This is installment #4 in a series of blogs and articles written to examine the barriers that block persons presumed to have major mental illnesses from living longer and more effective lives. Just to remind those of you who have read any of the previous blogs, I use a model of analysis which can be summarized by the acronym MAP: Mission, i.e., objective and related tasks; Accountability, which, in my model, is first and foremost to the persons being served; and Post-Psychiatry, or, perhaps more accurately, Post-disease model, which relies on psychosocial interventions, with psychoactive medications in an adjunctive and non-central role. More on this in my next blog.
In this blog, I've chosen to take a look at the proprietary or for-profit adult home industry in New York City for several reasons. First, from the time adult homes opened their doors to mental patients newly discharged from State mental hospitals, they have remained essentially unchanged, reminiscent of the hospital back wards from which most of their first residents came.
Second, the homes have never promoted their residents' recovery; rather, they utilize the treatment they do provide, largely psychopharmacological, to secure their residents' acquiescence to barren and authoritarian environments. Finally, New York State, which is constitutionally responsible for the welfare of all State residents determined to have serious mental illnesses, has been recently sued by mental health advocates for failing to ensure appropriate care for all persons with serious mental illnesses currently residing in New York City's adult homes.
Approximately fifty years ago, New York State began to empty out its large mental hospitals, discharging their inmates back to their home communities. The great majority went back to live with their families; but many, particularly older inmates who had been institutionalized for many years, were sent to group homes scattered throughout the state. In New York City, those who didn't go home were discharged to proprietary, i.e., for-profit, adult homes or to SRO's, i.e., single room occupancy hotels.
The adult homes had originally been built, at the State's behest, to house what was anticipated to be a rapidly increasing post-war elderly population that would require independent housing. When this cohort never materialized, the State fulfilled its end of the bargain with the adult home proprietors by filling their homes with mental hospital discharges, a largely one-way flow that has continued over these past fifty years as the State's institutionalized population has dropped from nearly 90,000 to less than 3,000.
At present, 28 homes, licensed by the State Department of Health and located in the farthest reaches of the City, house over 4,000 residents, virtually all of whom have Axis I diagnoses, are poor and receive SSI and Medicaid. From the very outset, the homes were considered by advocates and the residents themselves as re-creations of the State hospitals, warehouses for the recently discharged relocated from the nearby suburbs to the City's neighborhoods. Many of their original residents were the hospitals' "back ward" patients, believed to be irrevocably regressed and cognitively impaired, requiring total care and supervision, suffering, in short, from what Goffman termed "institutionalization syndrome."