Mental Illness

fife

jeffbr said:

brianlux said:

unsung said:

oftenreading said:

unsung said:

Side question...

Why did Sanitariums/Mental Hospitals more or less become extinct in the US?

The correct answer is more than I can type right now, but the short answer includes (1) they aren't more or less extinct; every state had at least one large state psychiatric facility, and usually more than that. Capacity is much reduced, though  (2) the de-institutionalization movement focused on the fact that most people want to be closer to their homes and loved ones, and most people can be successfully treated out of hospital. Unfortunately, as fife noted, the necessary funds did not follow, because of ....(3) administrators saw this as a way to cut costs by cutting hospital beds, instead of re-vamping community services. 

There is a lot of research on what makes for effective community treatment and how to deliver services that maximize psychosocial rehabilitation. Too bad much of the results aren't put into practice. 

I asked because there are two fairly close to me that are abandoned, and apparently they are popular with the urban explorer crowd.  

I thought they went away because of political correctness.

Here in California a number of mental health institutions were closed when Ronald Reagan was governor.  He shut them down and created a situation where the number of homeless rose dramatically.  It's a shameful legacy.

Yes, but why did he shut them down? If you recall, the ACLU in the 70's fought many battles against involuntary commitment, and their work culminated with the Civil Rights of Institutionalized Persons Act of 1980.  There were a number of factors, from the involuntary nature of why they were there, to the deplorable conditions of some of these state institutions. It wasn't just California, either. New York, and Florida had cases which altered the way in which people were committed. Many were homeless because they couldn't be kept against their wills, but also wouldn't seek help for themselves. 

I just found this short little blurb about the ACLU's fight on their site:

ACLU HISTORY: MENTAL INSTITUTIONS

"The ACLU's most important Supreme Court case involving the rights of people with mental illness was filed on behalf of Kenneth Donaldson, who had been involuntarily confined in a Florida State Hospital for 15 years. He was not dangerous and had received no medical treatment. In a landmark decision for mental health law in 1975, a unanimous Supreme Court ruled that states cannot confine a non-dangerous individual who can survive on his own, or with help from family and friends."

what that decision did was make it that families could not just decide to put people in hospital against their will ie  kids with downs, other people with mild mental health issues, hell back then being gay was considered a mental health disorder to many people.  what was happening was that you had families putting kids who were deems to be "crazy" into hospital where they didn't have to be. 

the reason why many became homeless is that there was no planning about where these people would go.  parents would not let them back home.  the government and also mental health professionals didn't realize how difficult it was to create  a network to support people with mental health.  you wrote that people would not seek help but the truth was that there was no help to be seeked. 

hell if President Carter signed a bill in 1980 called the mental health systems or something like that which took money from mental health hospitals. 

fife

PJ_Soul said:

fife said:

unsung said:

Yeah, I question if people are really getting the proper help nowadays.

I would say that most people are getting help but there are many things that have to be corrected which have been mentioned already.  ie, more funding for community workers, more funding for a variety of different type of housing such as supportive housing, wait time for help, cost of getting help.

Really? I would say that most people are not getting help. Yes, the severely mentally ill people are mostly getting help I think, but the majority of mentally ill people are not severe (i.e. psychosis, schizophrenia, etc). The majority of those with a mental illness are, I think, probably not getting help due to the stigma still very much attached to the non-severe types of mental illness, such as anxiety and depression, OCD disorders, PTSD, etc. Even in a very open-minded environment like the one I work in, I can think of 5 people I know personally just off the top of my head who are not getting any help for their more "mild" mental illnesses because they are either ashamed or in denial, thinking they can manage it on their own... maybe they can, and maybe they can't.

sorry should have been more precise.  i kindof confused 2 things.  what I meant was that I do believe that people who are in help are getting proper care.  but yes more has to be done to get more people into care.

brianlux

jeffbr said:

brianlux said:

unsung said:

oftenreading said:

unsung said:

Side question...

Why did Sanitariums/Mental Hospitals more or less become extinct in the US?

The correct answer is more than I can type right now, but the short answer includes (1) they aren't more or less extinct; every state had at least one large state psychiatric facility, and usually more than that. Capacity is much reduced, though  (2) the de-institutionalization movement focused on the fact that most people want to be closer to their homes and loved ones, and most people can be successfully treated out of hospital. Unfortunately, as fife noted, the necessary funds did not follow, because of ....(3) administrators saw this as a way to cut costs by cutting hospital beds, instead of re-vamping community services. 

There is a lot of research on what makes for effective community treatment and how to deliver services that maximize psychosocial rehabilitation. Too bad much of the results aren't put into practice. 

I asked because there are two fairly close to me that are abandoned, and apparently they are popular with the urban explorer crowd.  

I thought they went away because of political correctness.

Here in California a number of mental health institutions were closed when Ronald Reagan was governor.  He shut them down and created a situation where the number of homeless rose dramatically.  It's a shameful legacy.

Yes, but why did he shut them down? If you recall, the ACLU in the 70's fought many battles against involuntary commitment, and their work culminated with the Civil Rights of Institutionalized Persons Act of 1980.  There were a number of factors, from the involuntary nature of why they were there, to the deplorable conditions of some of these state institutions. It wasn't just California, either. New York, and Florida had cases which altered the way in which people were committed. Many were homeless because they couldn't be kept against their wills, but also wouldn't seek help for themselves. 

I just found this short little blurb about the ACLU's fight on their site:

ACLU HISTORY: MENTAL INSTITUTIONS

"The ACLU's most important Supreme Court case involving the rights of people with mental illness was filed on behalf of Kenneth Donaldson, who had been involuntarily confined in a Florida State Hospital for 15 years. He was not dangerous and had received no medical treatment. In a landmark decision for mental health law in 1975, a unanimous Supreme Court ruled that states cannot confine a non-dangerous individual who can survive on his own, or with help from family and friends."

Rather than being shut down, those hospitals should have been seriously revamped.  Yes, they were only OK at best, barbaric at worst but the problem is, the worst outcome of all that was, the number of homeless skyrocketed.  I was living in the Bay Area at the time and saw it happen all over the place.  Very sad.  A lot of those guys were Vets.

But yes, involuntary commitment was a problem, and in some cases still is, problematic (I know this from talking to people in PHFs in our county).  That still needs to be looked at more closely.

fife

While involuntary commitment is a major issue, it can also be very usefull.  I don't know how it works it the states but in Ontario we do have rules around involuntary commitment.  for example, e have something call Form 1 which a doctor fills out that can force a person to go to the hospital for up to 3 days.  there are different types of forms.  here is some basic information about the different forms

http://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/Keeping_You_in_the_Hospital_Against_Your_Wishes.pdf

brianlux

fife said:

While involuntary commitment is a major issue, it can also be very usefull.  I don't know how it works it the states but in Ontario we do have rules around involuntary commitment.  for example, e have something call Form 1 which a doctor fills out that can force a person to go to the hospital for up to 3 days.  there are different types of forms.  here is some basic information about the different forms

http://www.uhn.ca/PatientsFamilies/Health_Information/Health_Topics/Documents/Keeping_You_in_the_Hospital_Against_Your_Wishes.pdf

In California is called a "51-50".  I'm not sure what the rules are but from what I know and have heard, the conditions vary.  One person I know who worked "on the inside" said that some of the people in those institutions try to make the experience as bad as possible so the client will be frightened into not getting detained again.  I'm not sure instilling fear is the best therapy.

Have we moved beyond "One Flew Over the Cuckoo's Nest"?  Not everywhere, I'm guessing.