Drastic Soluution to Court Ordered Psychiatric Evaluations: Stop Doing Them

In an article published this date,July 20, 2017 in the Argus Leader of Yankton South Dakota, “State hospital no longer performing court-ordered mental health exams,” and referenced articles published several months ago in the same paper which I have referenced and linked below, there is explained in some of the best and most clear, succinct reporting I have seen in several years, all the fuss and complicated issues surrounding one very critical part of the national mental health service delivery crisis for which there appears no end or easy solution in sight.

The problem is that in South Dakota specifically to start there as our study example, the state psychiatric hospital system (the state has only one such hospital because of its relatively low population) has been and is still been flooded with court ordered inmates from county jails all over the state for admission to be given forensic evaluations for fitness (competency is the legal term) to stand trial. Most of these persons are truly mentally ill, which is another part of the Gordian knot comprising this crisis that has been developing for over three decades nationwide. South Dakota’s hospital came under review and journalistic investigation by the Argus Leader some six months ago because 1) overcrowding was at a crisis level; 2) the hospital was running full and could not literally admit in a prompt and responsive manner the growing number of “ITP” patients (incompetent to proceed to trial); 3) mentally ill inmates were logjammed in unrelenting and overwhelming numbers in the state’s country jails; 4) counties’ budgets were being decimated by the costs of housing and trying to treat as much as they could with very limited resources, the psychiatric needs of these stalled patients/inmates; 5) the rights of the inmates/patients to a reasonably speedy trial-disposition of justice-were being far exceeded.

This is NOT a problem particular to way up there northern plain state of ‘lil ol’ South Dakota with its very small population, perhaps limited state revenue and budget. This is a NATIONAL CRISIS that is being seen in virtually every state in the United States. There are many factors for this and on the occasion of this post I will not go into much detail on why this has grown into the “Feed Me” monster plant of the famous play of decades ago that is devouring resources, facilities, budgets, policy wonk’s best ideas and stretching our mental health delivery system past its breaking point. The one factor I will briefly waggle my “I told you so” sorrowful finger at, is the predicted result of trans-institutionalization that I have written about quite often in this blog. ‘Nuff said for now. But it will be a very thorough conversation and historical revelation and analysis for another time.

Another very telling factor that I have not included in my list of causative/exacerbating factors above because it is literally out of South Dakota’s control, is the extreme shortage of psychiatrists and allied psychological professionals especially both forensic psychiatrists and psychologists. Training programs for these specialists have been too small since I was a resident in the 1970’s and the output of teentsy numbers of these subspecialists is now catching up with us in a big way and forming a “chokepoint” in the delivery of these systems for which there is no timely solution.

So what did poor South Dakota’s state psychiatric hospital do? They decided bravely to completely STOP performing such psychiatric forensic evaluations. This decision somewhat flabbergasted (I have loved that word since I was a blabber mouthed kid) at this really brave and somewhat bureaucratically perilous, singular decision. I think South Dakota is the only state to make such a governmental service decision. In my world, this is almost akin to stop paving the highways, or shut down half the public schools or some other state governmental function that we all take for granted whether we are aware of its importance or not.

The state went so far as the leave monies for all these legal-psychiatric services completely out of the state budget! To read the account of this very unusual move, read the following article: “ Mental health court money left out of state budget.”

Perhaps other states have done the same thing recently but honestly my Google and other search news bots have not alerted me that such has occurred at all anywhere. As we say in the South, I have not “heard tell of”  anything like this.

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Were State Psychiatric Hospitals Better 100 Years Ago?

A fundamental intellectual tenet of mine is that to have a comprehensive and ‘honest with oneself’ grasp of historical and social long term processes, history of the subject being studied should be included. George Santayana’ famous quote that those who ignore history are ‘doomed’ to repeat, seems to hold more and more power of truth the older I become.

The history modern mental health care began in almshouses, shelters for the developmentally disabled and intellectually disabled, earliest perhaps by the Quakers of the early 1700’s in Pennsylvania. Theirs was an extraordinary (and still is) ethos of charity, helping those in need and one of the original origins of the philosophy of “non-violence,” embodied in conscientious objects in our wars and taking on the needs of the shunned, ‘repugnant,’ disabled persons who frightened the average person. It is no new concept that state hospitals were built intentionally out of the ‘boondocks,’ the countryside, away from towns so delicate sensibilities of citizens were not disturbed by the sight of unpredictable persons, that in reality before the era of modern treatment in the middle half of the 1900’s NO ONE really understood beyond crude empirical approaches, i.e., “we do not know how but this medicine works on hallucinations so let’s give it for that.”

There are many, many articles, books, some films from the earliest days of the then miraculous, wondrous Brownie 8 movie camera, that record the abysmal conditions of many state psychiatric hospitals in the Western world and the US, Latin America, Scandinavia, Europe and a few other regions and countries where modest efforts at housing the chronically mentally ill occurred. For instance, it is not well known that the famous country singer, Johnny Cash, established and supported an orphanage for children in Jamaica and did so very quietly as a true philanthropist.

If it were not for Google’s miraculous search bots, I would never have come across or read the article to which I wish wholeheartedly to refer the reader. It is from this week’s edition of the English newspaper, The Daily Mail. In the usual British brutal journalistic tradition it has simply ghastly title: “EXCLUSIVE: Chained to their beds with no heat or water, and left to lie in their own excrement: How the 19th century mentally ill were sent to hide away in grisly insane asylums and categorized as ‘idiots’, ‘imbeciles’ or ‘lunatics,’

This article itself is based on what appears to be a singularly striking book with lots of old pictures of life and patients in state psychiatric hospitals in Scotland and England, entitled, ” Lunatics, Imbeciles, and Idiots: A History of Insanity in Nineteenth Century Britain & Ireland, by Kathryn Burtinshaw and Dr. John Burt.

Continue reading “Were State Psychiatric Hospitals Better 100 Years Ago?”

Millidgeville State Hospital, History & Pictures

I had a residency classmate at my training program some 40 years ago who eventually served as medical director of this huge old state hospital. I visited it once long after he had worked there for a stint and was overwhelmed by its size and vastness of its campuses. I had never seen such a massive mental hospital facility and was not prepared for its size.

It had its share, or more than its share of scandals and periodic tales of abuse for decades and did many such state hospitals especially early in their histories before the era of modern treatment with advent of effective medications, movement beyond just ECT, or electroshock therapy for out of control mania and truly treatment resistant long-standing depressions and the addition of all the behavioral and cognitive therapy, art therapy (and that really is valuable stuff speaking as someone who in my younger stupider days, thought it was not very relevant [I was a dummy young Turk type then to some extent], music therapy, DBT [Dialictal Behavioral Therapy which is wonderful stuff], psychodrama [which is sadly not practiced in enough hospitals] and so on.

What I am leading up to in my habitual meandering style is pointing the reader(s) to a post I somehow discovered one night recently, on a sort of mixed text and wonderful pictorial history of Milledgeville State Hospital [latter called Central State Hospital in recent modern days before it closed in 2016] that is so well done I had to do this post and highlight/publicize it by offering its URL so readers could read it and marvel at this institution, its history and dilapidated kind of grandeur. I know there are those that would rankle at having the term ‘grandeur’ applied to state hospital that personally represented horrors to them or their extended families, and I understand and completely accept that sentiment as all state hospitals had their sins, tragedies, and horrors to say the least and were in ways certainly ignoble chapters in our nation’s history.

But anyway, here is the URL to the extremely well-done website that shows an enormous amount of artistic photographic effort and historical research that I think many will enjoy and as I said above, marvel at. URL: Milledgeville State Hospital in Georgia.

 

Larned State Hospital Turns to Law Enforcement Figure for Hospital Superintendent

I am calling attention once again to the long-standing troubles at one of the two Kansas state psychiatric hospitals, Larned State Hospital, which has had over the last few years a host of staffing, management, clinical and accreditation problems. I am reaching back a bit, now six months to refer to an article, published June 29 of last year, 2016, by the online arm of KHI News Service of Topeka, “Longtime Kansas State Attorney Name Larned State Hospital Superintendent by Bryan Thompson.” The new hospital superintendent is Mr. Bill Rein, long experienced in state mental health affairs. Mr. Rein brings a vast amount of experience with him, including his former positions as the former chief counsel for the Kansas Department for Aging and Disability Services, which oversees the state’s mental health hospitals in Larned and Osawatomie. He also had been the former chief counsel for the Kansas Department for Aging and Disability Services, which oversees the state’s mental health hospitals in Larned and Osawatomie. He also had supervised attorneys representing the state hospitals from 1984 to 1987. So this man has had an unusual career of experience in mental health policy planning, drafting mental health-related legislation and direct experience in a vital sector of legal representation of the state’s mental hospitals.

 

Bill Rein the new superintendent of Larned State Hospital since June 2016
CREDIT FILE PHOTO, KHI News Service, Topeka KS

 

When Mr. Rein was appointed he spoke of the tasks facing him and showed an unusual and encouraging grasp of the magnitude of the problems that face this hospital in particular which mirror those of other state hospitals around the country, including long-term inadequate funding, overworked staff forced into overtime work shifts much too frequently causing high staff turnover, difficulties recruiting care and professional staff at all levels because of the very rural location of the hospital with a small’ish surrounding population base, and particular difficulties attracting professional mental health staff because of low salaries that are noncompetitive.

This man is shouldering a very large task and this writer hopes he can turn this hospital and vitally needed system around in time. I hope to watch and monitor developments and bring them to the reader in the future. Kansas hopefully can become an example to other states of what it will take to put in place quality based reforms at the state psychiatric hospital system level for other states facing almost exactly the same problems, of which there are more than a few in this country.

 

Progress at Western State Hospital in Washington State: A Good Example for Other Beleaguered Hospital Systems?

Western State (psychiatric) Hospital has been in operational distress for more than a year now and following the travails of this facility and its staff from the line ward workers and behavioral care technicians, nurses and professional staff has been quite sad and discouraging for anyone interested in mental health reform and service delivery policy.

Continue reading “Progress at Western State Hospital in Washington State: A Good Example for Other Beleaguered Hospital Systems?”

Washingston State Hospital System Fined

IN a very recent story of less than a week ago, entitled: “Washington accrues almost $7.5 million in contempt fines,” written by Martha Bellislea of the Associated Press published in many major newspapers across the country, the sad story of the travails of Washington’s Western State Hospital continues to showcase the plight of a number state public psychiatric hospitals.

 

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New State Hospital Already Destined to be Closed

In an article, “New state hospital may close,” published in the Bulletin of the Salem’s Central Oregon region,  the Associated Press reported December 3, 2016, that Oregon’s Governor Kate Brown had suggested she had decided or was in the process of deciding to close a new state psychiatric hospital, in the Eugene, OR area, near Junction City. which is the new site of the original Oregon State Hospital.This hospital has a total capacity of 100 beds.

The hospital which has been open only 18 months and cost $130M to build, is slated for possible/probable closure in mid-2018. Its closure was heralded as necessary to save the economically beleaguered state much-needed monies. No real details are given by the state personnel’s’ announcement concerning this drastic move except there is a large budgetary “hole” in the state’s health care departments’ budgets and closing the hospital, which has 422 employees will save the state $34.5M a year.

Continue reading “New State Hospital Already Destined to be Closed”