The Post-Gazette's recent series on mental health services in southwestern Pennsylvania ("After Mayview," Sept. 22-25 and 29) suggests that the closure of Mayview State Hospital was unsuccessful. But our scientific tracking of 92 people discharged from Mayview shows that the majority of former patients have done well in many ways after being integrated into the community at large.
One of us is the lead investigator from the University of Pittsburgh team that followed former patients and the other is a senior staff member from Allegheny HealthChoices Inc., which assisted in managing the closure. Our systematic evaluation followed a representative sample of people for four years using scientifically validated research instruments to document outcomes in psychiatric symptoms, quality of life, social functioning and whether services met people's needs. All assessments took place in participants' homes. We interviewed people multiple times regarding their experiences settling into new homes and communities. The study has been presented at national scholarly meetings, open to question and critique from our peers.
Our study shows convincingly that people improved after leaving Mayview. Every overall measure was stable or improved over the study period. Some people had poor outcomes, but people in institutions can also experience very negative outcomes.
Participants overwhelmingly told us that they preferred living in their new residences to Mayview. The most common description of Mayview was "prison." As one person said: "The best experience has been knowing I can make it in the real world. Not as hard as I projected it to be."
We saw people experiencing success and real excitement about renewed opportunities to live full, meaningful lives. One young man holds down a job, which he loves. He had been encouraged to live in one of the more restrictive forms of housing available to people with psychiatric disabilities. However, his passion for improving his ability to cope and his ability to work with his treatment team persuaded those helping him that he could live on his own. He is now thriving in his own apartment.
This young man told us, "I live a modest life ... [in] my comfort zone. My rest and relaxation come from a comfortable apartment, a place where I can relax, listen to some music, write some songs, read. I can leave this comfort zone and go to the office, a supplementary comfort zone. I cherish being comfortable and at peace. I really wanted this place, to be on my own; ... [having] privacy gives you confidence and self-esteem."
His story, and those of Bobbi Bishop, Sharon Brown and Topaz Calloway, which were cited in the PG series, are more reflective of the lives of individuals than the few tragic incidents also reported.
The series noted difficulties that some people experienced when they needed to access a hospital for a short time. Data carefully tracked by Allegheny HealthChoices Inc. and included in the PG series shows that hospital beds are available. This does not mean that gaining access is easy in every individual circumstance. But hospitals remain open and available to people with psychiatric symptoms when they need them.
The series noted that state and county officials involved in the Mayview closing pursued this course with a "belief" that people with mental illness deserve to live in the least-restrictive environment possible. This is not only a belief of local officials, it is the decision of the Supreme Court in Olmstead v. L.C. (1999). The Supreme Court stated that unjustified segregation of persons with disabilities constitutes discrimination in violation of the Americans with Disabilities Act. Indeed, the court stipulated that public entities must provide community-based services to people with disabilities whenever possible, particularly when it is the preference of the person in treatment.
The PG series emphasized the importance of adequate funding for services for people with psychiatric disabilities, and we wholeheartedly concur. But these services should be community-based, not in institutions that compromise the liberty and dignity of people with psychiatric disabilities. Concerned citizens should advocate for the adequate funding of community mental health services, not for the return of institutions.opinion_commentary
Katie Greeno is associate dean for research for the University of Pittsburgh and lead investigator of the Pitt team that followed people discharged from Mayview State Hospital. Brandi Phillips is chief operating officer at Allegheny HealthChoices Inc. Sue Estroff of the University of North Carolina and Courtney Kuza of Pitt also contributed. First Published October 15, 2013 8:00 PM