Oh, Snap! (kutsuwamushi) wrote in little_details,
Oh, Snap!

[ANON POST] Children's mental health institutions in the USA, 197's-80s

Setting: Eastern USA, starting in 1979-1980, continuing to the 1990s.

I have a character, here called Adam, who was placed into long-term private psychiatric care at the age of six, continuing into adulthood. He was found to have planned and participated in the death of a 2-year-old sibling; he was acting alone, was intellectually bright/above-average, and, as far as I can tell, he didn't have a prior history of violent challenging behavior. The only cases of children killing other children that I'm familiar with are cases like Mary Bell's, where the victim was not a member of the family, the perpetrator was older than this individual was, and torture/mistreatment of the body was a factor as well as a history of severe child abuse in the life of the perpetrator. The family of the child have no desire to press charges, but neither is their top priority on mental health care and therapy for Adam. His parents are financially well-off enough to seek out better long-term care than a state institution could provide, and would be strongly pushing to have Adam taken off their hands. Would there have been hoops to jump through or additional measures necessary to have a child without a long prior history known to his parents of violent or disturbed behavior (before one major act) placed in an institution? I don't know a great deal about diagnostic criteria prior to the DSM-IV; would there have been a broad-strokes diagnosis given, or a more specific one sought? I've read about conduct disorders and antisocial personality disorder; I don't think Adam would strictly fit the modern diagnostic criteria for a conduct disorder upon arrival, but would be showing some emotional disturbances and frequent deceitfulness (though not frequently violence).

Can anyone refer me to resources regarding young children in private institutions, or what the services for children and adolescents might be like in about this time period? What kind of education options would there be for Adam? I presume that most things would have to be negotiated with the doctors responsible for his care or specially requested; would he be allowed to have books? As he grew older, would he be permitted or encouraged to write stories/keep a journal/write letters? (I'm only familiar with the way reading material is restricted for adult patients who've checked themselves in for short-term psychiatric care, basically that books are checked for forbidden objects or substances and there's usually other stuff around to read that's on the older side.)

Would parent visits have been permitted or expected? Assuming good behavior, would he have been able to take part in activities or recreational opportunities? Would any of these be exclusive to young patients? (At an institution that didn't specialize in children and young people, could age-appropriate activities be arranged?) Once Adam was roughly the age to hit puberty, what kind of sex ed would he receive? It sounds like sexual abuse of patients of all ages was rampant in state-run institutions; was this also the case (or a recognized concern) in smaller or private institutions?

The canon I'm working from (and this is for a fan work, so strongest apologies if the terminology used in canon is ableist or the founding assumptions are inaccurate-- suggestions of more appropriate terms or subjects to search for would definitely be appreciated) seems to indicate that it was arranged that Adam would/could leave the institution when he reached a certain age -- I'm presuming this would likely be 18, is that correct?

Google searched: "private mental health care", + 1980s, +1970s; "pennsylvania mental institutions" + private, "DSM-II", a couple search terms related to conduct disorders in children. I've been getting a lot of modern information or descriptions of policy changes in the 70s-80s rather than information on living conditions, and much of it relates to public institutions.

I've read and been referred to the Manteno Project and DSM-II and DSM-IV guidelines for personality and conduct disorders in children.
Tags: 1980-1989, ~psychology & psychiatry (misc), ~psychology & psychiatry: institutions, ~sexual abuse & assault

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