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JFK, Deinstitutionalization and It’s Impact on the Mentally Ill and Addicted

This month marks the 50th anniversary of the John F. Kennedy (JFK) speech, Special Message on Mental Illness and Mental Retardation. Being a longtime admirer of all things Kennedy, I decided to read through the 14-page speech, which highlighted the problem of psychiatric hospitals, most of which were built before World War I:

“Every year nearly 1,500,000 people receive treatment in institutions for the mentally ill and mentally retarded. Most of them are confined and compressed within an antiquated, vastly overcrowded, chain of custodial state institutions.” … “It has troubled our national conscience – but only as a problem unpleasant to mention, easy to postpone, and despairing of solution. The Federal Government, despite the nation-wide impact of the problem, has largely left the solution up to the states. The states have depended on custodial hospitals and homes. Many such hospitals and homes have been shamefully understaffed, overcrowded, unpleasant institutions from which death too often provided the only firm hope of release.”

JFK Proposes an Alternative to Institutionalization: Psychiatric Medications and Community-Based Care

In his 1963 speech, John F. Kennedy recognized the need for a new program to replace the psychiatric hospital model:

“I propose a national mental health program to assist in the inauguration of a wholly new emphasis and approach to care for the mentally ill. This approach relies primarily upon the new knowledge and new drugs acquired and developed [italics mine] in recent years which make it possible for most of the mentally ill to be successfully and quickly treated in their own communities [italics mine] and returned to a useful place in society.”

“These breakthroughs have rendered obsolete the traditional methods of treatment which imposed upon the mentally ill a social quarantine, a prolonged or permanent confinement in huge, unhappy mental hospitals where they were out of sight and forgotten.”

Fifty years later, psychiatric medications and community-based care are well-established as the preferred treatments for mental illness.

Public Outcry Leads to Change

While Washington worked out the details of a new approach to treating mental illness, very little had changed in the daily operations of most psychiatric hospitals. In 1965, following his brother’s legacy, then New York State Senator, Robert F. Kennedy, visited Williowbrook State School in Staten Island, New York, describing it as a ‘snake pit’.

In January, 1972, Willowbrook once more became the centre of controversy. This time, however, the American public stood up and demanded change following a nationwide broadcast by reporter Geraldo Rivera:

As Mr. Rivera was to describe it in a 2005 Fox News follow-up,”… Institutions of this type were giant catch-alls, kinds of warehouses for children with all kinds of ailments or conditions.” *

(*) Source: See “Geraldo Rivera – The P&A System

Deinstitutionalization and the Rise of the Homeless and Incarcerated Mentally Ill and Addicted

With gathering momentum, residents were transferred out and institutions closed. This social experiment, which started in 1955 under President Dwight D. Eisenhower, that finalized Federal government support in the 1960’s and public support in the 1970’s would, ultimately, come to be known as ‘deinstitutionalization‘.

According to psychiatrist E. Fuller Torrey, “Deinstitutionalization was based on the principle that severe mental illness should be treated in the least restrictive setting.”* During the administration of Jimmy Carter, the Commission on Mental Health stated that deinstitutionalization rested on “the objective of maintaining the greatest degree of freedom, self-determination, autonomy, dignity, and integrity of body, mind, and spirit for the individual while he or she participates in treatment or receives services.” **

However, as Dr. Torrey points out, “For a substantial minority … deinstitutionalization has been a psychiatric Titanic. Their lives are virtually devoid of “dignity” or “integrity of body, mind, and spirit.” “Self-determination” often means merely that the person has a choice of soup kitchens. The “least restrictive setting” frequently turns out to be a cardboard box, a jail cell, or a terror-filled existence plagued by both real and imaginary enemies.” *

(*) Source: Torrey, E. Fuller (1997). Out of the Shadows: Confronting America’s Mental Illness Crisis, Chapter 1.

(**) Source: Bachrach, L.L., “Is the Least Restrictive Environment Always the Best? Sociological and Semantic Implications,” Hospital and Community Psychiatry 31 (1980): 97.

The Present State of Care for the Mentally Ill and Addicted

The closure of psychiatric hospitals across North America has long since run it’s course. Many have concluded the deinstitutionalization was a failed experiment, including British Columbia Premier, Gordon Campbell. *

This story has a personal angle to it as my family owned and operated a 36-bed psychiatric hospital called the Banyan Centre until our contract with the provincial government was terminated in 1994. At the time, the province offered to continue funding 12 of our mentally handicapped clients in 4-bed group homes closer to the town of Powell River. The rest of the clients, many of whom were mentally ill, were transferred to Riverview Hospital. Unfortunately, Riverview was also a victim of funding cuts that saw their bed count go from a high of 4,630 patients in 1951 down to 1,000 by the early 1990s. ** Did our clients end up in the streets or in jail? We don’t know but we’re quite certain that they would have managed just fine had they remained at the Banyan Centre.

Residential facilities continue to close. This month, the Interior Health Authority will lose it’s own primary residential treatment facility, Crossroads. In 2008, Nechako Treatment Centre closed, leaving the Northern Health Authority without a residential program. And, since Vancouver Island has no primary residential treatment, that means British Columbians must travel to the Lower Mainland to get services.

The likely scenario of this later chapter of the deinstitutionalization story will be, unfortunately, more demand for homeless shelters and prisions until all levels of government can provide the funding that community-based care has always needed but, to date, has not received.

(*) Source: Smyth, Michael, Deinstitutionalization Deemed a Failure, Vancouver Province, October 29, 2006.

(**) Read, Alison, Psychiatric Deinstitutionalization in BC: Negative Consequences and Possible Solutions, University of British Columbia Medical Journal, September, 2009, pgs. 25-26.

Recommended Reading

Morrow, Marina & Dagg, Paul K B, Is Deinstitutionalization a ‘Failed Experiment’?, The Ethics of Re-institutionalizationJournal of Ethics in Mental Health, November, 2008.

 

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