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View Full Version : What happened to insane asylums?



dacrunkest
01-23-2008, 11:19 PM
I was wondering when did asylums for lunatics stopped being used? Did I miss this? Do we no longer have insane asylums? The reason I ask is because I work with a guy I think should be committed, and I wanted to know the proper procedure.

meatwad
01-23-2008, 11:53 PM
I was wondering when did asylums for lunatics stopped being used? Did I miss this? Do we no longer have insane asylums? The reason I ask is because I work with a guy I think should be committed, and I wanted to know the proper procedure.

Now we have mental health institutions. While I think that's better for a lot of people, I still think it'd be a good idea to have an Arkham Asylum or two around to put the real whackos.

PenforPrez
01-24-2008, 12:03 AM
I was wondering when did asylums for lunatics stopped being used? Did I miss this? Do we no longer have insane asylums? The reason I ask is because I work with a guy I think should be committed, and I wanted to know the proper procedure.

We still have them; every state still runs modern equivalents of those. We just don't think of them as the dark, dank warehouses of torture that previous generations thought they were (and some were). The Menninger family of Topeka did a lot of work in that regard in the early-to-mid 20th century.

Here in Missouri, the big state hospital in Fulton is still going strong after 150 or so years. So is Malcolm Bliss in St. Louis; Matt Blunt was trying close that one down. So they're still around, if less metaphorically.

Or am I completely off base here?

Paul

dacrunkest
01-24-2008, 01:07 AM
We still have them; every state still runs modern equivalents of those. We just don't think of them as the dark, dank warehouses of torture that previous generations thought they were (and some were). The Menninger family of Topeka did a lot of work in that regard in the early-to-mid 20th century.

Here in Missouri, the big state hospital in Fulton is still going strong after 150 or so years. So is Malcolm Bliss in St. Louis; Matt Blunt was trying close that one down. So they're still around, if less metaphorically.

Or am I completely off base here?

Paul

No. Jess and I were having a debate as to where they put the criminally insane who haven't committed any crimes. These are people that are batshit crazy enough to be dangerous, but have not yet had the chance. I was under the impression that bona-fide institutions were still around for these folk. I have seen institutions like these in movies such as Silence of the Lambs and others I don't care to name.

PenforPrez
01-24-2008, 01:21 AM
No. Jess and I were having a debate as to where they put the criminally insane who haven't committed any crimes. These are people that are batshit crazy enough to be dangerous, but have not yet had the chance. I was under the impression that bona-fide institutions were still around for these folk. I have seen institutions like these in movies such as Silence of the Lambs and others I don't care to name.

No. Nowadays, those people get elected to high office. :evil:

winneythepooh7
01-24-2008, 07:25 AM
Honestly, there are not a lot of these places left (state hospitals). It's really, really hard to get people a bed in the ones that do still exist. Everything these days has turned to "deinstitutionalization" which obviously leads to lots of problems.

There are band-aid solutions at best (ie. ACT teams where teams of social workers and psychiatrists are expected to go to find the client in the community as much as needed for treatment, doesn't really work IMHO which is a major reason I left this job), and limited housing resources for the severe mentally ill and people coming out of jail. It's probably only going to get worse before it gets better. Lack of housing in general is the major hot issue in social work, regardless of what population you work with. Try finding a person in a wheelchair an accessible apartment, under $1600.00 a month in the NYC/Long Island/Westchester area...........pretty much non-existent, or very long wait-lists. Many apartment buildings don't have ramps either.

blueyes
01-24-2008, 10:09 AM
movies such as Silence of the Lambs and others I don't care to name.
Parts of that movie was actually filmed in the Pittsburgh jail, which was (at one point) the state penitentiary building. It's pretty effing creepy even empty as it is now.

He was even held there for a time, if memory serves correctly.

Deavan
01-24-2008, 10:19 AM
I was wondering when did asylums for lunatics stopped being used? Did I miss this? Do we no longer have insane asylums? The reason I ask is because I work with a guy I think should be committed, and I wanted to know the proper procedure.

Yeah it's called celebrity rehab now :evil:

I kid, I kid...I really have no idea but oddly enough was discussing this with someone the other day...

meatwad
01-24-2008, 10:46 AM
Yeah it's called celebrity rehab now :evil:

I kid, I kid...I really have no idea but oddly enough was discussing this with someone the other day...

Is it wrong that I find entertainment in Jeff Conaway's misery? I feel bad for pretty much everyone else on that show, but somehow I can't feel sorry for him.

PenforPrez
01-24-2008, 11:42 AM
Honestly, there are not a lot of these places left (state hospitals). It's really, really hard to get people a bed in the ones that do still exist. Everything these days has turned to "deinstitutionalization" which obviously leads to lots of problems.

I thought most states still ran public mental institutions. I know Missouri and Kansas do.

wordsmith
01-24-2008, 11:50 AM
Here's how it worked in Illinois, when, over time and with various jurisdiction changes and legislation, "insane asylums" gradually evolved into "state hospitals" and "treatment centers":


"The words "asylum", "feeble minded", "incurable" and "insane" seem to have been replaced in the state institutional system of Illinois around 1909 when the board of commissioners and the Board of State Commissioners of Public Charities were abolished. At that time, control of all state charitable institutions passed to the newly created Board of Administration and the new name for these institutions became "state hospital".

The Civil Administrative Code of 1917 transferred jurisdiction of the institutions to the Department of Public Welfare. In 1961, when the Department of Public Welfare was abolished, the Department of Mental Health assumed responsibility for the hospitals and they were thus renamed again.

In 1997 the Department of Mental Health was abolished and the newly formed Department of Human Services assumed responsibility for 10 psychiatric hospitals previously under the Department of Mental Health.

The Department of Human Services is divided into "divisions" which are divided into "offices". Mental health services are covered by the Division of Mental Health and Developmental Disability Services. Mental Health falls under the Office of Mental Health and Developmental Disabilities falls under the Office of Developmental Disabilities. Thus some "state hospitals" became "mental health centers" some "developmental centers" and some are both.

This constant change of names caused by politics and changing ideas about the mentally ill seems to have caused much confusion when attempting to track each hospital's history."

That information came from a site that details the history of some of Illinois' mental health facilities...it has old photos (http://www.mantenostatehospital.com/ilsthospls.html)


Some of these, in their asylum days, were very haunted-house-esque and creepy. Some, I know from living near them, like Dixon and Bartonville, had a lot of scary stories and such attached.

The changes (and in some cases, lack of changes) in views on mental health and how various illnesses have been perceived and treated over the centuries, and just how it's all played out even in just American history alone is really an interesting thing to study.

winneythepooh7
01-24-2008, 06:56 PM
I thought most states still ran public mental institutions. I know Missouri and Kansas do.

They do. But that doesn't mean it's easy to get someone placed in them.

PenforPrez
01-24-2008, 06:57 PM
They do. But that doesn't mean it's easy to get someone placed in them.

Especially in states like Missouri where mental health budgets have been seriously cut. :(

wordsmith
01-24-2008, 07:07 PM
It's not just availability of space that makes it complicated to get people committed, it's also that there's overall much more attention given to patients' rights and patient privacy than there once was. It all ties in with the shift in ways that mental health is viewed.

winneythepooh7
01-24-2008, 07:18 PM
And in general, the view today is that no one belongs in a hospital/institutionalized setting for the long-term.

But in many cases, money is not really poured into preventative services in the community, either. And when people live in the community, they still have the right to fail and make bad decisions.

Bottom line, there's a lot of gaps in both systems and as a social worker who has been doing this kind of work for ten years, I don't know what the answer is, besides give more $$$$$ to help people and create better preventative services, smaller caseloads, housing, etc. but that's not going to happen anytime soon.

Also you can't force people to take meds, and in many cases, people who belong in "insane asylums" CANNOT be treated with meds really. Often they have serious personality disorders/behavioral issues, which again, are not really treated by psychotropics.

awhitmer83
01-24-2008, 07:40 PM
In many states, it's fairly easy to have someone committed for a 72-hour evaluation in a mental hospital. In Kentucky, the person has to be considered a danger to themselves or others, and you just go to the courthouse and fill out paperwork. A judge reviews it, the person is evaluated first by a mental health professional, and if deemed appropriate that person will be involuntarily committed. At least twice a month I get a court order to assess someone for the 72-hour eval, and more often than not the person ends up going to the hospital. They have to be suicidal with intent (or homicidal with intent), actively psychotic, or totally unsafe to be left alone.

We are fortunate in that Kentucky offers mental health crisis services to divert people from the hospital. I actually work as a therapist for my region's crisis program. If someone is, for example, suicidal but doesn't necessarily have a plan to commit suicide, we place them in a crisis unit for 3-5 days where they see a therapist and case manager daily. They see a psychiatrist within 2 days and the staff at the crisis unit make sure they take their medications as prescribed. We then step them down to outpatient therapy twice a week, with a case manager checking on them daily. It has really helped lower hospitalizations in my area, though there are still people who truly need to go to the hospital as I mentioned before.

Edited to add: There are still people who simply cannot function in the community because of mental illness. These are usually your people with schizophrenia or other psychotic disorders - generally the ones who can't be trusted to take their medication. (After all, they don't feel like there's anything wrong with them.) I know of several states, including mine, that utilize personal care homes - kind of like a nursing home but for people who can feed, bathe, and pretty much care for themselves - to house these people so their meds and behaviors are monitored. It's also much easier to get them to their scheduled mental health appointments since the staff drive them to the clinic.

winneythepooh7
01-24-2008, 08:46 PM
In many states, it's fairly easy to have someone committed for a 72-hour evaluation in a mental hospital. In Kentucky, the person has to be considered a danger to themselves or others, and you just go to the courthouse and fill out paperwork. A judge reviews it, the person is evaluated first by a mental health professional, and if deemed appropriate that person will be involuntarily committed. At least twice a month I get a court order to assess someone for the 72-hour eval, and more often than not the person ends up going to the hospital. They have to be suicidal with intent (or homicidal with intent), actively psychotic, or totally unsafe to be left alone.

We are fortunate in that Kentucky offers mental health crisis services to divert people from the hospital. I actually work as a therapist for my region's crisis program. If someone is, for example, suicidal but doesn't necessarily have a plan to commit suicide, we place them in a crisis unit for 3-5 days where they see a therapist and case manager daily. They see a psychiatrist within 2 days and the staff at the crisis unit make sure they take their medications as prescribed. We then step them down to outpatient therapy twice a week, with a case manager checking on them daily. It has really helped lower hospitalizations in my area, though there are still people who truly need to go to the hospital as I mentioned before.

Edited to add: There are still people who simply cannot function in the community because of mental illness. These are usually your people with schizophrenia or other psychotic disorders - generally the ones who can't be trusted to take their medication. (After all, they don't feel like there's anything wrong with them.) I know of several states, including mine, that utilize personal care homes - kind of like a nursing home but for people who can feed, bathe, and pretty much care for themselves - to house these people so their meds and behaviors are monitored. It's also much easier to get them to their scheduled mental health appointments since the staff drive them to the clinic.

The system in NY is just completely overwhelmed to function this way. And in addition, if a person says they don't want to go to a supervised residence, often the residence won't accept them. Especially because there's a wait list from here to Kentucky to get people in. For those mandated to treatment through Kendra's Law, it's still a very lengthy process with not often positive results.

In NY, doctors also really hate to get involved in mandating clients to treatment. It's a very lengthy, drawn out process here, and in the end, nothing much is really accomplished anyways, because the majority of clients still remain "non-compliant" with their treatment orders, if they do actually receive them.

It's also been my experience that many clients, even if they should not be discharged to the streets, are, because they know the magic words to get out of the inpatient unit. Either that, or there's someone else slightly worse then them waiting to go into the unit, so they discharge them. It's an endless cycle.

ACT is New York State's band-aid solution to mental health care, and it does not work in my honest opinion, speaking from direct frontline experience. I was responsible for 64 severe mentally ill clients, who were basically a danger to themselves and others on a daily basis. My "team" was made up of another social worker, with only internship experience, who was scared of the clients, two peer advocates (former mental health consumers themselves) a psychiatrist who worked with us for 1 1/2 days a week and an LPN. The RN position was filled for like 2 weeks and then she left because she was overwhelmed. I wonder why :rolleyes: .

I got screamed and cursed at LITERALLY almost every hour, of every day at the god forsaken place because it was my fault you know that my clients were severely mentally ill and refusing to take meds and follow the treatment plan. :rolleyes: (Screamed at by the people involved with the program who mandate the clients). I was also told that I was to "police the clients".

I also had a team leader who was on the verge of a nervous breakdown everyday, and was constantly harrassed by one of the higher up's for not bringing in more consumers and $$$ to the agency. One of the peer advocates I mentioned clearly had borderline personality disorder herself, and was sabotaging whatever treatment plans myself, and the other two social workers and psychiatrist would come up with.

The mental health system is very much beyond a crisis state in NYS.

awhitmer83
01-24-2008, 09:28 PM
The mental health system is very much beyond a crisis state in NYS.

Sounds like that's an understatement! It's amazing how much the processes differ between regions of the country. Kentucky's mental health practices were abysmal for a long time, but the state has made it a priority to improve the system. Our problem is actually the opposite - we have people who desperately want to go to the hospital (usually borderlines wanting attention) and know exactly what to say to stay in. Our state hospitals have plenty of room, but the only reason is because of our crisis programs that try to keep them out if at all possible.

I do get very frustrated with the hospital on my end of the state because they tend to discharge people so fast. They love to dump very sick clients into the mental health centers because our state law mandates that they be seen within 5 days of discharge. Many times we have to send them right back because they are so obviously psychotic. For the most part, though, we have a decent system in place and are able to meet most of the needs.

Our biggest problems are homelessness and substance abuse. We get a lot of people in the crisis program who aren't really having a mental health crisis - they're just homeless and say they're suicidal to have a bed to sleep in. There are very few shelters in this state. The same with substance abuse; the waiting lists for rehab stretch into several years, and we don't really have any resources for medical detox. My agency is now building a facility for detox that includes housing for female addicts and their kids, but all 120 beds and 30 duplexes were spoken for before they even broke ground.

It's so frustrating not to be able to meet needs. So many people could dramatically improve their lives if they were able to access treatment. It makes me sick to see people who genuinely want help and are prepared to work hard, only to find that they'll have to wait five years for services.

winneythepooh7
01-24-2008, 09:40 PM
What sucks too, is that these populations are probably the most in need of real help and support. If social workers, doctors and nurses are burning themselves out because of how horrible the systems are, how is that helping anyone?

Sporadically, and then all the time towards the end, I used to cry at least once a week at that job. And it happened in front of my team on a couple of occasions. That's not good, or professional, at all. But I really felt powerless to making any kind of positive changes.

I was just starting to date my husband at the time I worked there and he used to get so angry, saying what a waste of tax-payer dollars programs like that are. He used to say I would go into work everyday, run around in circles and jump through hoops, to accomplish absolutely nothing, and be at a worse off place the next day when I went in.

That's probably the only place that threw me a huge party on my last day of work, and I had several of the "big bosses" take me aside in a seperate room and say they would try to come up with more money if I would be willing to stay.

NewMrs.
01-24-2008, 09:58 PM
In Pennsylvania, our state government decided to "save money" by shuting down residential treatment facilities and kicking out the people being treated there. A few months ago, a 19-year-old jumped off of one of the bridges in downtown Pittsburgh. The guy survived, but the article in the newspaper pretty much said that the kid had struggled with depression and had not been able to get the help that he needed since he had been displaced from a residential treatment program. The same article quoted several mental health professionals that were seeing a trend in incidences such as this.