Part II ended with the phrase: “gradually reduce reliance on mental hospitals.” “Gradually” is the operant word here, even though, as I recall, during the kinds of planning workshops, conferences, meetings we had in those days, at least during the “visioning” part of the exercise – the “vision thing” as George H. W. Bush once called it – some of us imagined a day when mental hospitals would no longer be necessary.
From 1971 until 1995 I worked in a variety of settings, sometimes as a participant, sometimes as a leader, developing comprehensive outpatient programs for serious mental illness – programs for schizophrenia, supported housing, programs for mood disorders, programs for early detection and comprehensive treatment, programs for brain injury, for crisis intervention, programs for isolated regions, programs for consultation to medical wards and family doctors. We revamped the mental hospital, transferring more and more funding to outpatient services, redefining “chronic ward” to rehabilitation program, reducing the use of restraints. We worked at connecting with school and social services, housing and job training.
Still, for some people, the mental hospital remained an asylum, the one place in the world where they were safe, could eat meals and sleep in a bed, could receive medical and nursing and dental care, could sit in the sun on a bench, have a shower, cadge money from the medical director for a coffee, and wander about in eccentric fashion making outrageous observations.
And someone mentally ill in the jail on minor charges might be transferred to the hospital without a great deal of fuss. Some fuss, but not a great deal. Police would apprehend someone creating a disturbance, observed to be mentally unbalanced in some way, and bring that person to the emergency department, to the emergency psychiatric team rather than the jail. They would have to sit around for a bit to await outcome, but they could usually count on the hospital keeping that person and they could get back on patrol.
Government policy shifted focus and money from the worried well to those suffering from severe and persistent mental illness.
Better treatments were being developed, more money spent on research; our country was not at war, the economy was growing, more people were being educated, the digital age arrived, information became readily available. This era of progress could only continue, one would think.
Of course the new drugs proved only marginally better than the original mood stabilizer, the original anti-depressant, and the original anti-psychotic. Talk therapies were being refined, codified, made more practical, but they too did not add much more than having an empathic, nonjudgmental, reasonably wise counselor in your corner. Yet the world was becoming a better place for the mentally ill and their families, at least my part of the world, and much of Europe, and parts of the United States. Surely this progress would continue and Dorothea Dix, Drs. Pinel, Kraeplin, Tuke, and Rush would be pleased.
During the latter part of those years, I attended a psychiatric conference in San Francisco. I was probably there to talk about comprehensive treatment for schizophrenia. But what I remember most clearly is the number of homeless and psychotic people living on the streets near the hotel and convention headquarters. An ironic tableau: a thousand psychiatrists within, a hundred mentally ill living on the streets outside, and a few people picketing with anti-psychiatry placards. Another psychiatrist from another state (I think it was Georgia) came to give a talk in Ontario during that period. He came with a warning. Do not let happen in Canada what was happening in his country. His hospital, the mental hospital in which he had worked, in which he had pursued all the same goals mentioned in that second paragraph of mine – it had been closed and transformed into a medium secure prison facility for the mentally ill and criminally insane.