Back in the flush sixties, the federal government provided millions of dollars to support community mental health programs. The eerie, dark, cavernous hospitals for the insane were bulldozed or turned into condos, and the care of thousands of mentally ill patients was shifted to local community mental health centers. Graphic visions of schizophrenics chained and screaming was now going to be a thing of the past.
Since Hahnemann (now Drexel University School of Medicine) had a terrific, community-based program and psychiatric residents had the opportunity to treat all forms of mental illness, I decided to do my residency there. My first six months were spent at Philadelphia General Hospital (PGH), an ancient psychiatric fortress with a unique treatment program. During the morning meetings everyone had a vote. Doctors, nurses, art therapists, psych techs and patients would vote on all sorts of things, including discharges. No chains, no demonic ECT toting psychiatrists, just young enthusiastic psychiatric residents wearing bell bottoms and colorful shirts.
It all sounded great except for one “little” problem; most of these patients were psychotic! They heard voices (auditory hallucinations), thought people were after them (paranoid delusions), and without medication were impossible to reason with. Some even became violent and very dangerous. Not a fun experience for a clueless 1st year psychiatric resident who was assigned to treat a violent paranoid man — but more about that in my novella, The Man with a Microphone in his Ear.
Fast forward fifty years to 2013. The government’s money stream has diminished from a mighty river to a trickling creek. Thousands of mentally ill patients have chosen to wander the streets of our cities begging for food, mumbling aloud to themselves, and pushing all their worldly belongings in a battered food cart. Like the patients I treated at PGH, they refuse medication and refuse help.
Most are just hungry and needy and mean no harm, but some believe, really believe, that they are under attack, and without provocation will attack first. They aren’t in psychiatric hospitals, but still suffer from a profound psychiatric illness. Now their illness is simply visible to anyone who takes the time to look.
Should the state hospitals be reopened?
I think so.
Very sick people need structure and treatment. Their impulses to attack, because they feel under attack, need to be treated. If they are too sick or too dangerous to be among us, they will at least have a safe, comfortable environment in which to live until they get better. It doesn’t have to be like in the primitive days of the screams and chains. New therapies, new medications, and an enlightened approach to mental illness is needed. Just because people have rights, doesn’t mean that mental illness will just disappear.
How many Cruise missiles will it take to rebuild our hospitals and care for our mentally ill street people? Would it really cost more to have this sick population in a hospital rather than all the money we spend on police work, social services, cleaning crews and a flawed community mental health concept?
Art Smukler MD is the author of Skin Dance, a mystery, Chasing Backwards, a psychological murder mystery, The Man with a Microphone in his Ear, and the blog, Inside the Mind of a Psychiatrist.