Walter Williams is a Liar

        Professor Walter Williams’ latest backhand slap at his favorite boogeyman comes in the form of an op-ed column titled “Deinstitutionlization is a Liberal Created failure.” His allegation is that the reason for the plight of America’s mentally ill citizens is squarely at the feet of “liberals.” As usual, he either doesn’t know what he doesn’t know or he’s simply a liar. I lean toward option 2 since the information regarding his scurrilous claims is so contradictory to his thesis. As usual, historical perspective is necessary, and he has little or none.

        Institutionalization of the mentally ill for all practical purposes began in London’s Bethlem Royal Hospital, the name of which was colloquially shortened to “Bedlam,” which word became synonymous with chaos and violent disorder. Founded in 1330, by the 18^th century, the directors had taken to admitting public visitors as an afternoon’s diversion for a fee, as there were rarely sufficient funds to truly care for patients, although in truth “care” usually consisted of confinement, little else.  Enough has been written about the treatment of the mentally ill in the past. More modern innovations included electro convulsive treatment, lobotomy, forced sterilization, and when all else failed, as it frequently did, brutal punishment.

        Most persons who ended up in American asylums were patients suffering from dementia, seizure disorders, diseases involving paralysis, or advanced neurosyphilis. These individuals were incurable by the available treatments of the day. Asylums thus became long-term homes for chronic patients whose care consisted of restraint, sedation with medications, such as bromides and chloral hydrate, or experimental treatment with opium, camphor, and cathartics. These treatments were neither effective in curing patients nor could they ever create improvement that could render patients able to survive outside the facilities. Populations in America's asylums swelled to more than 500,000 during the 1950s, with an all-time high of 559,000 United States psychiatric inpatients in 1953.

        The vast majority of mental facilities, in fact essentially all of them, were state run. Williams must know this but mention of it is strangely missing from his column. The story of deinstitutionalization is essentially a state budget story, complicated by withdrawal of federal funds, and to an even greater extent by events of which Walter Williams is apparently ignorant.    

        By the beginning of the 20th century, increasing admissions had resulted in serious overcrowding, causing many problems for state psychiatric institutions. Funding was often cut, especially during periods of economic decline and wartime. Asylums became notorious for poor living conditions, lack of hygiene, overcrowding, ill-treatment, and abuse of patients; many patients starved to death.

       The first community-based alternatives were suggested and tentatively implemented in the 1920s and 1930s, although asylum numbers continued to increase up to the 1950s. In 1946, President Harry Truman signed the National Mental Health Act, calling for the establishment of the National Institute of Mental Health to conduct research into neuropsychiatric problems. This was not a “liberal plot, and deinstitutionalization wasn’t its goal. The movement for deinstitutionalization moved to the forefront in various countries during the 1950s and 1960s with the advent of chlorpromazine and other antipsychotic drugs. This was not a liberal/conservative issue, but an economically worsening one. Marketed as Thorazine by Smith-Kline and French, chlorpromazine hit the market in 1954 (the Eisenhower administration!), as the first antipsychotic drug approved by the Food and Drug Administration. It quickly became a staple in asylums. Patients treated with Thorazine became tractable and controllable. By 1955 there were an estimated 560,000 patients in psychiatric hospitals and institutions in America.

        In 1963, John F. Kennedy signed the Community Mental Health Act, which aimed to provide federal funding for the construction of community-based preventive care and treatment facilities. Sadly, following JFK’s death, between the Vietnam War and an economic crisis, the program was never adequately funded. If this is one of Williams’ “liberal” actions, it must be pointed out that the law was passed to him for signing by Congress overwhelmingly with only 1 “Nay” vote in the US Senate and 18 in the House. This 96% affirmation was as close to bipartisan as we’ve seen in many years.

        In 1965, Congress passed the Medicaid bill, by an (again bi-partisan) 75% majority, but, with the passage of Medicaid, states were incentivized to move patients out of state mental hospitals and into nursing homes and general hospitals because the program excluded coverage for people in “institutions for mental diseases.” It is significant that the reason for the language was resistance of GOP hardliners (not “liberals,” as Williams implies) to actually paying for medical care for mental patients.Two years later, in 1967, California Governor Ronald Reagan signed the Lanterman-Petris-Short Act into law. Again, a bi-partisan law, not “liberal malfeasance,” it made involuntary hospitalization of mentally ill people vastly more difficult. One year after the law went into effect, the number of mentally ill people in the criminal-justice system doubled. That damned liberal Reagan!

        In 1973, a federal district court ruled in Souder v. Brennan that patients in mental health institutions must be considered employees and paid the minimum wage required by the Fair Labor Standards Act of 1938 whenever they performed any activity that conferred an economic benefit on an institution. Following this ruling, institutional peonage was outlawed, as evidenced in Pennsylvania's Institutional Peonage Abolishment Act of 1973. Until that point, inpatients who were capable of work of any kind, did so, generating revenue for the facility. This "forced labor by those in custody," concept goes back to the Magdalen Laundries of Ireland. The Magdalene Laundries , also known as Magdalene asylums, were institutions of confinement, usually run by Roman Catholic orders, which operated from the 18th to the late 20th centuries. They were run ostensibly to house "fallen women", an estimated 30,000 of whom were confined in these institutions in Ireland, but were, in fact, money makers for the Church..


        The myth, perpetrated by those of Walter William’s ilk, and  assumed by many is  that the advent of modern psychotropic medications was the catalyst for deinstitutionalization in the U.S., 
however, large numbers of patients began leaving state institutions only after new laws resulting from Souder vs Brennan made unpaid patient labor illegal. In other words, when patients no longer worked for free, the economic viability of many state institutions ceased, and this led to the closing of many state hospitals. It should be noted that these are all state issues, not federal initiatives. So, who is to blame for the admittedly under serviced mentally ill population’s plight?

       Start with the Reagan Administration. Where Truman had ordered a study and Kennedy had tried to increase funding. Jimmy Carter actually signed legislation, the Mental Health Systems Act (MHSA), aimed at restructuring the community mental-health-center program and improving services for people with chronic mental illness. While these three Democratic Presidents had done nothing to promote deinstitutionalization, Reagan signed an Omnibus Budget Reconciliation Act in 1981   repealing Carter’s community health legislation and establishing block grants for the states, ending the federal government’s role in providing services to the mentally ill.  Federal mental-health spending decreased by 30 percent. Reagan gave the appearance of making an ethical decision because he presented his repeal of MHSA as an action that would best serve American society and do more good than harm as a result. The MHSA gave mental patients a choice to seek treatment outside of a mental institution, an option to seek treatment at clinics at the state level, and the freedom to administer their own medication.  There is little doubt that Reagan, underinformed and under concerned as usual, was hasty in taking unsound advice to repeal MHSA because his real motive was to cut the federal budget.  He was a leader who “never exhibited any interest in the need for research or better treatment for serious mental illness” (Dr. E.F.Torrey, 2017)

         I cite Dr. Torrey, only because his book is apparently the source of essentially all of Williams’ column crucifying “liberals,” yet he (Williams) never mentions the arch conservative Reagan, who Torrey singles out as the source of many of today’s woes. I guess the pages stuck together. Williams also fails to mention that the proposed repeal of “Obamacare,” House Republicans who last year made good on longstanding promises to overhaul the mental health system could roll back coverage for millions of people with mental illness and addiction problems by overhauling Medicaid as part of an Obamacare repeal package. Goddamned liberals!

        Legislation as originally marked up would phase out Obamacare’s Medicaid expansion, which covers 1.2 million Americans with serious mental illness and substance abuse problems, as well as scrap baseline coverage requirements. The change means certain beneficiaries would no longer get coverage for mental health and substance abuse treatments guaranteed under the Affordable Care Act. More liberal malfeasance?

        Finally, what do we actually know about the results of the increased numbers of mentally ill persons into society? In 2004, studies indicate that approximately 16 percent of prison and jail inmates are seriously mentally ill, roughly 320,000 people. That same year, there were only about 100,000 psychiatric beds in public and private hospitals. That means there are more than three times as many seriously mentally ill people in jails and prisons than in hospitals. Is our safety truly threatened by those non-  institutionalized mental patients, for whom there is no bed or custodial care? Unlike Walter Williams, who is by trade an economist, I will simply let professionals tell us:   

"Although studies suggest a link between mental illnesses and violence, the contribution of people with mental illnesses to overall rates of violence is small, and further, the magnitude of the relationship is greatly exaggerated in the minds of the general population (Institute of Medicine, 2006)."

“the vast majority of people who are violent do not suffer from mental illnesses” (American Psychiatric Association, 1994)."

"People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime (Appleby, et al., 2001). People with severe mental illnesses, schizophrenia, bipolar disorder or psychosis, are 2 ½ times more likely to be attacked, raped or mugged than the general population” (Hiday, et al.,1999).

And finally, confirming that Walter Williams is just another hack, 

"The vast majority of news stories on mental illness either focus on other negative characteristics related to people with the disorder (e.g., unpredictability and unsociability) or on medical treatments. Notably absent are positive stories that highlight recovery of many persons with even the most serious of mental illnesses" (Wahl, et al., 2002).

        You might think a college professor with a Doctorate in any discipline would understand the need for research and valid commentary. Not so much in professor Williams’ case, apparently.