Deinstitutionalization turns out to be a cruel alternative.
by Tom Evslin
My friend Bill Shubart wrote a wise and kind essay on the need for a new institution for those who are homeless. He lists some of the institutions which used to fill this role including the Vermont Asylum for the Insane (Waterbury), the Weeks (reform) School, and the many poor farms.
The book and movie One Flew Over the Cuckoo’s Nest helped turn America against large “mental hospitals”. The horror of some of these institutions had long been documented. We decided to shut these places down and end the misery and abuse of patients. The theory was that modern psychiatry and drugs would allow the inmates to lead lives in the community or in pleasant local institutions. Deinstitutionalization became the rule; large institutions like Waterbury were emptied out and not replaced as they fell into decay.
The problem is that the theory was wrong. The community institutions were never built, largely because of community resistance. People with acute mental problems are not very good at taking the drugs prescribed for them – and are easy marks for those selling drugs which make their problem worse. Psychotherapy is hardly a quick or certain cure. Housing is hard enough to obtain and maintain for those with moderate income; it is impossible for those with severe mental problems. Our cities are spotted with filthy homeless encampments. Emergency rooms are increasingly dangerous for both patients and staff because the mentally ill are bought there and then remain far too long. Although most people with untreated mental illness are more danger to themselves than others, too much violence is committed by mentally ill people who are known and repeated offenders. The streets of Burlington, VT are increasingly scary at night.
“Let us imagine,” Bill writes, “a new institution, a dignified but modest communal home for the many Vermonters struggling with mental illness, alcohol and drug addiction disorders, extreme poverty, or who are simply unhoused.”
I agree with Bill that we need “a new institution” but think it should specifically be and only for those “struggling with mental illness, alcohol and drug addiction…”. Those who are suffering from “extreme poverty or simply unhoused”, including those who were recently displaced by flooding, will be much safer and better off in housing which already exists or congregate housing if they don’t have to share these facilities with people who ought to be either incarcerated or institutionalized.
Decker Towers in Burlington provided subsidized housing in the city’s tallest building. Two stories on WCAX (here and here) document the problems residents are facing:
“I see drug deals happening in the parking lot. I see them at the side door. I see them all around the building,” said one resident.
“The drug dealers, the people that steal all these goods, they know that Decker Towers is open for business,” said another.
“Residents have sent photos of needles scattered inside and outside the property, as well as bodily fluids and people sleeping in the stairway,” reports WCAX.
Steven Murray, the director of the Burlington Housing Authority, says “It’s not just Decker Towers, it’s just about every major apartment building in town.”
Those housed in motels around the state both before, during, and after the pandemic as well as the motel owners and neighbors, complain about rampant crime and drug use in their accommodations. The pods recently sited in Burlington for the homeless are now greatly resented by their neighbors because of the lawless crowds they attract. Neighborhood resistance to low-income housing is inflamed because the housing is used not only for those who need shelter for economic or other misfortune but also for those who cannot live safely outside of institutions.
Bill Shubart is right that incarceration should not be the only option for those who cannot safely live with others and who don’t belong on the streets, although he and I probably disagree on how often incarceration is appropriate. Everyone suffers from the lack of an institution, a modern Waterbury Hospital, where those with currently uncured mental problems can safely and humanly be cared for by professionals. Existing congregate shelters and subsidized housing – and emergency rooms – will be better and safer alternatives for those who need them if they are not dumping grounds for the mentally ill.
The author, an author, entrepreneur, former Vermont state cabinet officer, lives in Stowe. He founded NG Advantage, a natural gas truck delivery company. This commentary is republished with permission from his blog, Fractals of Change.
Categories: Commentary
I completely agree with you but would add a few more. Currently our schools are being used for students with many disabilities including mental disorders that can and do turn into violent behaviors. This is an unhealthy environment for staff and our children and costs towns more in education and ultimately tax payers. This cost has not been figured into what I have included but certainly should be. According to the American Rescue Plan of 2021, which is to help disable people stay in group or private homes, Section 9817, states, $72 million in additional funding to enhance and expand Medicaid HCBS valued at apprx. $158 million between April 2021 and March 2025. The actual total spending being more.
It seems to me there is obviously a better and cheaper way to deal with this growing problem. We do need some institutions to deal with it!
We already have one large mental institution in Vermont. We call it the State House.
Darn it Patrick Finnie…beat me to the punch, fair and square, but I was going to write, to merge Waterbury, into the existing State House, to save taxpayers money, and the rest of the state, would likely see an improvement, in legislation, by the combined forces of the lawmakers, and the inmates, compared to what we see coming out of the statehouse now.
I agree, I need to be quicker but that would save a LOT of money. Would need to deduct cost of “digester” for the well but all good after that!
I believe the State of Vermont opted for the open air, free range institution model.
I never agree with anything Mr. Evslin writes, however, I agree with him here. Except any mental institution built needs to go in Burlington. Waterbury and Vergennes have done more than their fair share in the past.
Hmmmm…. you beat me to it. “brilliant” minds often think alike, trapping notwithstanding.
Absolutely necessary. Now, not later.
The best comment of all is Patrick Finnie’s. We need complete change in Montpelier.
How about we start with making drugs really illegal again………….
I agree. I agree strongly but I would hope we could see a separate home for children up to at least 16 where services are started. Drugs are responsible for many of these issues and the environment is filled with hate, lawlessness and financial collapse. Money given to the financially challenged is largely being used to numb themselves with drugs. Soon dealers will become the ruling party due to funding. We need to empty the Legislature and re elect people with a brain and conscience. Faith and Hope needs to be restored . The economy is crashing and people need to see responsibility in Gov’t.
Keep in mind that what Mr. Schubert and Mr. Evslin don’t tell you about the lauded SOS Children’s Village model is that it isn’t a government organization. It’s private. And it accepts no government subsidies and, therefore, is not beholden to the kind of regulation that apparently corrupted Vermont’s State-run institutions.
Again, I refer to Milton Friedman’s wisdom.
“If you put the federal government in charge of the Sahara Desert, in 5 years there’d be a shortage of sand.”
“Many people want the government to protect the consumer. A much more urgent problem is to protect the consumer from the government.”
These replies sum it up perfectly
It was the Reagan Revolution’s spending cuts that shut down the state hospitals. Say what you will about Reagan’s legacy, this was one very unfortunate aspect of it.
Why do,we have to guild our mental hospital roofs with gold? Asking for a friend.
My father has been expelled from VT. He needed neuro psychiatric Geriatric care…
He is non verbal, brian injured, paralyzed and now 200 miles from anyone he knows. Our family has been destroyed by this distance. Vermont told us they are not interested in neuro facilities and therefore pays out of state facilities for services. Sooo much more expensive rates than we could offer in state. A second fulltime caregiver would have saved VT $. We did it for 23 years, at home, needed one more hand… They said no to funding it. May I say they offer less than 3 days in facility rates for a two week pay period for a single home health worker. Huge savings to stay home. They do not allow 2 paid at same time so… If you are paralyzed and need 2 folks on a hoyer lift… Not dice. They sent him to UVM. We learned that UVM does not allow the use of diapers. They trained a neuro patient to poo and pee on the bed. He was not the only one… Dozens patients… no diapers. After 6 months we were able to retrain for diapers. Vermont is a nasty place to age. Get your family out of here if you want to be with them. They will not cover the portion medicare will not cover for outpatient visits out of state. But they will cover ambulance to transport all the way back to vt for specialists. Then they take him back. Transport is more expensive than the 20% of the portion they would need to cover beyond medicare. He is so weak he cant be transported well…. So he goes without necessary heart and neuro specialists. They sent him to die. No necessary medical coverage for his heart defib…
Im exhausted from the driving, broke from buying gas, I have to sleep in my car when I come to see him. Its going to get cold. I am in dangerous situations as a woman traveling alone. I hate VT. They do not let him become a MA resident. But VT says he is no longer a Vermonter. That he lives in MA but they still pay the bills? Over 1000 a day. At home caregiver 1500 gross 2 week pay period for 1 home health worker.
In MA, he is at a place that is phenomenal. But they tried to put him in a place with cockroaches and mice and ceilings falling in…
Lets ask Timberlyn at Bear Mountain to build a facility. They are top notch. Im hands on. Have a ton of experience, a management degree… Someone wants to contact me… I KNOW where we can find a viable blueprint for operations. Lets fix this so no other family has to suffer like we are. This would keep our families intact. It would be so good for his care of we could help daily, we are willing. We could be a daily part of his healthcare team.
Mental health is for everyone, everywhere. VT cant ignore the need anymore. If you dont want them “clogging” the system. Want them unseen, unheard… Give them someplace to be. If the nursing homes arent equipped and they are allowed to refuse, these patients have no where but the street to go. They will be a constant irritant to the gentrification of Burlington area. Being mentally ill leads to easily to being homeless. Homeless folks without mental illness or ptsd from having no where to be… Thin line. There are no mentally ill clogging up the homeless situation. We are all the same and I know that is hard to accept. If you seek mental health help in this state as an outpatient… You will wish you had not tried to find help. The process is trauma
We do not value this… There will be more desperate desolate. They will disturb your peace and you cannot ignore them.