Deinstitutionalization Hasn’t Worked

Maureen MurdockCriminal Justice System, Mental Illness20 Comments

The recent mass killings in Isla Vista, CA by a man who suffered from mental illness has once again raised the issue of the insanity of deinstitutionalization of the severely mentally ill.

Deinstitutionalization (releasing severely mentally ill from psychiatric hospitals) began in 1955 with the widespread introduction of Thorazine, the first effective antipsychotic medication. The widespread use of Thorazine moved the severely mentally ill out of state institutions and closed those institutions without ensuring that those discharged would receive the medication and rehabilitation services necessary for them to live successfully outside of the hospital. Deinstitutionalization exacerbated the mental illness crisis because, once public psychiatric beds were closed, there was no available treatment for people who later suffered from a mental illness.

Consequently, today approximately 2.2 million severely mentally ill people do not receive any psychiatric treatment. According to Pete Earley’s book, Crazy: A Father’s Search Through American’s Mental Health Madness, the liberal movement of the 1960’s emphasized individual freedom and distrust of government, resulting in the perception by social policy makers of the time that mental hospitals victimized the mentally ill, depriving them of their right to freedom of choice over their lives.

The principle used for deinstitutionalization was that severe mental illness should be treated in the least restrictive setting. This ideology rested on “the objective of maintaining the greatest degree of freedom, self-determination, autonomy, dignity, and integrity of body, mind, and spirit for the individual while he or she participates in treatment or receives services.” A laudable goal, perhaps, but as Earley pointed out, this resulted in the mentally ill exercising their rights by living on the streets, starving and freezing to death.

Self-determination often means merely that the person has a choice of soup kitchens. The least restrictive setting frequently turns out to be a cardboard box, a jail cell, or a terror-filled existence plagued by both real and imaginary enemies.

Communities were supposed to replace mental hospitals with a system of community mental health facilities but these were never funded or established in most communities, resulting in a shocking increase in the criminalization of the mentally ill. Over 330,000 of the 2.3 million incarcerated Americans are mentally ill.

Most severely mentally ill people end up in jail because they have been charged with a misdemeanor, like disorderly conduct or stealing a pair of socks. Alcohol- and drug-related charges are also common because alcohol and drug use frequently occurs as a secondary problem among the mentally ill. Some police officers actually arrest homeless mentally ill people as “mercy bookings” to give them shelter or food. Other mentally ill people are jailed because their families have found it is the most expedient method of getting them treatment. As the public psychiatric system has deteriorated, it is common practice to give priority for psychiatric treatment to someone with criminal charges pending against them.

The magnitude of deinstitutionalization of the severely mentally ill qualifies it as one of the largest social experiments in American history. It hasn’t worked. The gay community was able to raise awareness about the scourge of AIDs in the 1980s and 1990s and demand treatment for their loved ones. It is past time for us to raise awareness and funds for research and treatment for our brothers and sisters who suffer with a brain disorder. We have to find a way to prevent such carnage as occurred last weekend in Isla Vista.

20 Comments on “Deinstitutionalization Hasn’t Worked”

  1. ” …A laudable goal, perhaps, but as Earley pointed out, this resulted in the mentally ill exercising their rights by living on the streets, starving and freezing to death…”

    Very well said. I have been living with mental illness for close to forty years. And given all the health care cuts (seeing a therapist on a regular basis is no longer an option. Plus there are co-payments on all of the meds I am instructed to take) just adds insult to injury.

    Most of my mentally ill friends have decided to die. This is especially sad because I believe if they had been able to receive humane therapy (and not just mind numbing drugs), they would still be alive.

    Many become homeless (I did). And I know what it feels like to be living on the streets in the middle of winter (in Chicago). I’m still amazed I survived.

    I just don’t understand why most people think mental illness is something that does not deserve to be treated as a life threatening illness? Most mentally ill people don’t live beyond the age of 50. That should be a wake up call. Sadly, it is not.

    I thank you for a most insightful post. You dare to write about important issues which are too often ignored. Keep up the good work!

    Dylan

    P.S. A poem I wrote about what it feels like to be mentally ill, and not being able to find any compassion or cure:

    SUDDEN LIGHT

    I slept
    in my clothes
    again
    last night. Those stubborn
    buttons were beyond
    my dying

    fingers. No energy to
    unzip my pants, take off a
    shoe. The stark sun

    stabs my exhausted eyes
    each morning.
    Shrill

    street sirens startle
    my numb mouth open:
    A long

    silent scream, in a deaf man’s
    nightmare. Under the heavy
    covers

    I try to shut
    out the world
    until

    I’m somehow able to rise
    again. Maybe Jesus
    will

    come to me
    during this suffocating
    darkness

    and take my soiled hand.
    He will pull me out of this deep
    black hole

    and guide me towards that sudden
    light. His sweet and gentle hands will bless
    my blind eyes

    open
    and make my
    body

    pure. He will wash
    away the decay
    and

    deadly fear
    with his unearthly love.
    He will make the sullen worms

    forgive my fallen flesh.
    He will throw out the mouldering
    shroud.

    He will sing me
    wide awake until
    I’m wearing

    something white and waltzing
    in the sun. He will
    carry my heavy burden,

    and stand beside me,
    as I laugh and dance on
    my own empty grave.

    – Dylan Mitchell

  2. Very interesting tie-in to the Isla Vista mass killing. Much of the public reaction to these terrible events focuses on gun control which, while laudable and needed, runs into the brick wall of the “2nd Amendment” lobby. Changing the focus to advocate re-establishing involuntary institutionalization and care for the severely and/or dangerous mentally ill may be able to achieve better results. It would also serve a much larger population because only a small percentage of the mentally ill actually perpetrate mass violence, but so many of them now populate our overcrowded jails and prisons. I think the effort should be made at the state government level, not federal, and with state budgets starting to recover from the recession now may the best time to persuade state legislators to do this.

    1. Good point, Bill. Maybe if each person wrote their state legislators and demanded a bill to fund research and treatment for the mentally ill, there wouldn’t be such overcrowding in the jails and prisons.

    2. So well said, Maureen and your respondent, Bill, too. Bill raises an excellent point about engaging at the state government level, rather than federal, because unfortunately financial concerns always come into play. (Apart from anything else, I have a hope that if research was done into re-establishing involuntary institutionalization and care for the severely and/or dangerous mentally ill, the overall financial impact might be relatively favorable for state budgets and therefore encourage policy makers to act.)
      I wonder Maureen, if you might be willing to draft a letter that we could use to write to our state legislators? If your readers need help finding addresses or information about their state legislators, here is an easy website:

    3. Thanks for including your poem, Dylan. It’s beautiful, poignant and heartbreaking.
      Your comment about the fact that mental illness deserves to be treated as a life threatening illness is really important. I don’t think most people view it that way. If they did, there would be more attention to funding treatment for mental illness. I am sorry your friends chose to die but I certainly understand their lack of options in the present climate of stigmatization.

      1. Thank you for all your kind words, Maureen. I really do appreciate it much – especially since my poem’s stanzas somehow managed to get mixed up! I’ll try one more time (plus I have very good news about Virginia Davis!)

        Anyway, my poem was supposed to look like this:

        SUDDEN LIGHT

        I slept
        in my clothes
        again

        last night. Those stubborn
        buttons were beyond
        my dying

        fingers. No energy to
        unzip my pants, take off a
        shoe. The stark sun

        stabs my exhausted eyes
        each morning.
        Shrill

        street sirens startle
        my numb mouth open:
        A long

        silent scream, in a deaf man’s
        nightmare. Under the heavy
        covers

        I try to shut
        out the world
        until

        I’m somehow able to rise
        again. Maybe Jesus
        will

        come to me
        during this suffocating
        darkness

        and take my soiled hand.
        He will pull me out of this deep
        black hole

        and guide me towards that sudden
        light. His sweet and gentle hands will bless
        my blind eyes

        open
        and make my
        body

        pure. He will wash
        away the decay
        and

        deadly fear
        with his unearthly love.
        He will make the sullen worms

        forgive my fallen flesh.
        He will throw out the mouldering
        shroud.

        He will sing me
        wide awake until
        I’m wearing

        something white and waltzing
        in the sun. He will
        carry my heavy burden,

        and stand beside me,
        as I laugh and dance on
        my own empty grave.

        – Dylan Mitchell

        P.S. I’ll post the good news about Virginia Davis in the next comment…

      2. In Memoriam

        Virginia Elizabeth Davis ’65

        A picture of Virginia Davis
        Courtesy of Dylan Mitchell

        Virginia Elizabeth Davis ’65, October 22, 2013, in Portland. Ginny earned a degree in history at Reed, completing the thesis “Henry Adams: A Political Biography of an American Intellectual.” After graduation, she worked at Harvard Business School, intending to enter the doctoral program in communications. Diagnosed with schizophrenia in her 20s, Ginny spent two decades in and out of psychiatric institutions. Prof. Jack Dudman ’42 [mathematics and dean of students 1953–85] and Barbara Reid Dudman ’60 [mathematics 1966–69] were instrumental in Ginny’s care during the difficulties she encountered while she was at Reed and when she returned to Portland in the late ’70s. Ginny completed an MA in English and creative writing and poetry from San Francisco State in 1978, and then traveled to Ireland, where she spent a summer writing and studying Gaelic. In Portland in later years, she became involved in the local literary community and gave poetry readings and occasional workshops. She also completed and published several poetry collections, including Rivers in the Left Quadrant, Anima Speaking, and Civilization of the Heart. Supported by the insight of a compassionate director and mentor, Ginny was employed for a number of years as a secretary in the Oregon Health Division. His accidental death forced her to deal with management less understanding and with the loss of her job as well as the opportunity to be meaningfully employed for the rest of her life. She volunteered with Oregon Consumers Network, the World Federation for Mental Health, Oregon Advocacy Center, and Southeast Uplift Neighborhood Program, and received an outstanding service award from the Mental Health Association of Oregon. She maintained a connection to Reed, and donated a bookplate collection done by her aunt, artist Donna Davis. She had one daughter and one sister and lived alone. Says Caroline Miller ’59, MAT ’65: “She was a published poet with a keen eye for life’s injustices. Having once been homeless, Virginia had a soft spot for the downtrodden. More than once, she opened her home to those desperate for shelter. Beyond that, she collected art to the extent that money and paying in installments made it possible. She harmed no one and helped as many as she could. She struggled with her inner demons every moment of her life, and I admired her for the grace with which she carried her burden. She was a brilliant woman, a poet with a tender heart, but so troubled with mental illness that her life was shattered.”

        Appeared in Reed magazine: June 2014

        Finally! An intelligent and thoughtful summary of a brilliant poet’s life! It may have taken eight months to appear, but better late than never. Too many chronically mentally ill people fall through the cracks and are forgotten forever. This was what I feared might happen to Virginia.

        Thank you to Reed College for keeping the spirit and talent of Virginia Davis alive. She was my friend. And she was remarkable:

        thorazine imperative

        the task
        to discover
        if a duck
        or the mother
        of Christ sits
        still in the still life
        on the day-room wall

        (from Anima Speaking)

  3. Thanks for putting a spotlight on this. It affects all of us. Interesting that you bring up AIDS. When he was president, Ronald Reagan had no interest in dealing with the epidemic. And it was Reagan as Governor of California who emptied the mental institutions without funding new programs. I believe his lack of empathy was gargantuan.

  4. This is the clearest, best discussion of deinstitutionalization I have ever read. I thought it had a history of being a Republican cause, such as Reagan when he was governor. I wish there was a way for this to be read by all of our legislators.

    1. I thought it started with Reagan, too, Wendy. I hadn’t realized Thorazine had such a powerful policy effect. I worked in a psychiatric hospital in Philadelphia in the late 1960s and Thorazine made our patients zombies so I can’t imagine how the decision was made to let patients try to make it out of the hospital on their own.

  5. Thanks for this fact-based atrocity in our culture. What we are seeing with the VA group feels similarly inadequate. No hiding the fact that those who do not fit in are relegated to the most expendable in our collective imaginations. The deeper myth of America, far from being a dream, feels more like the American Hallucination.

    1. It’s true, Dennis, that those who are “different” or “invisible” get relegated to the fringes of our collective imagination until there is a tragedy like Isla Vista. And as soon as the images of that carnage fade from the media, we lose our determination to make the changes needed in our health system.

  6. I knew very little about this and the sad statisitcs–so tragic–thanks for writing an excellent article about it–the time has come–and is well past the time–to do something about this.

  7. Excellent piece, Maureen. Our attention to the plight of the mentally ill and their families is long overdue.

  8. Bravo Maureen! To care for our mentally ill is not only the humane thing to do, as you brilliantly said, it serves society as a whole to care for them before tragedy hits again. Please support Mental Wellness.

  9. Great piece, Maureen. Not only are they not getting treated but likely are set up to explode when the world does not give them what it seems to give everyone else.

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