Closing State Psychiatric HosptalAs: Consequences, Good and Not So Good

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.

Continue reading “Closing State Psychiatric HosptalAs: Consequences, Good and Not So Good”

More on Milwaukee county mental health overhaul

I would remind previous, and inform new readers to this blog that I have been loosely covering recently (as this blog is NOT very aged…) the very long sad of the saga of the Milwaukee County’s combined mental health services. These actually started being chronicled in the Milwaukee Journal Sentinel in 2000. There is a comprehensive website at that paper’s website that contains the easily listed and read articles since those began in earnest in about 2006 when things really started falling apart there. I am primarily interested in the long term struggle to modernize, and fashion a new sensible integrated system of mental health care delivery in my home state of North Carolina where I have practiced since my training at Duke in 1974 with the exception of 9 years spent in two other states for family reasons.

Continue reading “More on Milwaukee county mental health overhaul”

Unintended Consequences of Mental Health Care Delivery Reform

A small town newspaper can often offer a startlingly accurate portrayal of policy governmental changes not noticed, or reported upon by the mega-media in many locales. One such North Carolina very small regional newspaper is the Laurinburg NC Exchange. This town is likely unknown to 99% of my readers unless you are from northeastern NC, an area to the east of Interstate 85 as it curves north from Durham “The City Of Medicine” toward the state border with Virginia. It has a proud heritage of being a center of Scot (not “Scottish”) culture with an annual festival with the wearing of clan tartans and kilts.

The Laurinburg NC Tartans
The Laurinburg NC Tartans

Just three weeks ago, one of its weekly lady columnists that all Southern papers worth their while seem to have to comment on the higher ordinations of life, Ms. Mary Katherine Murphy, published a most perceptive piece of analysis entitled, “State of Mental Health: Barriers Impede Treatment.” As this is what I blog about in large part, this piece caught the ever roving eye of one of now well trained roving Google searchbots, and snagged this piece for persual. Ms. Murphy may be from a small town area and culture but her piece is well worth reading for anyone interested in this 15-20 year crisis in the  social fabric of our country. I would most strongly recommend it if I had the power to do so, to policy wonks and governmental planners, scholars in research and “think tanks” of all political stripes in this country for thorough pondering. It is that good in its brief but very on target two pages.

Continue reading “Unintended Consequences of Mental Health Care Delivery Reform”