From mental health reform to homelessness

    This morning in the Baltimore Sun there was a story about the sale of the Spring Grove Mental Hospital complex to UMBC.  The State will lease back the hospital for the foreseeable future but eventually, it will probably close.  The State has done similar things to Springfield Hospital and Crownsville all of which were the locations for mental health treatment for the past 100 years.  Closing these institutions and transitioning care to community settings was the basis of the reform movement of the early 1970s. The development of psychotropic drugs to manage mental illness was supposed to make this transition possible.  The reality was that the drugs made people even less able to function independently.   In 1972 I worked in a psychiatric halfway house in DC.  The halfway house movement was supposed to be part of the transition from hospital to the community.  I remember going to St. Elizabeths Hospital  to pick up patients to bring to the halfway house.  The hospital sat in the best location in southeast DC for a view of the city.  I always remember standing and admiring the view and thinking how much a developer would pay to build homes there with that view of the city.  Now, much of the land is used for Homeland Defense offices.

      Like so many reform efforts to move people from institutions to the community, the mental health deinstitutionalization movement has had more failures than successes.  The lack of transferring the money from the institutions closed to create community resources has meant that many people with mental illnesses have ended up in homeless shelters or living on the street.   The money saved in closing the institutions was never tied to the development of new community services but got spent for other more politically popular government services.  The mentally ill population is politically weak and relies on others to advocate for their needs.  That reality and the stigma of mental illness will probably always mean that when dollars get allocated for government services the mentally ill will be shortchanged and the streets will remain where many will be deinstitutionalized to.