Bring Back Asylums or Fund What We Already Have?

“It’s Time to Bring Back Asylums” (Review, July 22) is a reminder of how neglecting people living with untreated mental illness has compounded the risk they pose. When the big state psychiatric hospitals were closed, the money saved was meant to go to community treatment and housing. Instead, governments pulled funds to reduce taxes and build prisons. With the best of intentions, America emptied these hospitals without ensuring that released patients would receive the necessary treatment.

Law-enforcement and healthcare workers have borne the burden ever since. Emergency rooms must treat patients in crisis without the possibility of long-term care. Police must subdue people who aren’t of sound mind.

We should consider bringing back asylums or reinvesting in public psychiatric facilities. Until more resources are allocated for community treatment, our jails and prisons will remain the repository of our mentally ill. Yet with proper treatment, many people overcome their illness, contribute to society and live happy lives.

Dottie Pacharis

Fort Myers, Fla.

Thirty years of practicing psychiatry, including several in jails and prisons, along with critical advances within the field, have shaped my thoughts about severe “mental illness.” For one, it will be useful to stop calling schizophrenia a mental illness. It is a neurological illness with neurological symptoms in every sense that Alzheimer’s dementia is a neurological illness. If grandma with Alzheimer’s is found wandering the neighborhood, looking for her deceased husband, we manage her with greater compassion and realism than we do with a homeless lady in her 30s with schizophrenia, who won’t take reasonably useful medications because she “knows” she doesn’t have schizophrenia.

David Hager, M.D.

Kerrville, Texas

Deinstitutionalization was the right concept—asylums were indeed horrible places where patients languished out of view—but its shortcoming was the lack of proper funding. That remains the case today.

Community mental-health centers, which are a front door to the behavioral-health system and early treatment, operate under the strain of a workforce crisis. The only solution is higher rates of reimbursement to enable higher clinician pay. A study of ours found that for every 10 new clinicians hired, 13 are leaving.

Some people who are a danger to themselves or others need hospitalization, but the infrastructure already exists for that. Fully funded community mental-health services will help this population. Institutions were the locus for unspeakable abuse and neglect. Who is to say that anything would change in newer buildings?

Lydia Conley

Association for Behavioral Healthcare

Framingham, Mass.

In his 1981 budget submission, President Ronald Reagan included repeal of the bipartisan Mental Health Systems Act of 1980. Soon thereafter, many mental-health facilities were emptied. The administration had signaled that the actions Reagan took as governor of California—reducing state funding and support for mental institutions—was now national policy. As a teenager then living in Northern Virginia, I saw the outcome: A mass of homeless mental patients flooded Washington’s streets and Metro grates.

Simsbury, Conn.