By Stephen Smoot
A half-century ago a brazen, but unknown, reporter for a local New York City ABC affiliate made a journalistic choice that would end a long held policy concerning the mentally ill and, at the same time, rocket his career to a star status that he still enjoys today.
Geraldo Rivera, with help from disgusted facility doctors, smuggled himself and a cameraman under the fence of the Willowbrook State School. Not a psychiatric hospital per se, it became the home of up to 6,000 adults and children with varying levels of disabilities.
“Children, naked on the floor and smeared with their own feces . . “ was how Rivera opened the television report, naked and half clothed children wandering in the dark like zombies, fearful and wailing.
Bracketed with powerful cultural expressions about residential mental health facilities from the 1948 classic “The Snake Pit” to “One Flew Over the Cuckoo’s Nest” in 1975, scandals and stories alike turned Americans against the ideal of residential psychiatric hospitals.
For the State of West Virginia, the flagship mental health residential facility operated in Weston. Originally called the Trans-Allegheny Lunatic Asylum when first conceived before the Civil War, it carried the less unattractive moniker of Weston State Hospital for most of its operational existence.
At its peak, it held 2,400 residential patients.
The prospect of experiencing haunted hallways and ghostly apparitions of the dead who cannot rest draws tourists to the gigantic structure – which resembles something of both a palace and a fortress.
The facility closed in 1994, part of a wave of such closures across the United States from the 1960s through the end of the century.
A federal Substance Abuse and Mental Health Services Administration study showed that significant changes had occurred. From 1950 to 2010, the population of those in residential psychiatric and mental health facilities dropped from approximately 560,000 to 60,764 on April 30, 2010/
At the same time, however, the prison and jail population expanded considerably. The population of the nation almost doubled from 151 million in 1950 to 309 million in 2010. In those decades, the population of the incarcerated rose from a total of just over 171,000 men and women in 1950 to 1.6 million men and women in state and federal installations in 2010.
Additionally, last January, the United States Department of Housing and Urban Development counted over 771,000 homeless across the United States, though that number is certainly higher.
Also, a 2022 survey by the National Institutes of Mental Health showed that perhaps 15.1 million Americans experience some sort of severe mental illness.
The residential psychiatric hospital system as it once existed had serious issues.
WBOY recently quoted historian Titus Swan about life inside the institution. He said that stories of people simply abandoned on the grounds rarely occurred. Instead “there was always due process involved, so it starts there.” He shared that the hospital had a mixed record of treatment, that many turned out differently than they went in, but some had a positive experience, while others definitely did not.
Patients came in for a number of reasons, the farther back one goes in its history, the stranger some of the ailments seem. Modern eyes might pick out combat trauma from “decoyed into the army” or “exposure in the army,” or depression from “death of sons in the war.” Others might show what would be called today obsessive and/or compulsive behaviors.
By the 20th century, Weston also took in chronic drug addicts.
A mixed record would offer light years more improvement over the prospects faced by those today who would have been in Weston – or most other facilities – 70 years ago.
When the old residential psychiatric facilities closed, the needs of the State and the desires of progressive-minded people coincided. State governments, who usually operated the hospitals, spent vast sums on them, even though they generally remained underfunded and understaffed. Progressive-minded individuals imagined that life could be better for most patients outside of walls that tended to institutionalize, rather than cure, patients.
States saw closing the hospitals as a way to save money with progressive-minded people believed that releasing the patients gave them a more compassionate fate.
Patients thus had to go out in the world to contend with both their mental health problems and also figuring out how to navigate what most would call a typical adult functioning world. Some could go to families for help and shelter, and this was seen as a viable replacement for residential care.
What really happened was that patients with severe illness and/or addictions went out into society with instructions on how to obtain treatment and a handful of pills. Their lives would be their own responsibility – or the responsibility of whatever family or friends would care for them.
Instead of getting care from loved ones or support from community resources, increasingly the most challenged cases ended up in jail or on the streets. If they disliked the effects of their medication, they either went without or found illicit substances that may have helped with some problems, but brought many more dangers.
They also more often overwhelmed their family supports and created more issues affecting more people in this way. Family is rarely trained to provide expert care and, in too many cases, their resources were stretched to the limit even before taking on the responsibility of caring for someone with a serious illness.
Mental illness and drug addiction cases often form a Venn diagram with a great deal of overlap. The presence of one tends to make the other even more prevalent. Society tends to underestimate the ability of addicts to break their chains, even with strong support.
It’s time to rethink how America treats the chronically mentally ill and/or drug addicted. Compassion was lost long ago as the mentally ill and addicted gravitated from, in many cases, safe and secure facilities to prison, to the streets, to bad relationships where people take advantage, or even worse.
Many addicts and the mentally ill need structure that life in a free society cannot provide. Rules, structured schedules, a safe place to sleep, nutritious food, and treatment can help many live fulfilling lives within the boundaries imposed by their condition and the requirements of safety. The freedoms that others use to make choices everyday intimidate, rather than liberate, them.
They need the structure. They need safety and stability. They need the return of residential facilities as part of helping them find the right equilibrium in their lives.
Rebuilding the residential hospital system will impose a lot of cost. That said, millions of people homeless, in prison, committing crimes, enduring poor health, and a myriad of other problems that they cannot deal with also impose costs that taxpayers, one way or another, have to pay.
If the choice is made to return to this system, like repatriating illegal aliens, it will take time. Priorities should lay in bringing in those who have the lowest capability of function or pose the most threat to themselves and others. Then gradually expand capacity and resources until the need is met, a process that would likely take decades.
Fortunately, the State would have options. It could start with the former United States Navy Base at Sugar Grove in Pendleton County, currently owned by a private consortium looking for tenants.
States tried to do the right thing when they closed these hospitals and no one could predict the social disaster that would come of it. It’s time to address the problem by reversing course on residential psychiatric institutions.