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.
Finding housing for the chronically mentally ill after discharge from psychiatric inpatient services has come to be one of the most vexing problems that all states continue to struggle with. In brief, this has risen to be one of the paramount issues facing every state’s public mental health service delivery system due primarily to two factors: 1) decades of “de-institutionalization,” phasing out the practice and philosophy of housing the chronically mentally for decades or lifetimes, coupled with cutting back in every state of the numbers of state hospital psychiatric beds, and, 2) the rise of legal decisions and enforcement measures since the 1970’s emphasizing transferring patients to “less restrictive” levels of care, which is most clearly spelled out and embodied by the Olmstead Supreme Court decision.
An earlier post described the revelation that in Nevada in this past decade or less, that state had been discharging patients on planes to San Francisco, California! Patients were apparently given a suitcase of a supply of clothes and supposedly some amount of money to help them set down roots in the neighboring state. By report, this practice had been utilized for about two years before it was revealed and a brouhaha resulted. New York state’s practice of turning out of use old hotels turned into “welfare hotels,” for housing not only persons or families on welfare but also the chronically mentally ill and paroled ex-convicts has long been known.
This past week or so, an article entitled: “Deaths, delays paint grim picture of Georgia mental health reform: State still discharging patients to extended-stay motels, homeless shelters, by veteran reporter Alan Judd was published May 11, in the Atlanta Journal-Constitution newspaper. that shows the huge problems states face in completing the long heralded de-institutionalization process, that of moving the “CMI” [chronically mentally ill] populations from hospitals to safe housing with adequate outpatient treatment, supervisory and rehabilitation services.
Georgia has been contending with this issue for at least 7 years since the federal government began to monitor and require positive changes in finding housing for the discharged patients, instead of releasing them as the article put it: “with just a bus token and directions to a homeless shelter.” Now Georgia apparently faces the imposition of a looming deadline of June 30, 2018, to comply with a legal settlement and pledge Georgia entered into with the federal U. S. Department of Justice back in 2010.
The article even-handedly notes the many steps of progress that have been undertaken and implemented by the state and gives credit for notable and partial improvements.
But this article illustrates the Herculean tasks that states face in transitioning themselves from the traditional custodial role utilizing large massive hospitals and viewing treatment as often lifelong or at least so long that it may as well be lifelong, to a system aiming at re-integrating the chronically mentally ill safe enough to be returned to the communities and constructing complete new and entirely different systems of housing and care for literally thousands of persons within spans of a relatively few years. There are no simple answers in any quarter and the task which may have been viewed as achievable within approximate task-timer periods clearly is proving to be greater, harder, more coslty and complicated than likely almost anyone could have imagined.At the least, enforcement by the “feds,” may have to consist of extending time periods of effort to the states and partnerships that help with costs and perhaps even approaches not yet widely appreciated by any of us.