Better financed and with a lower staff-to-patient ratio, they were often able to provide the quiet therapeutic atmosphere and patient attention that could lead to improvement. However, private hospitals were usually available only to the wealthy. Most people requiring hospitalization went to the inadequate public facilities.
As knowledge of abnormal functioning improved it became clear that many people who needed treatment did not have to be hospitalized. Outpatient treatments (treatments that do not require the recipient to stay in the hospital) proved helpful to many people. Again, the therapy was available only to those who could afford it. Others in need tended to receive no outpatient treatment or were hospitalized even though they might have been helped by outpatient treatment.
Thus effective outpatient and inpatient care was available only to a small number of people with emotional and behavioral problems. The less well off received inadequate custodial care or no care at all. This situation continued until after World War II, when major developments brought about changes. First, psychoactive drugs were developed in the 1950s. These drugs provided an easier way to control violent patients and reduce anxiety and depression. Such drugs generally lowered the incidence of “crazy” behavior on the hospital wards, in turn facilitating other kinds of patient therapy. The drug-moderated decrease in symptoms of mental disturbance also helped create a more favorable climate of opinion for a second major development-what is called the reinstitutionalization movement: the return of mental patients to care provided by the local community.
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