On a recent Sunday afternoon, my wife Gayle and I met with her cousins to catch up for the first time since COVID-19 descended nearly two years earlier. They’re from Danbury and we’re from West Hartford, so we decided to meet halfway in Fairfield County.
We met at a craft brewery named “Asylum.” This struck me, an experienced psychiatrist, as a slightly odd name for a brewery.
The four of us settled into a booth in a beautiful room with vaulted ceilings of tile and brick. We shared stories from our two years of coping with COVID since we had attended their wedding in February of 2020. I sipped my pilsner and looked out the window. I saw an expansive green campus with people jogging, walking their dogs and sitting with their families. The campus had many stately, columned edifices. I was overcome by a sense of deja vu and unease.
Our server informed us that this large park-like campus was formerly Fairfield Hills Hospital, a state hospital for psychiatric patients. There were thousands of patients who spent much of their lives here until about 30 years ago.
Suddenly, I felt as though I was sitting in somebody else’s living room, uninvited. I knew too well what had happened to many of these people. Most no longer live on beautiful campuses.
Sitting in this room made me think about what was lost when these patients were “deinstitutionalized.” Indeed, they now often live in shabby single room occupancy hotels or group homes. Some are homeless or live in shelters. Others are incarcerated in jail or prison. Patients now cycle in and out of our modern-day asylums with about a five-day length of stay. My mind drifted and I was less interested in my drink.
We in psychiatry have known, without exception and for decades, how to promote the recovery of our patients with serious mental illness. Medication and therapy are often important. Access to basic needs such as healthy food, shelter and income are also key. Connection to family and social reintegration are necessary because isolation and loneliness impair the restoration of mental health. Critically, full recovery, and not just the absence of illness, requires the restoration of purpose. Reintegration into the community, cultivating interests, hobbies, work, education, meaningful relationships and a renewed sense of hope for the future are crucial.
If we know all of this, why is full and successful recovery from serious mental illness not the norm? Why do so many of our patients remain chronically ill?
For many years, psychiatrists filled leadership roles in mental health organizations. This was true in long term inpatient facilities and in the first community mental health centers. These physicians understood what was necessary for recovery from serious mental illness. They were able to bring together the various biological, psychological and psychosocial elements at the right time and place to make a crucial difference in the lives of those recovering from serious mental illness.
Today, such clinicians and their unique skill sets are viewed solely as a cost in a never-ending cost-benefit analysis. Psychiatrists with a decade of postgraduate education, years of clinical training and a wealth of experience are now often relegated to medication management or a limited role in the decision making at organizations responsible for promoting the recovery of patients with serious mental illness. The result is a mental health system without clear medical and clinical leadership.
It is said that every system produces the results that it is designed to produce. Unfortunately, our clinically rudderless and leaderless system all too often perpetuates chronic mental illness.
Surely, we can do better than this.
Steven Madonick MD is the Medical Director of CHR and President of the Connecticut Psychiatric Society.