Time to Bring Back the Asylums

What does the word asylum conjure up in your mind? An overpopulated mental ward with screaming patients frothing at the mouth? A snake pit, as depicted in the 1948 movie of the same name in which actress Olivia de Havilland, battles schizophrenia, shock treatments and a sadistic nurse?

The word asylum simply means, “An institution offering shelter and support to people who are mentally ill.” So why don’t we have more psychiatric asylums to help the ever-growing number of Americans who battle serious mental illnesses like schizophrenia or bi-polar disease? “Asylum” is not a dirty word.

The answer is simple: Money. And the fact that decades ago, following shocking disclosures about the care in some institutions it was decided to close the doors of almost all psychiatric hospitals in favor of smaller community-based treatment centers. Thousands of troubled souls were released but the centers never materialized, in part because few citizens wanted a psychiatric care home in their backyard. Today the majority of severely mentally ill people have become the problem of the police whose only alternative is to arrest them and lock them up.

This is what we do to mentally sick people – put them in an unsafe and violent environment? When did we decide that being mentally ill is akin to a criminal offense? And, how does jailing such a person help anyone? Once released they will still suffer from their illness, and it may be even more profound at that point.

“We need to treat these individuals like we would treat someone with a serious cancer,” Professor Dominic Sisti of the University of Pennsylvania told me the other day.

Prof. Sisti – University of Penn. Dept. of Medical Ethics and Health Policy

Sisti, is a PhD in Ethics of Behavioral Health Care and author of an often-quoted  paper called, “Improving Long-term Psychiatric Care – Bring Back the Asylum.” He noted the moral distress of his student interns at being forced into the practice of “treating and streeting” mental patients. That is, getting them back out on the street within 72 hours when the federal funds to treat them run out.

The way we allocate money and resources to help these most vulnerable people is not fair and it is clearly not working.

According to The Treatment Advocacy Center, an organization dedicated to making treatment possible for the severely mental ill, an estimated 15% to 20% of inmates in local jails and state prisons have a diagnosable and serious mental illness. In 2014, for example, there were 383-thousand people with severe psychiatric problems locked up compared to about 38,000 getting treatment in state psychiatric institutions. Something is wrong there.

Dr. Emmanuel Trujillo

At the same event at which I met Dr. Sisti I listened to several other experts in the field of mental illness. Dr. Emanuel Trujillo, a former Director of Psychiatry at New York’s famous Bellevue Hospital believes it is unethical for society not to force the profoundly mentally ill to take anti-psychotic medicines. He cited one of his own patients who declared, “I am fine. I am God. You are the crazy one.”

The Washington Post reports that a man with schizophrenia stabbed out both his eyes while incarcerated in a Minnesota county jail. Jailers in New York did not know what to do with a schizophrenic inmate, so they left him in solitary confinement for 13 years. It is clear penal institutions are no place for those suffering from profound mental disease. I’ll go one step further and agree with legal scholars who believe it constitutes cruel and unusual punishment.

The biggest hurdle to getting mental patients out of jails, off the streets and into bona fide treatment programs is money. States look to the feds to help but regulations on Medicaid and other government programs are so restrictive that meaningful treatment is impossible. Hospital emergency rooms are flooded with those needing urgent mental health care and according to D.J. Jaffe, executive director of Mental Illness Policy Org, “If you can walk in you’re not considered to be a priority (patient)” and the alternatives are “homelessness, jail or the morgue.”

Dr. Jeffrey Geller

Dr. Jeffrey Geller, Director of Psychiatry at the University of Massachusetts Medical School addressed those who worry about the “warehousing of people” should asylums make a comeback. Geller says that is already happening in substandard, poorly subsidized adult homes and other care facilities where mental patients get room and board but no services due to the ill-conceived structure of federal assistance. Once targeted therapy begins Geller said, “Most could be treated, live on their own and for those who could not, they can be afforded asylum care.”

The conversation about the need to bring back asylums – once a taboo subject – is now being openly discussed among academics and other experts in the field of mental illness. Its time the rest of us began to listen.




Note: All photos courtesy of the institutions mentioned


  1. Diane Dimond on May 14, 2018 at 11:57 am

    Reader Jerry Blazek writes:

    Hi Ms. Dimond. I enjoyed reading your column regarding asylums. For further ideas on a more modern approach to the mentally ill, I would refer you to the “German concept”. One doesn’t see many homeless mentally ill people in Germany. They live in half way homes with a therapist, get breakfast- some meals, are encouraged to work and work is offered in the way of late night office clean up etc. in partnerships with the government and private employers. I realize I’m talking about socialist Germany where taxes are 50% and people are happy to pay high tax for effective and efficient programs in addition to a value added tax with nary a billionaire to be found. However, there are probably a few points to be learned from these folks.

    Best wishes, Jerry Blazek

  2. Diane Dimond on May 14, 2018 at 11:58 am

    ABQ Journal Reader Debbie Srongin writes:

    Dear Ms. Diamond:

    Thank you for bringing up this very important issue.

    My Father, a very wise clinical psychologist who practiced for over 60 years, used to say that “not since the Middle Ages have we turned our backs on the mentally ill as we do today.” My Dad would have applauded your Op-Ed in today’s Albuquerque Journal, and so do I.

    Debbie Strongin
    Albuquerque, NM

  3. Diane Dimond on May 14, 2018 at 12:00 pm

    Reader Rick Bentley writes:

    Excellent article. Bringing back mental hospitals, institutions or asylums, however they are called. They are so needed. The mentally ill need protection from themselves, from other criminal elements, and the population of society needs protecion from mentally ill dangerous actions.

    Please continue this dialog. This would be an excellent project to be funded by the billionaires in our nation, and would be even more helpful to more people than rocketships and delivery drones.

    Rick Bentley

  4. Diane Dimond on May 14, 2018 at 12:01 pm

    ABQ Journal Reader Elaine Stevens writes:

    HI, I just read your opinion piece in todays ABQ Journal. I couldn’t agree more !

    As the ClinicalDirector of a community mental health center (CMHC) in the mid 70’s, I was
    tasked with developing and implementing a plan to coordinate the discharge of long time
    patients from Longview State Hospital to the community.

    The model was that local CMHCs would develop and supervise group housing, add staff to monitor
    patients transition to the community, and coordinate medication evaluations with
    CMSD psychiatrists. The model also anticipated savings from closing state psychiatric
    hospitals would be passed on to the CMHCs to provide these services. Guess what never happened ?

    In Ohio, the state government decided to use those monies to balance the state
    budget, and probably reduce taxes, although I don’t remember that specifically.

    The county government was suppose to help fund this transition, and they did. They just
    had counted on the state helping, which they didn’t.

    As a result, we were very short staffed, patients didn’t get the services they needed,
    medication monitoring was uneven at best.

    Yes, some patient did very well and should have been living in the community. But
    there was a group of patients that did very poorly: group living was incredibly challenging,
    learning to manage money, to use local transportation, to take their medication regularly,
    were way above their skill level. These folks ended in ER rooms, in police stations, and
    on the street….w/out medication and without a skilled mental health workers to help
    them navigate a whole new world.. Many had been in the hospital 20 years or more.

    Some studies done at Ohio State prisons in Cleveland Ohio by Joseph Calabrese, MD of
    University Hospitals found that up to 75% of inmates had a current diagnosable mental
    illness….that was untreated.

    Well, I have written much more than I intended, but was so glad to see your
    article. No one talks much about our broken mental health system. And yes it
    is all about MONEY, not expertise. We know how to treat people with serious mental
    illness, but they are a largely invisible minority. I do wonder if at every interstate exit
    in Albuquerque the folks we see soliciting help could benefit from well planned mental
    health care.


    Elaine Stevens, MSW, LISW

  5. Diane Dimond on May 14, 2018 at 12:02 pm

    ABQ Journal Reader Ray Orley writes:

    Dear Ms. Dimond:

    Thank you very much for your piece that appears in the Albuquerque Journal of May 12 under the title “We owe it to the mentally ill to bring back asylums.” It is a model of clarity and a real breath of the fresh air of understanding. However, I’m afraid the solutions you mention can only come about once people truly understand that mental illnesses are just like physical ones. Their causes and workings are just as much in need of scientific research and probably just as susceptible to proper scientific treatment. And for both the research and new treatments to come about, money must be spent on a level equal to that spent on physical illness.

    Do any of our current politicians have the necessary interest or understanding? I fear not. The last one I can remember who did was our own New Mexican Senator Pete Domenici–and of course he has a daughter with a severe mental illness. Without him on Capitol Hill, the subject hardly ever even comes up.

    –Ray Orley, Albuquerque

  6. Diane Dimond on May 14, 2018 at 12:04 pm

    ABQ Journal Reader Mary Ann Edwards writes:


    I remember back in the late 60’s when the asylums were closed and the community center treatment was conceived. It never happened…you are right!

    Now 50 years later treatment for the mentally ill is costly, and in many places non existent. Surely there are models in other nations for humane care for the mentally ill.

    We should be ashamed of ourselves for the way we are ignoring these human beings and fellow citizens.

    Asylums? Absolutely! How do we make that happen?

    Mary Ann Edwards

    Santa Fe, New Mexico
    Mary Ann Edwards

  7. Diane Dimond on May 14, 2018 at 12:06 pm

    Twitter Pal Dave Imbriaco@DaveImbSays writes:

    I don’t know if asylums would be better or worse than what we have now, as the present state of things was an unintended consequence of the de-institutionalization movement. We have completely criminalized mental illness, but we did so indirectly.
    We’ve made it all but impossible for people who need the most help to get said help, and as result, they end up in the criminal justice system – think the chronically homeless/people with drug addictions. So many of these people have diagnosed or diagnosed illnesses, but…that’s only one side of the problem – awareness.
    The other side is making help affordable or even available at all. Finally, it’s getting law enforcement on board and giving beat cops the training and support that they need to make better decisions on the job.
    On one hand, it’s hard to ask police officers to play doctor on the job. But on the other, with power comes responsibility, and I have zero pity for police officers who harm anyone who was not posing a threat to anyone.

  8. Diane Dimond on May 14, 2018 at 12:09 pm

    Facebook Friend Mary Hoffman writes:

    I agree. The Government shut down all the mental instatutions and most now are gone. I have an older brother who grew up in a child’s mental instatution and still suffers bipolar disorder, and manic depression. He is paranoid over just about everything and doesnt trust the Drs. anymore because many Fridays when my dad would sign him out for the weekends the staff over medicated him to the point my dad had to carry him to the car and my brother stayed asleep all weekend long. My folks called the state government about this and tried to contact local media. The institution was hush hush about everything.
    // Each state needs to start from scratch and open up mental institutions to help the mentally impaired people so when they freak out they dont end up in a prison system with brutal predators waiting to hurt these innocent victims. Too much conspiracy and cover-ups.

  9. Diane Dimond on May 14, 2018 at 12:10 pm

    Facebook Friend Kate McCullough writes:

    Yes, I have mentally ill sister who does not get care…only evictions and homelessness

  10. Diane Dimond on May 14, 2018 at 12:11 pm

    Facebook Friend Richard Hydell writes:

    I I’m in a small southern town and I saw a shopping cart lady completely out of her mind (god bless her) yes we need care for the mentally ill .

  11. Diane Dimond on May 15, 2018 at 2:45 pm

    Reader Patti Welsh writes:

    Ms. Diamond –
    I read your recent opinion piece about bring back the asylum, and while I agree with you that seriously mentally ill people need better care than we are currently providing, it’s not just money that is needed.

    What also happened in the 1970’s, was a Supreme Court case, O’Connor vs. Donaldson (O’Connor v. Donaldson – Wikipedia) which made it impossible to keep someone against their will if they have not committed a crime.

    Mentally ill people are unlikely to commit themselves, and it is extremely difficult
    to get a loved one committed for any real length of time. How could institutions have remained opened in recent decades if there are no patients to fill the beds?

    We will never solve the problem without addressing the 5th and 14th amendments, and will just continue to throw good money after bad if the involuntary commitment laws aren’t changed.

    Patty Welsh, MSW

  12. Diane Dimond on May 15, 2018 at 2:52 pm

    Reader J. Solstice writes:


    Thank you for caring about people who have serious mental illness. However, I want to ask, rhetorically, Do we call nursing homes or veteran’s homes asylums?

    Psychosis spectrum disorders were poorly understood back in the day that residency facilities were called asylums. An asylum is a place of psychologically restorative refuge – which is not a clinical or residential medical case management facility. These illnesses were misconceived as psychological disorders and emotional disturbances.

    Medical science now knows that Schizophrenia and Bipolar are not “mental health” problems. They are neurological disorders, and the most competent of psychiatrists know that they have a biological, predominantly hereditary root cause (meaning that they are not caused by trauma and abuse…which is the prevailing view among a very troublesome faction of the mental health industry).

    In my state, there are community based facilities known as LTSRs and CRRs, for example. They are staffed with 24/7 staff that provide assistant with medication regimens and personal care in some cases. In my state, these facilities are known as supported housing. However, there is a paucity of those facilities because legislators would prefer to fund supportive (…ive) housing, which has no onsite staff..just someone checking in on the person or performing some level of case management. The most severely ill fail catastrophically in supportive housing and often end up unjustly in jail or prison. Unfortunately, Long Term Structured Residences and CRRs are not even long term. They are transitional. CRRs are often transitional for “justice-involved” people. People in supported transitional housing often end up being stepped down to inappropriate community housing or at home with families who cannot cope with the seriousness of their symptomatic behaviors. We do not need asylums to house people with brain disorders that disorder the semblance of mind (i.e neurological disorders)

    State funded inpatient facilities are also needed in order to admit people who need longer term treatment or those who are very ill and are biologically resistant to pharmaceutical treatment. My state has virtually eliminated what remains of civil beds, turning over many of them to the criminal justice system to prepare people for prosecution (i.e. “competency restoration”).
    You are on the right track, except for terminology. Advocates need the help of the press to shine the light on these issues.

    J. Solstice

  13. Diane Dimond on May 17, 2018 at 12:26 pm

    Reader Suzanne Storer writes:

    I couldn’t agree more with your column “Time to bring back the asylums.” I’m afraid it will be a long time, if ever, that the money will be spent to make asylums happen. I’m dealing with such social justices in my sculpture as shown on my website. http://Www.suzannestorer.com


  14. Diane Dimond on May 17, 2018 at 6:22 pm

    Facebook Friend William Drummond writes:

    The reason they wind up in prison is that in the 1970s the country went through a wave of freeing the mentally ill from state hospitals for the insane. Ronald Reagan led the changer in California. Sent them back to the communities. Problem was that Reagan and his successors failed to provide facilities in the communities to deal with them. Thus, they wound up in prison.

    • Diane Dimond on May 17, 2018 at 6:23 pm

      Diane Dimond replies:

      Actually, William – it was JFK who first embraced the idea of closing the “Snake Pits” under the guise that the patients would be better off close to home, integrated into society so they could better learn society’s ways. The asylums began to close in the 60’s well before anyone would believe actor Ronald Reagan would become president. The lecture I went to (quoted in the column) went through the whole history of how/why we are a country that doesn’t know what to do with our mentally ill. It was fascinating. Read some of Sisti’s work on line if you’d like more information.

  15. Diane Dimond on May 21, 2018 at 2:54 pm

    Readers Catharine Stewart-Roache and Patrick Roache write:

    We were struck by the wisdom and boldness of Diane Diamond’s recent column supporting a return to asylums for some of those who are mentally ill. Defining “asylum” was a step in the right direction. What is currently needed is a safe place for mentally ill persons who cannot take care of themselves, nor are able to take medications to help control some of the effects of their illnesses.

    Clearly, asylums are definitely not the answer for all, or most, of those suffering with severe mental illnesses. But it would be for some and it would save lives. We were parents of a child who suffered (and that must always be remembered) from severe mental illness and took her life when the treatment plan led to proximate release from a transitional living facility. The situation appeared hopeless to her and she took her life. Suicide is frequent among severely mentally ill.

    We would have welcomed an alternative to living on the streets, or living without adequate care and support.

    Yes, academics, physicians and those specializing in ethics need to take a serious look at a modern, caring form of asylums. And we would urge them to think about the needs of parents, spouses, relatives and friends of those who suffer so much from the current, lacking system.

    Catharine Stewart-Roache
    Patrick Roache

  16. Diane Dimond on May 22, 2018 at 12:43 pm

    Twitter Pal jan@Bee_Happening writes:

    Good article. Important facts to point out.

  17. Diane Dimond on May 27, 2018 at 11:12 am

    Creators Syndicate Reader the_sculptor writes:

    Well dressed? Did you see the pictures of them? These men were wearing sweat shirts for a meeating.

    • Diane Dimond on May 27, 2018 at 11:13 am

      DD replies to The Sculptor:

      It saddens me that THAT is what you took away from this column. But for the record, I thought they were well (enough) dressed for a meeting in a coffee shop. No droopy pants, no hoodies, no visible tatoos. Yes. I thought they were well dressed for the occasion.

  18. Diane Dimond on May 30, 2018 at 10:23 pm

    ABQ Journal Reader Peter Ives writes:

    On the topic of re-opening asylums. I have had two friends who committed suicide due to mental illness. I keep thinking, perhaps they would be alive if they knew that they could seek sanctuary in such a place. There are too many lost souls wandering our streets; it is a scandal that we see this everyday. Give the mad a refuge from the madness. Thank you.

    • Diane Dimond on May 30, 2018 at 10:24 pm

      Thank you, Peter, for sharing your story. I too wonder if your friends (and countless others) would be alive today instead of part of the sad suicide statistics of America. If only there were more treatment places for them to go!

      Here’s hoping America can evolve its focus on the problem of the mentally ill. I will keep writing about it as long as I am able.

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