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Out Of Bedlam
A clinical social worker argues that the USA could not have designed a more insane system of mental health services for the chronically mentally ill if it had tried. The author draws on her experience with the severely mentally ill in a wide range of health settings.
336 pages, Hardcover
First published November 18, 1990
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Displaying 1 - 4 of 4 reviews
April 27, 2023
In the early 1980s, the state mental hospital in my hometown released several hundred patients into the community. I remember them well, hanging out in the library, talking to themselves, sleeping in doorways.
This compelling, beautifully written 1990 book fascinated, saddened, and infuriated me, given how little has changed since then.
Other than the eventual canonization of Ronald Reagan. As California governor, he tried booting out all state hospital residents; his administration went one better in 1981, kicking everyone they could off of SSI: "even though only 11.2 percent of disability recipients were mentally disabled, they made up over 28 percent of those who lost their benefits." I disliked the man and his contempt for the least among us then amd still do. If you love him, read at least chapter 8 and get back to me.
While Johnson acknowledges the strong role of deinstitutionalization in homelessness, she convincingly argues that a) the majority of people sleeping rough are not mentally ill, b) the factors that cause homelessness (high housing costs, lack of resources, job loss, etc.) the mentally ill are least able to combat, c) being homeless *makes* people mentally ill.
The book also gave me hope. Cooperative models for successful mental health treatment are provided. It made me laugh just once: "Agencies whose workers visit their homeless clients on the street are adamant that what homeless people, mentally ill or not, need and want is homes and money." Thirty-three years since this book was published, nearly 50 since massive deinstitutionalization, and we still haven't understood the simplest solution. Homes and money. Who wouldn't wind up homeless, maybe even mentally ill, without them?
This compelling, beautifully written 1990 book fascinated, saddened, and infuriated me, given how little has changed since then.
Other than the eventual canonization of Ronald Reagan. As California governor, he tried booting out all state hospital residents; his administration went one better in 1981, kicking everyone they could off of SSI: "even though only 11.2 percent of disability recipients were mentally disabled, they made up over 28 percent of those who lost their benefits." I disliked the man and his contempt for the least among us then amd still do. If you love him, read at least chapter 8 and get back to me.
While Johnson acknowledges the strong role of deinstitutionalization in homelessness, she convincingly argues that a) the majority of people sleeping rough are not mentally ill, b) the factors that cause homelessness (high housing costs, lack of resources, job loss, etc.) the mentally ill are least able to combat, c) being homeless *makes* people mentally ill.
The book also gave me hope. Cooperative models for successful mental health treatment are provided. It made me laugh just once: "Agencies whose workers visit their homeless clients on the street are adamant that what homeless people, mentally ill or not, need and want is homes and money." Thirty-three years since this book was published, nearly 50 since massive deinstitutionalization, and we still haven't understood the simplest solution. Homes and money. Who wouldn't wind up homeless, maybe even mentally ill, without them?
February 2, 2017
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.
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.
August 9, 2014
With as much as I have railed against deinstitutionalization, I felt it would behoove me to learn more about it. This book is strongest in the early chapters, where it details what went into deinstitutionalization and dispels the myth that it was ever an organized effort.
I already hated Ronald Reagan, and this book made me hate him more while also showing that things were already bad before he made them worse, and it was hardly all his doing. He just... made things as bad as he had the power to do.
The book breaks down the closer it gets to the present - the present of writing in 1990 - and I can't help but chuckle bitterly when the author predicts that perhaps we'll be building too many prisons soon. Oh honey, did we ever.
Generally the root cause of the problems are shown to be ignorance, self-serving regulation, anxiety over bottom-lines and scrambles to get federal funding. So... as usual, never ascribe to malice what can be explained by incompetence.
I already hated Ronald Reagan, and this book made me hate him more while also showing that things were already bad before he made them worse, and it was hardly all his doing. He just... made things as bad as he had the power to do.
The book breaks down the closer it gets to the present - the present of writing in 1990 - and I can't help but chuckle bitterly when the author predicts that perhaps we'll be building too many prisons soon. Oh honey, did we ever.
Generally the root cause of the problems are shown to be ignorance, self-serving regulation, anxiety over bottom-lines and scrambles to get federal funding. So... as usual, never ascribe to malice what can be explained by incompetence.
February 18, 2012
The book really makes you think about what was done with the mentally ill when they started deinstiutionalization. Lots of promises made and not very many, if any, were kept. Well written by a psychologist and through her view. As a person reading it without the educational background as she does, I have the expierence as a person who has lived experience as a mental health problems, it wasn't always a easy read. Yet I was able to understand it, even contiuned read through it when it got a bit "dry". I would recommend it to both professionals and those who lived or have reovered from mental illness.
Displaying 1 - 4 of 4 reviews