Indeed, it was a long time ago, but I live to tell the story of my last quarter at the University of Washington in the nursing program.
The state legislature recently struggled to define and pass a bill intended to criminalize the possession of controlled substances (potentially addictive and/or toxic drugs for which dispensing and administering are monitored by law) and provide for treatment. The bill reminded me of an unfulfilled promise around the treatment of mentally ill people decades ago.
My last college quarter (in the year 1965) was spent in a dorm room at Northern State Asylum for the mentally ill. We were assigned to a chronic care ward with a rotation period to the short-term care ward, which housed the newly-diagnosed and criminally insane.
I still search for the right words to describe what I felt when I observed and spent time with the residents. I was mesmerized by them, their histories and life in this old structure built in 1912. What happened in their lives to end it here only to become a routinized soul?
Many had been in these rooms for years and would never again know a non-institutional life. Depression, alcoholism, drug addiction, schizophrenia and violence were among the recorded causes, none of which was apparent in their life now. I remember most as not smiling, just staring with blank expressions.
Treatments included electric shock therapy which as a student I was allowed to observe. Insulin therapy was also used. Both these treatments were thought to shock the body and brain into sanity — how other worldly it seemed.
The development of tranquilizing and other medications that calmed behavior in the 1950s led to the blank stares and making the “insane” easier to manage and provided an opportunity for the state to unload the burden of carrying for the chronically mentally ill.
The further development of medications and two federal laws enacted provided the rationale to shut down facilities that cared for the mentally ill.
President John F. Kennedy signed the Mental Retardation Facilities and Community Health Centers Construction Act in 1963. The law intended that places like Northern State would be replaced by community mental-health centers, thus allowing patients to live — and get psychiatric care — in their communities (Alisa Roth, The Atlantic, May 25, 2021).
In 1965, the creation of Medicaid, health insurance for eligible low-income individuals was the final fatal blow to the state’s care of the chronic mentally ill. Medicaid carried a provision that the program would not pay for inpatient psychiatric care.
The transition was completed in 1973 and Northern State closed. Western and Eastern State Hospitals remain open today to provide short-term inpatient psychiatric services. Many residents were transferred to nursing homes which are covered by Medicaid.
Northern State bussed many younger, more able residents to the streets of Seattle with the intention they and the mentally ill of the future would be treated in community mental health centers.
Community mental health centers never materialized.
Any there there?
It took a special session to finally respond to the State Supreme Court ruling that the law criminalizing drug possession was unconstitutional because it did not address intent. Our legislators were able to pass a law that makes drug possession a gross misdemeanor with up to six months jail time for the first two offenses and up to one year after that.
The law encourages police and prosecutors to divert cases for treatment and provides millions of dollars to provide for diversion programs. Encourage is an interesting word in a law that intends to provide for treatment and made me wonder how we measure “encourage” such as “hey, we have a treatment center you can go to for help instead of jail” or “go to the treatment center or jail — your choice.”
Still, it is a start, an option written into the law.
That is, if there is a treatment center.
Our state senator and representatives voted in favor of the bill. They were also instrumental in securing state funds that helped establish the Jamestown Healing Center and recently announced funds for an inpatient psychiatric center in the same area.
Our community is well on its way to having a place to divert those who illegally possess controlled substances, but we remember how the community roiled over it. It was not an easy lift, nor will it be in the rest of the state.
Seattle Times columnist Danny Westneat warned in an April 30 column that our state can go the way of Oregon that passed a measure to decriminalize possession of “hard drugs” two years ago. The measure included a statewide network of substance abuse disorder treatment centers which have yet to materialize.
Monies may be available but what if communities baulk at providing a treatment center in their cities or towns. It will take more than money.
As well-meaning as the law is, statewide drug treatments centers may never materialize.
Why were community mental health centers not built? What will it take for substance abuse centers to become accepted parts of all our communities?
Our state, our country, has been struggling with incorporating mental health into our concept of health care and subsequently into health insurance plans for decades.
As much as lawmakers are advised by experts in the field before they vote and spend taxpayer money, they vote for the foreseeable future and not the long-term comprehensive vision that addresses the quality-of-life issues that prevent as well as treat; give hope and inspire purpose as well as shelter.
The solution calls for a complicated multi-faceted approach so much bigger than institutions, jails, and treatment centers. We have made a start but have a long way to go to keep it up if our past efforts are any indication.
We must do more than move unsmiling vacant expressions to the streets and jail.
Bertha Cooper, an award-winning featured columnist with the Sequim Gazette, spent her career years in health care administration, program development and consultation and it the author of the award-winning “Women, We’re Only Old Once.” Cooper and her husband have lived in Sequim more than 20 years. Reach her at firstname.lastname@example.org.