As a dialogue emerges amongst some mental health experts and academics, advocating for the return of asylums for people living with serious mental illness, Kenn Dudek responded to a recent article on the topic in the Journal of the American Medical Association (JAMA).
In “Improving long-term psychiatric care: bring back the asylum,” Dr. Emanuel, Dr. Sisti and colleagues point out the inadequacies of community based mental health programs in meeting the needs of the most seriously ill and advocate for the reopening of institutions.
In his response, Kenn Dudek admits that while there have been failures by community based mental health providers in effectively serving this population, these programs remain the most cost-effective and successful in reintegrating people with serious mental illness into the mainstream.
Read Kenn Dudek’s Letter to the Editor below regarding “Improving long-term psychiatric care: bring back the asylum.” You may also download the letter here.
Expanding Long-term Care Options for Persons With Serious Mental Illness
To the Editor:
In their Viewpoint, Dr Sisti and colleagues addressed the need for expanded and cost-effective care options for people living with serious mental illness. As the authors pointed out, closing state psychiatric hospitals made prisons the new institutions. Although the authors noted that the best option for a person with serious mental illness is “assisted treatment in the community,” they appear to believe that current community-based programs are inadequate for the most seriously ill.
Community mental health programs need to take some responsibility for these failures and for the inability to provide adequate services to enough people with the most serious mental health problems. I believe that this failure has been partially attributable to a loss of focus on the most seriously ill, coupled with inadequate funding. But more funding is not the only answer. Serving the neediest individuals in more effective ways is necessary.
Since 1948, Fountain House has served thousands of people living with the most serious forms of mental illness through a partnership model (not a peer-only model, as suggested in the Viewpoint) between members and professionally trained staff. Fountain House provides the “safety” and “sanctuary” Sisti and colleagues attributed to asylums but has also adopted a 3-part approach needed to assist patients in rejoining mainstream society: a psychiatrist trained in psychopharmacology, a primary care physician, and a supportive environment that offers hope and opportunity.
People living with serious mental illness, specifically schizophrenia, experience a 22.3% rate of hospital readmission. At Fountain House, our hospital readmission rate is 10%. For less than the cost of a 2-week stay in a psychiatric hospital, Fountain House provides members with housing, community support services, and access to medical and psychiatric care for an entire year.
The authors’ call to action could not come at a more important time. New York is witnessing the largest shift in funding since deinstitutionalization, transitioning to Medicaid and Medicare funding and in the process seeing major reductions in state government funding. I urge the authors to reconsider the value of cost-effective, community programs that focus exclusively on people with serious mental illness.
-Kenneth J. Dudek, MSW