A tour of one of Indiana’s remaining Psychiatric Hospitals
The word "asylum" in the English language is associated with "protection," "security," "retreat," "shelter," "refuge," in political, legal, economic, and medical realms. In the 19th Century, America saw the birth of numerous institutions in every state that over just such asylum to persons with severe neurologic and psychiatric deficits. What happened to these places, and why did they get such a bad reputation?
Dr. E. Fuller Torrey is author of the book American Psychosis. He worked for the National Institute of Mental Health and in public psychiatric hospitals for years. He describes the consequences of such hospitals being emptied during the trend of "deinstitutionalization," as "like watching the effects of a tsunami or a Category 5 hurricane in slow motion..."(1)
Just like Dr. Torrey, I spent my career growing infuriated over the countless stories of patients with severe mental illness and comorbid medical illnesses struggling and dependent on meager outpatient support. People with these illnesses tend to decline in their ability to maintain adequate economic support, yet Medicaid funding for psychiatric services remained pitiful. In my own private practice in Illinois, I was often receiving just 20% of my charged fees, and sometimes two years after the claim had been made. More and more private physicians were getting out of seeing Medicaid or uninsured psychiatric clients, so it was getting harder to find specialist referrals so my patients could get their healthcare needs met. In addition, if I had a patient who was at significant risk of suicide or harm to others, there was nowhere for clients without means or without support to go. If one approached me in my office with acute distress that I felt needed hospitalization, I would have to shut the clinic down for hours, wait for the police to arrive, convince the patient to go to the hospital, only to have that patient discharged a few days later or never admitted in the first place. There was no robust Gatekeeper and State Psychiatric Hospital System to support the community hospital sector, and community hospitals themselves were closing down adult and pediatric psychiatric beds so there were very few places to provide any inpatient stabilization at all. I fought to get home health services and social service intervention, only to hear reports that the patient living conditions were deplorable in ways I care not to describe. This is a far cry from what President John Kennedy meant when he promised "reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability." (2)
