de-institutionalization

ok. nationwide (US), the state hospital system has been basically shredded since, say, the 60s. where i live...

i asked my counselor about it at the last session. just...curious. he explained that very few people are admitted, long term. usually...even the ngri (not guilty by reason of insanity) cases are medicated, treated, and released for "community treatment under court supervision," which...honestly...scares me, just to think about. but it saves money, and maybe its better than being in a state hospital for years? i don't know. i imagine each person is different.

what do you all think, honestly? they weren't good places, some were terible, some were ok...

but at least they were there, you know? some people struggle to make a go of things in the 'real world,' and i wonder, sometimes, if perhaps bringing back a modified version of the state hospital system (long term care/commitment) might actually be a --good thing-- . I'd hate to go to one, personally, but...

I have a good support system. it isn't that im 'too good' for the asylum, its just i (thankfully...) don't need it, because of my support system. some people do. is it better, you think, to risk locking people up for a long time who might do OK...to help vulnerable people who might need it?

It is interesting you bring this up. My therapist and I were discussing this very system and how it began to fall apart in the 60s at my appointment this week.

I know there was a lot of corruption. Pretty much every system I have ever studied suffers from it in one form or another eventually. However, I think there is a need for long term care for many. I know the hospital I was recently in had a long term program that seemed pretty ok. They have apartments and the rules are more flexible than the typical IP programs. A guy I was in with transferred to it and had done it before. He said it was a nice program and it gave his family a much needed break. He also said it is quite expensive. It seems cost is always the deciding factor. People usually cannot afford what their insurance wont pay for and most companies push back hard after 10 days or so. I remember watching several people being discharged that definitely needed more time. Some of them didnt want to leave, but they were pushed out because of insurance. It seems counterproductive though. These same people told me stories of their frequent hospital stays. Maybe they wouldn't need to return as often if they were allowed to stay and truly heal the first time.

I wrote an article on a part of this topic a while back. If anyone is interested, it's at Why Jails And Prisons Shouldn’t Be Mental Asylums – Bird Flight

Anyway, I visited my dad today. He's currently in a psych ward. The place was lousy, in my opinion. The nurse said he'll be there through the weekend, but that may turn out to be fewer than seven days. My dad said he's only sleeping, eating, or getting vitals taken. I asked the nurse if my dad is seeing a psychiatrist daily and she said "yes", but my dad doesn't recall doing so. I told the nurse to encourage him to attend therapy groups and that if my dad doesn't, it may be a partial waste. I think it will be a waste. He had the chance to be in a good psych hospital and he blew it. Now he's in the same crap joint my nephew was prematurely released from on a measly 500 mg Lithium. Fewer than seven days later my nephew died by suicide. Believe me when I say I kept my cool there, but now I'm not.

My dad told me he wishes he could have a visiting nurse service. I will have to ask my sister if that's any kind of possibility.

im torn. the long term private places were a mixed bag, too...probably better than the state hospitals, in most areas, most of the time, but...really, that's not saying a whole lot.

my hospitalizations were -not- helpful. both were traumatic. the first destroyed me, until I (I think miraculously) recovered, reconciled with my family, got healthy, and moved on with life. The 2nd was marked by unprofessional behavior from pretty much everyone involved in my care, then some insurance fraud. both were private facilities. and yet...

honestly, there have been times i wanted to be in a real, life -asylum- , as in...a place to be more or less out of society, largely because...being 'severely mentally ill' in often difficult for me because of labels and stigma, and the conflict between what people think of when they think 'psych patient' and what they see in me, hear from me, etc. basically...as is the case with a lot of people, i seem to be 'in recovery' -despite- society, not because of it.

but that's just me. i also see severely mentally ill people who need care and experience nothing but deprivation and pain in society...but no one seems to care. even the mental health 'professionals,' at least the bulk of the ones in the community system ive dealt with, seem to think the answer is more antipsychotics, more psych control, a job they approve of, etc...

what about just rest and retreat, space? not exactly the most hi-tech medical advance ever, but...important, nonetheless.

Here's an excerpt from another one of my past blog posts:

"In the past, particularly before 1955 when the psychiatric deinstitutionalization started in the United States, people with grave mental illness who committed crimes were held in psychiatric institutions. These establishments were definitely far from being desirable places, but they weren’t literally jails or prisons. As the deinstitutionalization progressed over several decades, many of the circa half a million critically ill patients ended up on the street or in prison. Between the woefully underfunded Community Mental Health Act signed by President Kennedy, and the Mental Health Systems Act signed by President Carter, but later repealed under President Reagan, the deinstitutionalization has been a social experiment disaster.

To this day, the crisis continues with far too many people with mental illness incarcerated, one too many in solitary confinement, and some even on death row. Seriously ill patients in need of an in-patient care have to wait months for available space. According to the World Health Organization’s data, there are about 23.5 mental health hospital beds per 100,000 population in the US, which is roughly the same number as in Guyana. For comparison, the numbers are 52.1 in Germany and 82.4 in Czech Republic. As a person with a mental illness, I find this to be extraordinarily sad and unjust. As an American, I find it inexcusable."

I worked in a trio of facilities that were established to provide care to people who no longer were eligible for long-term state hospital care but too sick to live independently or in group homes. Many of them had lived a lot of their lives in state hospitals before coming to us. I loved the job and the patients but it was hard to watch some of what they went through. It was a confusing at times mess trying to adhere to Medicare/Medicaid rules while providing appropriate psych care. For example I sometimes had to provide physical restraints and we used more and more involved restraints than in normal nursing homes. I had a hard time with that at first. When I was there things were actually better than 10-20 years before; once I was searching storage for something and found a straight-jacket. We most definitely did not use those. I was there a few years after the last patient with a frontal lobotomy had died. We provided good care but it was sad in that most people had very little family contact. At Christmas the staff brought tons of dollar store gifts (body wash was a huge favorite for the women who otherwise had to use body wash/shampoo combined and it was nasty stuff) and those small gifts were divided up and were most of what most people got. I once was there Christmas Eve and there were so few families.

Some people said they preferred the state hospital. Others still cycled back there occasionally or (more often) to long-term VA IP stays. Most people were pretty happy. Many, maybe most, had at least some symptoms of TD. Most people considered it home.

It was a good place to work and a place I felt I could and did make a difference. It was also sad because of the harm done in the state hospital years.

I think there needs to be studio apartments with visiting nursing services. My old pdoc wanted me to have a daily visiting nurse. He wanted me to try to get home cleaning service. Sometimes I’m too sick to cook, shop and clean even if I’m not a danger to myself I need extra help. I’m lucky enough to have my husband who can pick up the slack sometimes. When it’s just me and him we will get a much smaller place, if I get my way. If I was to be on my own I would need help.

I don’t trust ANYONE. I don’t open my door for mail or people knocking. I don’t talk unless my husband is there. I don’t go outside. I certainly don’t let anyone in my house, (Including maintenance). I don’t go into stores. I don’t stay in the house alone just in case someone breaks in. Hell I only answer the phone unless it’s family and that’s when I’m well. I have no idea what getting help will look like when I need it

I want to thank still_crazy for starting this thread and also thank everyone who has contributed to such a thoughtful thread. I think there are no good answers.

By and large I am more comfortable tilting towards freedom than locking people up for mental health reasons. I find the coercive aspects of hospitalization where I live in Canada to be mind bogging. I have nothing good to say about hospitalization for mental illness where I live. For that reason i can't advocate for more places like them.

I didn't enjoy being locked in an rehab for six months. family and T hold this over my head as a deterrent to use drugs and promiscuous behavior. I believe they are important for some people but not for me

there is a huge need for improved psychiatric care, both long & short term. long term care suffered when many of the facilities were shuttered decades ago. it was thought folks would reintegrate into the community and all would be well....that rarely happened. homelessness , abuse deaths, those occurred. lack of care occurred. so many fell thru the cracks which were really canyons.

now long terms care is better in some small instances but it still needs work. I visit nursing homes & state care facilities and while there is good care given, the facility space is tight. more is needed. talk is there will be a new facility built. care is good in the one state one I visit..staff care about the residents but it is still a state home. few residents have family that visit (that is no one's fault , certainly not the state's). there are activities, trips etc and much is done to make it homey.

as for forced hospitalization, my feelings are if it is needed then there must be a reason. you have to meet criteria to get to that point..it isn't just a random thing. you are unwell or in danger. it isn't supposed to be a spa stay but a let's keep you safe stay and help you get well. could facilities be nicer? sure always, but again lets not lose track of purpose..some folks are violent, some at risk so safety is an issue as well. and $$$...health care doesn't get as much funding as it did and probably never will so some amenities have gone by the wayside...staff numbers decreased.

I know there are group homes near where the community clinics are. Unfortunately most of those are for men only. There may be one for women but I haven’t heard of it. Other people live in small apartments and are visited by health workers.

The only long-term facility I know of is way out of town. I don’t even think we have state facilities anymore. There’s a hospital that houses violent individuals but most go out of town.

I’ve only been in for short periods of time, and there are times I should’ve stayed in longer but once meds were changed it seemed I was booted out the door. Good mental health professionals are being redirected to deal with the substance abuse crisis so I don’t think a state facility would be good here unless for forensic purposes.