Mental health spas; how money intended for homeless psychotics went to suburban neurotics

Washington Monthly, Dec, 1990 by Andrew Bates

Mental Health Spas

Remember the dozen or so homeless people you saw sleeping in the park or scrounging for food on your way to work this morning? Had the nation's Community Mental Health Centers (CMHCs) been doing their job providing basic care and treatment for the mentally ill, one-third of them--the homeless afflicted with schizophrenia and other forms of psychosis--would have been off the streets. Instead, more than twice as many Americans with serious mental illnesses are living in public shelters and on the streets than in CMHCs. And not only are the mentally ill being cheated, so are the rest of us: After all, the federal government is still spending $20 billion a year for this "care."

This isn't what the initial proponents of deinstitutionalization had in mind. Deinstitutionalization--the transfer of the nation's mentally ill from large state mental hospitals to local CMHCs that would provide more specialized care and treatment--was supposed to represent, as President Kennedy said in a special address to Congress in February 1963, a "bold new approach" to caring for the mentally ill. Proposing the establishment of a national network of CMHCs, Kennedy proclaimed that "reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability."

This initial vision has been perverted by so many CMHC directors and officials at the National Institute of Mental Health (NIMH), that care for those with chronic mental illnesses is, according to a recent report by the Public Citizen Health Research Group and the National Alliance for the Mentally Ill, "a disaster by any measure used."

Compounding this disaster are the nation's psychiatrists, the vast majority of whom have been trained at least in part with federal funds (over $2 billion) and who've repaid their debt to society by abandoning the public sector in droves for lucrative private practices, where instead of ministering to the miserable, they cater to the comfortable. Also culpable are guilt-ridden liberals, advocates for the homeless, and ACLU lawyers, whose generosity in defending the "right" of the mentally ill homeless not to be hospitalized or to be given medication against their will has enabled these unfortunates to keep those rights, but little else.

Outraged? You should be--especially once you learn what many of our federally funded CMHCs are being used for. Take the Park Center in Fort Wayne, Indiana, for example. Its 1989 advertising brochure points out that "counseling services" are available for those afflicted with such severe mental disorders as "unhappy relationships," "anxiety," "procrastination," "an inability to communicate effectively," and "poor job performance."

What the advertising conveniently fails to mention, however, is that taxpayers spent $12.7 million on Park Center (originally known as the Fort Wayne CMHC) so that it could provide basic services for the region's mentally ill, not high-priced psychotherapy for its anxiety-ridden elite. Instead of complying with its federal mandate to serve the mentally ill, Park Center is--quite literally--leaving them out in the cold.

Then there's the Battle Creek Adventist Hospital in Michigan, which received more than $700,000 in federal funds to construct a new building and become a CMHC. Since the 37-bed unit was completed in 1971, this taxpayer-subsidized facility has operated exclusively as a private psychiatric hospital; space designated solely for CMHC use has been given instead to the hospital for its X-ray department, laboratory, and storage needs, none of which benefit the mentally ill. An independent inspector's report following a 1987 visit to the site puts it plainly: The Battle Creek CMHC "as originally conceived never materialized." Meanwhile, nearly 7,000 mentally ill homeless, many of them the intended patients of Battle Creek who were never treated there, are now wandering the streets of Detroit.

Club Mad

What's occurring at Park Center and Battle Creek is symptomatic of the larger tragedy that has befallen the nation's mentally ill: While federal funds are being used to support private care for the worried well, those with serious mental illnesses are finding it increasingly difficult to get proper psychiatric care at the CMHCs obligated to serve them. "It is likely that thousands of mentally ill people were not able to find treatment because federal funds in their communities were spent on [facilities] that did not provide services they could afford," says Rep. Ted Weiss. "Some of these people became homeless. Others had their lives shattered by untreated mental illness."

What happened? After receiving millions in federal construction and staffing grants, many community centers followed the Park Center/Battle Creek strategy and converted into private psychiatric hospitals--for-profit corporations providing virtually no public care to the seriously mentally ill they were intended to serve. In fact, a 1988 report by NIMH revealed that only 9 percent of those being treated by the nation's CMHCs suffered from schizophrenia or "other psychotic disorders," while 20 percent were found to be suffering from "social maladjustment" or "no mental disorder." Dr. Jerry Dincin, executive director of the Chicago-based Thresholds clinic, one of the nation's leading psychiatric rehabilitation programs, puts it bluntly: "The leadership of the CMHCs decided that they like psychotherapy and that they don't like mentally ill people."