Review: Out of Bedlam: The Truth about Deinstitutionalization

Out of Bedlam: The Truth about Deinstitutionalization by Ann Braden Johnson
My rating: 3 of 5 stars

Back in the early '90s I witnessed, I believe, a state hospital community release instance at Woodward and McNichols on the edge of Detroit and island community Highland Park, Michigan. I was in a diner there making a small purchase to stay out of the cold awaiting my next bus. A bus did pull up, but it wasn't mine and it disgorged what appeared to be confused, mental patients. Many entered the same diner and were hustled out with practiced ease by the chef who mentioned "community release" as an explanation. Periodically, this experience comes to mind and I will Google in the hopes of some confirmation, alternative explanation, or shared grief. This time, as a comment on "Did Reagan’s Crazy Mental Health Policies Cause Today’s Homelessness?", I found this comment:

Michigan Governor John Engler went on a crusade cut state spending on mental health by closing all the state psychiatric hospitals. Ypsilanti Regional Psychiatric Hospital was one of the first to go, closed in 1991, though the "C-Building," and the various service buildings on the property obviously stayed in partial use until early March of 2005 under the title CFP, or, "Center for Forensic Psychology"—meaning it was a hardcore detention facility that housed the 210 State of Michigan inmates who were either unfit to stand trial by reason of insanity, or who pleaded innocent to murder by reason of insanity.

Governor Engler's biography on michigan.gov does not mention any crusade against mental hospitals in his list of accomplishments, and instead classifies it as "serving an additional 45,000 patients annually with mental health services." I wasn't aware that Governor Engler was also qualified to administer such care (a little sarcasm there). Anyway, according to a September 2012 report by the Detroit Free Press, the rapid dismantling of Michigan's once-vast state hospital system in the 1990s perhaps did not achieve quite the positive outcome that was hoped for--at least partly because the "community-based" resources that were supposed to pick up the slack were never given the proper funding they were promised.

As the state hospitals closed, tens of thousands of patients who didn't have family to make sure they got proper care were literally turned out on the streets, "with a bus ticket to Detroit, and one bottle of pills," as the local saying goes. After that, they just ended up homeless and untreated...

Well, there is at least another Michigander with some similar recollections...

Michigan State Hospital closures 1991-1997 included 6 State Adult Hospitals, 5 State Children’s Hospitals. Michigan figures into this assessment of the roots of deinstitutionalization and its effects. Michigan led the nation in forcible sterilization of the feebleminded (1897) in then, making as a step toward redemption, hosted the 1954 Governor's Conference where states collaborated on improving mental health care.

However, health care for the mentally handicapped did not improve. It got worse, way worse and is now outsourced to penal institutions, by and large, and privately run, profit-driven "homes". They are no more "homes" than state "hospitals" were places of cure or rehabilitation. Starting out with a corrections model and building inertia toward funded program stability and staff routine, health care was tertiary or lower. My copy of this book had a Post-It Note in it with "NIMH" on one side and "Chlorpromazine" (thorazine) on the author. That relates to two, large themes of this book: federal involvement and the leaky bucket of dispersing funds that way; and the "miracle" of thorazine that offered compliant patients if not cured ones.

Beside a complete, readable history the author concisely offers what patients need (homes, life skills, outreach and more including coffee & cigarettes) and how programs that do succeed, at least better than the devolved and fragmented model we have now. Interestly, these few succeeding programs have a high proportion of ex-inmate founders.


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