Diane Dimond: Time to bring back the asylums

Diane Dimond

What does the word “asylum” conjure up in your mind? An overpopulated mental ward with screaming patients frothing at the mouth? A snake pit, as depicted in the 1948 movie of the same name in which actress Olivia de Havilland’s character battles schizophrenia, shock treatments and a sadistic nurse?

The word “asylum” simply means “an institution offering shelter and support to people who are mentally ill.” So why don’t we have more psychiatric asylums to help the ever-growing number of Americans who battle serious mental illnesses like schizophrenia or bipolar disorder? “Asylum” is not a dirty word.

The answer is simple: money. And the fact that decades ago, following shocking disclosures about the care in some institutions, it was decided the doors of almost all psychiatric hospitals would be closed in favor of smaller community-based treatment centers. Thousands of troubled souls were released, but the centers never materialized, in part because few citizens wanted a psychiatric care home in their backyard. Today the majority of severely mentally ill people have become the problem of the police, whose only alternative is to arrest them and lock them up.

This is what we do to mentally sick people — put them in an unsafe and violent environment? When did we decide that being mentally ill is akin to a criminal offense? And how does jailing such people help anyone? Once released, they will still suffer from their illness, and it may be even more profound at that point.

“We need to treat these individuals like we would treat someone with a serious cancer,” professor Dominic Sisti of the University of Pennsylvania told me the other day.

Dr. Sisti is the director of the Scattergood Program for the Applied Ethics of Behavioral Health Care and co-author of the often-quoted paper “Improving Long-term Psychiatric Care: Bring Back the Asylum.” He noted the moral distress his student interns experienced at being forced into the practice of “treating and streeting” patients, that is, getting them back out on the street within 72 hours when the federal funds to treat them run out.

The way we allocate money and resources to help these most vulnerable people is not fair, and it is clearly not working.

According to the Treatment Advocacy Center, an organization dedicated to making treatment possible for those with severe mental illness, an estimated 15 percent of inmates in state prisons and 20 percent of inmates in local jails have a diagnosable and serious mental illness. In 2014, for example, there were approximately 383,000 people with severe psychiatric problems locked up compared with about 38,000 getting treatment in state psychiatric institutions. Something is wrong there.

At the same event where I met Dr. Sisti, I listened to several other experts in the field of mental illness. Dr. Emanuel Trujillo, former director of psychiatry at the famous New York University Bellevue Hospital Center, believes it is unethical for society not to force the profoundly mentally ill to take antipsychotic medicines. He cited one of his own patients, who declared: “I am fine. I am God. You are the crazy one.”

The Washington Post reports that a man with schizophrenia stabbed out both his eyes while incarcerated in a Minnesota county jail. Jailers in New York did not know what to do with one schizophrenic inmate, so they left him in solitary confinement for 13 years. It is clear penal institutions are no place for those suffering from profound mental disease. I’ll go one step further and agree with legal scholars who believe it constitutes cruel and unusual punishment.

The biggest hurdle to getting the mentally ill out of jails, off the streets and into bona fide treatment programs is money. States look to the feds to help, but regulations on Medicaid and other government programs are so restrictive that meaningful treatment is impossible. Hospital emergency rooms are flooded with those needing urgent mental health care, and according to D.J. Jaffe, executive director of Mental Illness Policy Org, “If you can walk in you’re not considered to be a priority (patient),” and the alternatives are “homelessness, jail or the morgue.”

Dr. Jeffrey Geller, director of psychiatry at the University of Massachusetts Medical School, addressed those who worry about the “warehousing of people” should asylums make a comeback. Geller says that is already happening in substandard, poorly subsidized adult homes and other care facilities where patients get room and board but no services due to the ill-conceived structure of federal assistance. Once targeted therapy begins, Geller said, “Most could be treated, live on their own, and for those who could not, they can be afforded asylum care.”

The need to bring back asylums — once a taboo subject — is now being openly discussed among academics and other experts in the field of mental illness. It’s time the rest of us begin to listen.

To find out more about Diane Dimond, visit her website at www.dianedimond.com. Her latest book, “Thinking Outside the Crime and Justice Box,” is available on Amazon.com.