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The Return of the Mental Hospital
https://politicalwire.com/2024/01/01/the-return-of-the-mental-hospital/The Return of the Mental Hospital
January 1, 2024 at 10:50 am EST By Taegan Goddard
“Nearly 60 years after Congress barred Medicaid from treating people in what were then derided as insane asylums, lawmakers are on the verge of reversing course.”
“The reasons: Community-based care championed since the 1960s hasn’t stopped record overdoses — and constituents have had it with the brazen drug use and tent encampments in their cities. Some public health advocates agree that times have changed and the magnitude of the crises justifies lifting the rule.”
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Timewas
(2,739 posts)Reagon first eliminated the mental hospitals in Cal. then in the entire country, the mental hospital system worked very well but Gop doesn't like things that work just things that allow their owners to get more tax breaks.
sinkingfeeling
(57,835 posts)live in tents until they're arrested for being homeless.
Timewas
(2,739 posts)That what he did worked, I meant that the mental hospital method worked. I lived in Ca. at the time and saw how things went to hell afterward.
I lived in SF when Reagan pulled this. Overnight the streets filled with a bunch of very unhappy and confused people. I was stunned. I've hated Ronnie from that day to this. I hope he's rotting in hell.
BigmanPigman
(55,137 posts)
live love laugh
(16,383 posts)Timewas
(2,739 posts)My fault there, that is what I meant just worded wrong.. It was and still is a total disaster.
relayerbob
(7,428 posts)Homelessness, drug addiction, mass shootings and mass jailing with private prisons are just some of the symptoms. Are there better solutions? Yes, but not having places where severely impacted individuals can go to be helped or treated is, in itself, insane. One of the worst legacies of Reagan.
former9thward
(33,424 posts)But the ACLU proudly takes the credit for ending mental institutions. It is right on their website.
https://www.aclu.org/documents/aclu-history-mental-institutions
Suits were filed against authorities involuntarily confining people starting in the 60s and proceeding into the 70s. Finally, the Supreme Court ruled that people could not be confined if they could take care of themselves. That is what ended mental institutions as we knew them. And it makes it impossible for cities to deal with homeless. Many of whom are mentally ill.
IbogaProject
(5,913 posts)And they did a calculation that the clients being out in the community would play into their hands of blame our party for that cohort visibly loitering around. I have a developmentally delayed sister stuck at pre-toddler mental age. We have had to fight against the state of NJ always suggesting that community placement is some how preferred, which is an incorrect reading of the Olmstead Decision[1]. I had to sue Governor Christie on Her behalf when his administration tried to close the actual facility where the VDS, the standard score of relative mental age, was created.
https://www.hhs.gov/about/news/2023/06/22/hhs-marks-24th-anniversary-olmstead-decision.html
thucythucy
(9,103 posts)to ensure that the shops created in community health centers, group homes and other alternatives to institutions would be union jobs. Thomas K. Gilhool, an attorney at the Public Interest Law Center in Philadephia--PILCOP--who argued deinstitutionalization cases before the Supreme Court, describes reaching out to union leadership in his oral history, housed at the Bancroft Library at UC Berkeley.
https://digitalassets.lib.berkeley.edu/roho/ucb/text/gilhool_thomas.pdf
The unions, unfortunately, turned him and others down.
SEIU-the Service Employees International Union--has done great work in the past decade unionizing the jobs at community based services, for instance personal care workers at independent living centers.
https://seiuhcilin.org/divisions/home-care/
Whatever the motivation of Republicans--and I also see them as the primary villians in all this, most especially Reagan but others as well--deinstitutionalization didn't fail so much as it was never truly tried.
BTW--just a personal aside--I was in the audience at the USSC for the oral arguments for the Olmstead case. A group of us camped out all night on the steps of the Court to make sure we could get seats. Particularly distasteful were the comments of Justice Scalia, who seemed more intent on bullying the attorney representing the side he obviously intended to rule against, rather than asking actual questions or listen to any arguments.
hlthe2b
(113,971 posts)these community programs would be under or non-funded and these poor people would end up on the streets, in our jails, and clogging our nation's ERs. That is exactly what has happened.
Institutions will need to be well-regulated and overseen to avoid the horrific care and maltreatment that was present in some of them all those years ago. But, at least there is hope of some appropriate care-- free of street violence and exploitation.
relayerbob
(7,428 posts)There was never any intention of providing alternatives. One look at CA was all that was needed.
Mosby
(19,491 posts)But it was never funded properly and yet the large state institutions were still closed down one by one.
If they do bring mental health centers back the ptb need to ensure that psychologists have significant authority, so the medical doctors desire to put everyone on psychotropic drugs is balanced by other non medical interventions. Keep in mind that doctors are still using electroconvulsive "therapy" to tx depression and psychosis, and that there is sufficient evidence that putting people on a half dozen psychotropic drugs often has poor outcomes and doesn't address the underlying issues.
hlthe2b
(113,971 posts)or at best Underfunded "solution" for all that largely eliminated any institutional option for the most severely impacted, except prison. I certainly don't criticize either JFK or the mental health community for identifying and proposing this model. Only the RW took it and ran with it as a way to avoid spending money that could otherwise benefit their wealthy benefactors, including the privatization of long-term residential treatment centers, many of which are now lacking treatment at all.
I likewise do not like the overreliance on drug therapy--especially without prior full and comprehensive medical work-up that likewise evaluates non-pharmaceutical therapeutic options--at least as an adjunct therapy. The recent cases of decades-long diagnosed "severe schizophrenia" who emerged from comas and show improvement-- once a thorough reassessment of their underlying medical conditions identified rare or at least less common forms of autoimmune disease impacting the brain should give a LOT of psychiatrists and those most invested in these issues great pause.
Mental health care should include a large range of services and options targeting condition severity, patient compliance, and the individual's well-being-- and be appropriately funded. That includes community-based outreach and options up to and including comprehensive care in institutions when needed. For a nation that does not want to fund universal comprehensive physical health care, that mental health services get an even "shorter shrift" should surprise no one.
thucythucy
(9,103 posts)in the 1970s, I can attest personally--and also from voluminous studies, court records, and other personal accounts--that such places were hardly free of violence, mistreatment, misdiagnosis, and in extreme cases torture and murder. This is why the disability rights movement fought to shut them down.
Just as an example, Ted Chabasinski, a leader in that movement, spent his childhood in an institution where he was subjected to medical experimentation, including dozens of electro-shock treatments, all before he was eighteen years old. Dr. William Bronston, another leader in the movement, described the back wards of Willowbrook, where he worked as a staff physician, as "the most dangerous neighborhood in New York City," where rapes and sexual and physical assaults--by staff and other "patients"--were routine. Gunnar Dybwad, another leader in the movement, testified in numerous federal court cases about the abuse he'd seen in multiple institutions he inspected over the course of several decades.
The failure of deinstitutionalization came about because Reagan and others deliberately chose not to fund the alternatives for which the movement was advocating--community based mental health centers, group homes and supported living options that had been proven to work. These options, as well as being more effective and far more humane, would actually be less expensive to tax payers and society in general than another round of forced incarceration in "total institutions."
One good source for all this is "What We Have Done: an Oral History of the Disability Rights Movement," by Fred Pelka, published by the University of Massachusetts Press. He has several chapters on institutions and the movement to shut them down. Another source, though perhaps more difficult to find, is "The Madness Network News Reader," which contains material about the same. Another basic text on the experience of being institutionalized in the era so many here want to return to is Judi Chamberlin, "On Our Own: Patient Led Alternatives to the Mental Health System." She was institutionalized, in both private facilities and public, because of depression due to a failed marriage and a miscarriage. In the book she describes both her experiences in them, and also in community based programs where the counseling and control was done by former patients.
You might also check out some contemporary activism, for instance The Wildflower Alliance in New England, that has established respite for people in crisis, Mind Freedom International, and the National Empowerment Center, all of them proposing solutions to the issues of homelessness and drug abuse that don't involved locking people away:
https://wildfloweralliance.org/
https://mindfreedom.org/
https://power2u.org/
It distresses me that so many progressive folk who should be our allies are so quick to condemn what the movement has accomplished, and willing to again consign us to places we consider to be a part of our most shameful history of abuse and dehumanization.
hlthe2b
(113,971 posts)institutions. But as one who daily sees similar horrors from those left to perish on the street until their half-beaten bodies end up in my ER or those in a near-fatal drug overdose, or in a violent schizophrenic episode, I have seen the opposite extreme with the underfunded/unfunded alternative. We are ill-prepared to deal with this on a constant daily basis as evidenced by physicians and other ER colleagues who have suffered serious injury as a result.
Please read what I wrote. In no place do I condemn the movement, but rather the RW's lashing onto it as an excuse to pull funding and close ALL institutions. That is the very opposite of what you seem to be accusing me of. I understand, given your experience, but that is NOT what I am saying. I am saying we need a wide range of options with appropriate oversight and funding. Those who CAN effectively be treated in an appropriately funded/monitored outpatient setting or residential center absolutely should be. Those are not the ones dumped in mine or other ERs with little security to assist with violent decompensation. Nor is jail/prison the place for them.
thucythucy
(9,103 posts)and also admire the work you do and respect the experiences you've had.
I suppose my post was in reply to what I see as the general drift of this thread. which seems to support a return to "total institutions" without knowing the history of why they were shut down--and the hard work that entailed--and without considering other options that experience has shown would work as well or better, and which are far more respectful of individual rights and dignity.
Among these options would be peer run community health and crisis centers, and free access both to emergency drugs for overdose victims and genuine access to rehabilitaion and drug treatment programs. As for homelessness in general, providing a basic income, and investing in affordable housing, would go a long way to dealing with these issues. I can't put my finger on it right now, but only a few weeks ago I saw a post here on DU about a program that provided homeless people with a monthly stipend. A year later a survey of those in the study showed that the majority were now off the street, using the money--not, as so many would believe--on drugs or alcohol--but as a way out of homelessness.
For those who, for whatever reason, and I believe these would be a small minority, can't break out of the cycle, we can provide community meal programs, showers, temporary shelters that are clean and safe and well managed in times of crisis such as inclement weather, as well as street based counseling.
My partner was in such a program--that is she was a street counselor who with others reached out to homeless people to provide meals, clothing, and options when wanted and needed.
There is also a major shortage of beds in short term psychiatric facilities, caused largely by the closing of facilities in the rush of the big chains to "consolidate" to maximize "efficiency." This seems especially acute for child and adolescent care, for which beds simply don't exist, especially in rural and under served communities.
As a society we seem always to go for the easy, one size fits all solution, especially when this works to maximize profits for the select few.
I hope you might check out the links I provided, if these groups are unfamiliar to you, in that they may offer some resources appropriate to some of the folks you encounter in the ER.
Again, I apologize for misreading you, and wish you best of luck with the important work that you do.
hlthe2b
(113,971 posts):
multigraincracker
(37,651 posts)That just made it worse.
OldBaldy1701E
(11,142 posts)That is all that matters. 
DarthDem
(5,462 posts)Making life safe for corporations and the super-rich - and woe betide anyone, especially anyone needing help, who gets in the way - is all the Republicans ever do. Oh, plus using vulnerable populations as the basis for wedge issues to distract from their real agenda and divide Democrats, who actually appreciate nuance and want to govern.
OldBaldy1701E
(11,142 posts)enough
(13,760 posts)A long and interesting article.
https://www.politico.com/news/2024/01/01/mental-hospitals-drug-users-congress-00132671
erronis
(23,880 posts)but it's better for everyone to have the source material.
MuseRider
(35,176 posts)I remember reading how those who needed medication could just walk to a clinic and get their meds. Really? There was no understanding in making this change. I had rotations in the State Hospital as a nurse and I can tell you that none of those in the wards I worked in could do that, it was hard enough just to keep their clothes on and get them to eat let alone injuring us or others or themselves. It was where all the worst criminals were kept along with those with mental health issues. It was a travesty for those who needed so much and those who cared for them. They found no kindness in the streets and little from a population that had no idea what to do.
Fiendish Thingy
(23,236 posts)And involuntarily committing millions of people just because they are homeless, addicted, mentally ill, or combination of all three.
PortTack
(35,820 posts)
MorbidButterflyTat
(4,512 posts)to get rid of wifey once she became too old, unattractive, argumentative, etc. so hubby could start over with a newer model.
hunter
(40,691 posts)It's working in other nations but the U.S.A. is somehow "special" so we can't do it here. There are a lot of things we can't do in this can't do nation.
Even people like me, a person whose mind went a little sideways in adolescence, picking up some PTSD along the way -- people with supposedly good insurance and the support of family and friends -- frequently have problems finding appropriate mental health care.
It's only worse for people living on the streets.
keep_left
(3,210 posts)...mental-health care, as far as I can tell. If they weren't first, they certainly played a pioneering role. Unfortunately, a lot of confounding factors interfered with that plan: NIMBYism, supply-side economics, tax revolts, and of course Vietnam. By the time the Reagan regime took over, the attitude was "anything the government does is socialism, and the more government does, the socialist-er it is". Thought-terminating clichés replaced public policy. 
2naSalit
(102,793 posts)End of mental health options. My next younger sister was deemed schizophrenic after her first child was born, in California. Between the lack of proper services and my mother's inability to comprehend the issue and the need for proper care, they failed my sister miserably and contributed to her death at the age of forty, after years of a horrid existence even I could not save her from when I stepped in. I moved her to a more compassionate state only to witness the end of care there as well almost as soon as she arrived, with her child, at my door.
I will never forget nor forgive for that one.
hlthe2b
(113,971 posts)The loss of your sister to a system that failed her is just wrenching. I can only hope that there is a realm in which she found peace. 
2naSalit
(102,793 posts)She never knew what it was for her entire life. Our DYSFUNCTIONAL family failed her from the start. When she was born, I had a feeling she would be the first of us to exit and I knew it would be a slow rolling tragedy, I was only 4.5 years old and I knew it the day she came home from the hospital.
The one blessing is her son, who is like the son I never had, is faring well as a high functioning adult, married, professional, advanced degree education. The rest of we sisters have been there for him during his rough years and he made it so far! He still has three of his aunts who are still here. We have sort of knit together the remnants of what should've been a large family and that's what we hang onto now. We all have PTSD and an assortment of other problems but we are still here and functional humans...
And we're not an anomaly, it's a condition for many more Americans than any agency would be comfortable admitting to in our society.
hlthe2b
(113,971 posts)in a tragedy that truly needed more than one. His success is clearly that for all of you.
2naSalit
(102,793 posts)And his gratitude, along with knowing that he'll be okay when I go, is all the reward I need because it shows that he understands what it took and how it has been of benefit to him. His personality is one of compassion, almost to a fault, but his respect for women is of the utmost importance and he has that in his DNA.
I see it as one of my long-term achievements, guiding him when he had serious questions about life issues. He'll be my heir should I have anything left when I exit the physical realm.
Happy New year to you and yours! 
hlthe2b
(113,971 posts)
3catwoman3
(29,406 posts)...was able to sense about your newborn sister? I spent a 45 year career as a pediatric nurse practitioner, and am always fascinated by how perceptive some young children are.
(Please answer only if you are comfortable doing so)
2naSalit
(102,793 posts)I still have that presents itself as both blessing and curse. Some have told me it's clairvoyance of a type. It's sometimes just a sense of knowing with certainly about something and other times all my senses are involved. About a year before that sister was born, the first of three in rapid succession, I had a childhood meltdown because I had a vision when I was supposed to be taking a nap that upset my world. Mom was out in the garden while she thought I was napping, I was but the vision woke me up. I got up and made my way down to the kitchen and I couldn't find her anywhere in the house so I sat in the middle of the kitchen floor and cried. What I saw made me go to check for her to see if it was a dream, I had a strong sense that she had left while I was sleeping, sure she had run away. When she came inside she found me all upset and was troubled about the reason. But six years later she did leave in the night. I didn't see her again until I was entering my late teens, after I had raised her three babies.
When I get those episodes, I pay attention to them because a lot of that stuff ends up happening.
The story of my non-childhood is a torrid tale of almost everything you can imagine of a messed up family. Some of us survived for the long haul.
2naSalit
(102,793 posts) ColinC
(11,098 posts)flashman13
(2,403 posts)of our economic system. Addiction and homelessness both spring from the vast gulf between the haves and the have nots.
erronis
(23,880 posts)Plenty of "rich" people have mental illness, and there are many other physical/mental/psychological factors that can lead to addiction and homelessness.
ck4829
(37,761 posts)Rich people don't have to say "I know I need this, but this therapy is prohibitively expensive"
Timewas
(2,739 posts)Is a large part of the problem, and could be helped enormously buy providing affordable housing for the families that are in fact in a position to buy a home but the requirements and costs are too steep.
ecstatic
(35,075 posts)I know of at least three families who are struggling and have little or no options for treating their adult family members. One of them is addicted to huffing keyboard cleaner sprays, the other two have untreated schizophrenia. It's hard to watch because I've known these people for many years. 10 years ago they were normal.
What a lot of people don't realize is that you can't force someone to take their medication. You can't force someone to stop using drugs and harming themselves or those around them. There is literally nothing the families can do and there's little or no State resources around to help. In extreme incidents, the hospital will hold them for maybe 24 hours. Then they're sent right back home. Rinse. Repeat.
Cherokee100
(454 posts)Seems like, I remember Ronald Reagan was the one, who closed all the public mental hospitals. To save money, of course.
Doodley
(11,913 posts)Start with Trump and those who want to destroy our democracy.
bucolic_frolic
(55,140 posts)You have to keep them happy.
The patients? Some will be better off, some worse off. Most will be about the same.
ismnotwasm
(42,674 posts)Sometimes all more appropriate facilities have no room, sometimes they have nowhere to go.
Sometimes, despite clear signs of inadequate self care, we cannot keep them. We release them to temporary housing, to more traditional shelters, to the streets.
I had one dual-diagnosed patient who got in a street fight, neglected his significant head wound and was literally dripping maggots when they came in with suicidal ideation —we could not keep them once they said “I’m ok, I’m no longer thinking of harming myself” released them to the streets maggots and all.
There are so many stories. Society does not deal well with mental illness and addiction
LiberalArkie
(19,806 posts)Spearheaded by the New York Civil Liberties Union’s (NYCLU) Mental Patients’ Rights Project, the shuttered world of people confined because of mental illness and developmental disabilities was one of the next major enclaves targeted for legal action. Bruce Ennis, Director of the Project, was a prime participant in several landmark cases that became the highpoint of the civil rights movement for people with mental disabilities. In Wyatt v. Stickney (1972) and Wyatt v. Aderholt (1974), Ennis challenged the conditions of hospitalization for those with mental illness and developmental disabilities, leading to significant reductions in the institutions’ populations; major increases in expenditures for mental health and rehabilitative services; improvement in psychologist-patient ratios; significant reductions in the abuse of patients; and the adoption of the then-innovative concept of specific treatment and rehabilitation plans for each individual. The principles argued for by Ennis, and included in the judge’s final order, were subsequently adopted by 35 other states. Another significant result of the Wyatt litigation was the formation of the Mental Health Law Project (MHLP), now the Bazelon Center in Washington, DC.
Ennis’ most sensational case while at the NYCLU began with a class-action lawsuit filed in 1972 on behalf of the 5,400 residents of the Willowbrook State School for mentally disabled children in Staten Island. At the time Willowbrook was the biggest state run institution of its kind in the United States. Filthy conditions and questionable medical practices and experiments prompted Senator Robert Kennedy to call it a ‘snake pit.’ Public outrage grew after broadcast journalist Geraldo Rivera exposed the abhorrent conditions in a video showing developmentally disabled children lying naked on the floor, many of them in their own feces.
The three-year-long legal battle against Willowbrook culminated in a 1975 consent decree mandating significant reforms; but it took years of tenacious litigation and advocacy to force officials to improve conditions and supply the funds necessary for reform. Historians David and Sheila Rothman subsequently published a detailed account of this process in their widely-read The Willowbrook Wars. In 1983, the state of New York announced plans to close Willowbrook, and the last children left the grounds in 1987. The nationwide publicity generated by the Willowbrook case helped contribute to passage of the Civil Rights of Institutionalized Persons Act of 1980.
The ACLU’s most important Supreme Court case involving the rights of people with mental illness was filed on behalf of Kenneth Donaldson, who had been involuntarily confined in a Florida State Hospital for 15 years. He was not dangerous and had received no medical treatment. In a landmark decision for mental health law in 1975, a unanimous Supreme Court ruled that states cannot confine a non-dangerous individual who can survive on his own, or with help from family and friends.
Snip
https://www.aclu.org/documents/aclu-history-mental-institutions
MorbidButterflyTat
(4,512 posts)"Public outrage grew after broadcast journalist Geraldo Rivera exposed the abhorrent conditions in a video showing developmentally disabled children lying naked on the floor, many of them in their own feces."
I remember this. It was disgusting. The ACLU fought to protect people from abusive government forcing confinement and drugs.
"In a landmark decision for mental health law in 1975, a unanimous Supreme Court ruled that states cannot confine a non-dangerous individual who can survive on his own, or with help from family and friends."
Then came Ronnie.
gulliver
(13,985 posts)I think the mental hospital is a good idea, but it's not as easy as it seems. Competent, good-natured people need to work in them. And the mental health industry is grotesque. We need to make the world more amenable to human beings, more fit as a habitat. That's really job one.
et tu
(2,387 posts)my mom and dad worked at crownsville state mental hospital for black patients for a number of years.
when they worked there it was a humane place however, later cost cutting administrators had a very negative impact.
metal illness is not going away and all patients need good care. hopefully if brought back into use, these hospitals can once again
help our fellow citizens in need and hopefully there will be kinder and better professional administrators with good oversight.~
Bmoboy
(642 posts)Too many of us. No room for the different. Living in a poisoned environment. The grind of capitalism.
As long as the root causes of our dis-ease are ignored, the pills and potions of medicine will only mask symptoms or induce further damage.
I grew up while atmospheric nuclear testing was popular. My uncle smoked Camels while he covered pipes in asbestos. He died from lung cancer. My father and his father worked in shipyards, steel mills, print shops and other very loud workplaces. They became increasingly deaf. And we are white.
The world is an overcrowded and hostile environment. Re-opening state mental hospitals using the same questionable meds and therapies will take some homeless off the streets, but how will that be different from the MAGA concentration camps?
nitpicked
(1,834 posts)I'm thinking of one in Northern VA.
It was still operating in the 1970s, but by the end of the 1980s it had been shut down.
Even if it was in like-new condition, there would still be issues such as asbestos, etc. to deal with.
J_William_Ryan
(3,496 posts)Constituents are in no position to complain; indeed, constituents have only themselves to blame, the consequence of decades of voting for Republicans and their failed, wrongheaded, reckless, and irresponsible tax cuts and elimination of funding for programs and policies that addressed drug addiction, mental illness, and homelessness.
The voters are alone responsible for the bad government they get.
brooklynite
(96,882 posts)He pulled Federal funding. States and cities chose not to compensate. In part that was due to a liberal movement against involuntary commitment. Through the 1980’s there were homeless advocates in NYC and elsewhere who said people had the right to live wherever they wanted, and regardless of how they behaved.
Kennah
(14,578 posts)BigmanPigman
(55,137 posts)because that is what we always do. Anyway, my mom worked at a mental hospital and she can tell you first hand how Raygun ruined everything for the next 40+ years. She is still pissed off and so am I!
Mz Pip
(28,455 posts)I certainly blame him for the start of this fiasco but we’ve had several administrations, both Republican and Democratic, since then and we’re still without decent mental health care for those who don’t have the means to get it on their own.
Republicans blame Democrats for the homeless encampments but I haven’t heard them offer any solutions other than voting Republican.
UpInArms
(54,984 posts)History[edit]
Coinciding with a movement during the 1970s for rehabilitation of people with severe mental illnesses, the Mental Health Systems Act supported and financed community mental health support systems, which coordinated general health care, mental health care, and social support services.[2] The law followed the 1978 Report of the President's Commission on Mental Health, which made recommendations for improving mental health care in the United States. While some concerns existed about the methodology followed by the President's Committee, the report served as the foundation for the MHSA, which in turn was seen as landmark legislation in U.S. mental health policy.[3]
The Omnibus Budget Reconciliation Act of 1981, passed by a Democratic-controlled House of Representatives and a Republican-controlled Senate, and signed by President Ronald Reagan on August 13, 1981, repealed most of the Mental Health Systems Act. The Patients' Bill of Rights, section 501, was not repealed; per Congressional record, the Congress felt that state provisions were sufficient and section 501 served as a recommendation to states to review and refine existing policies.