One Flew Over the Lone Star State

Jesse Walker | May 7, 2008

The Dallas Morning News runs a blistering exposé of Texas' state psychiatric institutions:

Patients with severe mental illness are committed to Texas' state psychiatric hospitals to be protected from themselves. Instead, some are suffering vicious abuse from the very caregivers hired to look after them.

Last year, one state mental hospital employee tackled an adolescent patient who was sobbing for his mother, dragging him across the floor by his wrists and hair.

The year before, another brought a female patient into a hospital bathroom and sexually abused her....

State officials say there will always be some reports of abuse and neglect in an institutional setting. And they say they take any allegations of mistreatment seriously. But the records show that as in other state-run facilities, abuse and neglect are systemic.

Naturally, the system's supporters believe the problems can be solved with more money:

The state psychiatric hospitals, like other systems for vulnerable Texans, are chronically starved for cash, advocates of more state funding say, and services at the local level can't keep up.

"You get what you pay for," said Rep. Garnet Coleman, D-Houston, who has bipolar disorder. "When you financially dumb something down, you make services cheap, something's got to give. Unfortunately, it usually ends up being a mentally ill or disabled Texan."

Before we go any further, I'd like to pause to savor the phrase "Rep. Garnet Coleman, D-Houston, who has bipolar disorder." In a better world, the AP styleguide would require reporters to identify all elected officials with a party affiliation, a district or state, and a psychiatric diagnosis.

Now I'll turn the microphone over to Charles Johnson -- the Rad Geek guy, not the Little Green Footballs guy -- to argue that it might not be a good idea to give abusive institutions more resources:

no matter how bad and how widespread the abuse may get, the administrators can always count on the pro-establishment wing of their supposed critics to go to the public and to the legislature to beg for even more tax money and even more prison guards to be sent into the psychiatric prison system, so that the very people who created these maddening prison-ward hellholes can be rewarded for their institutionalized violence by being allowed to take even more money from taxpayers to go on doing the same old thing...

What is really needed is a power change, so that psychiatric wards are no longer artificially packed by court order, so that patients can leave and seek help through other means if conditions become unbearable, and so that supposed patients are no longer "treated" against their will and held down at the mercy of their helper-captors. If you make a hospital into a prison camp, then it should be no surprise when the hospital "caregivers" start acting like prison camp guards.

Comments

Episiarch|5.7.08 @ 12:22PM|#

Before we go any further, I'd like to pause to savor the phrase "Rep. Garnet Coleman, D-Houston, who has bipolar disorder."

Yeeeeeesssssss.

|5.7.08 @ 12:26PM|#

What is really needed is a power change, so that psychiatric wards are no longer artificially packed by court order, so that patients can leave and seek help through other means if conditions become unbearable, and so that supposed patients are no longer "treated" against their will and held down at the mercy of their helper-captors.

Perhaps. Deinstitutionalization and lack of involuntary commitments have been no walk in the park where they've been tried either. Might be a better solution, but I'm absolutely certain that nasty, horrible anecdotes would exist either way.

|5.7.08 @ 12:29PM|#

It is actually already much harder to commit someone against their will and keep them there than it used to be. The rate of hospitalization alone demonstrates that. There's been a large debate about its ongoing effects already.

jtuf|5.7.08 @ 12:32PM|#

In tomorrows news, reports detail how state officials removed 400 teens from mental institutes and into foster care just to be one the safe side. Oh no, wait. The public calls them isolated incidents as long as the child abusers have the proper training.

|5.7.08 @ 1:14PM|#

"What is really needed is a power change, so that psychiatric wards are no longer artificially packed by court order, so that patients can leave and seek help through other means if conditions become unbearable, and so that supposed patients are no longer "treated" against their will and held down at the mercy of their helper-captors."

We already did that and we ended up throwing people out on the streets who were completely unable to take care of themselves. We also filled our prisons with the mentally ill. Deinstitutionalization was one of the biggest crimes of the last 50 years.

For once I actually agree with the bureaucrats on this one. We should spend more money. One of the reasons why the abuse happens is that these institutions don't pay worth a damn. Lousy pay gives you lousy employees and people who work there only because they are sadistic. This is one area where society really does owe people help. I have no problem paying higher taxes if the money went to actually help people suffering from mental illness.

|5.7.08 @ 1:46PM|#

Lousy pay gives you lousy employees and people who work there only because they are sadistic.

We arent talking about a highly skilled trade here. You start paying more and then what? The sadist will not like the extra income and quit? Or are you suddenly gonna get MDs, engineers, IT guys etc..., quiting their jobs and becoming prison camp guards? I dont think you can raise wages THAT much. You gotta consider the type of job, the pay range and the pool of applicants. This would be the same reason we dont exactly get the best of the best in the police, and Im sure police get paid way more then these guys. I think that raising wages will simply put more cash in the abusers pockets, ie, the very people who created these maddening prison-ward hellholes can be rewarded for their institutionalized violence by being allowed to take even more money from taxpayers to go on doing the same old thing

D.A. Ridgely|5.7.08 @ 1:47PM|#

Most shocking allegation of all?

"Others stole state property and sold tobacco products to patients." (Emphasis added.)

Public policy regarding institutionalization may have changed in the past 50 years, but the reality for those still institutionalized remains -- such 'patients' are essentially being warehoused, psychoactive drugs are used as chemical restraints, actually therapeutic help (such as there may actually be) is minimal or nonexistent, staff shortages are chronic and so on and so forth. Add to that the sheer statistical inevitability of anecdotal cases if abuse, medication mistakes and iatrogenic deaths and injuries.

D.A. Ridgely|5.7.08 @ 1:48PM|#

EDIT: "anecdotal cases of abuse"

Abdul|5.7.08 @ 1:53PM|#

We arent talking about a highly skilled trade here. You start paying more and then what? The sadist will not like the extra income and quit?

I worked in institutionalized care before and we were paid better than average for the industry. This was only one aspect of a better than average instituion--the pay denoted respect for staff. They also invested in frequent training and educational retreats. Respect for the staff trickled down to respect for inmates.

Kap|5.7.08 @ 2:11PM|#

My wife is a forensic psychotherapist. She recently transferred to working in a jail, specifically because the pay was better.

Pay more and folks other than the sadists start showing up.

A libertarian blog is not the place to be arguing that economic incentives don't work.

|5.7.08 @ 2:50PM|#

I wasnt really arguing that economic incentives dont work. I imagine that increasing wages could dilute the pool enough that 'sadists' would be rarer, but I highly doubt that you could increase wages enough for this particular position to fix the problem. The nature of the job will still attract a certain type of individual more frequently than other types of work.

Your wife is a forensic psychotherapist, a highly trained professional, not the security guard I was refering to.

Abdul, may I ask in what capacity you were employed, was it as some variation of an orderly?

But the records show that as in other state-run facilities, abuse and neglect are systemic.

The same article that mentions the anedoctal evidence, suggest that there is a larger systemic pattern here. We could also go through Radley's articles and shout 'anedoctal evidence' everytime a jackbooted foot kicks in a door. Or every time prison rape comes up.

Jennifer|5.7.08 @ 3:01PM|#

Concerning the "we need more money" crowd: just how much does it cost to hire a guard who understands that "dragging a sobbing adolescent across the floor by the wrists and the hair = bad?"

It's easy for any psychiatric institution to default into patterns of cruelty, because "behavior which is healthy and normal" doesn't necessarily equal "behavior which does not annoy the guards." For example, I personally would probably be very annoyed by the presence of a sobbing adolescent who kept whining for his mother, but I am also humane enough to understand that this is normal behavior coming from a sad, lonely teenager who's been branded "nuts" and locked away from his parents.

And you know what? I know this even though most of the jobs I've had have paid rather low wages. It's not like such insight is the exclusive domain of people making six or seven figures a year.

Eric Hanneken|5.7.08 @ 3:13PM|#

What is really needed is a power change, so that psychiatric wards are no longer artificially packed by court order, so that patients can leave and seek help through other means if conditions become unbearable, and so that supposed patients are no longer "treated" against their will and held down at the mercy of their helper-captors.

Hm. It sounds like he's suggesting "mental therapy vouchers," dispensed by a judge to those he deems mentally ill. The recipients would not be forcibly confined, and institutions would have an incentive to treat their customers nicely.

Tacos mmm...|5.7.08 @ 3:42PM|#

Hm. It sounds like he's suggesting "mental therapy vouchers," dispensed by a judge to those he deems mentally ill. The recipients would not be forcibly confined, and institutions would have an incentive to treat their customers nicely.

One of the issues that arises in treatment of the mentally ill is that many patients have little or no insight into their own illness. You can't expect all mentally ill people to recognize that they are even ill, much less recognize that they need to seek help.
Sadly, there will always be a role for forcable treatment, and even confinement, in the patient's best interest.

Tacos mmm...|5.7.08 @ 3:46PM|#

I wasnt really arguing that economic incentives dont work. I imagine that increasing wages could dilute the pool enough that 'sadists' would be rarer, but I highly doubt that you could increase wages enough for this particular position to fix the problem.

Diluting probably WOULD fix the problem, simply because one sadist in a staff of ten can't get away with what six could. Staff keep an eye on each other as well as the patients.

|5.7.08 @ 3:50PM|#

Lousy pay gives you lousy employees and people who work there only because they are sadistic.

But enough about the DMV.

Seriously, qualifications, training and pay rates for the caregivers of the mentally ill, needs to be addressed. Likewise accountability for the heads of these institutions needs to be demanded. Throwing money, by itself, will do nothing for those involntarily committed.

|5.7.08 @ 4:47PM|#

I get the point about higher pay.

What I thought of while reading was more vigorous prosecution and perhaps better oversight. Maybe even cameras in mental hospitals. I take it patients don't have much privacy anyway, and how much expectation of privacy should the staff have while working at a job like that?

Eric Hanneken|5.7.08 @ 5:00PM|#

Sadly, there will always be a role for forcable treatment, and even confinement, in the patient's best interest.

Does that mean you would support vouchers if recipients were required to use them?

Speaking for myself, I have difficulty approving of that idea. The state's power to confine is fearsome, and when its use is justified using a soft science like psychiatry there are bound to be abuses. For example, the government classifies all illegal drug users as diseased and routinely compels them to "treatment."

On the other hand, I can't reasonably deny that there are atypical people who would die miserably if their autonomy was respected, in spite of their own best intentions.

|5.7.08 @ 5:33PM|#

If theys nuts enough to be in the crackerbox palace, what is considered abuse? Can we get the guidelines from the same folks that give us torture rules?

Invisible Finger|5.7.08 @ 5:42PM|#

Or are you suddenly gonna get MDs, engineers, IT guys etc..., quiting their jobs and becoming prison camp guards?

The problem isn't the pay, the problem is the less sadistic job applicants choose a TSA job over stuff like this.

jtuf|5.7.08 @ 6:52PM|#

Isn't arresting abuser the best way to reduce the odds of another victim encountering them. It also helps if the victims are not forced to be sitting ducks through involentary hospitalization.

Tacos mmm...|5.7.08 @ 6:53PM|#

Does that mean you would support vouchers if recipients were required to use them?

This might be seen as an improvement on the surface, but in reality if the patient is convinced that pyschiatrists are trying to implant a transmitter in his brain, his ability to choose between facilities might be somewhat impaired. If family is available, they might make the choice, but frequently it would probably fall back on the state again, which gets us right back where we started.

Speaking for myself, I have difficulty approving of that idea. The state's power to confine is fearsome, and when its use is justified using a soft science like psychiatry there are bound to be abuses.

There are abuses by the patients probably more often than by the physicians. Mentally ill people learn quite quickly that they can garner endless attention and resources simply by wandering into an ER and claiming to have "suicidal ideation."

The motivation for physicians to lock up people against their will is pretty low. It's lots of annoying paperwork, may have to go before a judge, etc. etc.

Paul|5.7.08 @ 7:17PM|#

Before we go any further, I'd like to pause to savor the phrase "Rep. Garnet Coleman, D-Houston, who has bipolar disorder."

latest word on the street (NPR), that's overdiagnosed.

Rad Geek|5.7.08 @ 11:08PM|#

Eric Hannekan:

Hm. It sounds like he's suggesting "mental therapy vouchers," dispensed by a judge to those he deems mentally ill.

No, I'm suggesting that involuntary commitment be abolished, and that judges and other government officials be removed from the psychotherapeutic process entirely.

If you want to get together a voluntarily-funded charity or mutual aid society that covers the costs of psychotherapy, possibly including hospitalization in a psychiatric ward, then you should be free to do so, but one of the chief points that I'm trying to stress is that government officials and political power need to be kept as far away from psychiatry as possible.

Tacos:

One of the issues that arises in treatment of the mentally ill is that many patients have little or no insight into their own illness. You can't expect all mentally ill people to recognize that they are even ill, much less recognize that they need to seek help.

Many people with diabetes or human papilloma virus have little or no insight into their own illness, and many may not even recognize that they are ill. Yet very few people are willing to imprison diabetics or HPV carriers and force "treatment" on them without their consent.

This might be seen as an improvement on the surface, but in reality if the patient is convinced that pyschiatrists are trying to implant a transmitter in his brain, his ability to choose between facilities might be somewhat impaired.

Ah, paternalism.

I know of some cases of people with cancer who chose to go for quack "therapies" rather than submitting to the usual regimen of treatment. Sometimes at the cost of their own lives, and often on the basis of beliefs that are no less irrational than the delusions common among certain people labeled as "schizophrenic." Yet people who believe stupid or crazy things about magic cancer cures are not forced to undergo chemotherapy or radiation therapy against their will. If they were it would be more or less universally considered an atrocity, even if putatively forced on them "for their own good."

What, if anything, do you think explains this difference in treatment? What, if anything, do you think justifies it?

Rad Geek|5.7.08 @ 11:24PM|#

John:

We already did that and we ended up throwing people out on the streets who were completely unable to take care of themselves.

Allowing people to leave when they want to leave is not the same thing as "throwing people out on the streets." If someone is completely unable to take care of herself, it's fine in my book for you to try to help them out. What's not fine is forcing your "help" on her against her will.

We also filled our prisons with the mentally ill.

Transferring people from one prison to another is not what I advocate.

Deinstitutionalization was one of the biggest crimes of the last 50 years.

Compared to camphor-shock therapy? Electroconvulsive therapy? The ice-pick lobotomy?

Bullshit.

Jennifer|5.8.08 @ 10:19AM|#

Diluting probably WOULD fix the problem, simply because one sadist in a staff of ten can't get away with what six could. Staff keep an eye on each other as well as the patients.

This theory hasn't resulted in honest cops ratting out the dishonest ones. Why do you think psych-ward guards would be any different?