping mechanisms such as substance abuse, which in turn causes its own host of mental health issues.

Mental health and stability is a very important factor in a person's everyday life. The human brain develops many skills at an early age including social skills, behavioral skills, and one's way of thinking. Learning how to interact with others and how to focus on certain subjects are essential lessons to learn at a young age. This starts from the time we can talk all the way to when we are so old that we can barely walk. However, there are people in society who have difficulties with these skills and behave differently. A mental illness consists of a wide range of conditions that affects a person's mood, thinking, and behavior.[48] About 26% of people in the United States, ages 18 and older, have been diagnosed with some kind of mental disorder. However, not much is said about children with mental illnesses even though many develop one, even as early as age three.

The most common mental illnesses in children include, but are not limited to anxiety disorder, as well as depression in older children and teens. Having a mental illness at a younger age is different from having one in adulthood. Children's brains are still developing and will continue to develop until around the age of twenty-five.[49] When a mental illness is thrown into the mix, it becomes significantly harder for a child to acquire the necessary skills and habits that people use throughout the day. For example, behavioral skills don't develop as fast as motor or sensory skills do.[49] So when a child has an anxiety disorder, they begin to lack proper social interaction and associate many ordinary things with intense fear.[50] This can be scary for the child because they don't necessarily understand why they act and think the way that they do. Many researchers say that parents should keep an eye on their child if they have any reason to believe that something is slightly off.[49] If the children are evaluated earlier, they become more acquainted to their disorder and treating it becomes part of their daily routine.[49] This is opposed to adults who might not recover as quickly because it is more difficult for them to adopt when already being accustomed to a certain direction of life.

Mental illness affects not only the person themselves but the people around them. Friends and family also play an important role in the child's mental health stability and treatment.[51] If the child is young, parents are the ones who evaluate their child and decide whether or not they need some form of help.[52] Friends are a support system for the child and family as a whole. Living with a mental disorder is never easy, so it's always important to have people around to make the days a little easier. However, there are negative factors that come with the social aspect of mental illness as well. Parents are sometimes held responsible for their child's illness.[52] People also say that the parents raised their children in a certain way or they acquired their behavior from them. Family and friends are sometimes so ashamed of the idea of being close to someone with a disorder that the child feels isolated and thinks that they have to hide their illness from others.[52] When in reality, hiding it from people prevents the child from getting the right amount of social interaction and treatment to thrive in today's society.

Stigmas are also a well-known factor in mental illness. A stigma is defined as “a mark of disgrace associated with a particular circumstance, quality, or person.” Stigmas are used especially when it comes to mentally disabled people. People have this assumption that everyone with a mental problem, no matter how mild or severe, is automatically considered destructive or a criminal person. Thanks to the media, this idea has been planted in our brains from a young age.[53] Watching movies about teens with depression or children with Autism makes us think that all of the people that have a mental illness are like the ones on TV. In reality, the media displays an exaggerated version of most illnesses. Unfortunately, not many people know that, so they continue to belittle those with disorders. In a recent study, a majority of young people associate mental illness with extreme sadness or violent tendencies .[54] Now that children are becoming more and more open to technology and the media itself, future generations will then continue to pair mental illness with negative thoughts. The media should be explaining that many people with psychiatric disorders like ADHD and Anxiety, can live an ordinary life with the correct treatment and should not be punished for something they cannot help. Along with social stigmas, individuals with a mental illness can develop a self-stigma. A self-stigma is when the affected individual does not come forward about their feelings in fear of being judged. These self-stigmas can deter the individual from seeking help and treatment.[55]

Sueki, (2013) carried out a study titled “The effect of suicide-related internet use on users’ mental health: A longitudinal Study”. This study investigated the effects of suicide-related internet use on user's suicidal thoughts, predisposition to depression and anxiety, and loneliness. The study consisted of 850 internet users; the data was obtained by carrying out a questionnaire amongst the participants. This study found that browsing websites related to suicide, and methods used to commit suicide, harmed suicidal thoughts and increased depression and anxiety tendencies. The study concluded that as suicide-related internet use adversely affected the mental health of certain age groups it may be prudent to reduce or control their exposure to these websites. These findings certainly suggest that the internet can indeed have a profoundly negative impact on our mental health.[56]

Psychiatrist Thomas Szasz compared that 50 years ago children were either categorized as good or bad, and today "all children are good, but some are mentally healthy and others are mentally ill". Social control and forced identity creation is the cause of many mental health problems among today's children.[57] A behavior or misbehavior might not be an illness but exercise of their free will and today's immediacy in drug administration for every problem along with the legal over-guarding and regard of a child's status as a dependent shakes their personal self and invades their internal growth.

Mental illness is not only prevalent among children and young adults but also the homeless. Mental illness is thought to be extremely prevalent among homeless populations, though access to proper diagnoses is limited. In an article written by Lisa Godman and her colleagues, they reference Smith’s research on the prevalence of PTSD among homeless people. His research stated, "Homelessness itself is a risk factor for emotional disorder."[58] What this quote is saying is that being homeless itself can cause the emotional disorder. Without looking for other reasons for emotional disorder and really looking at the simple fact that an individual is homeless can cause the emotional disorder. Godman’s article stated "Recently, Smith ( 1991) investigated the prevalence of PTSD among a sample of 300 randomly selected homeless single women and mothers in St. Louis, Missouri. Using the Diagnostic Interview Schedule (DIS; Robins, 1981; Robins & Helzer, 1984), she found that 53% of the respondents could be diagnosed as exhibiting full-blown cases of PTSD." As the source explains, the conclusion that was drawn from Smith’s investigation after studying 300 homeless individuals is that 53% of those people were eligible to be diagnosed with PTSD. She continues and states: "In addition, data from clinical observations, self-reports, and empirical studies suggest that at least two commonly reported symptoms of psychological trauma, social disaffiliation and learned helplessness are highly prevalent among homeless individuals and families."[59] Other data were able to prove that PTSD and learned helplessness were two symptoms that were very much present among homeless individuals and families. The question would be how are these people being helped. This is evident that mental health among the homeless is an issue existing but barely touched.[60] In another article by Stephen W. Hwang and Rochelle E Garner, they talk about the ways that the homeless are getting actually getting help. It states "For homeless people with mental illness, case management linked to other services was effective in improving psychiatric symptoms, and assertive case management was effective in decreasing psychiatric hospitalizations and increasing outpatient contacts. For homeless people with substance abuse problems, case management resulted in greater decreases in substance use than did usual care."[61] The question would be how are these people being helped. As the source explained, case management provided by services helped improve psychiatric symptoms. It also caused a decrease in substance use than usual media care.[62]

The Rohingya from Myanmar are a large group of stateless people who experienced war, deprivation of social rights, and other cultural and political instability and they are currently residing in the southeastern part of Bangladesh as refugees. There are very little research has been done on their mental health status due to war, daily environmental stressors due to continuous displacement, historical trauma, and life in the refugee camp.[63]

A cross-sectional study was conducted among 148 Rohingya adults in the refugee camp in Bangladesh and the result indicated that people are suffering from post-traumatic stress disorder (PTSD), depression, somatic impairment, and other associated functional impairment as well. this study revealed that all these MHCs developed due to the high level of daily environmental stressors in the camp, also due to lack of food, lack of freedom of movement.[63]

Mental health is a socially constructed and socially defined concept; that is, different societies, groups, cultures, institutions, and professions have very different ways of conceptualizing its nature and causes, determining what is mentally healthy, and deciding what interventions, if any, are appropriate.[64] Thus, different professionals will have different cultural, class, political and religious backgrounds, which will impact the methodology applied during treatment. In the context of deaf mental health care, it is necessary for professionals to have cultural competency of deaf and hard of hearing people and to understand how to properly rely on trained, qualified, and certified interpreters when working with culturally Deaf clients.

Research has shown that there is stigma attached to mental illness.[65] Due to such stigma, individuals may resist 'labeling' and may be driven to respond to mental health diagnoses with denialism.[66] Family caregivers of individuals with mental disorders may also suffer discrimination or face stigma.[67]

Addressing and eliminating the social stigma and perceived stigma attached to mental illness has been recognized as crucial to education and awareness surrounding mental health issues. In the United Kingdom, the Royal College of Psychiatrists organized the campaign Changing Minds (1998–2003) to help reduce stigma,[68] while in the United States, efforts by entities such as the Born This Way Foundation and The Manic Monologues specifically focus on removing the stigma surrounding mental illness.[69][70] The National Alliance on Mental Illness is a U.S. institution founded in 1979 to represent and advocate for those struggling with mental health issues. NAMI helps to educate about mental illnesses and health issues, while also working to eliminate stigma[71] attached to these disorders.

Many mental health professionals are beginning to, or already understand, the importance of competency in religious diversity and spirituality. They are also partaking in cultural training to better understand which interventions work best for these different groups of people. The American Psychological Association explicitly states that religion must be respected. Education in spiritual and religious matters is also required by the American Psychiatric Association,[72] however, far less attention is paid to the damage that more rigid, fundamentalist faiths commonly practiced in the United States can cause.[73] This theme has been widely politicized in 2018 such as with the creation of the Religious Liberty Task Force in July of that year.[74] Also, many providers and practitioners in the United States are only beginning to realize that the institution of mental healthcare lacks knowledge and competence of many non-Western cultures, leaving providers in the United States ill-equipped to treat patients from different cultures.[75]

Social work in mental health, also called psychiatric social work, is a process where an individual in a setting is helped to attain freedom from overlapping internal and external problems (social and economic situations, family and other relationships, the physical and organizational environment, psychiatric symptoms, etc.). It aims for harmony, quality of life, self-actualization and personal adaptation across all systems. Psychiatric social workers are mental health professionals that can assist patients and their family members in coping with both mental health issues and various economic or social problems caused by mental illness or psychiatric dysfunctions and to attain improved mental health and well-being. They are vital members of the treatment teams in Departments of Psychiatry and Behavioral Sciences in hospitals. They are employed in both outpatient and inpatient settings of a hospital, nursing homes, state and local governments, substance abuse clinics, correctional facilities, health care services...etc.[76]

In the United States, social workers provide most of the mental health services. According to government sources, 60 percent of mental health professionals are clinically trained social workers, 10 percent are psychiatrists, 23 percent are psychologists, and 5 percent are psychiatric nurses.[77]

Mental health social workers in Japan have professional knowledge of health and welfare and skills essential for person's well-being. Their social work training enables them as a professional to carry out Consultation assistance for mental disabilities and their social reintegration; Consultation regarding the rehabilitation of the victims; Advice and guidance for post-discharge residence and re-employment after hospitalized care, for major life events in regular life, money and self-management and other relevant matters to equip them to adapt in daily life. Social workers provide individual home visits for mentally ill and do welfare services available, with specialized training a range of procedural services are coordinated for home, workplace and school. In an administrative relationship, Psychiatric social workers provides consultation, leadership, conflict management and work direction. Psychiatric social workers who provides assessment and psychosocial interventions function as a clinician, counselor and municipal staff of the health centers.[78]

Unemployment has been shown to hurt an individual's emotional well-being, self-esteem, and more broadly their mental health. Increasing unemployment has been shown to have a significant impact on mental health, predominantly depressive disorders.[79] This is an important consideration when reviewing the triggers for mental health disorders in any population survey.[80]

The prevalence of mental illness is higher in more unequal rich countries

Emotional mental disorders are a leading cause of disabilities worldwide. Investigating the degree and severity of untreated emotional mental disorders throughout the world is a top priority of the World Mental Health (WMH) survey initiative,[81] which was created in 1998 by the World Health Organization (WHO).[82] "Neuropsychiatric disorders are the leading causes of disability worldwide, accounting for 37% of all healthy life years lost through disease.These disorders are most destructive to low and middle-income countries due to their inability to provide their citizens with proper aid. Despite modern treatment and rehabilitation for emotional mental health disorders, "even economically advantaged societies have competing priorities and budgetary constraints".

The World Mental Health survey initiative has suggested a plan for countries to redesign their mental health care systems to best allocate resources. "A first step is documentation of services being used and the extent and nature of unmet treatment needs. A second step could be to do a cross-national comparison of service use and unmet needs in countries with different mental health care systems. Such comparisons can help to uncover optimum financing, national policies, and delivery systems for mental health care."

Knowledge of how to provide effective emotional mental health care has become imperative worldwide. Unfortunately, most countries have insufficient data to guide decisions, absent or competing visions for resources, and near-constant pressures to cut insurance and entitlements. WMH surveys were done in Africa (Nigeria, South Africa), the Americas (Colombia, Mexico, United States), Asia and the Pacific (Japan, New Zealand, Beijing and Shanghai in the People's Republic of China), Europe (Belgium, France, Germany, Italy, Netherlands, Spain, Ukraine), and the middle east (Israel, Lebanon). Countries were classified with World Bank criteria as low-income (Nigeria), lower-middle-income (China, Colombia, South Africa, Ukraine), higher middle-income (Lebanon, Mexico), and high-income.

The coordinated surveys on emotional mental health disorders, their severity, and treatments were implemented in the aforementioned countries. These surveys assessed the frequency, types, and adequacy of mental health service use in 17 countries in which WMH surveys are complete. The WMH also examined unmet needs for treatment in strata defined by the seriousness of mental disorders. Their research showed that "the number of respondents using any 12-month mental health service was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care". "High levels of unmet need worldwide are not surprising, since WHO Project ATLAS' findings of much lower mental health expenditures than was suggested by the magnitude of burdens from mental illnesses. Generally, unmet needs in low-income and middle-income countries might be attributable to these nations spending reduced amounts (usually <1%) of already diminished health budgets on mental health care, and they rely heavily on out-of-pocket spending by citizens who are ill-equipped for it".

The Centre for Addiction and Mental Health discuss how a certain amount of stress is a normal part of daily life. Small doses of stress help people meet deadlines, be prepared for presentations, be productive and arrive on time for important events. However, long-term stress can become harmful. When stress becomes overwhelming and prolonged, the risks for mental health problems and medical problems increase."[83]

Mental health care navigation helps to guide patients and families through the fragmented, often confusing mental health industries. Care navigators work closely with patients and families through discussion and collaboration to provide information on best therapies as well as referrals to practitioners and facilities specializing in particular forms of emotional improvement. The difference between therapy and care navigation is that the care navigation process provides information and directs patients to therapy rather than providing therapy. Still, care navigators may offer diagnosis and treatment planning. Though many care navigators are also trained therapists and doctors. Care navigation is the link between the patient and the below therapies. A clear recognition that mental health requires medical intervention was demonstrated in a study by Kessler et al. of the prevalence and treatment of mental disorders from 1990 to 2003 in the United States. Despite the prevalence of mental health disorders remaining unchanged during this period, the number of patients seeking treatment for mental disorders increased threefold.[94]

Pharmacotherapy is a therapy that uses pharmaceutical drugs. Pharmacotherapy is used in the treatment of mental illness through the use of antidepressants, benzodiazepines, and the use of elements such as lithium.

For some people, physical exercise can improve mental as well as physical health. Playing sports, walking, cycling, or doing any form of physical activity trigger the production of various hormones, sometimes including endorphins, which can elevate a person's mood.[95]

Studies have shown that in some cases, physical activity can have the same impact as antidepressants when treating depression and anxiety.[96]

Moreover, cessation of physical exercise may have adverse effects on some mental health conditions, such as depression and anxiety. This could lead to many different negative outcomes such as obesity, skewed body image, lower levels of certain hormones, and many more health risks associated with mental illnesses.[97]

Activity therapies also called recreation therapy and occupational therapy, promote healing through active engagement. Making crafts can be a part of occupational therapy. Walks can be a part of recreation therapy. In recent years colouring has been recognised as an activity that has been proven to significantly lower the levels of depressive symptoms and anxiety in many studies.[98]

Expressive therapies or creative arts therapies are a form of psychotherapy that involves the arts or art-making. These therapies include art therapy, music therapy, drama therapy, dance therapy, and poetry therapy. It has been proven that Music therapy is an effective way of helping people who suffer from a mental health disorder.[99] Dramatherapy is approved by NICE for the treatment of psychosis.[100]

Psychotherapy is the general term for the scientific based treatment of mental health issues based on modern medicine. It includes a number of schools, such as gestalt therapy, psychoanalysis, cognitive behavioral therapy, psychedelic therapy, transpersonal psychology/psychotherapy, and dialectical behavioral therapy. Group therapy involves any type of therapy that takes place in a setting involving multiple people. It can include psychodynamic groups, expressive therapy groups, support groups (including the Twelve-step program), problem-solving and psychoeducation groups.

According to Neff, self-compassion consists of three main positive components and their negative counterparts: Self-Kindness versus Self-Judgement, Common Humanity versus Isolation and Mindfulness versus Over-Identification.[101] Furthermore, there is evidence from a study by Shin & Lin suggesting specific components of self-compassion can predict specific dimensions of positive mental health (emotional, social, & psychological well-being).[102]

The Callaborative for academic, social, emotional learning (CASEL) addresses five broad and interrelated areas of competence and highlights examples for each: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making.[103] A meta-analysis was done by Alexendru Boncu, Iuliana Costeau, & Mihaela Minulescu (2017) looking at Social-emotional learning (SEL) studies and the effects on emotional and behaviour outcomes. They found a small but significant effect size (across the studies looked into) for externalized problems and social-emotional skills.[104]

The practice of mindfulness meditation has several mental health benefits, such as bringing about reductions in depression, anxiety and stress.[105][106][107][108] Mindfulness meditation may also be effective in treating substance use disorders.[109][110] Further, mindfulness meditation appears to bring about favorable structural changes in the brain.[111][112][113]

The Heartfulness meditation program has proven to show significant improvements in the state of mind of health-care professionals.[114] A study posted on the US National Library of Medicine showed that these professionals of varied stress levels were able to improve their conditions after this meditation program was conducted. They benefited in aspects of burnouts and emotional wellness.

People with anxiety disorders participated in a stress-reduction program conducted by researchers from the Mental Health Service Line at the W.G. Hefner Veterans Affairs Medical Center in Salisbury, North Carolina. The participants practiced mindfulness meditation. After the study was over, it was concluded that the "mindfulness meditation training program can effectively reduce symptoms of anxiety and panic and can help maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia."[115]

Mental fitness is a mental health movement that encourages people to intentionally regulate and maintain their emotional wellbeing through friendship, regular human contact, and activities that include meditation, calming exercises, aerobic exercise, mindfulness, having a routine and maintaining adequate sleep. Mental fitness is intended to build resilience against every-day mental health challenges to prevent an escalation of anxiety, depression and suicidal ideation, and help them cope with the escalation of those feelings if they occur.[116]

Spiritual counsellors meet with people in need to offer comfort and support and to help them gain a better understanding of their issues and develop a problem-solving relation with spirituality. These types of counselors deliver care based on spiritual, psychological and theological principles.[117]

The mental health policies in the United States have experienced four major reforms: the American asylum movement led by Dorothea Dix in 1843; the "mental hygiene" movement inspired by Clifford Beers in 1908; the deinstitutionalization started by Action for Mental Health in 1961; and the community support movement called for by The CMCH Act Amendments of 1975.[121]

In 1843, Dorothea Dix submitted a Memorial to the Legislature of Massachusetts, describing the abusive treatment and horrible conditions received by the mentally ill patients in jails, cages, and almshouses. She revealed in her Memorial: "I proceed, gentlemen, briefly to call your attention to the present state of insane persons confined within this Commonwealth, in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience...."[122] Many asylums were built in that period, with high fences or walls separating the patients from other community members and strict rules regarding the entrance and exit. In those asylums, traditional treatments were well implemented: drugs were not used as a cure for a disease, but a way to reset equilibrium in a person's body, along with other essential elements such as healthy diets, fresh air, middle class culture, and the visits by their neighboring residents. In 1866, a recommendation came to the New York State Legislature to establish a separate asylum for chronic mentally ill patients. Some hospitals placed the chronic patients into separate wings or wards, or different buildings.[123]

In A Mind That Found Itself (1908) Clifford Whittingham Beers described the humiliating treatment he received and the deplorable conditions in the mental hospital.[124] One year later, the National Committee for Mental Hygiene (NCMH) was founded by a small group of reform-minded scholars and scientists – including Beers himself – which marked the beginning of the "mental hygiene" movement. The movement emphasized the importance of childhood prevention. World War I catalyzed this idea with an additional emphasis on the impact of maladjustment, which convinced the hygienists that prevention was the only practical approach to handle mental health issues.[125] However, prevention was not successful, especially for chronic illness; the condemnable conditions in the hospitals were even more prevalent, especially under the pressure of the increasing number of chronically ill and the influence of the depression.[121]

In 1961, the Joint Commission on Mental Health published a report called Action for Mental Health, whose goal was for community clinic care to take on the burden of prevention and early intervention of the mental illness, therefore to leave space in the hospitals for severe and chronic patients. The court started to rule in favor of the patients' will on whether they should be forced to treatment. By 1977, 650 community mental health centers were built to cover 43 percent of the population and serve 1.9 million individuals a year, and the lengths of treatment decreased from 6 months to only 23 days.[126] However, issues still existed. Due to inflation, especially in the 1970s, the community nursing homes received less money to support the care and treatment provided. Fewer than half of the planned centers were created, and new methods did not fully replace the old approaches to carry out its full capacity of treating power.[126] Besides, the community helping system was not fully established to support the patients' housing, vocational opportunities, income supports, and other benefits.[121] Many patients returned to welfare and criminal justice institutions, and more became homeless. The movement of deinstitutionalization was facing great challenges.[127]

After realizing that simply changing the location of mental health care from the state hospitals to nursing houses was insufficient to implement the idea of deinstitutionalization, the National Institute of Mental Health in 1975 created the Community Support Program (CSP) to provide funds for communities to set up a comprehensive mental health service and supports to help the mentally ill patients integrate successfully in the society. The program stressed the importance of other supports in addition to medical care, including housing, living expenses, employment, transportation, and education; and set up new national priority for people with serious mental disorders. In addition, the Congress enacted the Mental Health Systems Act of 1980 to prioritize the service to the mentally ill and emphasize the expansion of services beyond just clinical care alone.[128] Later in the 1980s, under the influence from the Congress and the Supreme Court, many programs started to help the patients regain their benefits. A new Medicaid service was also established to serve people who were diagnosed with a "chronic mental illness." People who were temporally hospitalized were also provided aid and care and a pre-release program was created to enable people to apply for reinstatement prior to discharge.[126] Not until 1990, around 35 years after the start of the deinstitutionalization, did the first state hospital begin to close. The number of hospitals dropped from around 300 by over 40 in the 1990s, and finally a Report on Mental Health showed the efficacy of mental health treatment, giving a range of treatments available for patients to choose.[128]

However, several critics maintain that deinstitutionalization has, from a mental health point of view, been a thoroughgoing failure. The seriously mentally ill are either homeless, or in prison; in either case (especially the latter), they are getting little or no mental health care. This failure is attributed to a number of reasons over which there is some degree of contention, although there is general agreement that community support programs have been ineffective at best, due to a lack of funding.[127]

The 2011 National Prevention Strategy included mental and emotional well-being, with recommendations including better parenting and early intervention programs, which increase the likelihood of prevention programs being included in future US mental health policies.[87] The NIMH is researching only suicide and HIV/AIDS prevention, but the National Prevention Strategy could lead to it focusing more broadly on longitudinal prevention studies.[129]

In 2013, United States Representative Tim Murphy introduced the Helping Families in Mental Health Crisis Act, HR2646. The bipartisan bill went through substantial revision and was reintroduced in 2015 by Murphy and Congresswoman Eddie Bernice Johnson. In November 2015, it passed the Health Subcommittee by an 18–12 vote.