Wednesday, July 16, 2008

Cuckoo's Nest Set to Fall

The decision by Oregon officials to close the state hospital in Salem where the 1975 movie, One Flew Over the Cuckoo’s Nest, was filmed ends yet another chapter in the deinstitutionalization of people with mental illness.   Few will shed a tear when the wrecking ball hits the dilapidated brick structure this fall.   

But now what?

Described in E. Fuller Torrey’s landmark book, Surviving Schizophrenia, as “the quintessential film for the counterculture: the mental institution as a metaphor for the abuse of authority,” the image of that hospital helped fuel a well-intentioned but misguided policy that has left the U.S. with too few beds to treat people with severe mental illness.  The movie blurred the line between fact and fiction.  No one does or should like Nurse Ratched.  But as new solutions are developed its important to separate fact from fiction.

The lack of treatment for severe mental illness, including too few hospitals and too few beds for patients, is a danger to the nation.

What’s the plan?

Oregon already has a severe shortage of beds to treat people with mental illnesses, according to a recent report by the Treatment Advocacy Center.  The state plans to replace the storied 685-person hospital with a new 620-bed facility.  Oregon still needs to add 1,300 more beds to meet the mental health needs for a state with 3.7 million residents.  The new facility will still leave more people with mental illnesses in Oregon jails than in hospitals or in assisted out-patient treatment.  Elsewhere in the state, the future of other mental hospitals is in question.  Crowding ever more patients into a newer facility that is still too small isn’t a complete solution.