Treatment of the mentally unwell during the 19th and early 20thcenturies were neither precise or specific, and were often harmful, including blood-letting, trepanation, organ removal, and lobotomies. The discovery of antipsychotics and antidepressants in the 1950s resulted in less harm, but their effects were neither specific or precise, and did not result in better efficacy. Sad, but true even in 2018.
Many parts of the U.S.A. struggle to find beds for the mentally ill, and we struggle with the opioid epidemic and increasing rates of depression and suicide. In the decades following the 1970s, mortality rates and outcome in schizophrenia worsened, despite the flood of antipsychotics and other treatment modalities.
one reason for this rather dismal picture is the rapid growth of socioeconomic inequality that began in the 1970s. Higher levels of income inequality are correlated with higher levels of suicide, depression, substance abuse, as well as other social ills. Indeed, migration alone carries a 250% increase in the risk for schizophrenia, considerably larger than the genetic risk, yet imaging and genetic studies often neglect the social status of their subjects.
The outlook for the United States is one of worsening income inequality and a diminishing safety net, leading to predict that the future of the mentally ill will worsen.