Mental Health Reform Legislation Coming?

After several years, much needed mental health reform legislation at the Federal level may finally be coming our way.

I must state at the outset, the gnawing sentiment that at least some of the suddenly growing and politically fashionable reason for pols to jump on this now aged, creaky bandwagon stems from the recent years of increasingly frequent mass shooting we have experienced in this country. And the growing heart-rending and hard to shout down with caustic political rhetoric often based on hysterical fears of somehow losing “our” guns rabid pushback that seems to instantly spring from the same blusterers of certain quarters because, surprise, surprise, these atrocities are committed with guns instead of Nerf toys.

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Mississippi budget cuts to close psychiatric beds

In a very recent article, “Mississippi budget cuts to close psychiatric beds,” published in the Clarion-Ledger newspaper on may 10, 2016, it is reported that Mississippi will close a number of treatment units and beds in the state’s public mental health and substance abuse facilities.

The article details that this has come about as a result of the state’s legislature deciding to cut funding by some 4.4% or $8.3M imposed by the current governor Phil Bryant’s yardstick, something called”performance- based budgeting process.”

The article goes on to detail a number of state-funded services that will be cut or reduced in size.  Such targeted/designated services include inpatient mental health services and residential and community-based substance abuse treatment programs. The reader may follow the link above to read exactly what services will be trimmed or shut down altogether.

This is a rare opportunity for the concerned mental health/substance abuse services policy wonk, observer of both the national and regional scenes in such matters, to monitor what happens in the coming  few years in this locale, the state of Mississippi.

Further, it affords almost an experimental laboratory, to watch the consequences unfold. One will be able to see if this has a positive influence on the overall “mental health of the state,” or negative consequences. To reveal this writer’s own bias from having watched many other states do the same since the early 1990’s,  it will test the hypothesis that this action likely will repeat the past history of such efforts , namely to cause predictable negative results.

These results in other states have included: 1) increase in the mentally ill populations in local jails; 2) increased waiting lists in ERs around the state of acutely disturbed public psychiatric patients in crisis who need inpatient hospital services; 3) perhaps an increase in public incidents involving the chronically mentally ill of both a minor nuisance variety or major ones of tragic proportions; 4) increase in deaths of the mentally ill through suicide; 5) increase in the deaths of mentally ill persons through extreme public law enforcement actions due to the more disturbed and the communities not having a timely access to treatment; 6) more grieving families and tales in the local media as time goes on of possibly preventable tragedies; 7) increased strain on private treatment facilities ranging from private hospital based psychiatric units to hospital ERs, to the university medical school based psychiatric services.

The reader is invited to watch Mississippi as this made for observation stage in the ongoing struggle with provisioning public mental health services plays out in the media and locales of Mississippi to see how this turns out. I know this observer will watching with keen interest and growing concern and foreboding.



Bridgewater State Hospital and Its Problems

I became aware of Bridgewater State Hospital during my college and medical school years in Ann Arbor, Michigan through two events in my student life back then.

First, I was able to see the famous documentary movie, “Titicut Follies,” almost accidentally at a university sponsored film festival in 1970 or so. The film was all the rage since it had been “banned in Boston” by the Supreme Court of Massachusetts.  It was filmed in 1967 by the now acclaimed filmmaker Frederick Wiseman. I remember not knowing really anything about the movie, but going with friends to see this controversial movie. At that time, I had not settled on a future career in psychiatry. I was stunned at the content of the movie which showed deplorable conditions at a correctional center division of the state hospital located at Bridgewater Massachusted. After I finished medical school, I was

After I finished medical school, I was fortunate enough to land a six-month externship in forensic psychiatry at the Center for Forensic Psychiatry located on the grounds of Ypsilanti State Hospital south of Ann Arbor. This was a state hospital that had become famous in its own right. It was the subject and setting of a famous book, The Three Christs of Ypsilanti, by Milton Rokeach.

The Three Christs of Ypsilanti
The Three Christs of Ypsilanti

The book was ahead of  its time, portraying the irony of three psychotic inpatients who shared a unit as well as the common delusion that each was Christ. The book was hit for years and required reading almost in every university in first-year classes in psychology. I had read the book as well and was fascinated by the premise of how these patients handled the dilemma of their common and contradictory claims.

Little did I know that my externship would bring me into contact with the late forensic psychiatrist, Dr. Ames Robey. Dr. Robey astutely had realized and discovered the identity of the “Boston Strangler” as one of the psychiatric inpatients at Bridgewater, Albert DiSalvo.

Albert Desalvo
Albert Desalvo, The Boston Strangler

This brought Dr. Robey national fame and publicity though he had no interests in all media attention. As an aside, I also was able to work under Dr. Elissa Benedek MD, an early female forensic psychiatrist, who was also a child psychiatrist, and a few years later, became President of the American Academy of Child and Adolescent Psychiatry. She was a small bespectacled woman, calm, supportive and incredible teacher, and clinician.

So, these two experiences acquainted me serendipitously with Bridgewater State Hospital. Late last year, Bridgewater State hit the headlines again as stories of abuse, poor treatment, a group of deaths of three men in 2015 were reported in the Boston media.  Within months, three guards at the facility were indicted of involuntary manslaughter and the Boston Globe had a documentary series of articles on the all too familiar, decades-old tale of sandals and substandard levels of care. I had actually assumed that Bridgewater State, by this time, had long been closed. Silly me. Like so many state psychiatric facilities, it was very much needed and like an old battleship kept in service for decades. The news about the hospital by April of this year just kept getting worse. To me, it was like somehow seeing an eerie reprise of the movie “Titicut Follies.” That goofy and weird feeling kept me following the news stories that have emerged in the last two months in the Boston Globe newspaper.

How did this hideous story come to be repeated nearly 45 years later? The Boston Globe reported on the slowly evolving, yet almost inevitable conditions that brought this tragic replay back to life in an article in April 2016, this past month at the time of this writing. The usual culprits of legislative neglect through decades of inadequate funding, lack of oversight and installation of a poor level of care, and a herculean task demanded of an institution not properly fueled for its job.

A once famous historical psychiatric institution forced into repeating its own tragic failings because of legislative “neglect” forced into a Kafka-esque re-run reinforcing all the negative stereotypes of a psychiatric institution. This has almost a psychotic quality, all its own, in which the observer, cannot tell reality from unreality…