The Cook County Jail has become a de facto mental health hospital, the county’s sheriff says. John Gress for The New York Times
The largest mental health center in America is a huge compound here in Chicago, with thousands of people suffering from manias, psychoses and other disorders, all surrounded by high fences and barbed wire. Just one thing: It’s a jail. The only way to get treatment is to be arrested.
Psychiatric disorders are the only kind of sickness that we as a society regularly respond to not with sympathy but with handcuffs and incarceration. And as more humane and cost-effective ways of treating mental illness have been cut back, we increasingly resort to the law-enforcement toolbox: jails and prisons.
More than half of prisoners in the United States have a mental health problem, according to a 2006 Justice Department study. Among female inmates, almost three-quarters have a mental disorder.
In the jail here, some prisoners sit on their beds all day long, lost in their delusions, oblivious to their surroundings, hearing voices, sometimes talking back to them. The first person to say that this system is barbaric is their jailer.
“It’s criminalizing mental illness,” the Cook County sheriff, Thomas Dart, told me as he showed me the jail, on a day when 60 percent of the jail’s intake reported that they had been diagnosed with mental illness. Dart says the system is abhorrent and senseless, as well as an astronomically expensive way to treat mental illness — but that he has no choice but to accept schizophrenic, bipolar, depressive and psychotic prisoners delivered by local police forces.
India, 42, suffers from manic depression and post-traumatic stress disorder. She has spent almost all of her adult life in jails and prisons. John Gress for The New York Times
People are not officially incarcerated because of psychiatric ailments, but that’s the unintended effect. Sheriff Dart says that although some mentally ill people commit serious crimes, the great majority are brought in for offenses that flow from mental illness.
One 47-year-old man I spoke to, George, (I’m not permitted to use last names for legal reasons) is bipolar, hears voices and abuses drugs and alcohol. He said he had been arrested five times since October for petty offenses. The current offense is criminal trespass for refusing to leave a Laundromat.
The sheriff says such examples are common and asks: “How will we be viewed, 20, 30, 50 years from now? We’ll be looked on as the ones who locked up all the mentally ill people.
“It really is one of those things so rich with irony: The same society that abhorred the idea that we lock people up in mental hospitals, now we lock people up in jails.”
North Attendant’s Building, Northampton State HospitalThe doors and windows of the North Attendant’s building have been removed in preparation for transformation. If to be demolished the loss of this 3 story rectangle is as unremarkable as its place in Northampton State Hospital and institutionalization history.
By 1919 the North Attendant’s home was all complete. Also known as the North Home and the Nurses’ Home, it was built to house 63 nurses, replacing two smaller buildings behind Old Main from the 1890s. The State Hospital under Superintendent Dr. John A. Houston was crossing the threshold of 1000 inmates. Through the Annual Reports the Superintendent and Trustees decry the poor funding, staffing and conditions of their own facility, even though two new buildings, including the North Attendant’s home have just been paid for.
From the superintendent’s report it will be noted that our condition of overcrowding continues despite the many patients, 92 in number, transferred to institutions in the eastern part of the State. We still believe that our hospital should care for all the patients of the district served by it, and we refer to the recommendations repeatedly made in former reports for suitable provision within the district for all the mental cases of western Massachusetts. This matter is so important that we feel it our duty to again call attention to it. The present conditions are not just to the institution nor to the patients who are here and the patients who are to come to us.
Northampton State Hospital Annual Reports. (1919, November 30), pp.7.
In the 1920 Annual Report the Superintendent details major staffing shortfalls, reporting that the State Hospital has been operating with nearly 100 fewer staff than prescribed. Only two doctors served the entire population.
All the routine activities of the hospital were conducted as usual, but under great stress, due to an extreme shortage of help in all departments. With a quota of 223 employees allowed us the average number on our pay roll throughout the year was only 127, and at times there were less than 100. Every one did extra duty. On the wards and in some other departments patients were given keys and conducted themselves as well as the employees, so well, in fact, that eight patients were placed on the pay roll.
Northampton State Hospital Annual Reports. (1920, November 30), pp.11.
Houston details the overcrowded conditions of the State Hospital in the 1921 Annual Report in another attempt for adequate funding.
Serious overcrowding makes it difficult to give our patients the care we should like to give. Too many of them are obliged to share a room with others. This is disquieting to the relatives and does not contribute to the comfort of the patients themselves. We realize that every State hospital has the same problem to deal with, and we accept the situation with what grace we may, hoping that in time adequate provision will be made for the care of all the patients of our district somewhere in this district, and not so far from their homes as are the institutions to which so many have been transferred in recent years.
Northampton State Hospital Annual Reports. (1921, November 30), pp.7.
And again regarding staffing in 1922, two years after the completion of the North Attendant’s building.
Despite frequent advertising and repeated applications to the employment bureaus, we have been unable to fill our quota of nurses and attendants. The quota of women nurses allowed us last year was 58, but the average number on the pay roll during the year was only 31. We have been fortunate in having patients comfortable and quite trustworthy, to help in the care of the wards and of other patients. Nine of them are now acting very acceptably as nurses and to their own pleasure and benefit, and four have done so well that they have been put on our pay roll.
Northampton State Hospital Annual Reports. (1922, November 30), pp.10.
Houston continues in the ’22 report…
The Department of Mental Diseases estimates our capacity at about 820, which is considerably larger than our estimate. The numbers we have been requested to maintain during each of the past five years have been, consecutively, as follows: 980, 990, 1,000, 1,010, 1,025, and for the coming year we are asked to make estimates for the maintenance of 1,060 patients. As a result of this constantly increasing growth in numbers, we have been seriously handicapped in the care of our patients. We cannot transfer our most troublesome patients, consequently a larger proportion of those who remain are of the disturbed class. The wards where easily distracted patients are cared for should accommodate only a very limited number of patients, but now our wards are occupied by anywhere from 40 to 60 patients, and many of these are obliged to sleep in corridors and day spaces. Naturally and inevitably they have an un-favorable influence on each other.
Northampton State Hospital Annual Reports. (1922, November 30), pp.11.
Like any building on Hospital Hill, the North Attendant’s home was as insignificant as staffing, funding and treatment were to the State Hospital system. Though the 1000 inmate threshold far exceeded the State’s own maximum for the facility, which in turn exceeded the staff’s estimate, the population would only continue to grow over the next three decades to reach 2500.
Prospect Meadow Farm, a project of Service Net, is about to celebrate its one-year anniversary. Carrie Saldo visited the Hatfield, MA farm to learn more about its business model, which is in-part, focused on employment of physically, mentally, intellectually, and economically challenged individuals.
A few years ago I heard about an abandoned school near Amherst. It was a massive campus that once served intellectually handicapped children in the town of Belchertown. The girl I was dating at the time told me about it. She had a dial she had taken from one of the buildings on the bookshelf in her bedroom; an old piece of machinery that seemed like it would fit in perfectly in the underwater metropolis Rapture. I was excited about the idea of exploring the decaying and abandoned buildings.
I have since learned that this place was the Belchertown State School, which lies only a few miles from Amherst center. This massive institution once covered almost 900 acres and housed about 1,100 residents. The grounds included a farm, a power plant and, at one point in time, a large carousel.
Not far to the west of Amherst stood the Northampton State Hospital, a facility for the mentally ill and another institution run by the Massachusetts Department of Mental Health. I never knew much about these places until last year, which is amazing to me, given their size and proximity to Amherst. As I found out more about them, I became fascinated with the history of these institutions and how we, as a society, have chosen to respond to those experiencing mental illness or intellectual handicaps.
‘Open Dialogue’ a documentary about treating mental illness
CHD will host a screening of the documentary film “Open Dialogue: An Alternative, Finnish Approach for Healing Psychosis,” by filmmaker Daniel Mackler, on Thursday, July 14, 2011, from 6 p.m. to 8 p.m. at its main office at 332 Birnie Ave., Springfield MA.
The screening is free and open to the public and co-sponsored by CHD and the Western Mass Recovery Learning Community. The film documents an alternative approach to treating individuals diagnosed with mental illness in Finland called “open dialogue,” developed by a group of innovative family therapists who meet with clients in crisis immediately and often daily until the crises are resolved, avoiding the use of anti-psychotic medications wherever possible.
A discussion with filmmaker Daniel Mackler will follow the screening. Mackler is a New York City writer, musician and filmmaker who spent ten years working as a psychotherapist before ending his practice last year. His writings focus on the causes, consequences, and significance of childhood trauma. His other documentary films, all focusing on psychiatric diagnoses and recovery, include “Take these Broken Wings” and “Healing Homes.”
Please RSVP to Marie Gilberti at (413) 439-2104 or Karen Cabana at (413) 439-2105
Twelve days after Jared Lee Loughner shot his way into the American psyche outside a Tuscon, Ariz., grocery store on Jan. 8, a 25-year-old mental health counselor in Revere was kidnapped from a group home and savagely killed, allegedly by one of her clients. Nine days later, it happened again when a homeless 19-year-old with a history of mental problems reportedly stabbed a shelter worker to death in Lowell, just 30 miles away.
No one can say for sure whether either murder had anything to do with funding cutbacks that have decimated the state’s mental health budget, but on the front lines in the war on mental illness, counselors are concerned.
“If you have one woman (counselor) and five men with mental health problems, it screams to me of mental health cuts,” Barry Sanders, a social worker for more than 20 years, says of the group home north of Boston where Stephanie Moulton was working when she was kidnapped and killed on January 20. “Having these kinds of staffing levels is like playing the odds, rolling the dice with someone’s life.”
Across Massachusetts, mental health agencies are feeling the strain of cutbacks that have ripped nearly $85 million from the state’s Department of Mental Health budget since 2009.
“It’s been devastation. Complete and utter destruction and devastation. The entire mental health system is shredded,says Laurie Martinelli, executive director with the Massachusetts Chapter of the National Alliance on Mental Illness, a mental health advocacy and research group.
Massachusetts Department of Mental Health Commissioner Barbara Leadholm takes a more diplomatic stance.
Mad in AmericaRobert Whitaker, an award-winning journalist and author best known for his work on mental illness, will speak at Mount Holyoke Thursday, December 2 at 7:30 pm in Cleveland L2. His lecture, titled “What You Don’t Know Can Hurt You: Magic Bullets, Psychiatric Drugs, and the Rise of Mental Illness in America,” is open to the public.
While on campus that day, Whitaker will also lead a discussion in psychology professor Gail Hornstein’s first-year seminar, Understanding Mental Health, at 1:15 pm in Reese 324.
In his newest book published this past spring, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Whitaker confronts a startling statistic: In the past 20 years, the number of Americans disabled due to mental illness has more than doubled–despite spending $40 billion each year on psychiatric medications.
“In media reports, we constantly hear these drugs being hailed as magic bullets, offering effective treatments for depression, anxiety, ADHD, bipolar illness, and a host of psychiatric conditions,” says Hornstein. “But Whitaker’s exhaustive review of the scientific literature of the past 50 years raises a profoundly troubling question: Do psychiatric medications increase the likelihood that people taking them, rather than being helped, are at risk of becoming chronically ill?”
Hornstein says Whitaker’s book is “important and controversial” and has been called “the Silent Spring of the pharmaceutical industry.”
From The Irish Times
By Carl O’Brien
Monday, August 24, 2010
Psychiatric nurses argue that more staff are needed to manage violent patients – but are patients with mental illness any more violent than the rest of the community?
When the union representing psychiatric nurses launched a campaign for extra staff earlier this month, it painted a disturbing and violent portrait of life on the wards of our mental hospitals.
Due largely to hundreds of staff vacancies, the union argued, there has been a sharp increase in assaults on members of staff. It said 1,314 assaults on staff were recorded last year, up from 966 in 2007 and 1,104 in 2008.
On one occasion eight gardaí in riot gear had to come to the assistance of nurses trying to manage a highly aggressive patient at St Brendan’s Hospital in Dublin. In Ennis, it says, a single patient was being managed 24 hours a day by security staff due to a shortage of nurses and secure facilities.
The result, the Psychiatric Nurses Association said, was that patients suffering from depression, anxiety and bipolar disorder were having their recovery threatened by this “frightening and threatening hospital environment”.
The picture depicted by the union, however, has been criticized by some mental health campaigners. John McCarthy, founder of the Mad Pride movement, says the behavior of a small minority of patients has been used to further nurses’ demands for higher staffing levels and better working conditions.
The collateral damage, he says, is that efforts to reduce stigma against people with mental health problems are being undermined.
Is bipolar disorder a disease? Can medications like lithium correct chemical imbalances and stabilize mood? Do psychiatric drugs act completely differently on the brain than recreational drugs? UK psychiatrist Dr. Joanna Moncrieff, author of The Myth Of The Chemical Cure: A Critique of Psychiatric Drug Treatment, discusses how seeing psychiatric medications as treatments for disease misleads the public about how they actually work, and obscures their potential for abuse as tools of social control.
From The Republican
By Fred Contrada
Thursday, July 29, 2010
Following a trend that has seen other hospitals sever their connections with outpatient mental health and substance abuse programs, Cooley Dickinson Hospital is turning over its behavioral health services to a nonprofit provider.
Clinical and Support Options, a Greenfield-based agency, will assume management of Cooley Dickinson’s behavioral health programs, most of which are based at 10 Main St. in Florence and at 170 University Drive in Amherst. The agency will also manage the response team located in the hospital’s emergency department, which treats people with emergency mental health and substance abuse needs.
Leesa-Lee Keith, Chief Nursing Officer and Vice President of Patient Care at Cooley Dickinson said most hospital employees working in those programs will transfer to Clinical and Support Options and see patients in the same locations.
“We want, for both the clinicians and the patients, to make this as seamless as possible,” she said.
From the New York Times
Friday, December 11, 2009
By Duff Wilson
New federally financed drug research reveals a stark disparity: children covered by Medicaid are given powerful antipsychotic medicines at a rate four times higher than children whose parents have private insurance. And the Medicaid children are more likely to receive the drugs for less severe conditions than their middle-class counterparts, the data shows.
Those findings, by a team from Rutgers and Columbia, are almost certain to add fuel to a long-running debate. Do too many children from poor families receive powerful psychiatric drugs not because they actually need them — but because it is deemed the most efficient and cost-effective way to control problems that may be handled much differently for middle-class children?
The questions go beyond the psychological impact on Medicaid children, serious as that may be. Antipsychotic drugs can also have severe physical side effects, causing drastic weight gain and metabolic changes resulting in lifelong physical problems.
On Tuesday, a pediatric advisory committee to the Food and Drug Administration met to discuss the health risks for all children who take antipsychotics. The panel will consider recommending new label warnings for the drugs, which are now used by an estimated 300,000 people under age 18 in this country, counting both Medicaid patients and those with private insurance.
A lot of people put in applications at the Hilltop Apartments on Village Hill when it opened three years ago, drawn by assurances from its developer, Community Builders, that its apartments would remain affordable. Hilltop has many nice apartments, the upper floors have terrific views, but it still has an institutional air to it. Long windowless corridors, no community space to speak of.
Bill “W” lives there, for now. He is a recovered alcoholic, works in food service in a supermarket. The pace is fast, he deals with the public directly, he works hard, puts in a full forty hour week and sometimes a weekend shift. He earns about $26,000 a year. For the last three years, almost since it opened, he has lived there. It was a big step up from a chaotic druggy rooming house on Green Street where he used to live. Community Builders engineered an $8 million rebuild of the old nurses quarters at the State Hospital, creating 33 apartments. Of the 33 units, 18 were supposed to be low income housing units, 8 would be for Department of Mental Health clients, and seven would be market level. The rents varied, based on your income and the square-footage of the apartments. The range of monthly rents in 2006 were $645 – $850 for a one bedroom apartments, $626 to $1050 for a two bedroom, and $1,050 for the lone three bedroom unit.
I had the pleasure of attending a Memorial put on by the Department of Mental Health (DMH) last week to celebrate the 30th anniversary of the 1978 Brewster Consent Decree which began the process of closing Northampton State Hospital by stipulating that people with mental illness had the right to live and be treated in the least restrictive environment possible. I felt the speech given by Rebecca Macauley was especially apt and moving, and I have a recording made by WFCR (the local National Public Radio station) of the first half of the event. I will post the audio as soon as I get a chance to clean it up and cut it into sections.
Brewster Consent Decree at Washington University School of Law
Updated
Full program and all speakers.
Dedication by Rev. Peter Ives, First Churches of Northampton.
Barbara Leadholm, DMH Commissioner.
Rebecca Macauley, Ex-patient, Security Guard and Advocate.
Elizabeth Cardona, Director, Western MA Office of the Governor.
Robert Fleischner, Center for Public Representation.
