(Oct. 20, 2015) It was only a matter of time before another tragedy would reignite the debate about how to prevent mass shootings. In recent years, untreated mental illness has entered the public discourse in these cases. Deinstitutionalization, the mass closure of state psychiatric hospitals, is often raised in that debate as if it were a relic of the past. Actually, it remains a modern phenomenon with serious consequences.
In a 2005 study of state psychiatric bed shortages, Massachusetts rated in the “severe bed shortage” category. Since then, 25 percent of beds have closed and Massachusetts now has a “critical bed shortage.” In the past 10 years, two state psychiatric hospitals have closed and Taunton Psychiatric Hospital is nearly closed.
But hospital closures are not the only problem. An increasing number of admissions to state psychiatric hospitals are “forensic patients,” those in the criminal justice system who are typically admitted from jails and prisons. In 2013, less than half of intermediate and long-term psychiatric hospital admissions were “civil” patients. That means that more chronically mentally ill people in the community have nowhere to go.
That doesn’t mean that forensic patients should be shut out of hospitals. Without treatment they are destined to an endless cycle of incarceration. What it does mean is that more continuing care psychiatric hospital capacity is needed.
After examining the state of the mental health system, Justice Brian Merrick concluded “state mental hospitals must be reopened,” a proposal that was virtually unheard of until recently.
Even though the public has an antiquated view of psychiatric hospitals, in 2012 the new Worcester Recovery Center and Hospital opened, consolidating two closed facilities. In a paper published in the Journal of the American Medical Association, three bioethicists from the University of Pennsylvania described the Worcester Recovery Center as a new model facility that “provides a full range of integrated treatment services, psychiatric research and medical education programs.”
They concluded, as did Justice Merrick, that more of these facilities are needed “to provide 21st century care to patients with chronic, serious mental illness.” They warned that reforms that ignore the importance of expanding modern psychiatric institutions and providing continuing psychiatric care will fail patients because there are few options for patients with chronic serious mental illnesses.
Cost is a legitimate concern in any discussion about expanding services, but in reality, the fiscal burden has shifted from state hospitals to county resources (law enforcement, emergency responders, courts, the county correctional facility and lost revenue for local business). Until there is an investment in treating the most seriously mentally ill, county expenses will continue to climb.
All things considered, it just makes sense to invest in reopening hospitals that will provide high-quality, accessible, long-term care options for patients with chronic serious mental illnesses.
MARY ZDANOWICZ
FORMER TREATMENT ADVOCACY CENTER EXECUTIVE DIRECTOR
To comment, visit our Facebook page.
Visit our blog archive to read all our recent posts.