Deinstitutionalization of People with Mental Illness: Causes and Consequences

Daniel Yohanna, MD

Virtual Mentor. 2013;15(10):886-891.

Here is an excerpt:

State hospitals must return to their traditional role of the hospital of last resort. They must function as entry points to the mental health system for most people with severe mental illness who otherwise will wind up in a jail or prison. State hospitals are also necessary for involuntary commitment. As a nation, we are working through a series of tragedies involving weapons in the hands of people with severe mental illness—in Colorado, where James Holmes killed or wounded 70 people, Arizona, where Jared Loughner killed or wounded 19 people, and Connecticut, where Adam Lanza killed 28 including children as young as 6 years old. All are thought to have had severe mental illness at the time of their crimes. After we finish the debate about the availability of guns, particularly to those with mental illness, we will certainly have to address the mental health system and lack of services, especially for those in need of treatment but unwilling or unable to seek it. With proper services, including involuntary commitment, many who have the potential for violence can be treated. Just where will those services be initiated, and what will be needed?

Nearly 30 years ago, Gudeman and Shore published an estimate of the number of people who would need long-term care—defined as secure, supportive, indefinite care in specialized facilities—in Massachusetts. Although a rather small study, it is still instructive today. They estimated that 15 persons out of 100,000 in the general population would need long-term care. Trudel and colleagues confirmed this approximation with a study of the long-term need for care among people with the most severe and persistent mental illness in a semi-rural area in Canada, where they estimated a need of 12.4 beds per 100,000. A consensus of other experts estimates that the total number of state beds required for acute and long-term care would be more like 50 beds per 100,000 in the population. At the peak of availability in 1955, there were 340 beds per 100,000. In 2010, the number of state beds was 43,318 or 14.1 beds per 100,000.

The info is here.

Trump Wants More Asylums — and Some Psychiatrists Agree

Benedict Carey
The New York Times
Originally published March 5, 2018

Here is an excerpt:

The third, and perhaps most critical, point of agreement in the asylum debate is that money is lacking in a nation that puts mental health at the bottom of the health budget. These disorders are expensive to treat in any setting, and funds for hospital care and community supports often come out of the same budget.

In his paper arguing for the return of asylums, Dr. Sisti singled out the Worcester Recovery Center and Hospital in Massachusetts.

This $300 million state hospital, opened in 2012, has an annual budget of $80 million, 320 private rooms, a range of medical treatments and nonmedical supports, like family and group therapy, and vocational training. Its progress is closely watched among mental health experts.

The average length of stay for adolescents is 28 days, and the average for continuing care (for the more serious cases) is 85 days, according to Daniela Trammell, a spokeswoman for the Massachusetts Department of Mental Health.

“Some individuals are hospitalized for nine months to a year; a smaller number is hospitalized for one to three years,” she wrote in an email.

Proponents of modern asylums insist that this kind of money is well spent, considering the alternatives for people with mental disabilities in prison or on the streets. Opponents are not convinced.

The article is here.

State mental hospitals were closed to give people with mental illness greater freedom

but it increased the risk they’d get no care at all.

By The Spotlight Team
The Boston Globe
Originally posted August 28, 2016

Here is an excerpt:

The result is a system that’s defined more by its gaps and gross inadequacies than by its successes — severely underfunded, largely uncoordinated, often unreliable, and, at times, startlingly unsafe. It is a system that prizes independence for people with mental illness but often ignores the accompanying risks to public safety. A system that puts blind belief in the power of antipsychotic drugs and immense trust in even the very sickest to take them willingly. A system that too often leaves people in mental health crisis with nowhere to turn.

It was never supposed to be this way. President Kennedy and his allies recognized the grim state of America’s mental institutions — which at their peak housed nearly 560,000 people — and promised a robust, humane system of community-based treatment in their place.

The article is here.

Texas allows guns into state mental health hospitals

By Rick Jervis
USA TODAY
Originally published January 8, 2016

Here is an excerpt:

Visitors to one of Texas' 10 state mental health hospitals will be allowed to openly carry weapons into the facilities, according to the Texas Department of State Health Services. Employees and patients will still be barred from bringing in weapons. The hospitals this week pulled down signs banning guns at its facilities and posted new ones asking people to leave their firearms in their cars or conceal them from patients, said Carrie Williams, a state health department spokeswoman.

“While licensed visitors are legally permitted to carry on our hospital campuses, our patients are being actively treated for psychiatric conditions and generally it’s best not to expose them to weapons of any kind.,” Williams said in statement.

The article is here.

Life in a Mental Hospital

"Erasing the Past at the Ghost Hospital"
By Lawrence Downes
The New York Times
Originally published on August 4, 2012

Engineers and earth movers have now joined nature and vandals in the slow dismantling of the Kings Park Psychiatric Center, an all-but-abandoned city of the sick on the North Shore of Long Island, on thickly wooded bluffs above Long Island Sound.
      

Kings Park was one of the island’s four giant state mental institutions — part farm, part warehouse — that treated hundreds of thousands of patients from New York City. It began in the 1880s and kept growing into the 1960s and ’70s until, like its counterparts on the island and across the country, it was made obsolete by new drug therapies and a new understanding of the rights of the mentally ill.

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New York State has largely abandoned its comprehensive commitment to caring for the mentally ill and disabled. When the hospitals emptied out, patients were sent to group homes to be better cared for; many were forsaken there, too. A recent series of articles in The Times found that abuse and neglect plague the mental-health system to this day. It would be wonderful if someday profitable redevelopment of Kings Park led to a surge in financing for care of the mentally ill. I’m not counting on it.

This article is here.

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A Letter to the Editor by Lucy Winer about this story is here.

I was committed to Kings Park Psychiatric Center on Long Island as a teenager in the 1960s after a series of suicide attempts. Having experienced the abuses of institutional life, I expected to rejoice at news of the hospital’s bulldozing. Instead, I feel grief.

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State hospitals were closed to save money. The promise was that savings would be invested in community mental health care. This never happened, and we are living with the fallout from this broken social contract.