Up First from NPR - The Sunday Story: Lost Mental Hospitals, Lost Patients

Episode Date: June 23, 2024

A few hours north of Seattle, Washington, there's a kind of ghost town dotted with decaying barns and milking sheds, an old cemetery, and once-stately buildings that housed thousands. It was never an actual town, it was a psychiatric facility, Northern State Hospital—a place that contained deep contradictions. The gardens and farm fields were designed to provide residents work and fulfillment in a bucolic setting. But the medical treatments were often harsh.Northern State closed in 1973. It was a time when states across the nation were shutting down their own mental institutions in favor of a new model of community care.Today on The Sunday Story, a look at the move towards deinstitutionalization—what it's meant for people with mental illness and for the entire society.Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

I'm Aisha Roscoe, and this is a Sunday Story. If you drive a couple hours north of Seattle, you'll find a lush valley, miles of farmland, gray mountains in the distance, and the ruins of an old psychiatric hospital. This hospital, Northern State, opened more than 100 years ago. It once had a working farm and its own power plant. Here's Sydney Brownstone, an investigative reporter with The Seattle Times, describing it. Northern State was founded on this idea of occupational therapy, this notion that if you are given work to do, like on the farm or in the dairy, in the laundry, you will develop better mental hygiene and then be able to return to society.

It was a very hopeful time. Northern State is how psychiatric care used to look in the U.S., sprawling campuses with armies of doctors and nurses employed by state governments. The buildings themselves look like they could be Tuscan villas or something. So they have these beautiful terracotta tiles, these neatly manicured lawns. This was done very intentionally for the purpose of healing. But, you know, some historians and experts say that it had a double purpose. It also served to make people outside the institution feel better about what was going on inside of it. States confined patients for years or even decades in hospitals like these. And doctors sometimes used brutal methods to try to control their behavior, induced comas, lobotomies. Then in the middle of the last century, antipsychotic drugs arrived and doctors adopted new progressive views

about psychiatric care. As a result, states started to shut down the old style hospitals. Over the past half century, 84% of state psychiatric hospital beds in the US have disappeared. Most of those vanished in a single decade from 1970 to 1980. This movement was called deinstitutionalization. The idea was

to transfer patients to smaller treatment centers in their communities, but it didn't go as planned. And today it's widely viewed as one of the most disastrous U.S. policies of the past century. In the new podcast, Lost Patients, reporters from Seattle public radio station KUOW and the Seattle Times delve into this history. They try to understand how we've ended up where we are today with seriously mentally ill people cycling between emergency rooms, jails, and homelessness. What went wrong? After a break, Lost Patients host Will James tells that story through the rise and fall of Northern State Hospital. Now Our Change will honor 100 years of the Royal Canadian Air Force

and their dedicated service to communities at home and abroad. From the skies to Our Change, this $2 commemorative circulation coin marks their storied past and promising future. Find the limited edition Royal Canadian Air Force $2 coin today. With respect to mental illness, our chief aim is to get people out of state custodial institutions and back into their communities and homes without hardship or danger. In the 1960s, two ideas of mental health care were colliding. For decades, society had leaned on psychiatric hospitals to hold patients it saw as having little hope of getting better,

to separate them from everyone else, sometimes hide them for the rest of their lives. This is called custodial care. But President John F. Kennedy was pushing a new model, getting patients better and returning them to society as quickly as possible, with the help of these new antipsychotic drugs. When Kennedy's sister Rosemary was 23, she underwent a lobotomy, leaving her mostly unable to walk or talk. She spent the rest of her life in institutions. Kennedy, informed by this family history, challenged states to get people out of custodial care and treat them closer to home. He envisioned a country where, quote, the cold mercy of custodial care would be replaced by the

open warmth of community. Kennedy's 1963 Community Mental Health Act set aside $150 million to build and staff 1,500 community mental health centers around the country. If we launch a broad new mental health program now, it will be possible within a decade or two to reduce the number of patients now under custodial care by 50 percent or more. Kennedy signed the Community Mental Health Act into law on Halloween 1963. It was the last bill he signed. Here's a piece of copy that was rushed. Two million was torn off from the United Press in Dallas.

President Kennedy has been shot in Dallas. Kennedy was assassinated three weeks later. President Kennedy died at 1 p.m. Northern State Hospital embraced Kennedy's vision. It wasn't just the open-door policy. The hospital shifted its entire purpose to getting patients discharged and back into their hometowns as quickly as possible. A Seattle Times article from the 60s summed up this new way of operating. Quote, The rhythm of the hospital changed.

In 1955, Northern State was at its peak with 2,200 patients at any one time. By 1970, that number was down by almost two-thirds to 700 patients at a time. There was almost one employee for each patient, and the numbers kept dropping. Washington had three state psychiatric hospitals in three corners of the state, northern, western, and eastern, and all three saw their daily populations shrinking. To psychiatrists, this was all part of the plan of deinstitutionalization. There were still thousands of people admitted to the state psychiatric hospitals every year. They were just cycling back out much more quickly, so there were fewer patients on the

campuses at any one time. But their bosses in state government saw it differently. It's the classic tension between the people with the green eye shades, the bean counters, and the people providing the care. Sydney Brownstone, an investigative reporter with the Seattle Times, has delved into northern states' history, trying to understand how our modern psychiatric system took shape. State officials were just looking at the declining numbers and the rising costs of care and going, we're not getting enough bang for our buck. And the people providing the care were going, no, you're getting bang for your buck, you're just not seeing it. The person presiding over all this transformation in Washington state was Governor Dan Evans.

He is the kind of man who makes us proud to be Republicans. Around this time, Evans was in his early 40s and having a moment. He gave the keynote speech in the 1968 Republican National Convention. He is attractive. He is articulate. Oddly enough, his background by training and education, he's that of a civil engineer. Let those who offer old promises step aside, and let those who promise new opportunities step forward. But by the early 70s, Evans was just trying to hold Washington State together. Because of problems in the airline industry,

Boeing laid off more than half its workforce. So many jobs disappeared that two real estate agents put up a billboard that said, will the last person leaving Seattle turn out the lights? Washington's unemployment rate hit 14%, the highest in the U.S. All this added to what the Seattle Times called the toughest budget crisis in state history as tax revenue cratered. It wasn't long before Evans, trying to balance the budget, started eyeing Northern State, the smallest of the state's three psychiatric hospitals with a shrinking patient population and the highest per patient costs. So you have the governor in particular saying it's time to wind this down. It's a massive cost and it's time to transition to community

health care, which is supposed to be better for the patients. When Governor Evans argued for closing Northern State, he cited both the national movement away from psychiatric hospitals and toward community care and the potential cost savings. The issues of deinstitutionalization and money blended together. I think a lot of politicians started calculating out what could be saved. Chris Hudson is a social worker and academic who spent decades at Salem State University in Massachusetts studying our systems for caring for seriously mentally ill people. He says deinstitutionalization started with a civil rights agenda, freeing patients who were warehoused at psychiatric hospitals. But soon, a second motivation got mixed in, as leaders in state governments saw an opportunity

to free themselves from a financial and political burden. Chris says these incentives acted like fuel, accelerating the push to close psychiatric hospitals. Beginning in the early to mid-60s and 70s, those dramatic declines in the psychiatric beds, it was precipitous. There was a rush to get people out. Governor Evans' plan was to transfer some of Northern states' patients to one of Washington's remaining psychiatric hospitals, Western State, and send the rest to community care. Washington had been building out a system of local treatment centers for a few years, and by 1973 had a program in

every county of the state. But the system had never been tested in this way, and some lawmakers started to wonder whether it would hold up. I just personally cannot buy the fact that the community mental health program is at this particular point in time ready and able to accept the caseloads, the mentally ill, the people that really need the care. State Senator Lowell Peterson was a Democrat whose district covered Northern State. And I, frankly, can't readily adapt myself or my thinking to the fact

that we're going to displace some 400 or 500 people and automatically transpose them overnight from northern to western and the community mental health centers are going to take care of all of our problems at a less expense. People in Governor Evans' administration were adamant. Community care was ready to pick up where Northern State left off. For the purposes of our budget discussion now, we again recommend the closure of Northern State Hospital as a state psychiatric hospital. Governor Evans got his wish.

Northern State Hospital would shut down by the end of 1973. According to newspaper stories from the time, Evans's administration thought closing the hospital would save something like $14 million over two years. And of those savings, some went back to Cedra Woolley, the town where Northern State was, to ease the economic pain of the closure. And only a fraction was reinvested back into mental health. Let's just be clear, $14 million would not have saved the mental health care system at all. But it does speak to our priorities. I mean, granted, the state was going through a period of austerity. It was slashing social service programs left and right. But you would think because such a fuss had been made about creating this new system of community health care that we would prioritize putting whatever money we had towards that promise.

A front-page story in Cedro Woolley's local paper marks the hospital's closure. Most of the article is about employees scrambling to find new jobs. It says nothing about the fates of the patients. It was kind of sad. I hated that it was closed. Joanne McInnes was a nurse at Northern State Hospital. And when the hospital closed, she was part of a group of nurses who got transferred to one of Washington's two remaining state psychiatric hospitals,

Western State, about a two-hour drive to the south. Joanne's now in her 90s, and Sidney Brownstone of the Seattle Times talked with her at the retirement home where she lives, not far from the old Northern State campus, which now sits abandoned. I felt like the patients weren't taken care of. There wasn't the follow-up and the support systems knocked out. I wish it would have stayed open and we could have done more. What happened to the patients? They were dispersed. We had patients from Northern that went to Western. We didn't get a chance to follow through with them or anything, but they did. And some went to Eastern. It depends too on where they were originally from or where there were beds available. Some

went into the community. Some were put on the streets. It would be years before people started taking stock of what happened to the lost patients of Northern State. I'm Will James. This is Lost Patients. As Sydney Brownstone of the Seattle Times sits with former nurse Joanne in her retirement home, on a whim, she asks about a particular patient, one among thousands who passed through the hospital while Joanne was there more than half a century ago. Did you ever know anyone named Phil Dyro? Oh, yes. You do? Oh, absolutely.

Oh my gosh. Yes. Okay. Sidney had read about Phil in old Seattle Times stories. He was the exact sort of patient deinstitutionalization was supposed to rescue. Phil's parents committed him to Northern State when he was 16. Hospital records say he had above-average intelligence, but he was, quote, overly talkative and overly concerned with other people's business. Phil would later tell a reporter he was sent to Northern State on a bum rap just for being noisy and talking a lot. He talked continually. He just went on and on and on. And how he managed to cram so much information into that head of his. And where he got it, we do not know. But you could walk on the grounds and I swear he knew what your name was, who you were married to,

how many kids you had, no matter what, where you lived. He just had this appetite for knowledge about each individual employee. It was just amazing. Three years after he was committed, Phil was lobotomized. He was 19 years old. It didn't stop him from talking a lot, but it did give him lifelong neurological problems. He got seizures and had trouble holding his bladder as a result of that operation. In some ways, his case was kind of a classic case of someone who could probably be independent, but was stuck in an institution and couldn't get out and had been there for his entire adult life. Phil would stay at Northern State for 26 years until he was in his

40s. In the waning days of the hospital, Phil wrote letters to lawyers begging to be released. Finally, the American Civil Liberties Union took up his case, and he was freed in 1971 as politicians debated whether to close Northern State. Do you know what happened to him when Northern was closed? I understood that he went to Seattle someplace, but other than that, I don't know. Phil kept popping up in news stories once he was released, but the focus of the articles changed. He was no longer a symbol of someone who didn't belong in a psychiatric hospital.

He was a symbol of the lost patients trying to survive in the world deinstitutionalization had created. Even when you have someone who's relatively high functioning, like Phil Dyro, it's still a struggle on the outside of the institution. Not because the institution let him out, but because of the world and the conditions that we created outside of the institution. In 1979, a reporter caught up with Phil.

Phil was living in a $100-a-month apartment in a building he had nicknamed the Heartbreak Hotel. It was on a man-made island in the middle of Seattle's port, surrounded by industrial plants, train tracks, and parking lots. Phil was becoming a fixture of Seattle's streets, a local character. In photos, he has a mustache, thick glasses, a fedora, and a pipe sticking out of his mouth. He spent his days wandering the city, chatting people up, carrying a bag that had 17 pipes in it. When one pipe got too hot, he said, he'd put it away and pull out a new one.

Phil was struggling to live on $226 a month in Social Security. A caseworker spent weeks trying to connect Phil with resources, but Phil's particular problems didn't fit neatly with any of the help that was available. Each agency just referred him to another agency. The caseworker said Phil was one of the toughest cases he had ever seen. At one point, Phil's friends threw a Halloween party to raise money for him. Phil dressed up as a mafioso. The party raised $375. Years after Phil left Northern State, this is who looked out for him not any kind of system just a cobbled together network of people he had managed to charm what does phil dyro's story

represent what does it tell you i mean it kind of tells of hardship on both sides of the institutional question, right? He was someone who was locked up, lobotomized, didn't need to be there probably for his whole life. Like he lost out on so many years of his life. And I mean, he was left with permanent damage as a result of the lobotomy. And then on the other side of being let out, he had his freedom, but it was a very marginal existence. He didn't have a lot of money. He had to move every so often. He was thrown out into a world

that had very few resources for the problems that Northern State gave him. Phil's saga is just one example of a whole new genre of article that appeared in newspapers after Northern State gave him. Phil's saga is just one example of a whole new genre of article that appeared in newspapers after Northern State closed. A string of stories by journalists trying to figure out where the patients ended up. Like this one from 1974, about a year after Northern State closed. Parents of a 22-year-old woman who had been a patient at Northern State struggled to care for her at home. Quote,

Her parents were assured that help for her would be available in the community. Her father was told glowing stories about community-based mental health centers, but he had no idea where to find them. Desperate, he called Northern State for help, even though it had been closed for more than a year. The call went to the campus' electrical plant. By the early 1980s, it was clear all around the U.S. that deinstitutionalization had gone disastrously off course. From National Public Radio, this is Horizons. This NPR story from 1984 documents a phenomenon people were seeing in cities all around the U.S. at that time.

A rise in people who seemed seriously mentally ill and were living on the streets. In this edition of Horizons, Frank Stasio reports that some experts fear the streets have become the asylum of the 80s. After more than two decades, deinstitutionalization has yet to be carried out as it was first planned. While hospitals have emptied their beds, follow-up care is erratic and often neglected. By the early 80s, state psychiatric hospitals had been shrinking and closing for two decades. Meanwhile, the rollout of community care was slow, and eventually those efforts stalled because of funding problems. A decade and a half after Kennedy called for 1,500 community mental health centers, only half of those were built. Patients left the hospital

for locally operated halfway houses and community mental health centers, but the dollars never followed. The institutionalization has been going on for an awful long time. There's been a lot of time to figure this out, isn't it? Well, you'd think we'd figure it out, but in fact, the deinstitutionalization has been a horror. Psychiatrist E. Fuller Torrey spoke with NPR in 1984. Fuller Torrey would later become a leading voice calling for more involuntary commitment and a foil for patient rights groups. But back then, he was reflecting what a lot of mental health workers were seeing. Deinstitutionalization itself was perfectly legitimate. A lot of these people can live outside the hospital.

However, we failed to set up programs to take care of them. In 1980, President Jimmy Carter tried to revive Kennedy's vision by signing the Mental Health System Act, which set aside more federal money for community mental health centers. But less than a month later, Carter lost re-election to Ronald Reagan, who repealed Carter's bill and slashed funding for mental health care. The community mental health centers that did exist provided a mishmash of different types of care. The latticework of agencies, rules, and entitlements. While these centers technically treated mental illness, many of them catered to people who were very different from the patients who had been at state psychiatric hospitals. Chris Hudson, the social worker and academic, says they focused on treating what some call the worried well,

people who live pretty normal lives but want treatment for things like depression and anxiety. The seriously mentally ill, they often had to chase down. They would miss their appointments, and it was a hassle. And they were very difficult to serve, and, you know, for lots of different reasons. The seriously mentally ill and the people coming out of the state mental hospitals were not popular patients, so the seriously mentally ill tend to fall by the wayside. The community mental health centers, with only rare exceptions, have never picked up and taken care of the seriously mentally ill.

Fuller Torrey again, talking with NPR. The community mental health centers have been middle-class psychiatry for people with problems of living. They have not confronted the problem of people with schizophrenia, manic depressive disorder, and the severe mental illnesses. It was clear by this point that the anti-psychotic drugs that had given psychiatrists so much optimism decades earlier, the drugs that set the stage for deinstitutionalization, did not work as well as they had hoped. It turned out these drugs were useful tools for managing psychosis, but not a cure. By the 80s, there had been no major advances in these drugs for three decades.

In some cases, the side effects were so brutal, patients couldn't tolerate them. Stiffness, trouble walking, uncontrollable restlessness, feeling sedated, weight gain. And the drugs could only work if patients took them. Some suffered from anosognosia, not believing they were sick. And others couldn't make or keep appointments. In these cases, community care was not designed in a way that actually reached the people who needed it. There was something else going on, too. Something that's often unappreciated in the story of how deinstitutionalization contributed to people with serious mental illness ending up on the streets. Kennedy's vision was to treat patients, quote, in their communities and homes.

Community care assumed that seriously mentally ill people could find places to live. From the 1970s onward, in many cities around the U.S., homes for the poorest people were disappearing. Kim Hopper, an anthropologist who has studied mental illness and homelessness, also talked with NPR in 1984. The difference between the absolutely abject marginal population today and the absolutely abject marginal population of 15 years ago is that 15 years ago they could afford crappy housing, and today there isn't even any of that. Here in Seattle, the city's center was home to canyons of residential hotels, where for decades thousands of the city's poorest people could rent a room for a few dollars a week. These were called single-room occupancy buildings, or SROs. Many were fire traps and poorly maintained, but SROs were a reliable source of housing someone could afford on government assistance or poverty wages. Just as deinstitutionalization swept the country, these residential hotels got regulated and redeveloped out of existence, sometimes transformed into more upscale apartments.

Newspapers documented these closures. Well, it's interesting because the reporters would trace these patients to group homes or SROs, for example. And then a few months later, they'd follow up with another article saying that the group home is closing down. And so you see this story over time of the refuges outside of the institution disappearing too. This is an era of massive change for the most vulnerable people in our society. And yet, that wasn't really felt by middle class or otherwise comfortable people at all. So even during this time of great change, it kind of was like motion under the surface.

It went by without a lot of comment, without a ton of political strife, and we carried on as if things were normal until we fast forward 20 or 30 or 40 years and all of those decisions that we made are breaking through the surface. Sidney was searching in the Seattle Times archives for evidence of what happened to the lost patients of Northern State when she stumbled on a missing link connecting the era of deinstitutionalization to the world of today. Let's go to December 27th, 1981. Oh, wow.

The headline of this piece is, The Mentally Ill Victims of an Experiment That Failed. And this is a piece by an editorial writer. Crowds, this is how it begins. Crowds rush past them on downtown streets pretending not to hear their confused or angry chatter. They are studiously avoided when they wander through neighborhoods. Occasionally, when they become a nuisance or create a disturbance, the police are called. Sydney noticed this story from 1981 had some of the same language she used in her reporting on homelessness more than four decades later. Even the institutions were the same.

Oh my god, this paragraph was written in 1981. Many mentally ill people find themselves caught in a revolving door that leads them from Harborview Medical Center to Western State Hospital to a place like the Downtown Emergency Center in the Morrison Hotel and then back onto the streets where the cycle begins again. It froze me. A lot of things were flooding my brain at once. Like, holy shit, the exact same thing is happening now. People are bouncing from the Morrison to the downtown King County Jail to Western and back again. We've been stuck in the same calcified loop for 40 years. And it's also like, what is even

the point of my job then? If I keep writing the exact same sentences that someone 40 years ago was writing, why do I exist? Why are we doing any of this? Because clearly presenting people with the same information over and over and over again isn't doing anything. It's like we have made a decision as a society to not care about this or that we are okay with this. And then what does that say about us? That we have been reading these same stories in our newspapers in every American city for 40 years and we've decided that that is okay. It wasn't too long after this that Sidney and I got a chance to talk

with former Washington governor Dan Evans, the man who made the decision to close Northern State half a century ago. He's in his late 90s now. We wanted to understand how Evans views that decision today, now that we can see on our streets how the failure to build community care has turned out. And one thing Evans said during that interview has stuck with us ever since. He said, some problems you're faced with in government have clear-cut, satisfying solutions. And mental health is not one of those problems.

It's something people in power really don't want responsibility for. That helped unlock something for me. Responsibility, I think, is the real story of deinstitutionalization. While it started as a civil rights movement, ultimately it created an opening for people in government to escape from a responsibility they didn't really want. A responsibility that cost a lot of money, was complicated to manage, and never delivered satisfying political wins. And once people in government saw that opening,

they slipped through it. For a century, we lived in a country where pretty much one entity, the state, took responsibility for seriously mentally ill people. And deinstitutionalization was the moment that ended. The state, which was once a provider of care with its own army of psychiatrists and nurses in state-run hospitals, became more of a funder of care, giving out money to a mishmash of nonprofit organizations and local agencies to handle things.

If you go to downtown Seattle today, you can see this fractured responsibility spread out among jails, emergency rooms, homeless shelters, like Seattle's Downtown Emergency Service Center, or DESC, known for taking on this city's most difficult cases of mental illness and substance use. On the sidewalk outside DESC, you can find a bronze leaf embedded in the cement with a name etched on it. Phil Dyro. Advocates put it here to memorialize him

after he died in 1999. It fits that his saga would start at Northern State Hospital and end here, outside one of the many broken-up islands of refuge that replaced it. That was an excerpt from the podcast Lost Patience, a production of KUOW Public Radio and The Seattle Times, made in partnership with the NPR Network. This episode was reported,

written, and produced by Sydney Brownstone, Esme Jimenez, and Will James. It was edited by Liz Jones. You can find all six episodes of Lost Patience wherever you get your podcasts. Up first, we'll be back tomorrow with all the news you need to start your week. Until then, have a great rest of your weekend.