Wednesday, October 22, 2014

Rhode Island's community mental health system is born

 Thirty years ago, I wrote a six-part series for The Providence Journal (The Journal-Bulletin then) about the creation of Rhode Island's community system. This is one of the stories from that "Building New Lives" series.

R.I. praised for its care of mentally disabled


Publication Date: November 28, 1984  Page: A-01  Section: NEWS  Edition: ALL 

Part four of six parts.

[NOTE: The "Building New Lives" series examined both the mental health system and the system for care of the developmentally disabled, people who in 1984 were labeled "retarded" -- and many of whom lived in the now-closed  Dr. Joseph H. Ladd Center in Exeter.]

This is how the mentally ill were treated in RI 50 years ago. Courtesy: Providence Journal. For more on the institutional era, click here.
A sun-drenched afternoon in August. The streets of Manhattan's Bowery stink of garbage and urine and cheap booze, and flies are buzzing everywhere, and everything's moving slow, and it's steamy hot, dog-day hot.

For eight years, since his discharge from a public psychiatric hospital, William J. Moody has lived on these streets. For eight years, he has carried his earthly possessions in a valise, a shopping bag and a tattered gym bag. For eight years, he has been unable to find a job, or an apartment he can afford.

"A Bohemian," he fancies himself. "You know, more or less in a clean, bummy fashion."

When he has the money, Moody eats sardines and mayonnaise, or treats himself to Chinese food or a bowl of noodle soup. When he doesn't, he picks through dumpsters. At night, when the weather is fair, he sleeps in parks. When it isn't, he rides the subway until dawn or finds a steam grate or a warm tunnel.

Moody shuffles along East Third Street, a once respectable neighborhood gone to seed. Most of the buildings are boarded, run down, covered with unintelligible graffiti, revolutionary slogans, posters for new-wave bands named "Live Skull," "Brooklyn Dead" and "Alien Love."

Around the corner, men congregate near the Palace Hotel, a tumble-down flophouse. The men are young, middle-aged, old. Some snooze. Others drink, play cards, swap stories in gravelly voices. Their faces are tired and dirty. Their clothes are grimy. There is no dignity on these streets, only survival.

Moody gives his age as "60s." He is a tall, slim, toothless man with a crazy, crackling laugh and a fondness for clean clothes and porkpie hats.

Moody also is a schizophrenic. During his years on the streets, he has been spit on, beaten, stabbed, robbed, arrested. He has been thrown out of rooming houses, kicked off buses, denied medical care.

He is a victim - a victim of deinstitutionalization. In contrast to Rhode Island, where the movement has succeeded, New York is a national disgrace.

Like thousands of New York City's estimated 40,000 street people, Moody, a onetime drummer in a big band, spent years in an institution. Like the others, he was discharged without an apartment or a job, without psychiatric care, without much concern for what would happen to him.

"These people aren't getting shelter, food or clothing. Some are dying," says Dr. Frank R. Lipton, assistant professor of clinical psychiatry at New York University Medical Center. "For this group of people, we aren't even at square one. For these people, it's a mess."

NATIONALLY, deinstitutionalization has a mixed record. One of the most successful states has been Rhode Island, a national leader in the movement.

Other states, Wisconsin, Nebraska and Vermont among them, also have spent the time and money to care for people who have left institutions. A few, including Oklahoma and Arkansas, have rejected the movement and continue to operate large, overcrowded, unsafe institutions.

Still others, such as New York and California, rushed to empty institutions without putting in place all of the programs longtime patients must have to live decently in the community. In New York, 60,000 patients of state psychiatric hospitals have been released since 1965; estimates of those who need community help, but don't get it, run to 25 percent or more.

One result was predictable: a mounting cry to turn back the clock a half-century to when severely disabled people were routinely packed off to asylums.

"Attempts since the 1960s to 'deinstitutionalize' these patients and treat them in the community have succeeded only partially, and the failures are increasingly visible on the grates and gutters of urban America," the Wall Street Journal reported in August.

A Massachusetts Senate committee, in a report released two months ago, faulted that state's mental health department for being too zealous in its deinstitutionalization. The committee urged officials to consider reopening mental hospitals.

"The committee's investigation has uncovered sound evidence that hundreds upon hundreds of former patients are winding up in jail cells, emergency rooms, emergency shelters and walking the streets . . ." the report stated.

"One need only to walk the streets of Boston, Worcester or Springfield, or any other urban center, to see real-life examples of deinstitutionalization gone sour."

And in California, a nine-month state commission study concluded this year that group homes in the state were plagued by "abusive, unhealthful, unsafe and uncaring conditions . . . some residents are actually killed in facilities each year."

RHODE ISLAND places near the top among states that have done the job of deinstitutionalization well.

Yes, there are gaps in service, and there are some homeless mentally disabled people, but experts agree Rhode Island has spent the time and money to ensure that most people who leave the Institute of Mental Health and the Dr. Joseph H. Ladd Center will be able to live at something better than survival level.

Experts in mental health and retardation with national perspectives speak highly of how well Rhode Island has managed deinstitutionalization, and many have come here for firsthand looks. Not coincidentally, the first legislation encouraging national deinstitutionalization was introduced by a Rhode Island senator, John H. Chafee.

"You can see in a comparison of similar states with similar size how one can do a better job," says Neal B. Brown, director of the National Institute of Mental Health's community support program. "Rhode Island is doing a better job. A tremendous amount has been done in the last few years."

Harry C. Schnibbe, executive director of the National Association of State Mental Health Program Directors, agrees. "It's working a hell of a lot better than in other places, I can say that," he remarks. "People are being taken care of when they get out of the facilities."

"There are only about three places in the country where there has been dramatic and consistent and persistent community development," says Thomas Nerney, a consultant to the U.S. Office of Special Education and Rehabilitative Services. "Rhode Island is one of them."

One recent survey by the National Institute of Mental Health, for example, shows that Rhode Island annually spends $61.56 per capita for private and public mental health services. Only three states spent more.

Another survey, by the University of Illinois at Chicago, showed that Rhode Island spent about $26 per capita for community services for the retarded. Only two of the 50 states spent more.

"Before you left the hospital, did anyone give you advice on how you were going to get by?"

Moody: "I was inquirin' while I was there but I couldn't make heads or tails out of what the people were sayin'."

"Do you have an income?"

"Yeah, I'm gettin' Social Security and an Army pension. About $450 per month. Four hundred fifty in 30 days. That's not much money in this city."

"Would you like to work?"

"Sure. Yeah. But you can't get anything these days. Everything seems to be filled. Then, on top of that, like I say, I don't have any identification. I can't tell them I belong to the union."

"What about an apartment?"

"Well, now, if I could afford it, and it more or less fitted my particular curricula, yeah, I'd go for it. I found a couple of places like that, but they're particular. You just can't get in there."

"What if someone found you a place. A state or city agency, say?"

"I'd love it. I'd go stark ravin' insane over it. Knowin' that I'd have my own private apartment? Would I like it? I'd end up paintin' the whole place in nothin' flat] Sure] I'd be crazy about that]"

RHODE ISLAND'S secret has been a combination
of money, leadership, and a consensus that moving people out of institutions is cost-effective and humane. In few states has there been such agreement among legislators, the public and experts in the field.

These are among the ingredients of Rhode Island's success:

* Time.

Unlike other states, which rushed to empty institutions in the 1960s, Rhode Island didn't get into high gear until a decade later. That comparatively late start gave the state the chance to learn from others' mistakes.

Says Leona Bachrach, professor of psychiatry at the University of Maryland School of Medicine: "I think it's probably okay to suggest that you overcame some of the errors of some of the other states that proceeded very rapidly."

The majority of people leaving institutions were adequately prepared for new lives outside; people who had trouble outside were returned to the institutions until they were ready to try again. That was crucial. Large numbers of obviously disturbed people acting strangely or offensively would have created great public pressures to slow, or reverse, the movement.

* Size.

Rhode Island is a small state with only one public psychiatric hospital and a single public institution for the retarded - a built-in advantage to the architects of the movement. Many of the problems of larger states, including New York, have been related to the sheer magnitude of the task.

"New York inherited a terrible problem of numbers," says Joseph J. Bevilacqua, former director of the Rhode Island Department of Mental Health, Retardation and Hospitals. "New York had literally 40, 50 institutions. The calculus to move that number into community services is horrendously complicated. It's a gargantuan problem."

* Administrative leadership.

Both Bevilacqua and his successor, MHRH director Thomas D. Romeo, have made deinstitutionalization a top priority, fighting to channel money and resources away from Ladd and the IMH into community programs. They also brought on board, or promoted, division-level bureaucrats who shared their vision.

* Dedicated professionals.

Without competent front-line staff, quality services cannot be consistently provided. Although a few public and private workers have little interest in the people they serve, Rhode Island has been able to attract primarily qualified, dedicated professionals willing to work long hours at low pay in what is acknowledged to be a high "burnout" field.

* Community advocates.

One of the driving forces behind the movement has been the Rhode Island Association for Retarded Citizens. Less powerful, but still important, have been the Mental Health Association of Rhode Island and the Rhode Island Council of Community Mental Health Centers.

* Public support.

Although many group homes were met with stiff opposition in neighborhoods around the state, Rhode Island voters have never turned down a bond issue for development of community programs. Since 1967, 10 bonds totalling $90 million (including money for the IMH and Ladd) have been approved. The latest was an $8-million bond passed on Nov. 6.

Says Schnibbe: "That is one distinction that Rhode Island has that is substantially different from the rest of the country. Everybody wishes they could use it."

* Political leadership.

Many states have been frustrated by legislative squabbles over cost and purpose. For the last decade, the General Assembly and the governor have been committed to the program. In particular, Governor Garrahy and former Senate Majority Leader Rocco A. Quattrocchi have been key figures in mustering support.

* Federal money.

Unlike some states, Rhode Island has been unusually successful in attracting federal dollars. Even under the Reagan administration, the state has managed to get millions annually for community programs.

* Monitoring and control.

Although local providers administer many programs, allowing for flexibility and innovation state bureaucracies often lack, Rhode Island has kept control of overall programs through their financing. In those few instances where community workers have been found negligent, the state has moved quickly to discipline them or bring court charges.

* Legal action.

A 1977 federal suit by RIARC against the state accelerated the movement of people from Ladd and led to improvements at the institution.

* Media attention.

Investigations in the 1970s by the Rhode Island media, notably the Journal-Bulletin, focused attention on deplorable conditions at the IMH and Ladd. That attention made it impossible for legislators and MHRH administrators to ignore the problems of the state's mentally disabled, in or out of institutions.

Tuesday, September 16, 2014

A few words about humor (actually, more than a few!)

From Jonathan Swift to Saturday Night Live and The Onion -- and now, absrdCOMEDY -- writers have used satire to offer what Wikipedia (see below) describes as “constructive social criticism.” In other words, food for thought, served with humor. Parody -- a close, if lighter, cousin -- aims less to be constructive than to get laughs (and perhaps provide a degree of insight) by revealing ironies, inconsistencies and contradictions, often with the use of mockery and ridicule.

Since first discovering these two genres, in high-school freshman English, I have savored both for their potential to make people laugh and their power to prompt serious thought about real-life social, cultural, political and international issues. I began writing satire and parody myself while editor of my high school newspaper and I continued in college, after which I got a “real” writing job. 

So imagine my delight earlier this year when I discovered absrdCOMEDY, a flourishing home for parody and satire. Actually, I discovered Michigan comedian Jeff Dwoskin’s absrdNEWS Twitter account first. Open-sourced, anyone could contribute. I started to. Jeff was already thinking web site when I and others encouraged him to take the plunge. He did. I wrote some of the earliest entries for absrdCOMEDY -- specifically, The Cave Times and Real Putin News, which I continue to write, along with posts under my own name. I also wrote part of the site's disclaimer, which I still think is kinda, sorta, maybe funny: Individual opinions expressed are those of the individual authors, not necessarily of absrdComedy, and may not even be those of the individual authors.

Jonathan Swift. Read his famous "A Modest Proposal"

Some people spend their few spare moments in the busy day playing Angry Birds or Candy Crush, or noodling around on Facebook or Twitter, or arranging their spice shelves, or whatever. In my leisurely moments, I write snippets of satire and parody, and stuff without higher purpose beyond a smile or a laugh. Whether they’re funny and thought-provoking or not -- well, you be the judge.

Under Jeff’s stewardship -- he calls himself Chief Creative Officer (I like that one!) -- absrdCOMEDY has continued to grow and grow. I am happy to be a part-time part of things -- and I like how it brings me down Memory Lane. One of my acquaintances in college was the great humorist Jim Downey, who went from Harvard and the Harvard Lampoon to become one of the legendary writers (and occasional actor) for Saturday Night Live. And two of my college friends were the late Mark O’Donnell and his Emmy-winning twin brother Steve, marvelous comedians and satirists/parodists themselves. I am hardly in their league, of course, nor in the rarefied place held by New York Times satirist Gail Collins, whose columns never fail to hit the mark. 

But in and around my "real" writing (mostly at 5 or 6 a.m.), I am having fun, with my modest little contributions to two genres of literature whose roots are in ancient Greece -- but which have never been more relevant than in today’s crazy world.

Satire is a genre of literature, and sometimes graphic and performing arts, in which vices, follies, abuses, and shortcomings are held up to ridicule, ideally with the intent of shaming individuals, corporations, government or society itself, into improvement.[1] Although satire is usually meant to be humorous, its greater purpose is often constructive social criticism, using wit as a weapon and as a tool to draw attention to both particular and wider issues in society.
Read more about satire's long history here.

And if you are really into wasting time (that's parody, folks... or is it satire?), read about parody here.

Sunday, August 31, 2014

Along Michigan Avenue, Detroit: Part One

A drive along the main boulevard of Michigan Avenue from Dearborn, Michigan, world headquarters of Ford, into downtown Detroit tells many stories: of decay, abandonment, life continuing among the ruins, hope for the rebirth one day of this once-mighty city. During my recent stay, I met only the most friendly and helpful people. May the city rise again.

First of two parts of a photo essay. Click here for Part Two.

Michigan and 35th: a child's playground, a boarded-up building.

Michigan Animal Hospital. As I watched, a man with a poodle emerged.

Derelict storefronts, a new cell tower.

Senate Theater: They show old movies here.

A young couple and their kid.

Mother and son.

Beyond salvation.

A man hidden by bushes.

Falling down.

A stronger America.

Truck, maybe built here.

A drive-through, once upon a time.

The goldenrod grows.

Fire-engine red.

Motown motorcycles.

Along Michigan Avenue, Detroit: Part Two

A drive along the main boulevard of Michigan Avenue from Dearborn, Michigan, world headquarters of Ford, into downtown Detroit tells many stories: of decay, abandonment, life continuing among the ruins, hope for the rebirth one day of this once-mighty city. During my recent stay, I met only the most friendly and helpful people. May the city rise again!

Second of two parts of a photo essay. Click here for Part One.

Zion, rotting home beyond.
A house.
Another house.
Dollar store.
Hair cuts.
Golden arches, CVS.
Liquor, lotto, WIC.
Open for business.
Also open.
Once-grand Michigan Central Station, long closed.
Upper stories of Michigan Central
Industrial legacy.
Almost into downtown.
Heart of downtown, a beautiful summer afternoon.
Hope for a storied city!

Friday, August 15, 2014

Middle Class Squeeze

Here we are in August already, the summer flying by. What with vacation and all, I have been absent for a few weeks from here (though not @gwaynemiller and Facebook!)

Readers of The Providence Journal have been reading our latest year-long series: Middle Class Squeeze, about the economic ground that the middle class has lost over the last two decades. This is a look the economy through the prism of personal stories and an election year and it follows Reinvent Rhode Island, our 2012 year-long look at the overall Rhode Island economy, which remains sluggish in 2014. As with all of our major efforts, this one has been expertly illustrated and designed, and supported online with innovative interactive graphics, polls, photos and video.

I wrote the lead-off story in the series: FRACTURED, a profile, supported with data and great graphics, about Cumberland's Danielle and Josh Maziarz and their three young sons and and their struggles to get by on Josh's blue-collar salary. The Maziarzes are illustrative of so many families today.

Josh and Danielle Maziarz and their sons.

I have written several more stories already published (with more to come), among them:

-- A mix of empathy, anger and frustration: readers speak out, May 24.

-- As incomes slide, voters check out, June 7.

-- Millennial flight, Aug. 3.

John DosSantos: Native Rhode Islander, now in Vermont

Several colleagues, including Kate Bramson, Paul Grimaldi and Paul Parker have also written stories and supplied other support, all under the leadership of project editor John Kostrzewa, and Karen Bordeleau and Sue Areson. And as always, the online and visuals people have pitched in nicely. For the full series, visit the Middle Class Squeeze page. For all of our recent special reports and series, visit the special reports page.

Stay tuned for more #MiddleClassSqueeze as the election season heats up...

Thursday, May 8, 2014

My response to responses to 'The Princeton Privileged Kid'

Several people have weighed in on my posting a link to “To the Princeton Privileged Kid,” which more eloquently than I ever could makes the case that white men enjoy an edge soley due to the circumstances of their birth (born white, born male).

Let me respond to their responses.

First, regarding advantage v. privilege, let’s not split hairs or play word games. We all know what we’re talking about here. I’ll use privilege, as the nom-de-plumed Violet Baudelaire did in his/her essay.
I could cite many professions where people of color and women are under-represented. Medicine, for example (for women, start with the data at; for people of color, start with the data referenced in Or Hollywood filmmaking (see: Spike Lee or Kathryn Bigelow).  

I'll discuss the area about which I can speak most authoritatively: Journalism, my profession for virtually all of my adult life. Along with my first-hand experience, I have been a student of the field for more than four decades.

There was one woman editor at my first newspaper, The Transcript, in Berkshire County, Mass., when I was hired in August 1978: she handled society events and gardening. The notion of a woman editor handling “hard” news would have been laughable to many. There were no people of color anywhere on the news staff of The Transcript.

There was one woman editor at my next paper, The Cape Cod Times, when I was hired in April 1979: she copy-edited four days a week, and on the fifth was the Saturday-night editor, a dead-end job. There were no people of color anywhere on the news staff of The Cape Cod Times then and when I left, in October 1981 for The Providence Journal, where I remain a staff writer. 

On a news staff of some 200 or more people when I joined The Journal that year, there was one person of color: a reporter. There was one woman editor: the great Carol Young, who made history in 1979 when she was named assistant city editor, the first woman at a newspaper that has been continuously published since 1829 to join news management. When she began at the paper, as a reporter in 1965, she was the only woman of 23 news hires that year. She brought to three the total number of women on the news staff.

Have things changed? Yes, but only to a degree. 

The two top news people now at The Journal are women: executive editor Karen Bordeleau and deputy executive editor Sue Areson. This remains an anomaly in the profession, however. According to hard data compiled by the American Society of Newspaper Editors, Media Matters, and other reliable sources, both women and people of color remain greatly under-represented in the media. A Poynter Institute staffer references the data in a recent column, writing: 

“An ASNE newsroom census cited in the report showed that newsrooms were 63.1 percent male and 36.9 percent female in 1999. In 2012, those percentages were exactly the same. For 2013, it was actually worse: 63.7 percent male and 36.3 percent female… the percentage of minorities in newsrooms is far smaller than their representation in the United States population.” Google “women in the media” and “people of color in the media” to find many similar reports.

I come from a blue-collar family that never had a penny to spare; looking back, I see that we could be classified as working poor. I caught a break when I was admitted, on merit (neither of my parents graduated from college, let alone an Ivy League school), to Harvard. Did my degree – my privilege – help in my career? Now that's a silly question. 

Hard work helped, too: working as a hospital orderly and then a baggage handler for Delta Airlines as I struggled to turn free-lance writing into full-time employment.

And what also helped was the fact that, by luck of the birth draw, I was a white male, seeking entry into a profession that was and still is dominated by similarly lucky white men.