Today, September 22, 2015, the Raleigh News and Observer newspaper revealed and published some very disheartening and totally surprising news that illustrates yet another dilemma in the ever more difficult tasks in improving mental health care public services in this state, and, likely reflects the kinds of dilemmas that other states are and will be struggling with in facing up to their obligations in this area. The article is entitled: “NC budget cuts $110 million from regional mental health,” and can be read here.
As usual I always bow to my internal ethics and try to be as open and transparent as possible about the subject at hand, revealing attitudes, biases, views based on long term experience, and an almost “historical view” of the galloping phenomenon of “mental health care delivery reform” thankfully occupying the attention of the country finally. I am old enough to have practiced in the so called mental health age of oodles of resources, and have watched them atrophy, became extinct, go corrupt and get themselves prosecuted out of existence, lose funding for many many understandable reasons, lose their place of importance, watch the ever decreasing number of bright talented younger generations of “would have been social workers, psychiatrists, and psychologists” shy away from the training programs, and our numbers go down especially in child psychiatry. One could take an inflammatory demagogic view and see is as necessary to prevent th abuse and horrors that indeed happened for decades shuttered away out of the light of public review and knowledge and responsible accountability and oversight. But that approach has nearly led to the old saw of “throwing the baby out with the bathwater because something was wrong with the bathwater, too dirty, too hot, whatever. I have seen the inhumane past and still in more restricted corners, inhumane treatment of patients in poorly run state hospitals that made me so mad I thought i would bomb them into the ground they were so bad, but of course after evacuating the helpless patients. I have helped to de-accredite the abominations of such hospitals, a few but enough to see first hand the decades old cultures of isolated facilities with poor faculty, psychiatrists who could work no where else due to histories of alcoholism, just plain bad practitioners and all the rest. I have had close colleagues since my residency days who presided over the deserved federally mandated dismantling of closure of famous hellholes permitted to exist far too long and heard their stories of generations of horror stories.
But in the midst of all this, or in my case in the last quarter of my career, I still know and hold to the somewhat unpopular certitude that state psychiatric hospitals are needed, good ones and now more than every. One simply statistic is that out country’s population and mental health treatment burden has at least doubled if now tripled since World War II. And we have had new mental health phenomenon syndromes, traumatic brain injuries of unforeseen overwhelming magnitude outstripping the abilities of public and private psychiatric-neurological treatment worlds to receive, treat and comprehensively help them out of our IED head rattling new genre of injuries in the Middle Eastern conflicts we have had to enter, police and try to stabilize at little thanks from much of the rest of the concerned world with some exceptions.
State hospitals across the country have been marked for closure and destructions for decades with the trend accelerating greatly in the last 2o years or so. It was thought and expected the the monies saved from funding these “dinosaurs” would be responsibly shifted to the long known need for massive outpatient services for the CMI, chronically mentally ill for which the state hospitals had long existed and served, and served well in a surprising high number of hospitals. Remember the famous Meninnger family of three generations of nationally recognized humane psychiatrists practiced in a state public hospital, Topeka State in Kansas a venerable training and research facility itself.
One of the former three truly old, historical state hospitals in North Carolina, Dorothea Dix Hospital in the state’s capital, Raleigh, is now cleared for completion of its sale to the city of Raleigh. The huge, many hundred acre site, established in the late 1800’s, and named after one of the early American crusaders for improvement in custodial (institutional) mental health care, Dorothea Dix, will proceed with its long debated and fought over sale. The sale will total somewhere around $52 million according to a very recent news story by WRAL ABC Channel 11, of Raleigh.
Why is this of note in the world of mental health reform in this country?
1. There are literally many dozens of old languishing state hospital properties and campuses in this country; many are almost unbelievably operating after perhaps an average lifespan of nearly 150 years, while many others are abandoned ghostly properties. If you are curiious about these architectural gems, or, monstrous relics of bygone eras of ghastly cruel inhumane care, depending upon your beliefs and attitudes toward the always controversial history of mental health care, please search on my favorite bookseller and go to reading search site, Amazon.com and look for books on asylums and state hospitals in America. Fascinating reading for those interested in this sector of esoteric social history if ever there was one.
So many of these properties need to be sold, preserved or whatever, now and in the future as the still active facilities gradually are “phased out,” and replaced by more modern facilities or closed altogether, depending on the need for inpatient public psychiatric beds in each state.
2. They represent a real source of monies, for state and regional/municipal coffers that could be put to good use.
I have been aware that very few of these properties around the country have been sold and converted to helpful assets or capital. There are a number, though honestly speaking, not many, websites that catalog the numbers of abandoned former state mental hospitals slowly proceeding to ruin through abandonment and fiscal and physical neglect. One website through the genealogy organization of RootsWeb, lists perhaps most of the former and current American state psychiatric hospitals state by state. And it unbelievably it offers information on the phenomenon of the “Asylum Tourist.” Sheesh. I appreciate historic sites and beautiful woodwork, antique furniture as much as a geek can. My late father was a master woodworker and proud owner of a “ShopSmith” all his adult life. [If you do not know what that is, well, Google it, or, don’t bother, it really is information will not make you stand out anywhere except at a woodworker’s convention, or in perhaps a Trivia Pursuit championship. But then again, I doubt even the latter.
State hospitals always have and had fantastic craftsmanship, furniture, architecture, woodwork etc. Much has been salvaged from closed state hospitals. If you are a “preservationist” like Europe seems to have been in their cultures for hundreds of years, this stuff matters. That’s why we go to Rome, to Paris, to Prague, to see the incomparable buildings, art, statues, gardens and on and on. But if you are a modern, [wasteful?] devotee of the disposable, rapidly obsolescent approach to “things,” then all this is likely drivel and unimportant. I certainly am in the former camp, the older I get.
Another historical website devoted to this kind of history, details the history of the “Kirkbride” architecture of state hospitals that totally dominated such institutions for nearly 3/4 of a century. Students of architecture and architectural history still study these, visit them and even go on “tours” of these sites around the country. [I know that sounds perhaps very weird to most, but bear with me].
So I have pondered in recent years, what could old state hospitals be converted to? This is my partial list of charitable causes I could see some of these grand and incredibly sturdy structures devoted to:
community college facilities
public school educational facilities
subsidized housing especially for the elderly, as there are bathrooms galore, and these places were hospitals for goodness sake
public governmental offices [don’t laugh, check out the connection between the former St. Elizabeth’s Hospital in Washington DC and the Department of Homeland Security…
Now marketing a state hospital even in the best of condition is not an easy task. They are often located in not the most economically active metropolitan centers; they are mostly located out in the boondocks, the isolated countryside, as part of their raison de etre, was to get the disturbed and disturbing mental patient, the insane, out of the public eye. Who wants a facility with many buildings, and hundreds of rooms out of the middle of nowhere? Raleigh, North Carolina’s Dorothea Dix Hospital is one of the fairly rare exceptions, being located in a major modern city.
They are all truly ageing physical plants. Most of the inactive hospitals, if not almost all, have deteriorated markedly through neglect for a few years to decades. They would take huge amounts of money to rehabilitate and bring up to modern building codes.
Though all of them were really sturdily built, they were never the most energy efficient structures even with their three feet thick walls and no wood in their make-up to attract the pest control companies’ best friend, the termite. It is not unusual for an operating state hospital to have utility bills of hundreds of thousands of dollars a month, even in the scaled down facilities. Thier heating plants are aged, and almost always belong to the steam non-electrical eras of heating.
I now am witness to a state’s dilemma of what to do, at a hoped for helpful profit, with a soon to be closed ageing state hospital. How does one market such a huge property that is not a brand spanking new outlet mall on a busy inter-metropolitan interstate highway, that will mint money the week it opens?
At least in Raleigh, Dorothea Dix herself, I think would be pleased with the coming sale of her namesake institution. It will become property of Raleigh, the state will gain a sizeable amount of monies that can be put to good use, and the city of Raleigh will receive a new very large regional mixed use business park out of the deal. That appears to be far better than the site becoming a huge, slowly deteriorating eyesore and environmental blight. A good deal all around.