Ethicists: Return mentally ill patients to asylums

Returning people with serious and chronic mental illness to psychiatric asylums that are safe and humane is the only sensible and morally appropriate solution for their care, a team of researchers and ethicists at the University of Pennsylvania wrote recently in the Journal of the American Medical Association.

Demand for residential placements for patients with mental illness far exceeds the supply. In the past 60 years, inpatient mental health services in the United States has nearly vanished. In 1955, state psychiatric hospitals cared for 560,000 patients. Today only 45,000 inpatient psychiatric beds exist to meet the needs of the estimated 10 million Americans who suffer from serious, chronic, mental illness. Unable to care for themselves, they often end up on the street or incarcerated.

The deinstitutionalization movement, which sought to transfer care of the mentally ill from state hospitals to community resources, began closing asylums in the 1950s. Fueled by the civil rights movement, those advocating such changes hoped to give the mentally ill more independence and end the abuse purported to take place inside psychiatric hospitals. Development of the first antipsychotic drug, chlorpromazine, in 1951, made outpatient treatment options seem possible. Federal policies accelerated the popularity of outpatient treatment, deemed less costly than residential treatment.

But adequate community resources were not available when hospitals began to empty out. Many patients moved to nursing homes or relied on general hospitals, where they received episodic treatment in ever-revolving cycles of admissions and discharges. Those options generated significantly higher costs than residential facilities.

Today, community resources for the mentally ill are still woefully unable to meet the enormous need. By default, jails and prisons have become the nation’s largest mental health care facilities. Between 15 and 20 percent of those incarcerated in state prisons have a serious psychiatric disorder. According to the National Alliance on Mental Illness, between 25 and 40 percent of mentally ill Americans will pass through the criminal justice system.

A corrections system that was never designed to care for mentally ill prisoners often is inadequate to meet their needs, the researches wrote. Prison psychiatrists, faced with a conflict of interest between loyalty to the patient and loyalty to the institution, may have difficulty providing compassionate, private, patient-centered care. The prison environment, often violent and unsafe, is designed for control and punishment, rendering it a very poor atmosphere for psychiatric recovery.

At times, prison officials’ limited understanding of mental illness can lead to severe neglect and sometimes outright abuse. Recently, two mentally ill men died within a few months of each other at the Riker’s Island jail complex in New York City. One of the men, who suffered from paranoid schizophrenia and diabetes, died after prison officials left him in a mental observation cell without regular insulin for more than six days, according to The Guardian. Another mentally ill inmate died after sitting for hours in a stifling cell that reached 101 degrees because of malfunctioning heating equipment.

The researchers acknowledge opening asylums will not be sufficient to remedy all of the nation’s mental health care difficulties. They recommend new models that can offer a full range of integrated, patient-centered treatment options, from residential services for severe cases, to quality out-patient programs for those with milder psychiatric disorders.

There is ample opportunity for churches and Christian organizations to help as well, said Heather Rice-Minus, senior policy advisor for Justice Fellowship.

“So often in churches we focus only on pro-life and marriage issues, but neglect other areas also involved with human dignity and the intrinsic value that God has given to each of us, such as ways of meeting the needs of the mentally ill and advocating for their fair treatment, ” she said. Christians can help through outreach to the homeless, advocating for the care and fair treatment of the mentally ill, and through prison ministries, she said.

While taking patients with mental illness out of care facilities was supposed to help them, it ended up doing more harm than good, the researchers maintain.

“It has become imperative to provide appropriate care and refuge for seriously mentally ill persons,” they wrote. “These individuals cannot help themselves or live independently, and they deserve a safe place to live with proper supports—not cycling between the streets, emergency departments, and prisons.”