Saturday, August 25, 2007
Requiem for a State Hospital
by Tory Butterworth
It’s been coming for a long time, but the final announcement was still a bit of a shock.
Perhaps, between presidential campaigns and other natural disasters, you missed the story. Mayview State Hospital will be closing at the end of next year.
Mayview was built by the City of Pittsburgh in 1897 and served as a home for the poor until 1941, when the Commonwealth of Pennsylvania took over its operations. The patient population reached a high of 3785 in June of 1967. There are slightly over 200 patients there now.
In the early 90s I had a job coordinating evaluation efforts for Unified Systems, a program where state funds were diverted to the county to pay for services that would, hopefully, help Mayview residents leave the institution. The basic question underlying this research was whether it was better for Mayview residents to live in a large state institution or the community.
Mayview became a state hospital in the era when the chronically mentally ill where placed in large, full-service institutions far from city limits. Many of these institutions encouraged residents to become involved in gardening, farming, or even operate small businesses. Directors often lived on the premises, adding to their insular feel. A friend of mine's brother who is schizophrenic still talks of his time in one state institution as, "the good old days."
Among mental health service providers, talking about closing Mayview can generate intense feelings. Some feel strongly that the state is “dumping” their responsibility for these patients, that many will end up in jails or living under bridges. Others look at a state hospital as the most restrictive and therefore least desirable form of care. The psychiatric medication available today allows many to live independently who couldn't have 40 years ago.
As an evaluator, I was expected to come from an unbiased position. I have to admit my one visit to Mayview didn’t leave me with any great love of the institution. And our data on community residences did seem to show more freedom there.
On the other hand, those still at Mayview are the lowest functioning of a very low-functioning population. Is moving them to smaller, community-based residences an improvement?
I think that part of the shock of Mayview’s passing is that it represents the end of an era. Nostalgia for the “good old days” can have a profound impact, even in mental health.
What do you think about Mayview closing?