The Sunday Story: Lost Mental Hospitals, Lost Patients

If you drive a couple hours north of Seattle, you'll find a lush valley, miles of farmland, gray mountains in the distance. And the ruins of an old psychiatric hospital. This hospital Northern state opened more than a hundred years ago. It once had a working farm and its own power plant. Here's Sydney Brownstone, an investigative reporter with The Seattle Times describing it.

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Sprawling campuses with armies of doctors and nurses employed by state governments.

Have disappeared most of those vanished in a single decade? From 1970 to 1980, this movement was called deinstitutionalization. The idea was to transfer patients to smaller treatment centers in their communities, but it didn't go as planned.

And today, it's widely viewed as one of the most disastrous u.

S policies of the past century. In the new podcast Lost Patients, reporters from Seattle Public Radio Station KUOW and The Seattle Times delve into this history. They try to understand how we've ended up where we are today, with seriously mentally ill people cycling between emergency rooms, jails and homelessness. What went wrong?

After a break, Lost Patients host Will James tells that story through the rise and fall of Northern State Hospital.

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With respect to mental illness, our chief aim is to get people out of state custodial institutions and back into their communities and homes without hardship or danger. In the 1960s, two ideas of mental health care were colliding. For decades, society had leaned on psychiatric hospitals to hold patients it saw as having little hope of getting better. To separate them from everyone else, sometimes hide them for the rest of their lives, this is called custodial care.

But President John F. Kennedy was pushing a new model. Getting patients better and returning them to society as quickly as possible with the help of these new antipsychotic drugs. When Kennedy's sister, Rosemary was 23, she underwent a lobotomy, leaving her mostly unable to walk or talk. She spent the rest of her life in institutions, Kennedy informed by this family history.

Challenged states to get people out of custodial care and treat them closer to home. He envisioned a country where, quote, the cold mercy of custodial care would be replaced by the open warmth of community. Kennedy's 1963 Community Mental Health Act set aside one hundred fifty million dollars to build and staff fifteen hundred community mental health centers around the country. If we launch a broad, new mental health program now, it will be possible within a decade or two to reduce the number of patients now under custodial care by 50 percent or more. Kennedy signed the Community Mental Health Act into law on Halloween 1963..

It was the last bill he signed.

The rhythm of the hospital changed in 1955. Northern state was at its peak, with twenty two hundred patients at any one time. By 1970, that number was down by almost two thirds, to seven hundred patients at a time. There was almost one employee for each patient, and the numbers kept dropping.

Washington had three state psychiatric hospitals in three corners of the state northern, western and eastern, and all three saw their daily populations shrinking to psychiatrists. This was all part of the plan of deinstitutionalization. There were still thousands of people admitted to the state psychiatric hospitals every year. They were just cycling back out much more quickly, so there were fewer patients on the campuses at any one time.

But their bosses in state government saw it differently. The Northern State Hospital staff compliment remains at 481, serving approximately 300 patients. The per diem costs at Northern have risen correspondingly from twenty two dollars and forty five cents last year to thirty five dollars and seventy eight.

It wasn't long before Evans, trying to balance the budget, started eyeing Northern State, the smallest of the state's three psychiatric hospitals with a shrinking patient population and the highest per patient costs.

State Senator Lowell Peterson was a Democrat whose district covered Northern state. And I, frankly, can't readily adapt myself or my thinking to the fact that we're going to displace some four or five hundred people and automatically transpose them overnight from northern to western. And the community mental health centers are going to take care of all of our problems at a less expense, people in Governor Evans's administration were adamant.

Community Care was ready to pick up where Northern State left off. For the purposes of our budget discussion, now, we again recommend the closure of Northern State Hospital as a state psychiatric hospital. Governor Evans got his wish Northern State Hospital would shut down by the end of 1973..

According to newspaper stories from the time, Evans's administration thought closing the hospital would save something like 14 million dollars over two years. And of those savings, some went back to Cedra Woolley, the town where Northern State was to ease the economic pain of the closure. And only a fraction was reinvested back into mental health.

But you would think, because such a fuss had been made about creating this new system of community health care, that we would prioritize. Putting whatever money we had towards that promise.

Joanne McInnes was a nurse at Northern State Hospital, and when the hospital closed, she was part of a group of nurses. Who got transferred to one of Washington's two remaining state psychiatric hospitals. Western State, about a two hour drive to the south. Joanne's, now in her 90s, and Sidney Brownstone, of the Seattle Times, talked with her at the retirement home where she lives, not far from the old Northern State campus, which now sits abandoned. I felt like the patients weren't taken care of, there wasn't the follow up.

And the support systems knocked out. I wish it would have stayed open when we could have done more.

Some went into the community, some were put on the streets. It would be years before people started taking stock of what happened to the lost patients of Northern State.

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I'm Will James. This is lost patients as Sidney Brownstone of The Seattle Times sits with former nurse Joanne in her retirement home on a whim. She asks about a particular patient, one among thousands who passed through the hospital while Joanne was there more than half a century ago.

Phil would later tell a reporter he was sent to Northern State on a bum rap just for being noisy and talking a lot. He talked continually, he just went on and on and on. And how he managed to cram so much information into that head of his and where he got it, we do not know. But you could walk on the grounds. And I swear he knew what your name was, who you were married to, how many kids you had.

No matter what, where you lived, he just had this appetite for knowledge about each individual employee. It was just amazing. Three years after he was committed, Phil was lobotomized. He was 19 years old. It didn't stop him from talking a lot, but it did give him lifelong neurological problems.

He spent his days wandering the city, chatting people up. Carrying a bag that had 17 pipes in it. When one pipe got too hot, he said he'd put it away and pull out a new one. Phil was struggling to live on $226 a month in social security. A caseworker spent weeks trying to connect Phil with resources. But Phil's particular problems didn't fit neatly with any of the help that was available. Each agency just referred him to another agency.

The caseworker said Phil was one of the toughest cases he had ever seen. At one point, Phil's friends threw a Halloween party to raise money for him. Phil dressed up as a mafioso. The party raised $375. Years after Phil left Northern State. This is who looked out for him.

Not any kind of system, just a cobbled together network of people he had managed to charm. What does Phil Dyro's story represent? What does it tell you?

He didn't have a lot of money, his, he had to move every so often. He was thrown out into a world that had very few resources for the problems that Northern state gave him.

Desperate, he called Northern State for help. Even though it had been closed for more than a year, the call went to the campus's electrical plant. By the early 1980s, it was clear all around the U..S that deinstitutionalization had gone disastrously off course from national public radio. This is Horizons.

This NPR story from 1984 documents a phenomenon people were seeing in cities all around the U.

S at that time, a rise in people who seemed seriously mentally ill and were living on the streets. In this edition of Horizons, Frank Stasio reports that some experts fear the streets have become the asylum of the 80s. After more than two decades, deinstitutionalization has yet to be carried out as it was first planned. While hospitals have emptied their beds, follow up care is erratic and often neglected.

By the early 80s, state psychiatric hospitals had been shrinking and closing for two decades. Meanwhile, the rollout of community care was slow, and eventually those efforts stalled because of funding problems. A decade and a half after, Kennedy called for 1,500 community mental health centers, only half of those were built. Patients left the hospital for locally operated halfway houses and community mental health centers. But the dollars never followed.

Deinstitutionalization has been going on for an awful long time. There's been a lot of time to figure this out, isn't it? Well, you'd think we'd figure it out, but in fact, the deinstitutionalization has been a horror. Psychiatrist e.

Fuller Torrey spoke with NPR in 1984.

Fuller Torrey would later become a leading voice, calling for more involuntary commitment and a foil for patient rights groups. But back then, he was reflecting what a lot of mental health workers were seeing deinstitutionalization itself was perfectly legitimate. A lot of these people can live outside the hospital.

However, we fail to set up programs to take care of them. In 1980, President Jimmy Carter tried to revive Kennedy's vision by signing the Mental Health System Act, which set aside more federal money for community mental health centers. But less than a month later, Carter lost reelection to Ronald Reagan, who repealed Carter's bill and slashed funding for mental health care. The community mental health centers that did exist provided a mishmash of different types of care. The latticework of agencies, rules, and entitlements.

While these centers technically treated mental illness, many of them catered to people who were very different from the patients who had been at state psychiatric hospitals. Chris Hudson, the social worker and academic, says they focused on treating what some call the worried well, people who live pretty normal lives but want treatment for things like depression and anxiety.

It turned out these drugs were useful tools for managing psychosis, but not a cure. By the 80s, there had been no major advances in these drugs for three decades. In some cases, the side effects were so brutal, patients couldn't tolerate them stiffness, trouble walking, uncontrollable restlessness, feeling sedated, weight gain.

And the drugs could only work if patients took them. Some suffered from anosognosia, not believing they were sick, and others couldn't make or keep appointments. In these cases, community care was not designed in a way that actually reached the people who needed it.

There was something else going on, too, something that's often unappreciated in the story of how deinstitutionalization contributed to people with serious mental illness ending up on the streets. Kennedy's vision was to treat patients quote in their communities and homes. Community care assumed that seriously mentally ill people could find places to live. From the 1970s onward, in many cities around the U.S, homes for the poorest people were disappearing. Kim Hopper, an anthropologist who has studied mental illness and homelessness, also talked with NPR in 1984.

The difference between the absolutely abject marginal population today and the absolutely abject marginal population of 15 years ago is that. 15 years ago they could afford crappy housing, and today there isn't even any of that. Here in Seattle. The city's center was home to canyons of residential hotels, where, for decades, thousands of the city's poorest people could rent a room for a few dollars a week. These were called single room occupancy buildings, or SROS. Many were fire traps and poorly maintained.

But SROS were a reliable source of housing someone could afford on government assistance or poverty wages. Just as deinstitutionalization swept the country, these residential hotels got regulated and redeveloped out of existence, sometimes transformed into more upscale apartments. Newspapers documented these closures.

This is an era of massive change for the most vulnerable people in our society. And yet that wasn't really felt by middle class or otherwise comfortable people at all. So even during this time of great change, it kind of was like motion under the surface. It went by without a lot of comment, without a ton of political strife, and we carried on as if things were normal. Until we fast forward 20 or 30 or 40 years, and all of those decisions that we made are breaking through the surface.

Oh, wow. The headline of this piece is The mentally ill victims of an experiment that failed, and this is a piece by an editorial writer. Crowds. This is how it begins.

Crowds rush past them on downtown streets, pretending not to hear their confused or angry chatter. They are studiously avoided when they wander through neighborhoods, occasionally, when they become a nuisance or create a disturbance, the police are called.

People are bouncing from the Morrison to the downtown King County jail, to Western and back again. We've been stuck in the same calcified loop for 40 years. And it's also like, what is even the point of my job? Then? If I keep writing the exact same sentences that someone 40 years ago was writing, why do I exist? Why are we doing any of this?

Because clearly presenting people with the same information over and over and over again isn't doing anything. It's like we have made a decision as a society to not care about this or that we are OK with this. And then what does that say about us? That we have been reading these same stories in our newspapers in every American city for 40 years, and we've decided that that is OK.

And mental health is not one of those problems, it's something people in power really don't want responsibility for. That helped unlock something for me. Responsibility, I think, is the real story of deinstitutionalization.

While it started as a civil rights movement, ultimately it created an opening for people in government to escape from a responsibility they didn't really want. A responsibility that cost a lot of money, was complicated to manage and never delivered satisfying political wins. And once people in government saw that opening, they slipped through it. For a century, we lived in a country where pretty much one entity, the state, took responsibility for seriously mentally ill people, and deinstitutionalization was the moment that ended.

The state, which was once a provider of care with its own army of psychiatrists and nurses in state-run hospitals, became more of a funder of care. Giving out money to a mishmash of nonprofit organizations and local agencies to handle things. If you go to downtown Seattle today, you can see this fractured responsibility spread out among jails, emergency rooms, homeless shelters. Like Seattle's Downtown Emergency Service Center, or DESC, known for taking on this city's most difficult cases of mental illness and substance use. On the sidewalk outside DESC, you can find a bronze leaf embedded in the cement with a name etched on it. Phil Dyro advocates put it here to memorialize him after he died in 1999. It fits that his saga would start at Northern State Hospital and end here, outside one of the many broken up islands of refuge that replaced it.

Until then, have a great rest of your weekend.