July 4, 1776-July 4, 2026— Happy Birthday, America! 250 years of freedom!
This month America celebrates a very special milestone, and many cities across the country are going all out to mark the occasion as a 4th of July to remember. The theme of freedom got me to thinking about how recovery gives us freedom: from addiction, from mental illnesses, from toxic relationships, from poor choices we made in our past. I also wondered about how the landscape of mental health recovery has changed throughout the last 250 years. I’ll try to keep this brief, as there have been significant changes throughout the course of time.
- The 18th and 19th century insane asylums were typically overcrowded and had poor living conditions. There was little understanding of mental illness, and the stigma was profound in the 1700-1800’s. The United States has gone from institutionalizing and hiding people with mental illness (think One Flew Over the Cuckoo’s Nest) to mainstreaming mental wellness and well-being, community integration, and personalized care.
- Mid-19th Century: Dorthea Dix was a champion for mental health advocacy, helping to change the prison system and insane asylums, to establishing state-run psychiatric hospitals that were designed to be more humane and with a focus on recovery and reducing stigma.
- In 1963, President John F. Kennedy signed the Community Mental Health Centers Act, focusing on funding local mental health centers and deinstitutionalizing large state hospitals, allowing care to be client focused and providing more individualized care.
- 1979: The National Alliance on Mental Illness (NAMI) was founded by two mothers who were frustrated with the medical community’s tendency to blame parents for their children’s mental illness. It has grown into a nationwide grassroots organization to reduce stigma, provide support, and train peers to run support groups for individuals, families, and children across the lifespan. NAMI has been a pivotal part in helping establish legislation for research on mental illness, advocating for mental health parity in 1996, and providing thousands of support groups throughout the country for clients—all at little to no cost to the consumer. (https://www.nami.org)
- Former First Lady Rosalynn Carter was an advocate for mental health and reducing the stigma around mental illness. In 1980, she supported the Mental Health Systems Act, established the Rosalynn Carter Institute for Caregivers in 1987, and co-founded The Carter Center Mental Health Program to shape national policy and promote equal healthcare. After leaving the White House, she founded The Rosalynn Carter Institute for Caregivers, eventually merging with The Carter Center Mental Health Program. These two programs are linked together, as caregivers need support for their mental well-being as they take care of their loved ones. She is quoted as saying, “We have a great opportunity to change things forever for everyone with mental illness. The solutions are truly within our reach.” –Rosalynn Carter (https://www.cartercenter.org)
- 1996: The Mental Health Parity Act was passed into federal law, mandating that commercial insurance plans establish equal annual and lifetime dollar limits for mental health and medical benefits. Insurance companies had to start recognizing mental illness as a valid diagnosis and be willing to cover the care so that the consumer was able to access treatment.
- 2008: The Mental Health Parity and Addiction Act was signed into law, expanding the original law from 1996. This law brought substance use disorders under the same umbrella as mental illnesses. It mandated that financial requirements (copays/coinsurances) and treatment limitations (maximum number of visits) for mental health and/or substance use treatment be no more restrictive than medical benefits. 2008 also introduced the Affordable Care Act, which extended the parity act requirements to small-group insurance plans, making health care more affordable and accessible, recognizing health care as an essential need for the American people.
- 2020: The 988 Suicide and Crisis Lifeline was signed into law on October 17, 2020, and launched nationwide on July 16, 2022. It was established by Congress to allow everyone easy access to mental resources, by only needing to remember three digits, as opposed to the old 800-number. It runs 24 hours a day, 7 days a week and cooperates with over 200 local crisis centers throughout the United States. Anyone can access it through voice, text, and chatting. It is available in English and Spanish and via videophone for people who are Deaf and Hard of Hearing. (https://www.988lifeline.org)
As you are celebrating the 4th of July and 250 years of freedom this month, take time to reflect on this historical anniversary.
Milestones and round numbers (think decade birthdays: (40 / 50 / 60 / 70) tend to prompt people to reflect on the past, set personal goals, and focus on healthy life changes. Regarding your mental health, it can be a time to rest, recover, reconnect with family and friends, and build a stronger community.
Amy Tilley, PsyD. has 20 years in the mental health and addiction recovery field. Her clinical interests include working with young adults and adults diagnosed with co-occurring conditions.
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