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State Mental Hospitals: Problems and Potentials
Book by Talbott, John A.
219 pages, Hardcover
First published May 1, 1980
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August 23, 2024
A SERIES OF ESSAYS ON THE STATE (circa 1980) OF STATE MENTAL HOSPITALS
At the time this book was published in 1980, John A. Talbott was Professor of Psychiatry at Cornell University; he was also the President of the American Psychiatric Association from 1984-1985. He has also written books such as 'Death of the Asylum: A Critical Study of State Hospital Management Services and Care,' 'Textbook of Administrative Psychiatry,' etc.
He notes that "Two decades ago... the decline of the state hospital care system was already underway... as alternative psychiatric facilities have sprung up in general hospital systems, the federal community mental health centers... But there have emerged as well glaring examples of the limitations of the narrow applications of both the psychopharmaceutical and sociological resolutions to caring for these impaired mentally ill with serious and persistent personality deficits." (Pg. 12-13)
He suggests, "Deinstitutionalization is the newest development affecting state hospitals and has been characterized by an unplanned but intentional movement of the severely and chronically mentally ill from state facilities to community settings. It is immaterial ... whether the motives behind deinstitutionalization were philosophical... therapeutic... or economic... Deinstitutionalization, by reducing the census both nationwide and for individual hospitals, has left the state facility in limbo, no longer either custodial asylum and institution of last resort for society's mental rejects, nor active, community-related and quality-oriented service, able to care for the very population it was designed to serve--the severely and chronically mentally ill." (Pg. 15-16)
Another essayist admits, however, that "The California experience began to raise serious doubts as to the feasibility and desirability of the ultimate closing of all state hospitals... A committee of the California senate... heard evidence that community mental health programs were not effective in caring for the chronically ill discharged from state hospitals." (Pg. 49) He points out, "In California, there is almost a 90 percent reduction of the mentally ill from 37,000 in 1955 to fewer than 4,000 now. This is a reality that state hospital proponents must face." (Pg. 133) He adds, "There are ... clearly some patients or groups of patients for whom community programs are not feasible at a given point in their illness. These are, in a sense, community program failures. They include chronic deteriorated patients, actively aggressive and assaultive patients, and some individuals suffering from a combination of mental and physical illness so severe as to tax any of the local facilities." (Pg. 165)
One essay argues, "It is not generally recognized that deinstitutionalization as applied to the state mental hospitals has fallen far short of expectations. What began as a manifestation of the highest moral, ethical, and legal motives has now been branded as a simple dumping of the mentally disabled from state facilities into the community and no more than a crude attempt to shift a financial burden from one agency of government to another." (Pg. 147)
Even though more than thirty years old, the issues raised in this book are often still quite "current," and its historical information makes it still a useful resource for anyone studying the modern state mental hospital.
At the time this book was published in 1980, John A. Talbott was Professor of Psychiatry at Cornell University; he was also the President of the American Psychiatric Association from 1984-1985. He has also written books such as 'Death of the Asylum: A Critical Study of State Hospital Management Services and Care,' 'Textbook of Administrative Psychiatry,' etc.
He notes that "Two decades ago... the decline of the state hospital care system was already underway... as alternative psychiatric facilities have sprung up in general hospital systems, the federal community mental health centers... But there have emerged as well glaring examples of the limitations of the narrow applications of both the psychopharmaceutical and sociological resolutions to caring for these impaired mentally ill with serious and persistent personality deficits." (Pg. 12-13)
He suggests, "Deinstitutionalization is the newest development affecting state hospitals and has been characterized by an unplanned but intentional movement of the severely and chronically mentally ill from state facilities to community settings. It is immaterial ... whether the motives behind deinstitutionalization were philosophical... therapeutic... or economic... Deinstitutionalization, by reducing the census both nationwide and for individual hospitals, has left the state facility in limbo, no longer either custodial asylum and institution of last resort for society's mental rejects, nor active, community-related and quality-oriented service, able to care for the very population it was designed to serve--the severely and chronically mentally ill." (Pg. 15-16)
Another essayist admits, however, that "The California experience began to raise serious doubts as to the feasibility and desirability of the ultimate closing of all state hospitals... A committee of the California senate... heard evidence that community mental health programs were not effective in caring for the chronically ill discharged from state hospitals." (Pg. 49) He points out, "In California, there is almost a 90 percent reduction of the mentally ill from 37,000 in 1955 to fewer than 4,000 now. This is a reality that state hospital proponents must face." (Pg. 133) He adds, "There are ... clearly some patients or groups of patients for whom community programs are not feasible at a given point in their illness. These are, in a sense, community program failures. They include chronic deteriorated patients, actively aggressive and assaultive patients, and some individuals suffering from a combination of mental and physical illness so severe as to tax any of the local facilities." (Pg. 165)
One essay argues, "It is not generally recognized that deinstitutionalization as applied to the state mental hospitals has fallen far short of expectations. What began as a manifestation of the highest moral, ethical, and legal motives has now been branded as a simple dumping of the mentally disabled from state facilities into the community and no more than a crude attempt to shift a financial burden from one agency of government to another." (Pg. 147)
Even though more than thirty years old, the issues raised in this book are often still quite "current," and its historical information makes it still a useful resource for anyone studying the modern state mental hospital.
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