Dear Trump, These Institutions Weren't The Answer

On Thursday, Donald Trump responded to the gruesome on-air murders of two Virginia journalists, citing the preponderance of mental health institutions of the past as a potential solution — but it's unclear if Trump actually knows what mental institutions in the "old days" looked like. During an interview with CNN, Trump stressed that the problem was not guns, but mental health care in America and that there are "so many things that can been done" to fix it the broken system. His main suggestion was institutionalization, something he believes gunman Vester Flanagan was in need of. "In the old days they had mental institutions for people like this because he was really, definitely borderline and definitely would have been and should have been institutionalized," Trump said.

The fact that Trump is addressing the need for mental health reform is important. The fact that he advocates for increased resources is even better. But he offers no explanation of how to do so, except by stating that Flanagan should have been institutionalized. Which is not necessarily a fix-all solution in terms of mental health.

Institutions have been a blessing and a curse to the mental health field, and current facilities are much needed resources that provide individuals with help and support. But institutions of the "old days," which Trump refers to, were not. We've moved away from the old culture of institutionalization — and for good reason.

America's mental health system has always been flawed and imperfect, but it has consistently improved as we make new discoveries. Initially, the idea of a mental health institution was one such improvement. In the mid-1880s, activist Dorothea Dix worked tirelessly to achieve funding for state-sponsored mental asylums that would provide safe housing as well as accessible and reliable health care. She was successful in her efforts and achieved funding for over 32 institutions.

But though the intent behind these facilities was to provide humane care, funding to mental health care was even harder to achieve back then than it is today. Many of these institutions suffered from lack of funds, staff, and overcrowding, and patient conditions often suffered as a result.

One of the first mental asylum exposés came in 1887, when journalist Nellie Bly went undercover at an institution on Blackwell's Island. While there she discovered horrific conditions: spoiled food, isolation, unclean laundry, and rampant abuse at the hands of patients. The institution was used as a dumping ground for New York's unwanted, including sane individuals who were foreign and struggled to communicate. “The insane asylum on Blackwell’s Island is a human rat-trap," Bly wrote. "It is easy to get in, but once there it is impossible to get out."

The conditions at Blackwell's Island were not unusual, and facilities across the nation continued to suffer from overcrowding and overstretched resources as institutionalization became more prominent. It was a solution to handling the mental ill, as well as the mentally and physically disabled. Children with illnesses or disabilities would be handed over to the care of institutions and were essentially abandoned.

In the early 1900s, inhabitants of institutions were often used for experimental medical tests. In the 1940s, patients at a mental institution in Connecticut were given hepatitis. In 1942, inhabitants at a Michigan asylum were given an experimental flu vaccine before being exposed to the flu. They were also used as testing grounds for advancements in mental health studies. As more was learned about the field of mental health, asylum conditions generally improved. But lack of resources crippled many institutions.

By the 1950s, approximately 560,000 Americans were institutionalized as the country began shifting toward deinstitutionalization. A community-based approach became more popular, which allowed treatment in the individual's home and community, aided by smaller residential homes and community health centers. The rise of antipsychotic prescription medicine also enabled individuals to have access to health care outside of an institution. But it was a slow process. Massive, overcrowded facilities that suffered from low funding and small staffs still existed in the late 1900s.

One of the last and most infamous of these facilities was Willowbrook, an institution on Staten Island for mentally ill and mentally disabled children. Parents would routinely abandon children at the institution, where they were exposed to poor hygiene, negligence, and at times physical and sexual abuse. According to NPR, almost 100 percent of the residents tested positive for hepatitis after either being deliberately injected with it, or contracting it from unsanitary water.

In 1972 Geraldo Rivera won a Peabody Award for his coverage of Willowbrook, and by 1987 the facility was permanently closed. But the legacy of the institution remains an example of what can happen when a society shuts away and ignores those who need help the most.

Our current mental health system is broken and badly needs repair. It is, almost unilaterally, understaffed and underfunded, and Trump is right when he says we need to dedicate more effort into providing mental health care. The idea of institutionalization — in a modern sense — is not a flawed one. Deinstitutionalization is not the best thing to happen to mental health care as it put heavy stress on the system and contributed to the broken system we have today.

But given the troubling history of the facilities and the tremendous advances and work we've done to end stigmas, we should never advocate to return to the "old days" of mental health care. It might have been a slip of the tongue on Trump's part, but it was a troubling one.

Images: Wikimedia Commons (4)