I had a vague understanding back then that something really important - and either very good or very bad, depending on who you talked with - had happened where the state hospitals that housed those suffering from mental illness had released boatloads of folks back into communities because, a) it was costly as hell to run those hospitals and the state was looking to save some money, and b) those individuals would do better in their communities than they were doing in the state hospitals, and at far less cost. I also hazily understood that when the state hospitals opened the doors, mental health agencies in local communities were supposed to pick up the slack and provide the services needed by those individuals.
From what I could see based on the populations in San Quentin and Folsom, local communities weren't doing a very good job, and I found out later that apparently this was because although the state hospitals were ordered to release folks, no one provided additional resources to local community agencies to beef up their staff to prepare for the influx.
Again, all of this was gleaned from news stories, anecdotal evidence, and hearsay, but the one thing that was absolutely crystal clear while I stood in the chow hall of San Quentin's reception center was that prisons had replaced state hospitals as the home of the mentally ill. If you thought they were being mistreated in those hospitals, you couldn't imagine the atrocities they were being subjected to while down with predatory inmates, brutal, sadistic, psychopathic guards, and opportunities for physical and mental torture inside those walls that would make hardcore Gitmo guards green with envy.
Turns out that everything I'd sort of figured out on my own while surrounded by my very sick brothers in state prison was true. You can see for yourself in the second article below, and here as well. What's most disturbing about this is that the NY Times article has a publish date of October 30, 1984.
So, for just about three decades now, we apparently knew that:
"The consensus seems to be that the more intelligent approach to the overall problem is to realize both the limitations and value of the drugs, the importance of combining drug treatment with proper care - either in hospitals or local clinics, depending on the individual case - and that mental illness is a sociological fact that cannot be ignored simply out of a desire to save tax dollars." ~ Dr. Jack R. EwaltWhen you compare the cost of the average state prison inmate (in California, it's around $47,102) to what I have been able to find is the average cost for a state mental hospital stay (amounts vary, but appear to range from $48,631 to $76,750 per patient) it appears we're a) not saving a lot of money, and b) we're exacerbating conditions rather than helping those with severe and persistent mental illness recover.
Worse, because our sick brothers and sisters are placed in the care of people who are woefully unprepared, lack effective training, and maintain control through shows of violent, retributive power of the state, they're being mistreated, victimized and oppressed not only by staff, but also by inmates who take advantage of their diminished mental faculties.
The old State Hospital "snake pits" were bad for sure, but I doubt they hold a candle to some of the more nefarious prison treatment we know is happening on a daily basis in just about every state in the country...
There’s
just no way to justify pepper spraying the mentally disabled and then
giving them a beating to boot. It’s the sort of thing that hurts to
think about–unless you’re a sociopath–but it’s become the norm in
what’s evolved into America’s largest mental institution: the U.S.
prison system.I feel morose after reading about the plight of one poor 57 year-old guy, a Jerry C. Williams down in Raliegh, North Carolina. If an IQ of 76, a childhood victimized by sexual abuse, and a diagnosis of schizophrenia haven’t cramped his life chances enough, a lawsuit filed on his behalf documents how these days Williams is regularly pepper sprayed through the slot in the steel door on the cell that holds him in solitary confinement—the hole, as it’s known in prison parlance, the place where our mentally ill increasingly go to rot in between beatings and sprayings, evidently.
State correctional officers have been menacing Williams so thoroughly that a federal lawsuit has been filed alleging cruel and unusual punishment in violation of the Eighth Amendment of the U.S. Constitution.
Eleven years into the 28 year bid he got as a habitual offender for trespassing, assault and burglary, the N.C. native has spent years shuttling between cells in the prison mental ward and solitary confinement in what’s known as Unit One.
Williams is by no means alone in being pepper sprayed in the hole. The standard 6 by 12 feet cells, with a toilet and a bed made of slab, houses an estimated 25,000 inmates in 45 states that practice solitary confinement.
While most countries have phased out the hole as barbaric, and imprison far fewer people than we do here in “freedom-loving” America, the mentally ill are incarcerated and kept isolated for weeks and months on end, with profound psychological consequences.
Nobody pretends it’s doing any therapeutic good to cage the mentally ill alone, a punishment that could drive a sane man mad.
According to the suit filed by the North Carolina Prisoner Legal Services, Williams and seven fellow inmates, who are locked up behind solid steel doors 23 to 24 hours a day, with only three to five hours a week of recreation, are also shackled and beaten out of view of security cameras on a regular basis.
“On the solitary confinement unit, some of the primary symptoms of Mr. Williams’s illness–agitation, yelling, kicking, and throwing things–are treated like pure behavior problems that must be punished with the intentional infliction of physical pain,” the court motion states.
The suit claims the mistreatment also violates the prison’s own protocol for handling inmates with chronic mental illness.
“The monotony of Unit One’s solitary regime is broken only by periodic inmate disturbances–flooding cells, setting fires, throwing liquids, and screaming, kicking, and banging on the doors,” the suit says.
“And the practice on Unit One is to deploy high-concentration Oleoresin Capsicum pepper spray as the first level response to any such disturbance, regardless of whether a real threat of bodily harm exists, and regardless of the mental health status of the disobedient inmate.”
The fiendish treatment Williams receives every livelong minute is not unusual. His experience echoes thousands of others across the country. More than half of all prison and state inmates now report mental health problems, including psychosis, according to information from the federal Bureau of Justice Statistics.
Well over a million prisoners report mental health disorders in the state prison population, a figure five times greater (56.2 percent) than in the general adult population (11 percent).
‘You Want to Do Anything to Get Out, Even Kill Yourself’
“The first time you get locked up (in the Hole), it about drive you wild,” the suit quotes Williams as saying. “You want to do anything to get out, even kill yourself.”Williams was thrown in the hole on the night of Sept. 17, 2009, when he became agitated that his dinner tray did not include bread or a spoon.
When a correctional officer returned to collect the tray, Williams jammed it through the slot, causing it to land on the floor outside.
For this he was sprayed back through the slot eight times over a three-hour period, according to the lawsuit.
His lawyers say video of the incident shows prison guard rolling a large “MK21″ canister of pepper spray into the hole, badly injuring him before a team of officers wearing body armor and wielding batons rushed in to administer high-voltage shocks from a stun gun.
The suit claims he was then dragged from his cell and punched and kicked out of camera view.
Why?
HOW RELEASE OF MENTAL PATIENTS BEGAN
By RICHARD D. LYONS/New York Times
Published: October 30, 1984
THE policy that led to the release of most of the
nation's mentally ill patients from the hospital to the community is now
widely regarded as a major failure. Sweeping critiques of the policy,
notably the recent report of the American Psychiatric Association, have
spread the blame everywhere, faulting politicians, civil libertarian
lawyers and psychiatrists.
But who, specifically, played some of the more
important roles in the formation of this ill-fated policy? What
motivated these influential people and what lessons are to be learned?
A detailed picture has emerged from a series of
interviews and a review of public records, research reports and
institutional recommendations. The picture is one of cost-conscious
policy makers, who were quick to buy optimistic projections that were,
in some instances, buttressed by misinformation and by a willingness to
suspend skepticism.
Many of the psychiatrists involved as practitioners
and policy makers in the 1950's and 1960's said in the interviews that
heavy responsibility lay on a sometimes neglected aspect of the problem:
the overreliance on drugs to do the work of society.
The records show that the politicians were dogged by
the image and financial problems posed by the state hospitals and that
the scientific and medical establishment sold Congress and the state
legislatures a quick fix for a complicated problem that was bought sight
unseen.
'They've Gone Far, Too Far'
In California, for example, the number of patients
in state mental hospitals reached a peak of 37,500 in 1959 when Edmund
G. Brown was Governor, fell to 22,000 when Ronald Reagan attained that
office in 1967, and continued to decline under his administration and
that of his successor, Edmund G. Brown Jr. The senior Mr. Brown now
expresses regret about the way the policy started and ultimately
evolved. ''They've gone far, too far, in letting people out,'' he said
in an interview.
Dr. Robert H. Felix, who was then director of the
National Institute of Mental Health and a major figure in the shift to
community centers, says now on reflection: ''Many of those patients who
left the state hospitals never should have done so. We psychiatrists saw
too much of the old snake pit, saw too many people who shouldn't have
been there and we overreacted. The result is not what we intended, and
perhaps we didn't ask the questions that should have been asked when
developing a new concept, but psychiatrists are human, too, and we tried
our damnedest.''
Dr. John A. Talbott, president of the American
Psychiatric Association, said, ''The psychiatrists involved in the
policy making at that time certainly oversold community treatment, and
our credibility today is probably damaged because of it.'' He said the
policies ''were based partly on wishful thinking, partly on the
enormousness of the problem and the lack of a silver bullet to resolve
it, then as now.''
The original policy changes were backed by scores of
national professional and philanthropic organizations and several
hundred people prominent in medicine, academia and politics. The belief
then was widespread that the same scientific researchers who had
conjured up antibiotics and vaccines during the outburst of medical
discovery in the 50's and 60's had also developed penicillins to cure
psychoses and thus revolutionize the treatment of the mentally ill.
And these leaders were prodded into action by a
series of scientific studies in the 1950's purporting to show that
mental illness was far more prevalent than had previously been believed.
Finally, there was a growing economic and political
liability faced by state legislators. Enormous amounts of tax revenues
were being used to support the state mental hospitals, and the
institutions themselves were increasingly thought of as ''snake pits''
or facilities that few people wanted.
One of the most influential groups in bringing about
the new national policy was the Joint Commission on Mental Illness and
Health, an independent body set up by Congress in 1955. One of its two
surviving members, Dr. M. Brewster Smith, a University of California
psychologist who served as vice president, said the commission took the
direction it did because of ''the sort of overselling that happens in
almost every interchange between science and government.''
''Extravagant claims were made for the benefits of
shifting from state hospitals to community clinics,'' Dr. Smith said.
''The professional community made mistakes and was overly optimistic,
but the political community wanted to save money.''
'Tranquilizers Became Panacea'
Charles Schlaifer, a New York advertising executive
who served as secretary-treasurer of the group, said he was now
disgusted with the advice presented by leading psychiatrists of that
day.
''Tranquilizers became the panacea for the mentally ill,'' he said.
''The state programs were buying them by the carload, sending the
drugged patients back to the community and the psychiatrists never tried
to stop this. Local mental health centers were going to be the greatest
thing going, but no one wanted to think it through.''
Dr. Bertram S. Brown, a psychiatrist and Federal
official who was instrumental in shaping the community center
legislation in 1963, agreed that Presidents Eisenhower, Kennedy and
Johnson were to some extent misled by the mental health community and
Government bureaucrats.
''The bureaucrat-psychiatrists realized that there
was political and financial overpromise,'' he said.
Dr. Brown, then an executive of the National
Institute of Mental Health and now president of Hahnemann University in
Philadelphia, stated candidly in an interview: ''Yes, the doctors were
overpromising for the politicians. The doctors did not believe that
community care would cure schizophrenia, and we did allow ourselves to
be somewhat misrepresented.''
''They ended up with everything but the kitchen sink
without the issue of long-term funding being settled,'' he said. ''That
was the overpromising.''
Dr. Brown said he and the other architects of the
community centers legislation believed that while there was a risk of
homelessness, that it would not happen if Federal, state, local and
private financial support ''was sufficient'' to do the job.
Resources Vanished Quickly
The legislation sought to create a nationwide
network of locally based mental health centers which, rather than large
state hospitals, would be the main source of treatment. The center
concept was aided by Federal funds for four and a half years, after
which it was hoped that the states and local governments would assume
responsibility.
''We knew that there were not enough resources in
the community to do the whole job, so that some people would be in the
streets facing society head on and questions would be raised about the
necessity to send them back to the state hospitals,'' Dr. Brown said.
But, he continued, ''It happened much faster than we
foresaw.'' The discharge of mental patients was accelerated in the late
1960's and early 1970's in some states as a result of a series of court
decisions that limited the commitment powers of state and local
officials.
Dr. Brown insists, as do others who were involved in
the Congressional legislation to establish community mental health
centers, that politicians and health experts were carrying out a public
mandate to abolish the abominable conditions of insane asylums. He and
others note - and their critics do not disagree - that their motives
were not venal and that they were acting humanely.
In restrospect it does seem clear that questions
were not asked that might have been asked. In the thousands of pages of
testimony before Congressional committees in the late 1950's and early
1960's, little doubt was expressed about the wisdom of
deinstitutionalization. And the development of tranquilizing drugs was
regarded as an unqualified ''godsend,'' as one of the nation's leading
psychiatrists, Dr. Francis J. Braceland, described it when he testified
before a Senate subcommittee in 1963.
Dr. Braceland, a former president of the American
Psychiatric Association who is a retired professor of psychiatry at Yale
University, still maintains, however, that under the circumstances the
widespread prescription of drugs for the mentally ill was and is a wise
policy.
''We had no alternative to the use of drugs for
schizophrenia and depression,'' Dr. Braceland said. ''Before the
introduction of drugs like Thorazine we never had drugs that worked.
These are wonderful drugs and they kept a lot of people out of the
hospitals.''
Testimony to Congress
His point is borne out repeatedly by references in
Congressional testimony, such as the following exchange at a House
subcommittee hearing between Representative Leo W. O'Brien, Democrat of
upstate New York, and Dr. Henry N. Pratt, director of New York Hospital
in Manhattan, who appeared on behalf of the American Hospital
Association.
Mr. O'Brien: ''Do you know offhand how much New York
appropriates annually for its mental hospitals?''
Dr. Pratt: ''It is the vast sum of $400 million to $500 million.''
Mr. O'Brien: ''So you see that, through a real
attempt to handle this problem at the community level, the possibility
that this dead weight of $400 million to $500 million a year around the
necks of the New York State taxpayers might be reduced considerably in
the next 15 or 20 years?
Dr. Pratt: ''I do, indeed. Yes, sir.''
He then told the subcommittee that ''striking proof
of the advantages of local short-term intensive care of the mentally ill
was brought out'' in a Missouri study.
Dr. Pratt's testimony and the Missouri study were
repeatedly cited in subsequent Congressional debates on the community
centers bill by such politicians as Senator Hubert H. Humphrey of
Minnesota and Representative Kenneth A. Roberts of Alabama.
The Missouri study, which compared a group of 412
patients in two intensive treatment centers with patients admitted to
five mental hospitals, showed that the average stays for patients in the
large hospitals were 237 days longer than for similarly diagnosed
patients at the treatment centers.
But Dr. George A. Ulett of St. Louis, the
psychiatrist who directed the study as head of Missouri's Division of
Mental Diseases, now says the numbers cited, though correct, were
misinterpreted. ''We did have dramatic numbers, but the initial success
of the community centers in Missouri hinged on the large numbers of
psychiatrists and support personnel who staffed the centers at that
time,'' Dr. Ulett said.
The centers were two pilot projects that were given
special staff and attention to demonstrate what could be accomplished,
he said. By linking the community centers to large teaching hospitals in
major cities and providing adequate funds for their maintenance it was
possible to attract the quality of staff that all but guaranteed better
results than the old state hospitals, he said.
''Unfortunately,'' he said, ''over the years the
budgets were progressively reduced, the professional staffs were cut,
and the program regressed to right back where it started.''
Dr. Frank R. Lipton and Dr. Albert Sabatini of
Bellevue Psychiatric Hospital in Manhattan, who have done research on
the problems of the homeless, say one of the major flaws in the concept
of deinstitutionalization was the notion that serious, chronic mental
disorders could be minimized, if not totally prevented, through care
provided within the local community.
''This philosophical and ideological shift in
thinking was not adequately validated, yet it became one of the major
conceptual bases for moving the locus of care,'' they said in a recent
study.
Value and Danger in Drugs
Some problems have actually been brought on for
mental patients by long-term use of drugs. This condition has been
considered by Dr. Loren Mosher of the Uniformed Services Medical
University in Bethesda, Md., who says that from 15 percent to 40 percent
of such mental patients develop uncontrollable movements of the mouth
and neck that can only be cured by taking people off the drugs.
The consensus seems to be that the more intelligent
approach to the overall problem is to realize both the limitations and
value of the drugs, the importance of combining drug treatment with
proper care - either in hospitals or local clinics, depending on the
individual case - and that mental illness is a sociological fact that
cannot be ignored simply out of a desire to save tax dollars.
Jack R. Ewalt, who directed the staff of the Joint
Commission when it was founded in 1955, says now that he remains ''a
great believer in the use of drugs, but they are just another treatment,
not a magic.''
''Drugs can help people get back to the community,''
he said, ''but they have to have medical care, a place to live and
someone to relate to. They can't just float around aimlessly.''
Dr. Ewalt said the 1963 act was supposed to have the
states continue to take care of the mentally ill but that many states
simply gave up and ceded most of their responsibility to the Federal
Government.
''The result was like proposing a plan to build a
new airplane and ending up only with a wing and a tail,'' Dr. Ewalt
said. ''Congress and the state governments didn't buy the whole program
of centers, plus adequate staffing, plus long-term financial supports.''
