The recent crises at the Osawatomie State Hospital are about much more than accreditation and oversight. They are part of a larger story of neglect toward the mentally ill, now lasting for a half century and counting.
The Osawatomie story is harrowing: A staff member raped by a patient, with subsequent investigations uncovering additional abuses, inadequate oversight of the patients, and staffing problems. Federal officials threaten to suspend Medicare payments to Osawatomie, while Miami County government leaders demand solutions.
Political scientists call this “fire alarm oversight.” The Legislature steps in when there is a highly publicized, immediate crisis. Unfortunately, initiating new procedures at Osawatomie will not fix the underlying problem.
From the 19th century to the 1950s, Kansas followed national trends by placing those diagnosed as mentally ill into large state institutions. Osawatomie State Hospital was just such a place, housed back then in a medieval-looking brick building, since closed.
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Conditions in such facilities were often horrific. Patients – including children – were given improperly administered electroshock therapy and heavy medication. Some were involuntarily sterilized or lobotomized. The 1962 novel “One Flew Over the Cuckoo’s Nest” made many Americans aware of such horrors, until then largely out of sight, out of mind for most people.
Also in the 1960s, the trend moved toward “deinstitutionalization”: The mentally ill were to be released from state hospitals and placed in community-based care. Patients would live in group homes, checking in periodically to state clinics where they could check their dosages of medicine, get talk therapy, and get help finding appropriate jobs. That was a time of great hopes for newer, better, less-intrusive medications.
Things then went sideways due to lack of funding. The anti-tax climate of the late 1970s left state policymakers desperate for funding cuts, and the possibilities of deinstitutionalization were too good to ignore. The new goal was cost containment, not compassionate care. State hospitals lost too many beds to treat those who still needed inpatient supervision, while many of the deinstitutionalized joined the ranks of the homeless because of inadequate follow-up care.
A good example of these intermingled trends occurred here in the 1990s, when Kansas closed the Winfield and Topeka state hospitals. There was concern about the quality of patient care in these aging facilities – but their closing was also a tempting target for budget cuts. On the other hand, Wyandotte County legislators have fought for years to keep the tiny Rainbow Mental Health Facility from suffering the same fate.
What now? Shall the state make a true commitment to care for those with mental illnesses, fully funding community-based follow-up care for those who can use it, while also ensuring adequate beds and sufficient staffing at state hospitals for those who need round-the-clock supervision? As things stand, most care for the mentally ill is left to the police, prisons and emergency rooms.
Michael A. Smith is an associate professor of political science at Emporia State University.