Social psychiatry is a branch of psychiatry that studies how the social environment impacts mental health and mental illness. It applies a cultural and societal lens on mental health by focusing on mental illness prevention, community-based care, mental health policy, and societal impact of mental health. It is closely related to cultural psychiatry and community psychiatry. Social psychiatry research is interdisciplinary by nature. It takes an epidemiological research approach and involves collaboration between psychiatrists and social scientists across sociology, anthropology, and social psychology. It has been associated with the development of community-based care and therapeutic communities, and emphasizes the effect of socioeconomic factors on mental illness. Social psychiatry can be contrasted with biopsychiatry, which focuses on genetics, brain neurochemistry and medication. Social psychiatry has influenced U.S. social policy and social movements, including the community mental health movement and the era of deinstitutionalization.
History
Early 20th century The term "social psychiatry" can be traced back to 1903 in a paper by German psychiatrist Georg Ilberg, 'Soziale Psychiatrie.' In it, Ilberg defined social psychiatry as factors that affect the mental health of populations and ways in which to prevent mental illness among society. Ilberg argued that there were many factors that influenced mental health, but the majority of mental illnesses were hereditary. In 1911, German psychiatrist Max Fischer defined social psychiatry as "the act of providing psychiatric care outside of asylums", and advocated for the creation of welfare centers to deliver psychiatric care outside of asylums. At this time in Germany, social psychiatry emphasized protection of the general public of those who are mentally ill and 'antisocial.'
United States mental health community movement The mental hygiene movement in the United States marked a shift from individual responsibility of mental health to how public health and society could promote mental health. In 1909, the National Committee for Mental Hygiene (now called Mental Health America) was created to focus on mental illness prevention and mental health promotion. In 1915, the National Committee for Mental Hygiene administered a series of social surveys that explored mental illness outside of asylums and institutions. These surveys uncovered the extent of mental health challenges in society, and led to the development of community-based mental hygiene clinics. A psychiatrist, social workers, and a psychologist staffed these clinics, and provided outpatient services and public health and educational initiatives to prevent mental illness. This would later become a key component of the mental health community movement, which influenced the deinstitutionalization era.
1930s-1940s Prior to World War II, the majority of research related to social psychiatry focused on the impact of urbanization on serious psychiatric disorders like schizophrenia. One of the first social psychiatric studies, 'Mental Disorders in Urban Areas: An Ecological Study of Schizophrenia and Other Psychoses', challenged this focus. The study, published in 1939 by University of Chicago sociologists Robert Faris and Warren Dunham, applied a social sciences methodological approach to the study of mental illness. Their findings introduced the concept of social isolation and poverty as factors in mental illness, when existing research had primarily focused on urban versus rural environments. This study captured the attention of United States politicians and policy officials and helped usher in a wave of policy reforms in the coming years.
World War II Social psychiatry turned its focus to veteran mental health as a result of World War II. The experiences of soldiers at war and coming home inspired psychiatrists to study the epidemiology of mental illness and the factors that exacerbate it. In particular, psychiatrists in the United Kingdom and United States began to study the impact of the environment on mental illness in soldiers and helped usher in the community mental health movement. 'Therapeutic communities' started forming across the UK, and community mental health services for outpatient care grew in number across the United States. In 1946, the United States passed the National Mental Health Act, citing the declining mental health of veterans during World War II. This act provided federal funding for prevention and treatment of mental illness. A direct result of this act was the creation of the National Institute of Mental Health (NIMH) in 1949. NMIH was formed to shift care from psychiatric hospitals to community-based services.
1950s-1960s As the community mental health movement gained traction, President John F Kennedy passed the Community Mental Health Act in 1963, which provided $2.9 billion to build community mental health centers across the country. This ushered in the deinstitutionalization era, which marked widespread closure of state psychiatric hospitals in favor of community mental health services. Lyndon B. Johnson's War on Poverty, declared in his State of the Union in 1964, further advanced social psychiatry in United States public policy. It justified more spending on social welfare programs and community mental health centers. However, its focus on the 'culture of poverty' rather than poverty itself led to criticism among social scientists and psychiatrists.
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