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The Return of Mental Hospitals: An Ethical Dilemma Amidst the Mental Health Crisis

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Ethan Sulliva
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The Return of Mental Hospitals: An Ethical Dilemma Amidst the Mental Health Crisis

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As the United States grapples with an escalating mental health crisis, a proposed legislation sparking intense debates has come to the fore. The proposed law would allow mental hospitals to return to the practice of warehousing patients, raising serious questions about the quality of care for the mentally ill. This move would not only change the landscape of mental health care in the country but also has ethical and practical implications that cannot be overlooked.

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The History of Mental Hospitals and Reasons for their Closure

Mental hospitals, once the primary care institutions for those dealing with mental health issues, have had a checkered past. The practice of warehousing, where patients were stored rather than treated, led to their eventual closure. However, the current mental health crisis has forced lawmakers to reconsider this approach. The rationale behind the revival of this practice is to provide immediate relief to vulnerable individuals who often end up in emergency rooms, jails, or even dead due to the lack of psychiatric beds.

Proposed Legislation and its Implications

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Lawmakers are on the brink of allowing Medicaid to cover substance use treatment in mental hospitals. This move, supported by public health groups and state Medicaid directors, is seen as a solution to the 1965 rule barring Medicaid funding for hospital treatment. However, this proposed change has elicited mixed reactions. While Republicans in Congress agree with the change, Democrats are divided, and civil rights advocates fear that lifting the Medicaid rule would lead to reinstitutionalization and forced care.

Concerns Surrounding the Revival of Warehousing

Opponents of the proposed legislation argue that it could infringe on the civil rights of an already vulnerable population. They fear that the law would lead to mass involuntary conservatorships, where individuals are placed under the legal guardianship of another due to their inability to make decisions on their own. This concern is particularly relevant in states like California, where changes to the state’s conservatorship law have been delayed due to worries of insufficient capacities at county behavioral health facilities, emergency rooms, and drug treatment facilities.

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The Role of Jails in Mental Health Care

The disturbing trend of jails becoming a warehouse for individuals with psychiatric problems is another reason for the renewed interest in mental hospitals. The harsh conditions, inhumane treatment, and inadequate supervision in jails have led to a surge in deaths among mentally ill detainees. The city has struggled to provide adequate care for these detainees, and the proportion of detainees with serious mental illnesses has doubled in the past decade. To improve care for these individuals, city officials have introduced intensive treatment units, therapy programs, and other measures, but many people refuse to take medicines that had previously stabilized them.

The Future of Mental Health Care

The proposed legislation, along with other measures like Senate Bill (SB) 240 in Texas, reflect the urgency to address the mental health crisis in the country. SB 240 aims to reduce workplace violence directed against healthcare providers by requiring health facilities to adopt a written workplace violence prevention policy and plan. While this initiative is a step in the right direction, it also underscores the pressing need for comprehensive mental health care reforms.

As the debate continues, it is imperative to remember that the ultimate goal should be to prioritize patient well-being and dignity. A balance needs to be struck between immediate relief and long-term care. Both community and hospital care are needed to provide people with what they need depending on their circumstances. The return of mental hospitals could be part of the solution, but only if the mistakes of the past are not repeated.

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