You Don’t Have To Be Crazy To Work There, But It Helps

Today, as part of my psychiatry rotation, a lucky few of us were able to go on a field trip to Mayview State Hospital. This is a long-term inpatient mental health facility, what in older days might have been referred to as an insane asylum. In its glory days, it had 3000 patients, and a staff of nurses and doctors who lived on the grounds, sustained by the produce of its own farm. Today, it houses about 250 patients on the “civil” side, plus an indeterminate further number on the “forensic” side (patients who have criminal charges pending or are serving jail sentences, but who need serious mental health treatment). A handful are all-but-permanent residents; the majority will stay for weeks to months until they are finally stable enough to go out into that wonderful world we call “the community”. The doctors, nurses, and support staff live in Upper St. Clair.

building photo

When someone says “state mental hospital”, the things that come to mind are right out of _One Flew Over the Cuckoo’s Nest_: catatonics, raving madmen, experimentation on helpless victims, and therapies bordering on torture. From what I know of the history of mental illness in America, those stereotypes were true… decades ago. Now, they’re an almost polar opposite of the truth. I saw an extremely caring and well-trained staff taking care of patients who (with the possible exception of a few forensics) aren’t violent or “basket cases” — they’ve got delusions and depressions and behavior issues that make them unable to live in “normal” society, and they’re getting a pile of counseling (and some meds) to try to help them function. It reminded me a lot of the Alzheimer’s nursing home where I volunteered when I was much younger.

Why am I telling you all this? Well, for one thing, almost nobody realizes that Mayview is so close that you can actually take a PAT bus right onto the grounds (33D, Bridgeville). The bigger reason is because the state hospitals are important; they are, in many cases, the only thing standing between these patients and homelessness/injury/death. They are also under a lot of pressure to move more and more of their patients back into the community, at a faster and faster pace, and not always with all the necessary services in place. Depending on who you believe, we might already be shoving seriously ill patients out the door and allowing them to exercise their “right” to promptly go off their meds, spiral downwards, and end up in the local ER or shot by the cops. This isn’t a “psychopaths are living next to you, be afraid!” thing — it’s a “people who can’t yet fend for themselves are being thrown to the wolves” problem.

Mental health care in America receives nothing near the attention it deserves, when compared to what we do for more “physical” illnesses. Mayview is just one more place where this is happening. It’s an invisible problem, but it’s one worth knowing about, because it’s killing innocents every day.

(On a lighter note, if you’d like to see more photos, start here.

2 Comments so far

  1. Alison Hymes (unregistered) on June 16th, 2007 @ 5:07 pm

    The author of _Crazy_ never investigated state hospitals, he investigated jails. If he had investigated Virginia’s state hospitals, he would have found in some a situation a lot closer to One Flew Over than you would like to believe. People die on a regular basis in Virginia’s state hospitals from abuse and suicide/neglect, we lost a 30 year old man to a prone restraint a few months ago in one of our state hospitals and that’s just one we happen to know about, most deaths are not known to the public at all.

    Would you prefer to live in an institution over the community? If not,please don’t be so paternalistic towards the patients of state hospitals, especially if you have any thought of going into psychiatry as a specialty. A better question than why are we releasing people from state hospitals is why were segregated psychiatric hospitals built in the first place? Why weren’t people with psychiatric illness integrated into the mainstream of medicine all along? And in the “glory days”, those farms were worked on by patients who were not paid a cent, e.g. they were supported by forced labor.

  2. Alik Widge (unregistered) on June 17th, 2007 @ 9:12 pm

    Could you cite some stats or an article about the VA state hospitals? I’d be interested in reading them.

    Regarding the rest of your comment, I’m going to have to disagree with you. Were I to start manifesting a psychosis tomorrow (I’m past the age that usually happens, but one never knows…), I would indeed want a paternalistic approach taken; I’d like them to get some neuroleptics into me and get me back to my current baseline, because as far as I’m concerned, this is who I am.

    Autonomy is a key component of medical ethics, but it’s rarely asked: autonomy for whom? In a patient with a mental illness, I’d say the autonomy of their baseline functional self outweighs any presumed autonomy of their non-functional self. That also answers your question about why some folks end up institutionalized (long-term or short-term) instead of in the community — they’re fundamentally unable to comprehend and interact with society as you and I know it, and that inability gets them hurt and/or killed.

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