Monday, November 14, 2022


Quillette has another sample of the boy-did-we-make-a-mistake in the 60s and 70s with deinstitutionalisation article. This one plays up the "Cuckoos Nest" slant, which occurs about a third of the time, I think. These articles are accurate insofar as they note that there are lots of people with mental illness on the street now, causing problems.

The hospital I used to work at has about involuntary 100 patients at present. At its peak it had about 3000.

How much do you think 30 more hospitals would cost? The current one goes at about $100M/year, operating costs. Of course, you'd have to have more buildings, just for openers.


james said...

It's always easy to say what's wrong. Not so easy to say what _else_ is wrong.

Douglas2 said...

Would 30 more hospitals be needed? Wasn't that peak well before the impact of de-institutionalization, and the significant decline before de-institutionalization largely because of the psychopharmacology revolution?

Those currently ending up in acute, inpatient state psychiatric hospitals are those most at risk to themselves and others, would expanding access&use somehow net more cases that are just as hard? Would it be of patients who are all as expensive to treat in terms of facilities and person-hours?

Christopher B said...

The current one goes at about $100M/year, operating costs

The deinstitutionalized system isn't free, either. It's just that the money is not coming out of an identifiable budget line item.

Assistant Village Idiot said...

Both good points. No, you wouldn't really need 30. You could probably go with 3 more and some enhancement of community care. And outpatient treatment laws would help a lot. Rent supports would probably help more than some other things we do. It bothers taxpayers to be giving away free rent, but damn, it's cheap compared to other interventions and it really contributes a lot to stability. A Section 8 voucher can induce a landlord to put up with a lot, because they have so many other people they have to argue with about rent every month. And yes, the social cost in $ is high in some places, mostly city downtowns and rural areas, rather than spread out over all the small city and suburban areas as well. You would get something back. It's just that in the discussion the costs of treatment are overlooked in nearly every article, so I decided to be dramatic about it.