Podcast Summary
Mental health care policies: The de-institutionalization movement in mental health care policies in the 1960s and 1970s aimed to return patients to their communities but faced challenges and is now widely viewed as a disaster, leaving seriously mentally ill individuals cycling between emergency rooms, jails, and homelessness.
The history of mental health care in the United States has seen significant shifts, from the large, institutionalized hospitals like Northern State, which emphasized occupational therapy and isolation, to the de-institutionalization movement that aimed to return patients to their communities. However, this movement, which gained momentum in the 1960s and 1970s, faced challenges and is now widely viewed as a disaster, leaving seriously mentally ill individuals cycling between emergency rooms, jails, and homelessness. The podcast "Lost Patience" explores this history and the consequences of these changes in mental health care policies.
Community-based mental health care: The 1960s shift towards community-based mental health care led to a decrease in institutionalized patients and tension between care providers and state officials over costs.
The 1960s saw a shift in mental health care from custodial institutions to community-based care, inspired by President Kennedy's Community Mental Health Act. This led to a significant decrease in the number of patients in mental health institutions, such as Northern State Hospital, within a decade or two. However, this transition was met with tension between those providing care and state officials focusing on costs. Governor Dan Evans, facing a tough budget crisis in the early 1970s, argued for closing Northern State Hospital, citing both the national trend towards community care and potential cost savings. This period marked a significant turning point in mental health care, moving away from institutionalization towards community-based services.
Institutional to community care transition: The closure of Northern State Hospital led to uncertain fates for many patients, with only a small fraction of the savings reinvested in mental health services, underscoring the challenges of transitioning from institutional care to community-based care and the importance of adequate funding and preparation.
The closure of Northern State Hospital in the 1970s was driven by a combination of motivations, including a desire for cost savings and political independence for state governments. However, the community mental health system was not yet prepared to absorb the large number of patients being transferred from institutions. As a result, the fates of many patients were uncertain, with some ending up on the streets or in the community without adequate support. Despite the promises of community care, only a small fraction of the savings from the hospital closure were reinvested in mental health services. This episode highlights the challenges of transitioning from institutional care to community-based care and the importance of adequate funding and preparation for such transitions.
Life after Institutionalization: Individuals face numerous struggles adjusting to life outside institutions despite being relatively high-functioning, emphasizing the need for ongoing support and resources.
The lives of individuals, even those considered high-functioning, can be challenging after being released from institutions, not because of the institutions themselves, but due to the external world and the conditions created outside. This is illustrated in the story of Phil Diro, a man who spent 26 years in a psychiatric hospital and, despite being relatively high-functioning, faced numerous struggles in adjusting to life outside. His case highlights the complexities and difficulties faced by those who have been institutionalized, and the ongoing need for support and resources to help them thrive in the world beyond the institution.
Deinstitutionalization challenges: Despite good intentions, deinstitutionalization led to a rise of homeless and destitute mentally ill individuals due to inadequate community resources and follow-up care.
The deinstitutionalization of mental health care in the United States, which began in the 1960s, did not go as planned. Phil Diro's story, among many others, highlights the challenges and hardships faced by mental health patients after being released from institutions like Northern State. Despite the good intentions of closing down large institutions and transitioning to community-based care, the follow-up care and resources were often inadequate or nonexistent. This led to a significant number of mentally ill individuals being left to fend for themselves in the community, resulting in a rise of homeless and destitute individuals living on the streets. The lack of funding and infrastructure to support the mentally ill in the community was a major shortcoming of the deinstitutionalization process. While some progress was made with the Mental Health System Act in the late 1970s, it was ultimately repealed, leaving many patients without the necessary support and care.
Mentally ill on streets: The de-institutionalization movement in the late 1960s and 1970s aimed to treat mentally ill patients in their communities, but lack of affordable housing and effective treatments led many to end up on the streets, without proper care, and facing numerous challenges in accessing the care they needed.
The de-institutionalization movement in the late 1960s and 1970s aimed to treat mentally ill patients in their communities, but the lack of affordable housing and effective treatments led many to end up on the streets. Community mental health centers focused on middle-class patients, leaving those with severe mental illnesses like schizophrenia and manic depressive disorder without proper care. The anti-psychotic drugs used to manage these conditions had limited success, and many patients couldn't tolerate the side effects or couldn't keep up with treatment. At the same time, affordable housing for the poorest populations was disappearing, leaving many without a place to live. The result was a growing population of mentally ill individuals living on the streets, ignored by society and facing numerous challenges in accessing the care they needed. This situation went largely unnoticed by the general public during this time, but its consequences are still felt today.
De-institutionalization of mentally ill: The de-institutionalization of mentally ill people led to a fragmented system of care, resulting in a revolving door system that leaves mentally ill individuals cycling through jails, emergency rooms, and homeless shelters with little progress towards long-term care and support
Learning from the discussion in the podcast "Lost Patience" is that the de-institutionalization of mentally ill people, which began as a civil rights movement, ultimately led to a failure of societal responsibility. The state, which once provided care for mentally ill individuals, became a funder of care instead, leading to a fragmented system of care that includes jails, emergency rooms, and homeless shelters. This shift in responsibility, according to former Washington governor Dan Evans, was not a satisfying or clear-cut solution for those in power, as it required significant resources and political will. The result is a revolving door system that leaves mentally ill individuals cycling through these institutions with little progress towards long-term care and support. This failure to address mental health care as a societal responsibility has been ongoing for decades, and the consequences are visible on the streets of cities across America.
1A podcast: The 1A podcast from NPR offers a more thoughtful and in-depth listening experience, going beyond surface level to provide context, analysis, and insight.
The 1A podcast from NPR offers a more in-depth and meaningful listening experience compared to traditional news sources. Instead of just delivering headlines and getting lost in the noise, 1A invites listeners to join a thoughtful exploration of the stories that matter. The podcast goes beyond the surface level to provide context, analysis, and insight, making it a valuable resource for anyone looking to stay informed and engaged with the world around them. By cutting through the clutter and focusing on the heart of the story, 1A helps listeners celebrate their freedom to listen and connect with the issues that affect us all.