Some States Refuse to Board Hospital-Closure Bandwagon

Downsizing has been the name of the game at state mental hospitals since the 1960s, when President John F. Kennedy signed the Community Mental Health Act, and America started the huge process of moving tens of thousands of patients out of mental hospitals and back into the community.

For instance, the population of New York state’s psychiatric hospitals plummeted from a high of 93,000 in 1955 to some 6,000 today, according to an article in the May 30 New York Times.

The downsizing has gotten to the point that even some people working close to the scene get the impression that all state mental hospitals will soon be closing their doors. For instance, as Rick Foster, a licensed practical nurse who has worked for 14 years at Montana State Hospital at Warm Springs, told Psychiatric News: “It scares me that hospitals all over the nation are closing.”

But are they?

True, some undoubtedly are. For example, when Tatjana Caddell, D.O., left Oklahoma three years ago to become a staff psychiatrist at Montana State Hospital, “They were closing the Eastern State Hospital in Oklahoma,” she said. Virginia’s governor has proposed closing three of Virginia’s 15 state mental hospitals, according to the April 11 “Virginian Pilot” on the Web.

However, a number of other state mental hospitals do not appear to be shutting down, according to Rajir Minhas, M.D., acting medical director of Montana State Hospital. Minhas attended a meeting of the National Association of State Mental Health Program Directors recently, which was also attended by representatives of state psychiatric hospitals from Arkansas, Connecticut, Louisiana, Maine, Minnesota, Texas, Wisconsin, and several other states. None of the conference participants talked about shutting down state hospitals, he said in an interview with Psychiatric News.

In fact, a number of state mental hospitals appear to be getting new facilities. A prime example is Montana State Hospital (Original article: see accompanying article). “Utah has recently built new facilities on their Utah State Hospital campus,” Ed Amberg, administrator of Montana State Hospital, told Psychiatric News. “Wyoming is looking at building a new facility on its mental hospital campus. State Hospital North in Idaho recently built a new facility.”

According to a January 24 article in New Jersey’s largest newspaper, the Star-Ledger, a new state-of-the-art psychiatry facility will replace the hulking, asylum-style Greystone Park Psychiatric Hospital in Parsippany. And as Thomas Gray, M.D., a young psychiatrist who left Maryland earlier this year to join the Montana State Hospital staff, said: “As I understand it, there is a recently completed mental hospital on the Eastern Shore of Maryland. I also think Crownsville Mental Hospital in Maryland is planning to build a new hospital.” So it doesn’t look as though the state mental hospital as a phenomenon is going to vanish any time soon, although as Amberg conceded, “Ten years ago, everybody was wondering whether state mental hospitals would continue to exist.”

So what form might state mental hospitals take during this coming decade? “Across the country we are seeing a greater proportion of state hospital patients who are committed [through] the criminal court system,” Amberg said. “I think that trend will continue.”

“I think there might be a greater proportion of personality disorder patients,” Gray predicted, “because the newer medicines are getting patients with schizophrenia out of the hospital,” yet medications are having only a limited impact on patients with personality disorders.

Caddell concurred with him: “If things keep going the way they are, we are doing a really good job with the schizophrenia-spectrum patient. What we haven’t handled yet are Axis II disorders such as personality disorders. This proportion of the mentally ill population is very difficult to deal with. They are time consuming and labor intensive,” she said, “and need a lot of attention and reassurance—things you can’t get from medications.”

In fact, Caddell anticipates that the state mental hospital as a phenomenon will be around for a long time yet. “Maybe some of the hospitals will be more regional, depending on the population,” she said. “But I think there will always be a need for a place for the severely mentally ill.”

Gray agreed: “I think there is going to be a role for hospitals like this for the severely and persistently mentally ill.”

And Minhas added that he believes “state mental hospitals will always be there. But their role will change, I think, from being long-term institutions to more acute-care ones.”

More information about the status of state mental hospitals can be obtained by visiting the Web site of the National Association of State Mental Health Program Directors at www.nasmhpd.org. ▪