Recovery From Schizophrenia: Psychiatry And Political Economy

THE POLITICAL ECONOMY OF SCHIZOPHRENIA 87from US mental hospitals were merely transferred to another category ofinstitution—nursing homes.For many patients the switch was to their disadvantage. Nursing-home staffwere generally low-paid and had no training in mental health, wards were oftenlocked and overcrowded, the environment was frequently shabby, there weregenerally no attractive grounds for recreation, and psychosocial treatment andactivity programs were deficient or absent. In general, the only treatment offeredwas drugs; and it was the advent of the antipsychotic drugs, facilitating control ofthe florid features of patients’ psychosis even when the patients were in grosslyinadequate settings, that allowed huge numbers of the mentally ill to be shuntedto cheaper nursing-home care. Thus, although the number of patients in US stateand county mental hospitals declined from 505,000 in 1963 to 370,000 in 1969,the number of patients with mental disorders in nursing homes increased to suchan extent that the total institutionalized population of the mentally ill was actuallyhigher in 1969. Mentally ill residents of mental hospitals and nursing homescombined rose from 726,000 in 1963 to 797,000 in 1969. Many patients wereelderly but large numbers of younger adults were also transferred to nursinghomes. The number of patients under the age of 65 in state and county mentalhospitals fell by nearly 100,000 between 1963 and 1969 but the number ofmentally ill patients in this age group in nursing home accommodation increasedby more than 25,000 during the same period. 19 Ellen Bassuk and Samuel Gersonpointed out, however:Untherapeutic though many nursing homes are, living conditions in most ofthem are at least tolerable. Conditions may be worse for discharged patientsliving on their own, without enough money and usually without anypossibility of employment. Many of them drift to substandard innercityhousing that is overcrowded, unsafe, dirty and isolated. Often they cometogether to form a new kind of ghetto subpopulation, a captive market forunscrupulous landlords. 20Newspaper reports exposed the impoverished condition of formerly hospitalizedpatients leading lives of isolation and fear in the community—100 dischargedpatients in Washington, DC, without therapeutic rehabilitation programs; 200 expatientsof Agnews State Hospital in California housed in boarding homes in SanJose with no medical care; 300 to 1,000 patients in rooming houses and hotels inLong Beach, New York, without supervision. A survey of discharged mentalpatients conducted in 1970 in California’s San Mateo County found 32 per centliving in board and care homes. 21 These “small wards in the community” weregenerally sordid and bare establishments in poor, inner-city areas where theft wasrampant. One-third of the chronic mental patients in a large sample of residentsof board and care homes in Los Angeles had been robbed or assaulted or both duringthe previous year. 22 Each such establishment housed more than fifty ex-hospitalpatients, and sometimes accommodated several hundred. 23 The patients often