When Mayview State Hospital closed in 2008, ending 115 years of treating people with mental illness, the Post-Gazette expressed what was doubtless the hope of many in the region -- that its patients would be safe, able to live with as few restrictions as possible and have access to effective treatment and support.
Five years after Allegheny County's last state mental hospital was shuttered, what is the verdict? Post-Gazette reporter Joe Smydo examined this question in a five-part series titled "After Mayview," which concluded on Sunday. The answer is mixed and not unusual in the national context of deinstitutionalization.
The closing of large facilities was born of several factors. One was a humanitarian response to the unfair treatment of patients in mental hospitals, as illustrated by the novel and film "One Flew Over the Cuckoo's Nest."
The development of a new generation of psychotropic drugs brought the promise that community care would be a better option than the untender mercies of Nurse Ratched. This appealed to government officials who believed that letting patients live in community settings might mean savings. In addition, the courts made involuntary commitments more difficult.
But the road to hell is paved with good intentions, in this case with cost-cutting officials playing their unhelpful part. Not that it is hell five years post-Mayview -- the closing helped some and hurt others. Still, the mental health system wallows in a state of crisis because the proper balance between inpatient and outpatient care has not been achieved.
The series found several challenges facing the region today, among them a shortage of psychiatrists, difficulties in finding housing for people with mental illness, the demoralization of caregivers stressed by staff reductions and pay freezes and a struggle by mental-health professionals to care for high-need cases served by Mayview.
All of these problems were aggravated by the state cutting in 2012-13 $11 million in basic mental health funding for the five counties that Mayview served. State Rep. Thomas R. Caltagirone, D-Berks County explained the attitude of some politicians for people with serious mental illness. "They don't vote. They can't be of any help to me. Why should I care about them?"
Why care? One in four American adults experiences mental illness each year and one in 17 has a serious psychiatric condition, such as schizophrenia, according to the National Alliance on Mental Illness. Why care? Because we are in the midst of a national debate about how firearms might better be kept out of the possession of people who are deeply disturbed.
The hopes attending Mayview's closure have not been fully met. Five years later, it is past time that Pennsylvania's leaders cared.