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?


Anonymous said...

I think it's short-sighted. As the population ages and those parents who now look after children who are unable to care for themselves or their dependent children, there will be a need to reinvent or provide alternative safe housing.

Better to improve the amenities of safe housing, de-institutionalise the institutions, than turf people out. That sort of action is unconscionable.

Anonymous said...

Thanks for visiting (and commenting) Jan. I think you're the furthest away blog commenter we've gotten so far!

So, let me see, is Australian time earlier or later than Pittsburgh time?

Anonymous said...

I have mixed feelings on this one, Tory.

I've visited Mayview and seen that, in many ways, it was like a prison where the mentally ill were warehoused, sometimes for life. And I don't have any doubts that properly funded and staffed community treatment is the better alternative for most patients. The problem comes with the "properly staffed and funded" part. At least in a big institution, the inhabitants will receive a minimum level of care -- food and shelter.

What seems to happen with community-based treatment is that a lot of seriously ill people are required to be responsible for themselves -- managing money, taking medication, following up on treatment, caring for themselves, etc.

There's a tendency to see mental illness either in terms of seriously dangerous (think Richard Baumhammers) or harmlessly quirky (Harvey). In real life, though, mental illness can be more analogous to being drunk. You wouldn't expect a friend who has just downed ten beers and two shots of whiskey in an hour to make a rational decision about whether or not to drive home. Yet society expects a person who may be just as impaired by mental illness to make much more complicated life decisions. As a result, many people end up living under bridges and self-medicating with alcohol and illegal drugs.

Yikes, this comment turning into a book on the subject. Enough said.

Anonymous said...

Yes, Gina, I think you've hit the nail on the head! State institutions can make people with mental illness under-responsible: reducing them to their lowest capabilities. But often community residences require them to be more responsible than they're really capable of. Where's the balance?

Framed in that way, certainly not an issue that's likely to change, even with Mayview's passing.

Anonymous said...

You folks are much better informed on this than I am. My only thought is it sounds as if nobody's coming out ahead on this.

My daughter, now an ICU nurse, recently flipped on the television and found herself watching One Flew Over the Cuckoo's Nest. For a few minutes, she marveled that somebody had taken the time to make a documentary where she'd done one of her practical rotations just 18 months ago---at the local veteran's hospital. I'm still aghast.

Great blog, Tory. Great comment, Gina! And it's nice to hear an opinion from Down Under, Jan!

Anonymous said...

Nancy: good reminder that great fiction conveys some form of truth, long after the specifics of a particular setting have changed!

Anonymous said...

Tory, what a great blog, and so timely. I am always amazed with the stigma associated with mental illness. We are talking about human beings, children, parents, brothers, sisters, husbands, and wives who are living in an institution.

The impetus for closing this state hospital is a law suit that finalized with any one who has lived in a state hospital for 2 years or more has had their civil rights violated. Since this is a large number of people, it was decided to close another state hospital.

Yes, there have been discharges in the past where needed services may not have been available. But being as involved with this process as I have as an employee of advocacy organization, I see that the state has been putting a lot of these needed services in place. Appropriate housing, Psych-Rehab, Social Rehab, Peer Mentors, Peer Specialists, Case Managers, Community Treatment Teams will all be in place to assist these individuals as they move into our/their communities.

The process that will help them adjust into the community is not as simple as you may think. There are three assessments. One is the clincal assessment which is completed by the staff at Mayview. In addition, which is equally important there are peer to peer assessments and family to family assessments conducted by my staff. This information (the opinions of the "professionals" and family as well as what the individual feels that they need and want) are reviewed in a meeting that includes all parties as well as county representatives, family advocates, individual advocates and peer mentors. A suitable plan is then developed before they are discharged.

They next phase of this is that they are interviewed regularly by peers (again, my staff) to assure that they are getting the services they need. Any problems, (i.e., not enough food, problems with budgeting, not seeing their case worker enough, seeing their caseworker too much, etc.) are reported and reviewed with the county during an accountability process.

This announcement to close Mayview only steps up what has been going on for some time. This process that I described has been going on for a year. The planning and allocating of money for these services has been in the works for quite a bit longer.

Presently, we are lucky to have a very supportive state and county government.

We need to bring our loved ones home. THEIR HOME.

Anonymous said...

I also have to admit that I'm not educated about this situation, so I can't really comment one way or the other.

Having said that, though, I do wonder and worry about the future of the patients.

Anonymous said...

Alan: Glad to hear there are so many services being offered these people! I feel better knowing you're part of a staff working hard as their advocates.

I do have to add, however, that one of the concerns is that the money in place while the state institution is in the process of closing might dry up at a later date, without anyone being the wiser.

I guess that's where advocacy organizations come in? :-) (Not to mention the rest of us.)

Anonymous said...

Tory, interesting post. I work right off Mayview Road, only a couple of miles from Mayview State Hospital, and I didn't even know it was closing and wouldn't have thought of all the issues you brought up if I had. Thanks for the information and education -- lots of food for thought from all who shared here.

Anonymous said...

Tory, you hit the nail on the head. There presently is pending legislation stating that the sale of Mayview (Upper St. Clair area) should go to the services of people recovering from mental health diseases rather than going into the genaral fund. It does take of of us to notify their legislators.

Anonymous said...

Alan: Glad to hear there is pending legislation! Is that at the state or county level?

Anonymous said...

This is state legislation. Although Allegheny Co. has most of the 220 patients in Mayview it does serve 4 other counties. I'm sorry but right now I cannot remember who has sponsored it.

Anonymous said...

Back in 2000, I was in the Bengs unit of Mayview. I was sent there due to multiple hospitalizations for my Bipolar Disorder. I remember being scared to death. I meet the Dr. G on my first day there and he said that the Dr that sent me there was a idiot for sending me there and that this was not a place for me. I remember having to sit in a day room all day with barely anything to do. There wasn't much therapy, or activities for the patients to do. Dr. G told me if I follow my treatment plan he would have me out in 30 days. The Dr. that sent me there wanted me there for 90. I meet a wide variety of people with many disorders. I was 19 when I was sent there. I am stable now, but I can remember talking to some of the other patients about how long they have been there and most of them where there for over ten years. Some because they were not getting better, others because there families gave up on them. I can see why some of them never go better, just being in the day room for 14 hrs a day would drive a normal person crazy. What do you think it would do to some one that had a mental illness? I think that residential programs need to be more available in all counties that use Mayview, and that Mayview needs to re-evaluate how they treat patients. It could be a better place if the DPW cared more about helping people rather than hassling them. I don't think people should be allowed to stay more than a year in a state hospital unless they are diagnosed as Criminally Insane.

Anonymous said...

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