Mental Healthcare in the 90s: We've Come a Long Way (and Still Have a Long Way to Go!)

There was a social media trend lately that was "mom, what were you like in the 90s?", with a picture of clip of the mom now, and then pictures of the mom as a child. I did a twist on the trend, "mom, what was mental health care like in the 90s?", so I thought it would be fun to break down mental healthcare in the 1990s (or at least, my version of "fun").

The DSM & New Diagnoses

The DSM-IV was released in 1994. The DSM (Diagnostical and Statistical Manual) is "The Bible" of mental health disorders and diagnostics. It spells out the various conditions, such as depression, and the conditions that must be true for a therapist or psychologist to diagnose that condition. The DSM-IV introduced new diagnoses, such as bipolar II and Asperger's syndrome (today, Asperger's is recognized as Autism Spectrum Disorder, although some people still use the term informally).

Community-Based Care

Advocacy for community based care officially began in 1955. Institutionalization- the philosophy of placing those struggling with their mental health into a state hospital - peeked in the 1950s. Fortunately, advancements in medical care, social and political reform, and reducing of stigma led to rapid deinstitutionalization throughout the 60s and 70s and the replacement with community-based mental health options. This move continued in the 90s, where outpatient care and integration (or reintegration) to the community was seen as the ideal, opposed to lifelong hospitalization.

Medication

The 1990s also encompassed a perod of expansion in medication research and developments, and therefore an uptick in prescription of psychotropic medications, especially SSRI's. In the 90s, approximately 77% of mental health treatment involved medications (compared to somewhere around 30-40% today).

Treatment Modalities

CBT (Cognitive Behavioral Therapy), in a very brief nutshell, is a structured, goal-oriented approach that helps individuals identify and change unhelpful thought patterns that influence emotions and behaviors. By challenging distorted thinking and practicing new skills, clients can develop healthier responses and coping strategies. Family therapy and mindfulness-based practices also gained popularity. In the1990s, outpatient therapy treatment modalities that are evidence-based gained prominence.

Political Shifts

Former President George H.W. Bush designated the 1990s as “the Decade of the Brain.” This proclamation stimulated public interest and led to increased research, clinical work, and advancements in imaging technology within the emerging field of neuroscience. Additionally, Congress passed the Mental Health Parity Act of 1996, which prohibited all large (over 50 employees) employer-sponsored group health plans from imposing annual or lifetime dollar limits on mental health benefits that differ from those for medical or surgical benefits. Admittedly, there were loopholes that companies used to limit reimbursement for services, such as limiting the number of visits for therapy for some mental health disorders. However, the Mental Health Parity Act did also recognize advanced practice registered nurses as eligible for reimbursement for mental health services.

The 1990s were a fascinating time! Advancements in technology and research laid the foundation for continued advancements in the 2000s (maybe that'll be the next blog). We've come a long way since we locked women up for life for having postpartum depression...and, we have a long way left to go (looking directly at you, insurance hurdles and year long waitlists!).

If you are struggling and could use some help from someone who remembers rewinding VHS tapes, going to Blockbuster, had a Tomagochi, and saw the Spice Girls live, give us a call (no corded phones or dial up internet necessary!) - 724.201.9815.

This blog is written and maintained by non-clinical staff. Therefore the contents of the blog should be taken as psychoeducational only and not as medical advice or a replacement for therapy. If you are experiencing a life-threatening emergency, please call 911. If you are experiencing a mental health crisis that is not life-threatening, please call 988.