A tour of one of Indiana’s remaining Psychiatric Hospitals
Providers in the outpatient trenches are fighting for a better of quality of life for patients so that they do not require a more restrictive level of care. However, though the nationwide movement of "deinstitutionalization" had the right political optics at the time it began, it was clearly short-sighted (pun intended.) During the 30 or so years as State Hospitals began to dwindle in their bed numbers, and eventually disappear entirely from many States, the efforts to meet the growing needs of those who had been served in long-term facilities in the outpatient arena could never be sufficient. As a result, persons with mental illnesses suffered high morbidity and mortality rates, reduced access to healthcare, and increased homelessness. These poor results were not through lack of hard work of community health centers and clinicians, nor for any lack of government spending. These results were because a lack of understanding of the neurologic nature of psychiatric illness.
Ironically, as the asylums began to shrink, our neuropsychiatric knowledge began to explode, particularly in the 1980s and 90s. This brought new technologies and pharmacologic interventions that brought a new wave of promise not seen since Freeman's lobotomies and Rhone-Poulenc's Thorazine. Discovery of SSRIs like Prozac and the novel antipsychotics like Risperdal were sweeping the nation, offering relief for patients without the potentially lethal side effects and intensive medical monitoring required of the older tools. So this was one of the final nails in the coffin for the asylum. Surely with such advances in the industry, psychiatric illnesses could be treated more quickly and no longer require the long-term stays and expense to the taxpayers.
In the new millennium, Mandeville State Hospital and Jacksonville State Hospital in Louisiana, both public psychiatric facilities where I trained in my residency, closed. In 2012, another Jacksonville State Hospital, this one being in Illinois that had been in operation since 1857, closed due to budget issues in 2013. Our own Central State Hospital closed in Indianapolis before the dawn of the '90s. And the list goes on and on.
Many of the closures were for good reason. The State Hospitals across the nation began to see an influx in patients who with irreversible neurocognitive disorders, such as those with developmental disabilities, progressive dementias, and other conditions which would have been better served in other more specialized facilities that we have today. As patient censuses approached the thousands, budgets and staffing numbers remained the same or decreased, which were not favorable to good patient care to say the least. It was not uncommon for one staff member to be left alone to supervise 60 to 80 patients. Nor was it unusual for a handful of staff to assist 100 patients in the dining area, all of which had feeding issues and needed close monitoring. The results of all of this was brutally captured on film for the world to see in an expose of Willowbrook State School by a young Geraldo Rivera. Images of young patients rocking themselves in dark corners and barely clothed were shocking and burned into the public consciousness, leading to more scrutiny of such facilities and driving another nail in the coffin of the good name of the asylum.
