The Future of Mental Health Institutions

Peter Nielsen photoThe Future of Mental Health Institutions

By: Peter Nielsen, Spring 2018 HeLP Legal Services Clinic Student Intern

The most recent round of school shootings once again has the topic of mental health featured in headlines across the country. Although both state and federal governments provide a variety of mental health programs, there is one end of the spectrum of mental health treatment that has been almost completely abandoned in America. The largely forgotten and most intensive area of mental health care is inpatient hospitals.

Just the word “asylum” carries a loaded history and stigma with it. Before being shuttered starting in the 1940s, asylums were notorious in this country for leaving droves of mental patients abandoned, abused, and worse off than they had been initially. The horrors of lobotomization and electroshock therapy gave them a truly horrifying reputation. Morally driven reform led to the creation of the modern mental health system, which is dominated by a strong focus on outpatient care and general hospitals with a reliance on pharmaceutical medication. Pills, however, often treat symptoms and not the causes of mental health disorders. Receiving prescriptions and actually utilizing them are not always the same thing. Over time, the levels of drug addiction, homelessness, and criminal imprisonment have only increased within the mental health patient population. While the prison system may appear to be a suitable method for housing and treatment, studies have shown poor prognosis and overall outlook for the imprisoned mentally ill.

In looking towards the future, a recent, wide-viewed article by researchers at the Perelman School of Medicine at the University of Pennsylvania has concluded, “the financially stable and morally appropriate way forward includes a return to psychiatric asylums that are safe, modern, and humane.” While acknowledging asylums alone are not sufficient by themselves, the researchers advocate for integrated, patient-centered care necessary for the mentally ill who cannot care for themselves. The article claims such reform is necessary to appropriately assist those who “deserve a safe place to live with proper supports—not cycling between the streets, emergency departments, and prisons.”

However, not all those involved in medical reform have come to the same conclusions, or even the same reasoning, as the authors of the Perelman School of Medicine article. Other doctors, leaders, and reformers believe that, rather than asylums, high quality, community-based care is the way forward. There is even an alternative view of the prison-homelessness cycle. Some hold this pattern is a result of a long chain of neglect rather than a simple byproduct of mental illness. A lack of early intervention and medical treatment results in an under-allocation of the established resources that could alter the outcome of those with long-term mental illness. Some argue that returning to the permanent asylum system appears doomed to repeat its own bleak history due to excessive costs and inadequacy of treatment. Whatever type of path is taken towards reform though, it seems everyone agrees the system in place could absolutely use an overhaul and bolstered support to better handle the mental health issues of our rapidly evolving society.