Two stories in today’s Boston Globe caught my eye. The first is a look at the reuse of old, closed public psychiatric hospitals throughout the state, mostly being turned into some type of housing. Typically developers purchase the properties (which is a lengthy, difficult process because the legislature must approve the sale of this public property), tear down most of the old buildings and structures, but keep one or two historic structures which are rehabilitated. Then new housing, typically apartments, condominiums, and/or affordable housing units, are built around the old structures. Since most of the old psychiatric hospitals were on vast scenic grounds (sometimes up to 200 acres), these are often pretty locations which bely their sometimes less-than-stellar approach to treatment of the mentally ill.
Why did these hospitals close? In the 1970s and 1980s, mental health treatment of the severely mentally ill switched from the warehousing psychiatric hospital approach — where patients often lived their entire lifetimes in the hospital — to smaller, group home settings, outpatient care, or day-treatment settings when possible (and some would argue, to homelessness for many). This is generally a good thing, as these newer approaches emphasized actually helping the people get better, learn new coping and life skills, and tried to help foster and nurture independence (rather than dependence on the state).
But psychiatric hospital still exist. Today, they are nearly all privately-run, for-profit hospitals. The average inpatient stay has gone from months, to 30 days, to its now current average of just 9 days. Some would say this is because our treatments have gotten so much better in the past decades, but some of us who are a little more cynical might point out that insurance companies don’t like to pay for any inpatient care beyond 30 days per year. So it’s in the patient’s best interest not to use them up all in one stay if there is a history of hospitalization.
So you’d think, in the intervening 30+ years of change from the 1970s and public psychiatric hospitals, we’ve learned a thing or two about people, their emotional needs, and treating them like, well, you know, human beings. You’d also think that someone who checked into a private psychiatric hospital would enjoy the benefits offered even to prisoners in our penal system. Simple things, like, fresh air.
Well, as the Globe points out in the second article, you’d be wrong. Many patients in private psychiatric hospitals are denied simple comforts such as fresh air, unless — ironically enough — they have to smoke. The people in charge claim this is for the patients’ own protection, since many are there for self-harm or suicidal behaviors or thoughts. Okay, but it would seem fairly obvious, even to me, that you could provide people with the opportunity for fresh air and watch to ensure they don’t try and kill themselves for that hour or two they are in a courtyard or such. It seems like a cop-out to say it’s for patient safety when it really boils down to not treating people with the simple respect and human decency they’d deserve.
I’d ask David Matteodo, quoted in the article, is that they way he would like to be treated if he were a patient? Is that the way he’d want to treat a loved one? Honestly, this is such a simple thing to offer, I would refuse to go to any psychiatric hospital that didn’t provide this basic human need.