History of Pennsylvania’s state hospitals

History of Pennsylvania’s state hospitals


There’s always been a stigma. Some would argue that religion and a sense of God not showing favor on some folks, the idea of demonic possession. Reaching back into the 18th century, you’d hear references to fools, to lunatics, to the insane and other more derogatory representations as we’d think of it today. Often times people were literally locked in basements in private residences or left to wander the streets. And so you have house-bound individuals you have people who placed into almshouses, other kinds of less formal psychiatric hospitals and sanatoria. And eventually the rise of large institutions. So when state institutions were created they were done so with the best intentions. They were done to be the most compassionate way to service a population. It was actually, at the time, considered groundbreaking nationally and of course in Pennsylvania. It was the first attempt for publicly funded what they called at the time “humane treatment” for people with mental illness. Harrisburg State Hospital was built to be a self-sustaining community. They had a farm. They expected the residents or patients to be working on the farm to have a productive day. To have staff support. And then the state hospital system in Pennsylvania grew from the original Harrisburg State Hospital throughout the rest of the 1800s and early 1900s to about 24 state hospitals If you have 5,000 people in the same institutional setting how do you simply manage adequate care? It proves to be impossible, and ergo, the controversies of the late 20th century. Bad things happened. When you look at the history of some of the state institutions, horrible things were done. Because that’s the nature of an institution when there’s one group totally in control and another group doesn’t have any control at all. Bad things happen. And Philadelphia State Hospital Byberry is a perfect example of that. End upon end of beds with shackles where people are just handcuffed to the bed so they can’t roam around. The use of isolation. The use of cages. Being handcuffed as a form of not only treatment but punishment, sometimes to run for days. It’s hard to justify that as a moral or even a rational basis of treatment for someone who has a cognitive or mental disability. In terms of treatment by the 1930s there was a both a kind of ethos of compassionate or humanitarian concern, and seeing mental health issues as a problem of a disease of the mind. But it was the late ’40s and early ’50s when there were some breakthroughs. Thorazine became known to be an effective antipsychotic and lithium became available to treat people with manic depressive disorders also in the early 1950s. So for the first time there were options available from a medication perspective. We really started to see a decline in people being served in state hospitals in the late 1950s. And in the ’60s and the ’70s we had, of course, the civil rights movement where we saw large groups that were formerly not really in the mainstream really move more into mainstream society. But the groundbreaking change was in 1963. President Kennedy signed into law a national community mental health act in 1963, which started to create the foundation for community-based mental health systems. And then Pennsylvania passed legislation in 1966 called the MH ID Act of 1966, which established a state-funded, county-operated system of community-based care for people with mental health disorders and people with intellectual disabilities. So those things were groundbreaking because it was literally the first time that Pennsylvania started to fund a community-based system as an alternative to institutions. And so that push began the push to deinstitutionalize people. In the 1980s because of the public uproar over institutions you begin to see a concerted effort to move people who can be moved back into the community. And that’s kind of the most recent phase in a long history of evolution. The notion that with the proper supports, the proper services, the proper supervision people may be able to leave institutions and live more independent lives. It’s not only a medical decision it also comes to be seen as a civil rights decision: The right to freedom the right to liberty. In the 1990s, early 1990s, they started a dedicated funding stream called CHIPP, with two P’s —Community Hospital Integration Program Project— which was a program where the state provided additional funding to counties to close state hospital beds and then use those funds to develop community-based services and supports. Then there was also the Olmstead Act in 1999, which the Supreme Court ruled that people should be given a community alternative as opposed to institutional care so basically, people shouldn’t be kept in institutions simply because of a lack of funding. Today we have less than 1,600 people being served in state hospitals. So we went from about 25 hospitals owned by the state at one point, to today we’ve got 6. It’s difficult to at some point justify having these large institutions that are costly. I mean, these are white elephants at this point. These were built a long time ago. They have a lot of cost associated with them. We are getting ready this year to close Norristown State Hospital’s civil unit. We now understand that community living
is the best option for a lot of folks, and if we can serve people in the community where they’re surrounded by kind of their natural community supports, their family and friends, that’s going to be better for individuals than being isolated in an institutional setting. We’ve been in a time of change and we continue to be in a time of change. You know, for our state hospitals, the Olmstead decision means we have to make sure that we are serving people in the least restrictive setting, and that we’re doing more community integration than we’ve done historically. And from DHS’s perspective that’s absolutely the right thing to do—we’re embracing that. But it definitely is a
time of change you


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