Pros uye Cons
Muna 1955, nhamba yacho yakawedzera varwere 558 000 kana 0.03 muzana yevanhu. Kana zviyero zvakafanana zvehuwandu hwevanhu zvaive zvikwangwani nhasi, izvo zvaizova 750 000 vanhu vanorwara mupfungwa.
Izvo zvinopfuura vanhu veBaltimore kana yeSan Francisco.
Migumisiro
Pakazosvika 1955 na1994, vanenge 487 000 varwere vanorwara mupfungwa vakadzingwa kubva kuchipatara. Izvozvo zvakaderedza nhamba kune varwere 72 000 chete. Nyika dzakavhara zvizhinji zvezvipatara. Iyo yakagadzirisa zvachose kuwanikwa kwemazuva mazhinji, mu-muchengeti wekuchengetedza zvivako. Pakazosvika gore ra2010, pakanga pane mabheji makumi mapfumbamwe nemakumi mashanu emapfungwa. Izvi zvakaenzana nemabhedha gumi nemaviri nevanhu 100 000. Ichi chaiva chiyero chakafanana se1850. (Chinyorwa: "Nguva Yakatarwa: Dheinstitutionalization Nemigumisiro Yayo," Amai Jones, April 29, 2013.)
Somugumisiro, mamiriyoni 2,2 evanhu vanorwara mupfungwa havagoni kurapwa kwepfungwa zvachose. Vanenge 200 000 veavo vanotambura nechichichirafrenia kana kuti bipolar disorder havana pokugara. Ndiyo chetatu chevanhu vese vasina pokugara. Tumi muzana ndeye veterans vanotambura kubva shure-kunetseka mupfungwa kunetseka kana zvimwe zvikuvadza zvine chokuita nehondo.
(Kubva: "Kubvisa zvekuita uye kusagadzikana kwevarwere," Hospital Community Psychiatry, September 1984, 35 (9), 899-907.)
Vanopfuura 300 000 vari mujeri uye mumajeri. Izvi zvinoreva 16 muzana yevasungwa vose vane chirwere chakanyanya kurwara. Kwakanga kune vanenge zana nemakumi mashanu emabhedha emapfungwa mumapepanhau ehurumende uye oga.
Izvozvo zvinoreva kuti kune vanopfuura katatu nevakawanda vanorwara mupfungwa mujeri nejeri kupfuura mune zvipatara. (Kubva: "Kusarudzwa kwezvematongerwo enyika: Imwe Yakakundikana," Chirongwa Chekuchengetedza Chirongwa. "Kubvisa Dhizinesi: A Psychiatric Titanic," Frontline, May 10, 2005.)
Zvinhu Zvinotatu
Zvinhu zvitatu zvehupfumi uye shanduko zvakaitika zvakakonzera kusava nekusimudzira. Chokutanga, kukura kwemishonga yepfungwa kunobata zviratidzo zvehutano hwepfungwa. Izvi zvaisanganisira chlorpromazine uye gare gare clozapine.
Chechipiri, sangano rakagamuchira kuti chirwere chepfungwa chinoda kurapwa panzvimbo yekuvharwa kure. Chechitatu, federal yemari yakadai seMedicaid uye Medicare yakaenda kunharaunda dzehutano hwepfungwa panzvimbo pezvipatara zvepfungwa. (Kubva: " Kuderedza Kusungwa Misa: Zvidzidzo kubva kuDenstitutionalization of Mental Hospitals muma1960 ," Ohio State Journal of Criminal Law, 2011.)
Nhoroondo
- 1946 - Congress yakapa Mutemo weNational Mental Health Act. Yakasimbisa National Institute of Mental Health muna 1949. Institute yakatsvaga nzira dzekurapa utano hwepfungwa munharaunda.
- 1954 - Zvokudya neDrug Administration zvakabvumira Thorazine, inozivikanwa zvikuru se chlorpromazine, kurapa maitiro epfungwa. Mamwe mishonga chete inowanikwa panguva iyoyo yaiva electroshock therapy uye lobotomies. Pakanga paine 7 000 vezvechirwere chepfungwa, 13 500 vepfungwa dzepfungwa uye 20,000 vashandi vomunharaunda munyika yose. (Mhedziso: "Utano Mukufunga," Richmond Fed Econ Focus, Chipiri Chetatu, 2013.)
- 1955 - Nhamba yevarwere muzvipatara zvehutano zvepfungwa yakawana nhamba ye 558 000. Vakatambura neschizophrenia, bipolar disorder uye yakaora mwoyo. Vakawanda vaiva nehutano hwehupfungwa hwehupfungwa dzakadai sedhementia uye kukuvara kwehupi kubva pamatambudziko. Vamwe vakatambura nekurasikirwa mupfungwa pamwe chete ne psychosis, autism kana kukuvara kwehupombwe kubva kune zvinodhaka. Vakawanda varwere vakanga vasingatarisiri kuti vawane zviri nani kupa mishonga panguva iyoyo. Congress yakapfuura Mental Health Study Act muna 1955. Yakasimbisa Joint Commission paMental Illness uye Health kuti iongorore mamiriro ehutano hwemamiriro enyika.
- 1961 - Komisheni yakabudisa zviwanikwa zvayo muAgent for Mental Health. Yakakurudzira kuti nzvimbo dzehutano dzemunharaunda dzigadziridzwe kuti dzirape avo vane zvirwere zvepfungwa zvishoma. Kutsvakurudza kwaro kwakaratidza kuti 20 muzana yevanhu vanobatwa nehumwe hutano hwepfungwa nekutambudzika. Komisheni iyi inotaura nezvekurapa matambudziko aya kuvadzivirira kuti vasanyanya kuoma. (Kubva: "Kuzivikanwa nekudzivirirwa kweMagariro makuru ekushandisa Mishonga uye Zvimwewo," American Psychological Association, peji 57.)
- 1962 - Ken Kesey akabudisa Rimwe Flew Pamusoro peNeckoo's Nest . Yaiva nhau inofunga nezvekushungurudzwa mune chipatara chepfungwa. Munyori wacho akafananidza zvakaitika kwaari semubatsiri wekoti mumapiko emapfungwa ezvipatara zveCalifornia. Bhuku rakabatsira kutarisa maonero evanhu pamusoro pe electroshock therapy uye maitiro. Aya ndiwo maitiro anowanzoshandiswa panguva iyoyo.
- 1963 - Mutungamiri John F. Kennedy akasayira Mutemo Mental Health Centers Construction Act. Yakapa hurumende mari yekugadzira nzvimbo dzehutano hwehutano. Vaizopa kudzivirira, kurapwa kwekutanga uye kuchengetwa kwakasimba. Chinangwa chacho chaiva nekuvaka imwe kubva kune 125,000 kusvika ku 250,000 vanhu. Iyo nzvimbo dzakawanda dzichibvumira varwere kuti varambire pedyo nemhuri dzavo uye vagobatanidzwa munzanga. Asi hazvina hanya nematarenda akaratidza 75 muzana yevaya vari muzvipatara vasina mhuri. (Inobva: "Community Community mentals Centers," MindDisorders.com.)
- 1965 - Mutungamiri Lyndon B. Johnson vakasayina Social Security Amendments muna 1965. Yakagadzira Medicaid kuti iwane mari yekuchengetedza utano hwemhuri isina mari. Izvo hazvina kubhadhara kutarisira muzvipatara zvepfungwa. Somugumisiro, nyika inotamisa varwere ivavo mumisha yevanotarisira uye zvipatara kuti vawane mari yehurumende.
- 1967 - Gavhuna weCalifornia Ronald Reagan akasayina Lanterman-Petris-Short Act. Iyo yakarongedza kodzero yemhuri yekuita hama yekurwara mupfungwa isina kodzero yekutongwa kwakakodzera. Yakaderedzawo mari yehurumende yemari. Izvozvo zvakapetwa kaviri nhamba yevanhu vanorwara mupfungwa muCalifornia yemhosva yehurumende yehurumende gore rinotevera. Yakawedzerawo nhamba inotarirwa nezvipatara zvinotambudza zvivako. Medicaid yakafukidza iyo mari. Zvimwe zviitiko zvakatevedzwa nemitemo yakazvipira yekuzvipira.
- 1975 - Mufirimu uyu, "Mumwe Anosvika Pamusoro Pechipu chaChakkoo," inopinda mafirimu. Jack Nicholson's Oscar-kukunda kuratidzwa kwemurwere ane utsinye kwakapfuurira kutarisa pfungwa yevanhu pamusoro pezvipatara zvepfungwa.
- 1977 - Nzvimbo dzehutano dzemunharaunda 650 chete dzaive dzichivakwa. Izvo zvakanga zvisingasviki hafu zvaidiwa. Vakashumira vatari mamiriyoni 1,9. Zvakanga zvakagadzirirwa kubatsira avo vasina zvirwere zvishoma zveutano hwepfungwa. Sezvo hurumende yakavhara zvipatara, nzvimbo dzakashamiswa nevarwere ivavo vane matambudziko makuru.
- 1980 - Mutungamiri Jimmy Carter vakasaina Mental Health Systems Act kuti vabatsire mamwe masangano ezveutano. Asi yakarongedza pamhando yakawanda yezvinodiwa zvehutano hwemagariro emunharaunda. Izvozvo zvakaderedza hurumende yehurumende kuisa pfungwa kune avo vane chirwere chepfungwa chisingaperi. (Inobva: "Public Public Policy uye Mental Illnesses," The Milbank Quarterly, September 2005, 83930, 425-456.)
- 1981 - Mutungamiri Reagan akadzora Mutemo kuburikidza neOnibus Budget Reconciliation Act ya1981. Yakashandura mari kune nyika kuburikidza nemabhadharo ekubvisa. Kupiwa kwacho kwakaratidza kuti nzvimbo dzemagariro ehutano hwepfungwa dzakakwikwidzana nezvimwe zvinoda zvevanhu. Zvirongwa zvakadai seimba, mabhizimisi ezvekudya uye kubudirira kwezvoupfumi kazhinji zvakakunda mari ye federal panzvimbo.
- 1990 - Zvokudya neDrug Administration zvakagamuchirwa clozapine kuti zvirwere zviratidzo zvechichichiphrenia. Izvozvo zvakasimbisa kusarura kwekuchengetwa kwevanorwara mupfungwa.
- 2004 - Zvidzidzo zvinoratidza inenge 16 muzana yejeri nejeri vasungwa kana kuti vanenge 320 000 vanhu vairwara mupfungwa. Gore iroro, pakanga pane mazana mapfumbamwe emibhedha yepfungwa mumasangano ehurumende uye oga. Mune mamwe mazwi, katatu vazhinji vairwara mupfungwa vaiva mutirongo kupinda muchipatara.
- 2009 - The Great Recession yakamanikidzwa kutaura kuti icheke $ 4.35 mabhiriyoni mumari yehutano hwepfungwa mumakore matatu.
- 2010 - The Affordable Care Act yakarayirwa kuti makambani einishuwarenzi anofanirwa kutarisira hutano hwepfungwa seimwe yezvinokosha gumi zvinokosha . Izvozvo zvaisanganisira kurapa doro, zvinodhaka uye zvimwe zvinodhaka nekudhakwa. Murwere anokweretesa angave akaenzana ne $ 40 semutambo. Nhamba yekushanyirwa kwevechiremba inogona kuderedzwa. (Mhedziso: "Nguva Yakatarwa: Dheinstitutionalization Nemigumisiro Yayo," Amai Jones, April 29, 2013.)
Pros
Kubvisa zvinyorwa kubudirira kwakaipa humwe hutano hwemangariro. Vakawanda veavo muzvipatara zvepfungwa vakagara kumadireji kumashure kwemakumi emakore. Vakagamuchira zvakasiyana-siyana kutarisirwa. Yakashandurawo tsika yekurapa kubva "kuvatumira kure" kuti vazvibatanidze ivo munzanga kana zvichibvira. Yakanyanya kubatsira avo vane Down's syndrome uye mamwe matambudziko ekushanda kwepfungwa.
Cons
Vakawanda vevakasunungurwa kubva kumasangano vakanga vaine zvirwere zvakanyanya. Vakanga vasiri ivo vakanakira kunzvimbo dzemunharaunda nekuda kwechimiro chezvirwere zvavo. Nguva refu, mu-mucheche kutarisira kunopa kurapa kwakanaka kune vakawanda vane zvirwere zvakakomba zvepfungwa.
Ikoko kwakanga kusina kukwana federal mari yezvipatara zvepfungwa. Izvozvo zvaireva kuti kwakanga kusina nzvimbo dzakakwana yekushandira avo vane zvido zvepfungwa. Izvo zvakaitawo kuti zvive zvakaoma kuumba chero mapurogiramu akazara. Nyanzvi dzezvehutano hwepfungwa dzakanyatsoona kuti zvakanga zvakaoma sei kuronga midhara yemiganhu yakapararira muguta rose kune avo vane dambudziko.
Matare akaita kuti zvive zvisingakwanisi kuita chero upi zvake kupikisa kuda kwavo. Icho ichokwadi pasinei nokuti chaiva chekuchengetedzwa kwemunhu uye yehupfumi kana yevamwe.
Kuita zvekuita uye kuuraya vanhu
Ko kusasarudzwa kwekodzero kunokonzera kuwedzera kwekuputika kwevanhu vakawanda here? Kubva muna 1976, kune makumi maviri kuurawa kwevanhu gore rimwe nerimwe. J. Reid Meloy, Ph.D., ndiye nyanzvi yezvepfungwa yakadzidza avo vakaidzidza. Akaona kuti mhondi yevanhu vazhinji inorwara zvirwere zvepfungwa zvinokonzerwa nekuvhiringidzika kwenguva refu kwepfungwa uye schizophrenia kune zvinetso zvepfungwa. Vane sarudzo, narcissistic, uye schizoid mararamiro ehutano hweunhu.
Ava vakanga vasiri vanhu vakangwara avo vaingo "tora". Pane kudaro, vakatambura kwemakore kubva pakusatenda kana kusarwara kunorwara kwepfungwa. Vakawanda vakaronga kupfura kwemakore. Meloy anotaura kuti maitiro ehutano ehutano anowanikwa. Kushandisa izvi zvishoma ndizvo tariro yedu yakanakisisa yokudzivirira. (Kubva: "Nhema dzeManomwe dzeUkuuraya," Psychology Today, April 21, 2014.)
Dr. Alan Lipman, nyanzvi mune zvepfungwa dzechisimba paGeorge Washington Medical Centre, anobvumirana. Akati vaurayi vemazhinji vanowa mune imwe yezvikamu zvitatu. Vangave a psychotic, a sociopath kana psychopath, kana murume pakati pe16 ne25 uyo akaora mwoyo uye ane chisimba.
Asi mitemo yekudzivirira kodzero dzevanorwara mupfungwa dzinodzivisa kurapwa. Somuenzaniso, mhuri haigoni kuita mumwe munhu kunze kwekuti atozviratidza kuti anotyisidzira ivo kana mumwe munhu. Vatongi havagoni kurongedza zvakanyanya vanhu vanorwara mupfungwa kuti varambe vachirapwa. Vanhu havabvumirwi kubvisa pfuti kubva kune vanhu vanorwara mupfungwa vanozvitsvaga kana vamwe. Kudzoka kwemitemo iyi kunobvumira nhengo dzemhuri kuwana rubatsiro kune vadiwa vavo vanorwara mupfungwa uye kuchengetedza nzanga.