Crackup in Mental Care

The psychiatrist at California's Atascadero State Hospital did not think that Edmund Emil Kemper III, a 20-year-old giant who five years earlier had killed his grandparents, should return to society. Even so, a parole board eventually sent Kemper home to the comforts of life with his mother. Within three years of his release, the 6-ft. 9-in. youth had slaughtered and dismembered Mom, six coeds and a friend of the family. Last month Kemper was convicted on eight counts of first-degree murder and sentenced to life in prison. Angry Californians were wondering why he was ever released in the first place.

A decade ago, Kemper and others like him would have stood little chance of ever leaving a state mental hospital. In the past nine years, because of judicial pressure to protect the civil liberties of mental patients and the growing use of drugs to treat mental illness, the population of state mental institutions has declined by almost half, from 505,000 in 1963 to 276,000 in 1972.

The inmate exodus had its roots in the 1950s when more and more psychiatrists challenged the concept of custodial institutions. In 1963 the Community Mental Health Centers Act was passed. Aimed at eliminating the "human warehouses" state hospitals had become, the bill envisioned the eventual creation of 2,000 local clinics to provide counseling and care.

Though hospitals began their steady discharge of patients as planned, money to fund this revolution in mental care never sufficiently materialized. After ten years, only 392 community centers are in operation. Economy-minded Governors, willing to save money by closing hospitals, have been less willing to divert the money into clinics. Moreover, while small states like Hawaii can boast of success in treating seriously ill outpatients, clinics in larger states like California and New York are often faced with .more people and more problems than they can handle.

Cheap Hotels. In the past year, hope for a federally financed community mental health movement died within the Nixon budget. First the Administration announced plans to phase out the federal grants that support the centers. Then it tried to impound funds already appropriated by Congress. The National Council of Community Mental Health Centers sued and won its money, but left court with an ominous sampling of budgetary battles to come.

In California, where the population of mentally ill in state hospitals was reduced from 36,000 in the 1950s to 7,000 today, chronically ill patients have been returned to communities poorly equipped to provide adequate treatment. With no one to care for them, former patients have ended up on welfare rolls, in boardinghouses, cheap hotels and even jail.

According to a Ralph Nader task force report, community centers across the U.S. have failed to provide care to those least able to find help: drug addicts, alcoholics, the young, the aged and "the poor in general." Thousands of people are being dumped into nursing or foster homes where conditions are often deplorable. Since New York State started emptying its mental institutions of thousands of inmates six years ago, many of them "have been jammed into tiny rooms, basements, and garages and fed a semi-starvation diet of rice and chicken necks," an investigation by the Long Island newspaper Newsday revealed last week. The state has made little or no provision to ensure the former mental patients "suitable housing or supervised after-care," charged Newsday. "As a result, they are taken from the steps of mental institutions by operators who jam them into what can only be described as private jails and confiscate their monthly welfare checks."

Neither civil libertarians nor psychiatrists seem willing to return to the old days when citizens could be committed for long periods of observation without even a court hearing. Yet many feel that the closing of state hospitals has been precipitate, with too much concern for economy and too little concern for mental health or public safety. Now that the Nixon Administration has apparently abandoned the community mental health centers, the future of mental care is shakier than ever.

From now on, local communities will also handle all drug addiction cases formerly treated in two big federal drug treatment centers. Last year the center in Fort Worth, Texas was closed and this month the famed huge 38-year-old fortress-like hospital in Lexington, Ky., will shut its doors. The explosion of the addict population in the 1960s made it clear that the treatment offered in the federal facilities was not effective. Getting the addicts jobs and re-establishing them in their own neighborhoods proved to be more important than drug therapy or psychiatric training far from home. "We never knew what the job markets were," admits Lexington Director Dr. Jimmie Hawthorne. "We just weren't close enough to the home environment of the addicts." Though the White House office for drug abuse prevention asserts that local facilities are adequate, others disagree. Dr. Edward Senay, director of the Illinois drug treatment program, estimates that 90% of U.S. addicts now go untended.

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