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Thread: The Case to Bring Back the Asylum

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    Default The Case to Bring Back the Asylum

    I don't claim to have an answer to this problem but living where I do I see lots and lots of mentally ill people living on the streets so for those better informed than I what do you think about this article? (I was reading the comments section and someone mentioned a1971 Supreme Court case that said people can't be held against their will and someone else mentioned Gould Farm is a private institution but I'm not sure what that changes in the big picture)





    The Case to Bring Back the Asylum

    A new generation of flexible, varied institutions would help reduce the vast numbers of mentally ill adults in jails and prisons


    When Richard Quintero broke into a Pizza Hut in High Point, N.C., early one morning in late March, he called 911 himself to let the police know. “Yes, this is Jesus Christ and I just broke into the Pizza Hut,” he said, according to a recording of the call. He then told the dispatcher that he was schizophrenic and kept getting kicked out of homes. When the police arrived, Mr. Quintero was cooperative but was still arrested on charges of felony breaking and entering and felony larceny. He spent time at a state prison before being found incompetent to stand trial and sent for a short-term stay at a state mental hospital.

    Many in his situation, unfortunately, tend to stay behind bars: In the U.S. today, jails and prisons have become our mental asylums. The Bureau of Justice Statistics estimates that some 365,000 American adults with serious mental illness are behind bars and an additional 770,000 are on probation or parole. A 2017 Justice Department study estimates that some 37% of all prison inmates suffer some mental illness and that 26.4% of jail inmates suffer from a psychosis.

    They are behind bars because, too often, they have nowhere to go. Two generations of policy have led to the mass closing of state mental hospitals. The extent of the resulting problems—for the seriously mentally ill in general, not just those in jails or prisons—is so widespread that a case is building to bring back the asylum, especially for those who pose a risk to others or themselves. But proponents aren’t advocating for a return of the inhumane places of the past. What’s needed is a new generation of flexible and varied institutions.

    To understand the problem, it helps to look back at the history of asylums. In 1840, Dorothea Dix, the former headmistress of a Boston school for girls, had completed a trip to England meant to help recover her health. Influenced by Quaker reformers there, she was exposed to the cause then known as “lunacy reform”—the idea that government had an obligation to care for the mentally ill.

    Back in the U.S., Dix went on to survey and expose what was quickly understood to be a scandal: the confinement of the mentally ill in prisons. Dix successfully convinced states to invest in large-scale asylums, where those suffering from mental illness would be well cared for in impressive and expensive facilities. The construction and staffing of those state hospitals—which, in the early days, were often lofty, light-filled buildings with communal dining halls and sprawling grounds for outdoor exercise—became major state expenses.

    By the mid-20th century, the system had grown into a vast network of 322 state and county hospitals holding more than 550,000 beds. But they had grown to encompass much more than housing the mentally ill. In an era before Social Security or long-term nursing care, they served as housing of last resort for those suffering with dementia, sexually transmitted diseases and other ills. “By becoming the dumping ground for all manner of people who could not care for themselves, the once-grand asylums deteriorated into snake pits and hellholes worthy of exposes,” says Jeffrey Geller, medical director of the Worcester Recovery Center and Hospital, one of the last surviving hospitals for the diagnosis and treatment of mental illness in Massachusetts. Overcrowding and less oversight created a much lower quality of care for patients. Work opportunities that taught valuable social skills disappeared under the guise of patient rights.

    Today, we face the same problem that Dix found: that treatment for mental illness is fundamentally inconsistent with imprisonment. As Dominic Sisti, Andrea Segal and Ezekiel Emanuel of the University of Pennsylvania argue in a 2015 essay in the Journal of the American Medical Association, “It is difficult to imagine how ethically sound treatment of mentally ill prisoners can be delivered.” Many such prisoners are so difficult that they are held in solitary confinement. One advantage we have today is that mental illness can often be successfully treated with medication—but that may require supervision to ensure the patient is following the regimen.

    As one option on a spectrum of possible settings, state hospitals would not require a huge number of facilities. In his 2013 book “American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System,” E. Fuller Torrey of the Treatment Advocacy Center, citing data from the National Institute of Mental Health, estimates that only 1% of the approximately 12.3 million people suffering from serious mental illness are a threat to themselves or others. That would mean facilities adequate to house a maximum of 123,000 people.

    Nor would they have to be large, isolated institutions filled with beds. Experiments with new models have begun to emerge, including those modeled after Massachusetts’ Gould Farm, a “therapeutic community” operating since 1913 that is based in farming, where its 40-some residents feed animals, prepare meals, participate in fitness activities, maintain walking trails and run the farm’s cafe and bakery. “There are many different modalities,” says Dr. Sisti, who has promoted the asylum idea as part of a broader continuum of care in a series of panels and papers for the American Psychiatric Association. “Therapeutic communities, farmsteads, recovery campus settings. There should be a range of hospitals, as well, both public and private—but they should be within reach and affordable.” Not every patient would need a long-term stay.

    Bringing back the asylum would, of course, require public spending. Dr. Geller notes that Medicaid, since its inception in 1965, has barred the use of its funds to support inpatient treatment in larger institutions—originally as a way to force states to continue to bear the expense of treatment. Instead, that policy, along with the deinstitutionalization movement, incentivized states to shift a huge portion of the cost of these hospitals to the federal government by encouraging patients to be served in small, community-based treatment centers, whether these services were sufficient or not. The mass closing of hospitals began, and the few inpatient beds left continue to decrease in number even today.

    Dr. Geller proposes that public support for treatment work as a sort of a patient voucher—accompanying a patient in any treatment setting. He envisions patients moving from hospital to involuntary outpatient treatment to their own apartments in “supportive housing,” with the same level of funding following them wherever they go. He believes that state hospitals, run well, should not be “wildly more expensive than community treatment”—and can be crucial as treatment options.

    Many of the asylums of the previous era still stand, often empty and eerie. We may not want to reopen those actual facilities—but it’s time to acknowledge that closing them has left a vacuum that must be filled.


    https://www.wsj.com/articles/the-cas...lum-1526658277
    Last edited by cawacko; 05-25-2018 at 03:59 PM.

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    That's a pretty big jump to conflate homeless on the streets with the criminally insane.

    I don't know about other states, but this state already has maximum security facilities for mentally ill criminals; which they benignly call psychiatric hospitals.

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    I would rather have a bottle in front of me than a frontal lobotomy........

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    Quote Originally Posted by Cypress View Post
    That's a pretty big jump to conflate homeless on the streets with the criminally insane.

    I don't know about other states, but this state already has maximum security facilities for mentally ill criminals; which they benignly call psychiatric hospitals.
    To your first sentence I feel like locally we deal with the mentally ill by putting them in jail then releasing them; rinse, wash and repeat. No easy answer I know.

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    There are lots of mentally ill people on the streets. there are lots of Vets in need of mental help too. Many, many mentally impaired are in jails. Jails are one of the worst places to put someone who needs help. Reagan shut down the mental asylums. We have been paying for that ever since.

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    Quote Originally Posted by Nordberg View Post
    There are lots of mentally ill people on the streets. there are lots of Vets in need of mental help too. Many, many mentally impaired are in jails. Jails are one of the worst places to put someone who needs help. Reagan shut down the mental asylums. We have been paying for that ever since.
    Ok. Did you read the article?

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    Quote Originally Posted by cawacko View Post
    Ok. Did you read the article?
    Reagan did empty the mental institutions in California. Then, the only place they had to go, other than the streets, was jail. So it comes down to which is more expensive (or which is cheaper for the Taxpayer) the mental institution or the jail. I'm pretty sure the actual compassionate care for the mentally ill is not a major concern, especially for our Christian friends that have a motto of "Greed Is Good" and "I got mine, fuck everybody else".

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    Quote Originally Posted by Nordberg View Post
    Many, many mentally impaired are in jails. Jails are one of the worst places to put someone who needs help.
    I disagree. We certainly need to do a better job keeping a lot of people from offending to begin with, but once they offend, jail is exactly where they need to be. We can't turn a blind eye every time a clepto steals, or a bipolar person feels they no longer need their meds, and falls into the yo-yo trap of leaving them, self-medicating with booze or street drugs and start robbing people and such. Putting them in jail protects the public from them and protects them from their own mistakes, or someone killing them in self-defense.

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    They are behind bars because, too often, they have nowhere to go. Two generations of policy have led to the mass closing of state mental hospitals. The extent of the resulting problems—for the seriously mentally ill in general, not just those in jails or prisons—is so widespread that a case is building to bring back the asylum, especially for those who pose a risk to others or themselves. But proponents aren’t advocating for a return of the inhumane places of the past. What’s needed is a new generation of flexible and varied institutions.
    call them therapeutic communities, and don't warehouse them.
    An asylum for mentally ill is better then being in jail or homeless and vulnerable on the streets.

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    great article!
    ​sounds of silence!

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    Quote Originally Posted by Kacper View Post
    I disagree. We certainly need to do a better job keeping a lot of people from offending to begin with, but once they offend, jail is exactly where they need to be. We can't turn a blind eye every time a clepto steals, or a bipolar person feels they no longer need their meds, and falls into the yo-yo trap of leaving them, self-medicating with booze or street drugs and start robbing people and such. Putting them in jail protects the public from them and protects them from their own mistakes, or someone killing them in self-defense.
    I can't see someone suffering from a mental illness being warehoused in a jail just to keep the grass green. It's reagan's fault.
    ​sounds of silence!

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    Quote Originally Posted by Rat Robbersson View Post
    I can't see someone suffering from a mental illness being warehoused in a jail just to keep the grass green.
    Far more complicated than that.

    It's reagan's fault.
    Most things are...at least the things that aren't Clinton's fault.

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