A lost opportunity to avert tragedy for the mentally ill

 

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A question has nagged me since the early 1970s, when, as a reporter for United Press International (UPI) in Harrisburg, Pa., I jumped into one of the most complex stories of my career, the plan to close state mental hospitals.

Could journalism have done more to avert the disastrous way our country treats the mentally ill? Should we have asked more questions?

On the surface, closing state hospitals was an attractive idea. The philosophy was simple: People who were mentally ill had the same rights to freedom and happiness as the rest of us and were unlikely to achieve those freedoms in confinement.

Those hospitals were big, hard, difficult to run and ultimately declined into maintenance facilities for the people no one knew how to deal with. We warehoused them. In some cases, particularly with youngsters, we moved them as far away as we could from their families, which made visiting difficult.

There, they experienced a range of treatments that stretched from compassionate care to criminal abuse, depending on the facility and its staff. It was hard to monitor and expensive to finance.

Deinstitutionalization was going to solve those problems.

But we—journalists—didn’t do enough to follow the decline of services. We didn’t tell this as a human story with consequences that would play out over time. We covered the closings and then moved on to the next story.

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This deinstitutionalization was actually a social and budgeting experiment in disguise, but we didn’t realize it at the time. The thought was that those troubling old facilities would close and the mentally challenged would be served in community living centers. They would become part of the passing river of life.

The legislature, now with funds no longer needed by state hospitals, would appropriate the money necessary to finance this new system (with help from the federal government) and welcoming communities would open their arms to help guarantee rights for these needy people. Medicines would be dispensed to keep everyone calm, their peculiar demons held at bay by brain drugs that disrupted everything from mobility to personality.

This deinstitutionalization was actually a social and budgeting experiment in disguise

There were so many problems with those thoughts that it would be tedious to write them down here.

I think the best way to put it is that the program never worked properly, the money was never enough and the communities never opened their arms, for the most part.

Journalism as a watchdog had a very short attention span (and me too, as a journalist). We were like firefighters in that era, responding to each day’s particular alarm and never quite getting the time we needed to follow things up. Wire service reporters were the first responders of journalism. Men and women with jobs on the big papers could get the time to pursue stories in greater depth, but that usually wasn’t the case in the vastly competitive world of wire service reporting.

Journalism as a watchdog had a very short attention span…

Had we been watching closely, the irony of the tragedy would have become apparent as it unfolded. Closing hospitals to assimilate the mentally ill into society was actually leaving them even more on the fringes. Maybe telling the story with more passion, more frequency, would have helped. But maybe not.

The foundation for what has now become an American public policy nightmare was solidly constructed on good intentions, of both policymakers and journalists. There are people who dedicate their lives today to helping repair the consequences, but that is a most frustrating mission.

I have friends who work with mentally challenged people of all kinds. The stories they tell don’t often make it into media, but they are as sad as you might imagine. We have inadvertently created a whole “other” class in society that includes everyone from schizophrenics to drug addicts to alcoholics to people who are simply troubled but not yet officially diagnosed.

A lot of them are on the street. Or, because of their behavior, they end up in Cook County Jail, where people trained to guard criminals find themselves functioning as social workers.

Some of them you might pass every day on the way to work, particularly if you work south of the river in the Loop. They are begging for money and sometimes seem vaguely threatening or completely defeated. Some of them are working a sophisticated con that depends on your good intentions and sympathies.

But of course, you can’t tell one from the other.

Public Broadcasting investigated the problem on one of its “Frontline” shows years ago. Citing a 1997 study, researchers concluded that 763,391 severely mentally ill people were living in communities who would have been hospitalized four decades before. And these are old figures. The problem has surely not improved.

Madigan on assignment in 1972.
Madigan on assignment in 1972.

And so I am voicing a “professional regret” here for a mistake I cannot repair. I tried to get a Stanford University fellowship in the mid-1970s to study the consequences of the emerging rights for the mentally ill. But everyone was focused on China that year, so it didn’t happen. I am sorry for that.

I was intrigued enough by the change that I wanted to follow it, but that’s not how UPI worked.

We speed-skated from crisis to crisis.

The object lesson it presents is about journalistic focus. In an era of declining media interests, the danger is that not many institutions will have the assets (or the interest) to attack such a difficult subject. That would compound the tragedy. It needs focused, long-term attention in the news.

Instead, we get a lot of “pity the poor street people” coverage and not much focus on Springfield and its responsibilities to fund solutions. “There’s no money” is always a good explanation for doing nothing.

Like many other things in declining parts of our culture, this mental health problem will draw attention only when it reaches the crisis stage—just as it did when the old hospitals were closed down.

We will scramble around for a quick solution, then start the whole sad cycle again.

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