Today’s state hospital patients sit idle on massive grounds designed to sustain meaningful work.
Author: John Hirschauer
Though it’s often said that America “closed the asylums” in the twentieth century, every state still operates at least one public mental institution. These facilities, called state hospitals, are the last stop on each state’s continuum of care for people with serious mental illness. Patients typically get admitted after an insanity plea, a declaration of incompetence, or a court finding of grave disability. Unlike patients at general hospitals’ psychiatric wards, those at state hospitals often stay for months, even years.
As an artifact of nineteenth- and twentieth-century mental-health policy, today’s state hospitals are often set on mammoth physical plants in small, rural towns; many operate on the same grounds as the old asylums. Those facilities, conceived as self-contained therapeutic farming communities for the mentally ill, downsized after the passage of the 1964 Community Mental Health Act. The vestigial population that remained behind, plus the dwindling number of patients later admitted, filled the husks of the properties, which officials rebranded as state hospitals.Instead of resigning patients to drugged-up days on locked wards, state hospitals should reopen their farm and occupational-therapy programs, paying patients commensurate with work performed. Doing so may be costly, but improving institutional care can reduce violence on hospital wards and, eventually, violence in the community if patients are discharged. The work may have the “emphasis of a different social era,” as Schwartz put it, but the structure and dignity it provides are perennially valuable.