Inauguration: A Mental Health Tipping Point

Watching the inaugural celebration yesterday brought back memories of another presidential swearing in. I was a young reporter at The Washington Post when President Ronald Reagan took his first oath of office in January 1981. Along with another reporter, I was assigned to write a front page story about the throngs of spectators who had come to celebrate. The big political coverage was left to the paper’s heavy-weights,  David Broder, Hayes Johnson, Helen Dewar, and Lou Cannon. I was excited to be part of the team that was covering a historical event and producing a commemorative issue.

I had not way of knowing then — as I walked through the crowds — of  how Reagan would impact our mental health system.

Reagan took office at about the same time that many states were closing down state mental hospitals. The so-called “de-institutionalization” movement  can be traced back to 1963 when President John F. Kennedy got Congress to pass the Community Mental Health Act.  The discovery of a new miracle drug, Thorazine, made it possible for persons with severe illnesses, such as schizophrenia, to live outside locked wards. Kennedy’s plan called for the creation of community-based mental health centers so that ill persons would no longer be isolated from our communities.

Unfortunately, Kennedy was assassinated, the nation became embroiled in the Vietnam War, Congress got stuck in Watergate, Thorazine turned out not to be so wonderful and neighborhoods proved not to be as welcoming as they should have been. In short, Kennedy’s grand plan was delayed. It wasn’t until the mid-1970s that the closing of state hospitals picked-up full steam and even then, the driving force behind the closing of the hospitals was not public concern and compassion. It was money.

After decades of neglect, many state hospitals had become giant warehouses where patients were abused and forgotten. Newspaper exposes pricked the public’s conscience and civil rights lawyers began filing costly class action lawsuits demanding that legislators either close hospitals or repair them. It was at this point that the federal government announced that it would begin shouldering the costs of taking care of persons with mental disorders. That care was conditional, however. The feds would only take care of people who were not in giant institutions. This gave state legislators an economic out and they began discharging patients as quickly as they could.

This is where President Reagan came into play. He had been sent to Washington with a clear mandate. Get Uncle Sam off our backs and out of our pockets. And that is exactly what he began doing. He began cutting the very social programs that the government had said it would use to help persons with mental disorders. Housing for low income persons was cut from $32 billion to $7 billion during Reagan’s first term.

The result was a “trans-institutionalization,” which saw persons with mental illnesses move from dreaded hospitals into substandard nursing homes, inadequate assisted living facilities and jails and prisons.

I didn’t see this coming in 1981. Nor did I realize that my son, Kevin Michael, who was a few months away from turning two, would some twenty years later be diagnosed with a severe mental illness.

I now realize that Reagan’s inauguration was a “tipping point” in mental health care. I wonder if President Obama’s will be another “tipping point,” given the objectives that he outlined last week when he spoke about the need for gun control and better mental heath care services.

On that inaugural day in 1981, I wasn’t  concerned about mental health. I was busy trying to prove myself as a reporter. The Post’s top editor, Benjamin Bradlee, had an unofficial management policy called “creative tension.” He liked to assign two reporters to the same story to see who could do a better job. He thought it made both work harder.

The reporter assigned to cover the crowds with me that day was judged the better of us two. She came back with an amazing anecdote. If memory serves me correctly,  she told our editors that she had seen a long-haired hippie wearing an upset down flag on his jacket being accosted by an irate Republican mob who had forced the man to remove his jacket and had told him that our nation was tired of his “type.”

That story got top billing and the quotes that I had collected were relegated to the bottom of our story. I remember feeling a sense of failure when I finally arrived home after attending one of the inaugural balls.

Three months later, my colleague would win a Pulitzer Prize for another story that she’d written. It was about a eight year old heroin addict. Janet Cooke  would later have to relinquish her Pulitzer after the newspaper discovered her story had been a complete fabrication. A review of Janet’s other stories would reveal that nearly all were fiction. I suspect the same is true about her account of Republicans accosting a hippie.

I felt a sense of optimism yesterday when I heard President Obama declare that “We are made for this moment, and we will seize it — so long as we seize it together.”

Inaugurations are supposed to inspire hope. And I am hopeful that in the days that are coming, we will make progress in ending stigma and providing meaningful treatment to persons with mental disorders. I am hopeful that my son’s illness will not return. I am hopeful that we will find a cure.

But with age, I’ve also come to realize that none of us knows what tomorrow will bring. I certainly didn’t in 1981. That unpredictably  is what makes the future both challenging and exciting.