TAC On Crack

Or whatever the hell the Full Torrey crowd is smoking over there in Alexandria, Virg. Last week, the fine folks at Torrey's Treatment Advocacy Center posted an asinine item on their blog. The post is so error-riddled that I look forward to TAC posting a correction and/or clarification on its blog.

In the post, TAC's anonymous blogger argued that the federally-chartered "P & As"--protection and advocacy systems for people with mental and physical disabilities in each state--were imposing "their own values on people who don’t have the resources to live independently. Rather than advocating to improve conditions in hospitals, boarding homes, and nursing facilities – they try to close them down."

TAC's implicit gripe is that the P & As are shutting down state hospitals, forcing the chronically mentally-ill into a world where there is no help for them and that that's at the heart of the crisis facing the mentally ill. Why TAC didn't just come out and call the P & As socialists or something is beyond me. But if TAC won't call them soft-brained, perhaps they would like to go after the US Supreme Court and President Ronald Reagan. After all, they are the pinkos behind the dynamic TAC's complaining about. Seriously.

In the mid-1980s, the Reagan administration moved to deinstitutionalize the mentally ill from state hospitals around the country. That continued a trend begun in the 1960s, when there were about 500,000 mentally-ill in hospitals. While California's governor, Reagan began shutting down hospital wards but offered the mentally ill no shelter but the streets. He repeated this disconnect as President, a move that led to the present cycle of homelessness in America. By the end of the Reagan Administration, 94,000 Americans remained locked up in state hospitals.

What's more, in 1999, the US Supreme Court ruled in the landmark Olmstead case that if the mentally ill lodged in state hospitals were clinically eligible for discharge--and indeed wanted to be out of the hospital--then the various states had the legal obligation to provide appropriate housing and social services to make that happen. The basic idea is that the states have no right to restrict the liberty of the mentally ill when there are far more humane and less-restrictive ways to treat them in the community. (I've written before at great length about the weird dynamic around deinstitutionalization as well as the Olmstead ruling and promising community-based treatments.)

TAC, of course, conveniently omits those two historical facts from its narrative, instead choosing to blame the P & As and the Bazelon Legal Center--which often works with the various P & As on legal cases--for what they see as an intolerable mess. Beyond Reagan and the SCOTUS, the reason that we have a mess in our system of care for the chronically mentally ill has more to do with massive cuts to federally-funded housing programs and to Medicaid. But the Fuller Torrey lapdogs cannot get past their single-minded obsession--one that deserves to be in the DSM--with expanding state hospitals.

It is amusing to note that, in Washington State at least, TAC might have to praise the Washington Protection & Advocacy System. In 2004, WPAS sued Washington State because the state's Department of Social and Health Services was kicking dozens and dozens of profoundly ill people out of Western State Hospital and onto the streets of Tacoma, returning female patients directly to the husbands who'd beaten them or, in one bizarre case, dumping a schizophrenic skinhead in a board and care facility (I have written about this lawsuit, as have other newspapers in Washington State). The state settled with WPAS out of court last year and this year the state legislature funded re-opening three adult psych wards at Western (that works out to about 90 beds).

I am generally not too thrilled with keeping patients in state hospitals--no matter how much more benign they are these days, the places still suck--but in this case, I support the move. It would be nice for the state to also get off its duff and use some of its billion-dollar-plus budget surplus to fund appropriate housing for those who can get out of Western (and its sister Eastern State Hospital near Spokane), partly to comply with Olmstead and also to realize the promise shown by the pilot community-housing programs the state already has in place in the Seattle area (and that save at least 50 percent on the cost of long-term hospitalization). That funding spigot will apparently be opened much more slowly. But it will be opened.

Meanwhile, back to TAC. Can you people explain to me the P & As are responsible for the mess you guys describe? Or do you want to run a correction and/or clarification to your post? If not, I'll make sure to run one for you.

GLOSSARY TERM: P & A. The Protection & Advocacy Centers are federally chartered and, in most cases, are federally funded. They are empowered to investigate state and federal programs designed to care for the mentally ill, developmentally disabled and physically disabled in state-run or financed facilities throughout the country. They speak for the people who cannot speak for themselves.