Bring back insane asylums?

[A-R]

This is something I've been mulling and quietly mentioning in private discussions for a while now ... especially when discussing mental illness aspect of mass murderer/active shooter tragedies.

I'm happy to see some in medical community taking this idea seriously.

http://m.theatlantic.com/health/archive ... ms/384838/" onclick="window.open(this.href);return false;

Although psychiatric hospitals still exist, the dearth of long-term care options for the mentally ill in the U.S. is acute, the researchers say. State-run psychiatric facilities house 45,000 patients, less than a tenth of the number of patients they did in 1955. With the doubling of the U.S. population, the researchers write, this is a 95 percent decline.

The process of “de-institutonalization,” or shutting the doors of psychiatric hospitals, started in the 1950s, and was expedited in the 1960s and 1970s with the passage of new healthcare laws that introduced peer-facilitated community treatment, as well as some highly publicized cases of patient abuse.

[Cedar Park Dad]

We already did, and biggie sized it Texas style.

Its called Austin.

[jimlongley]

Knowing that abuses were rampant in 1955, and that such systems appear (correlation does not always equal causation, but might) to breed abuse, both internally and externally, I would question the capability of the system to prevent those abuses.

A relative of ours was committed to such an institution for the rest of her life by her husband and one child. Her "problem"? She was denying her husband her "wifely duties" and had been found to have an STD. Of course the fact that the STD was contributed by her cheating husband, which resulted in the denial, was never presented during her involuntary commitment hearings. She was found to be "An Hysteric" and "incapable of self control" among other things and was committed to the Hudson River State Hospital. The only witnesses against her were her husband, her daughter, and the family doctor.

The week after she was committed her husband moved his girlfriend, ultimately the originator of the STD, in.

[ELB]

Clayton Cramer researched this issue in depth and wrote a book on it. He reviews the history of the treatment of mentally ill people from pre-colonial days until present. It is well worth reading his book: My Brother Ron: A Personal and Social History of the Deinstitutionalization of the Mentally Ill

He was motivated by the fact that his brother was mentally ill, frequently violently so, and yet there seemed to be no legal mechanism to deal with violence by seriously mentally ill people other than put them in prison for crimes.

He specifically looks into the issues of widespread wrongful committal and abuse of inmates in the institutional system, and it seems to me find rather weak support for it, especially for using it as justification for dismantling the whole thing. He notes that although the logic seemed to be that such people would be better treated in out-patient and community settings, in fact the out-patient and community-based treatment programs and centers were set up to treat entirely different sets of mental issues, and the folks who had serious, sometimes dangerous mental illnesses that previously got them committed were simply left to themselves. Although they might get treated if they showed up at a clinic, they were exactly the people who would not follow their therapy programs or take their medications without the strict supervision of an institutional setting (Instead they self-medicate with alcohol and drugs of their own choice). So they were left in the community, generally ended up on the streets because they couldn't keep their lives together enough to even take advantage of the various social safety nets, and there they stay until they commit a crime serious enough to lock them up. Even for the ones that had family that cared about them and tried to do something for them, there was no help if the patient chose not to cooperate --- until the patient decided to chop up his mother or shoot up a school or something similar.

It is sometimes noted that the rate of imprisonment has increased significantly over the last 30 or so years. This is usually in the context of criticizing the prison "industry" or sentencing laws or the war on drugs, something like that. But Cramer and others note that the actual rate of incarceration in the US is actually a bit less than it was in the pre-WWII era. What has changed is where people are incarcerated. If you add together the number of people in prison and the number of people committed to mental institutions prior to the 1960s and convert it to the rate of incarceration (i.e. number of people locked up divided by the population), then do the same for post 1960 era, you come up with rates that are nearly the same, with a drastic dip in between.

That dip in the 1960s was when state mental institutions were being closed, but not enough time had passed for the seriously mentally ill to begin entering the criminal justice system. In effect, the population of seriously mentally ill was simply transferred from mental institutions to prisons.

(Note also that closing state mental institutions and going to federally funded community treatment programs and such moved a huge debt burden from the states to the Federal government. Remember this was the era of "the Great Society" and a significant ramping up of the Federal Government's scope and power).

What do you think the opportunities for abuse of the mentally ill are in prisons, compared to that of an institution set up to treat, or at least safely house, a mentally ill person?

[chuck j]

The Texas mental hospitals in the 50's and 60's were hell holes , they did nothing but house the mentally ill . There is a large state hospital in Wichita Falls and an uncle and my brother in law worked there during that period . I was a kid and my brother in law would take me fishing at some stock tanks behind the hospital , it scared me to death , the state allocated about 200 aches to the hospital . They were suppose be be as self sufficient as possible , patients raised cattle , had their own dairy , chickens , hogs . There was a huge garden they worked , looked like a truck farm . Patients did all the grounds maintenance , janitorial on the units . Women's units were on the west side , men's units on the east side . 'There were no 'specialty' units , children / teenagers were placed in the men or women population , they were understaffed and my brother in law said it was a crime that the children were put with the adults but you can imagine that. They sill gave mandatory shock treatments , most 'doctors' (mainly Cubans that could not even speak English) Made their own shock treatment units out of model train control rheostats . They would wrap the patients in wet sheets , restrained with a sponge rubber ball in their mouth . He said he escorted only one patient to the therapy and told them he would not take another . They noticed a bad smell in the admin building and discovered a patient that had disappeared a week before had crawled under the offices and died . They wanted my brother in law to go in and bag him up , in was summer time , the brother in law quit . People would drive out from town and drive through the hospital units , patients climbing the expanded metal surrounding the porches inside screaming , cussing , pulling their clothes off , patients sitting in the yards drooling with a dead stare . It was a terrible thing . Much more to the description but you probably get the picture .

Flash forward to the mid 80's , My wife worked there for 21 years as director of nurses on different units . The patient population is one third of the old system , more than adequate staff , popcorn machines on every unit , children's unit with playground and swimming pool . There is a beauty shop , canteen , dance every Saturday night , patients can do simple work and earn spending money . There is a fashion shop (thrift store) coke machines , pay phones , trips to Walmart , circus's , sporting events , etc . Things have changed .

[rotor]

I worked in one in Ohio in the 60's and there was a movie in the 40's called "The Snake Pit" which optimized mental institutions of that time. Ohio at that era was number 50 in mental health spending and the hospital I moonlighted in was a snake pit. People were placed there as children with seizure disorders and 50 years later were still there, not crazy but living there. No family, no medical care, one RN for thousands of patients, I worked at night while going to school. I would come by and all of a sudden 30 patients would have had surgery. Next week 30 more patients had surgery. Then a magic drug came out ( I don't know when) which I guess changed everything and it was called Thorazine, every one became a zombie and I believe this is what changed the entire mental health system. Better?? You really can't believe how bad it was. When I worked there and had to go through the hospital I had two big goons at my side to protect me and the female part of the hospital was the worst. The roaches alone made Texas roaches shake in their shoes. A true snake pit.

[rbwhatever1]

Lock the doors and let the healing begin...

[Pawpaw]

Lock the doors and let the healing begin...

[ Image ]

Ok, this thread can be closed and locked now... rbwhatever1 won!

[tms119]

Most hospitals have a specific floor now. But they seem to be ill equipped for extreme cases

[The Annoyed Man]

I saw the outside of one old-school asylum - once - in New York City. It looked like one of those places that was used as a movie set for an asylum. But my experience of these institutions is limited to just a couple of things.

The first isn't the institutionts themselves, but rather the patients we sent to them for observation on a "5150" status when I worked in the ER at Huntington Memorial Hospital (HMH). Which institution we sent them to had a lot to do with the patient's insurance status and/or affluence. If they were either financially unable to bear the cost, or uninsured, we sent them to the psych ward at USC County General Hospital in downtown L.A. If they were insured for it, or wealthy enough to afford it, we sent them out to private hospitals. These patients were in severe enough psychiatric crisis to need triaging. Sometimes it was drug or alcohol related, and other time it was your good old-fashioned dingbat crazy psychosis. Either way, you were seeing a person at their very worst, and not in the same kind of "regular" way you would see in an ER. It was easy for me to have empathy for people who were physically injured, or in a medical (non-psychiatric) crisis of some kind. But psychosis was a lot more difficult for me to process because the poor patient seems to have left their humanity behind. I had to learn the discipline of reminding myself that these people would have rather not been in these circumstances, and that "crazy" is another form of "sick" or "hurt", and to have empathy for them instead of being frustrated by them. I could handle gunshot wounds and heart attacks all day long, but I had to make a deliberate effort to not be a little bit angry from being frustrated by irrationality. I eventually adapted to it, but it didn't come naturally. (It even colors the way I process people today in the political world. When someone who is otherwise "normal" spouts irrational political garbage, my first instinct is to marginalize that person as out of touch with reality.)

During my last 2-3 years of working at HMH, they broke ground on a new psychiatric facility a block down the street from the ER. HMH was a large private hospital, affiliated with the USC teaching system. When I started working there, it was a 600+ bed hospital. By the time I left, it was a 800+ bed hospital with every imaginable advanced facilities you could imagine; so I guess that adding a psychiatric facility was the next logical step. It was the regional level 1 trauma center. The pediatrics dept included a large regionally used NICU. Stuff like that. Anyway, I never had reason to enter the psychiatric building, but on the exterior it was a very modern "medical office" looking building, 3-4 stories tall, surrounded with small but pleasant gardens. It didn't look anything like one of those old dungeon-looking places.

The second experience is that Pasadena has had a long time psychiatric facility called Las Encinas, which had a sort of "Asylum to the Stars" reputation. For a long time, whenever a movie star from the golden era either flipped out or need to dry out, Las Encinas was where they went. I still remember the day that we were driving past it (Las Encinas was perhaps a mile and a half down the nearest major thoroughfare near to our house) and my dad pointed it out and said "That is where W.C. Fields died"....... which happens to be one of those local trivia bits - "you know you're from Pasadena IF you know that this is where W.C. Fields died". The hospital is still there and still in use. But even back in "the bad old days", Las Encinas was a pretty nice place.

At the time that I first applied for the job I got at HMH, I had also applied for a similar position at Las Encinas. I don't even remember what happened with that application because I got the job at HMH which was what I really wanted. But for the most part, my only contact with insanity (at least in other people ) was contact with people who were in the midst of a psychiatric emergency, and not as any kind of long-term resident of an asylum.

[Running Arrow Bill]

I don't think we need to bring back the "Insane Asylums". However...

Between 1967 and 1972 I worked as a Psychologist in an Illinois psychiatric hospital. In "those times" we didn't have any primitive "treatments". However, we freely dispensed Thorazine, Mellaril, and Stelazine to the paranoid and other aggressive patients. Yes, they were moderated and relative calm with no threats to other patients or staff.

We didn't use any electoshock treatment, lobotomies, insulin shock therapy, or other invasive approaches. This hospital was founded in the 1800s and in the basement was a "dungeon" that still had shackles hanging from the walls to restrain those before the advent of tranquilizers.

With the ill advised "deinstitutionalism movement" emerging rapidly numerous patients were discharged to outpatient status, half-way houses, families (that would take them) and some just turned loose. Of course, the more severe (paranoid) patients wouldn't take their medications (especially for schizophrenia, manic-depressive conditions, etc.). The "system" couldn't handle the discharges since the "liberals" only wanted to "set them free" and not thoroughly provide for their needs.

Some of the schizophrenics had been in hospital for decades for even minor problems; and, they had been "burned out" via shock treatments, etc. They were "calm" with the tranquilizers; but, without the medications they were lost, at risk, and potentially a threat to others.

On the positive side, we DID have an active out-patient and home care service for those not severe enough to be either voluntarily or committed by order from the Court. We also had an active adolescent unit and an alcoholic unit. One unit was dedicated to degenerated geriatric patients (aka "senile dementia" then) and some with brain damage due to syphilis. We also had an active group therapy program. However, unless the aggressive patients were tranquilized they didn't attend. Also had some in Catatonic Stupors (aka "The lights are on, but nobody's home" syndrome).

Those were the days!