I came across a local article today that raises some concern for me. On CBS 6 News (New York), local website was an article about a bill currently working its way through the Vermont State Legislature. The Vermont State Legislature is currently considering a overhaul of that state’s mental health system. Vermont’s remaining state hospital for psychiatric care was badly damaged and its 80 employees have been laid off. The hospital, as all state hospitals have, downsized dramatically over the second half of the twentieth-century. The use of psychotropic drugs to treat mental illness allowed the hospital – which had a peak population of 1,400 mid-century, the era prior to modern medications and deinstitutionalization. By the 1980s, the hospital had only 200 beds, and the hospital legislature is replacing was down-sized further to a mere 54 beds.
No one would dispute that the move in mental health treatment from institutionalization to community based treatment has benefited the mental ill most of all. For much of the century mental health treatment was defined by neglect and abuse in over-crowded hospitals. “treatments” for psychotic and violent patients included “hydro-therapy” (submersion in cold water), electroshock, lobotomy, and restraint. The abuse rampant in the large state hospitals is well-documented in popular culture due to movies like “One Flew Over the Cuckoo’s Nest” and “The Snake Pit.”
Certainly, anyone familiar with the mental health system today has no nostalgia for the era of twentieth-century mental health treatment, when being mentally ill could mean a life spent wasting away in massive hospital complexes that dotted rural areas near cities throughout the United States. Community-based treatment gives the mentally ill, and their families, options for mental health care that allow even the severely ill to live their lives with dignity.
However, the reliance on community based care, means that the mentally ill and their families rely on hospital emergency rooms to get their loved ones help during an acute crisis. Further, hospitals in cities throughout the country have divested in mental health care. In Albany, N.Y., where I live, Albany Medical Center converted 26 beds to surgical and pediatric beds that had been reserved for acute psychiatric care. (Informed Constituent) In Albany, Albany Medical Center has only 20 remaining beds, for psychiatric care, and most general hospitals in the area have gotten out of emergency psychiatric care altogether. The Capital District Psychiatric Center, which operates in a partnership with Albany Medical Center, and is nearby, cited that there were 8,735 average monthly visits to hospital emergency rooms from to 10/09 to 9/10. New York State’s Office of Mental Health had this to say in the first paragraph of their Introduction to their 2010 annual report:
Psychiatric emergency care in New York State was historically provided primarily in the emergency rooms of general hospitals and often resulted in overcrowded emergency rooms and over-utilized acute inpatient hospitalization services. An increase in the use of emergency rooms in the 1980s raised concern about the timeliness, quality, and continuity of care for people accessing psychiatric emergency services.
Some advocates for the mentally ill have watched the declines in beds for psychiatric emergency treatment and have begun to sound the alarm. According to the Treatment Advocacy Center, in 2005, there were 17 beds for psychiatric treatment for every 100,000 U.S. citizens.
Returning to the debate in my neighbor state: the Vermont House has given approval for a new facility with 25 beds in Berlin, Vermont, the Senate has approved a plan for a paltry 16. During difficult economic times, the debate is likely to be contentious over new funding to build hospitals. The ATC asserts there is a deficit of 100,000 psychiatric beds in the U.S. The results for the mentally ill and their families are long waits in emergency rooms for open beds (my experience is some patients wait 24-48 hours for an open bed), and “increased homelessness,” as well as “the use of jails and prisons as de-facto psychiatric hospitals.”
The end point is that hospitals are shedding programs to treat the mentally ill, and emergency rooms and prisons are over-burdened treating the mentally ill. There is also little political will to invest in treatment for mental illness. People who have mental illnesses have made significant contributions in every area of our society, from the arts and sciences, to public life and commerce. As is the case in Vermont right now, if states fail to make critical care available for the mentally ill, the result will be a new “age of confinement” where the mentally ill are warehoused in institutions, kept out of sight, and denied the dignity and rights that community-based treatment reform had promised.
Historical image reproduced from: http://www.asylumprojects.org/index.php?title=Vermont_State_Hospital
http://www.cbs6albany.com/news/hospital-1290613-state-senate.html
http://www.treatmentadvocacycenter.org/home-page/71/81
http://findarticles.com/p/articles/mi_m5QWD/is_5_5/ai_n25007564/
Robert B. Eaton is an author and free-lance writer. He is currently developing a book about the history of mental health treatment in the United States.