What an interesting history! Do you have any plans to expand this research? 

Thank you! I am continuing my research for this project as part of my Senior Thesis this semester.

Wow, this is such a cool research project! What do you think are the most important steps to addressing and mitigating this affordability issue?

So interesting how the practices of our history continue to shape the way that mental health care is accessed and delivered! I think it's really interesting how you bridged the gap between the past and the present. How were you able to access these archived resources? What was the experience like reading through the different sources of the past?

Thanks for the comment! I think that further enforcement of existing mental health parity legislation from the Mental Health Parity and Addiction Equity Act of 1996 and the Affordable Care Act is an important step to increase access and address affordability for mental health care. Mental health parity legislation mandates that insurers must cover mental health benefits equally to medical benefits, with equivalent metrics such as copays and deductibles. Currently it's often left up to patients to raise lawsuits when their mental health benefits are not equal, making it often unenforced. I think the provider shortage is another huge problem that needs to be tackled to make care more affordable. There's a large shortage of psychiatrists, psychologists, and other types of mental health providers in America. Allowing advanced practice psychiatric nurse practitioners to practice within the full scope of their training may help alleviate some of this shortage, helping care to become more available and affordable. 

Thanks for the comment Julia! I was able to find a variety of archival sources through the Penn library network of digital resources. Luckily there is a lot of recorded and digitized material from the history of Friends Hospital, including the founder's journal. A lot of the controversy surrounding my other case study Byberry State Hospital has been recent enough that there is still a lot of news articles online. I found a digital newspaper archive that had issues of the Inquirer and other Pennsylvanian news sources saved from the early 1900s, which helped inform a lot of my research. Piecing together different sources, especially for the earlier time period in the 19th C, felt a bit like working on an investigation and I've really enjoyed getting to build a fuller understanding of mental health care across time with each additional source. 

I'm so glad to see this type of research being done, especially in this day and age due to increased awareness of mental health and the movement working to destigmatize it. What factors do you think led to this stigma in the first place? How do you think lawmakers can help bridge the gap in the care provided?

These are great questions! My short answer is that people with mental illness are a vulnerable population who have been consistently exploited and discriminated against in America. Many of the advancements in understanding mental illness have occurred in the past several decades and still there is a lot that is not understood about mental illness, the unknowns contributing to the stigma. Also mental health conditions are often chronic conditions that are difficult for patients to manage. 

I would also argue that the history of mental health stigma coincides with the history of the asylum. Mental illness as a label has meant a lot of different things over the past few centuries and even decades, but the 19th C idea of madness included conditions such as "excessive study, religious enthusiasm, anxieties over work, reading vile books, and ecstatic admiration of works of art" – creating problems because it was easy to institutionalize people against their will by arguing they demonstrated some of these characteristics. With the rise of the state asylum across the end of the 19th C and early 20th C, local governments were able to forcibly institutionalize anyone deemed by society to be disruptive and then utilize them as labor for textiles and other industries. Essentially mental illness and its prior labels allowed a large group of people to be exploited and discriminated against. With the shift to deinstitutionalization, patients with mental diagnoses were placed into the community and given greater responsibility to navigate and manage their own care. This shift left many patients without the adequate resources to receive care, creating many issues still present today. 

I think some policy solutions to solve for the inaccessibility of the mental health system in the US are to 1) enforce existing mental health parity, 2) invest in public health interventions that prioritize prevention as a precursor to treatment, and 3) increase the number of mental health providers by expanding the role of advanced practice nurse practitioners or otherwise providing tuition relief for mental health providers such as licensed clinical social workers. Hope that answers your questions!