Long Term Residential Facilities For Persons With Severe Mental Illnesses: A Response

(7-8-18) Virgil Stucker has spent much of his professional career helping found and direct therapeutic residential communities, most recently serving for fourteen years as head of CooperRiis, which is based in North Carolina. He recently formed his own company to help parents navigate the mental health care system.

Here is his response to my Friday blog about recent calls for the building of modern day residential asylums. Specifically, I mentioned that while Americans are distrustful of state mental hospitals, long term residential facilities are available in many parts of this country if you are wealthy enough to afford them.

A Response To Your Blog:

Growing Talk About Modern Day ‘Asylums’ Being Heard: Good Or Bad Idea?

Good morning Pete,

I would encourage you to carry this theme further. First, let’s go back to the early days of the Asylum.

In the early to mid-1800s as communities stopped “taking care of their own“ and as mobility increased the asylums began to provide mental health care from A-to-Z, addressing all levels of acuity.
The superintendents of the, I believe, 13 asylums created an association that would become the American Psychiatric Association. They had rules for asylum operation, such as their population was to be limited to 150 residents. They also paid attention to the mix of mental health science, yes, even medications back then, and milieu therapy, in order to benefit from relationship-centered care within these nurturing environments. They also conducted outcomes research often showing improved results after stays of approximately one year.
Some of the residents benefited from much, much longer terms days.
Increased mobility, lack of political integrity and loss of mission-committed leadership for the asylums resulted in their demise. Their population sizes skyrocketed into the thousands of residents and the disabilities and challenges of these added individuals went beyond mental illness and included people with myriad maladies that were not a good mix in the milieu. It was a sad ending that followed a very good beginning.

As we fast-forward to today, the A-to-Z continuum of care has become piecemeal and disconnected. At best on the front end, the average seven-day hospitalization is an attempt to provide mental health science often within a negative milieu. Discharging patients may no longer be a “danger to themselves or others” but they are often far from stable. Too often, they face a gap in care options and must jump from point A to a place near the end of the continuum even though they need in-between care in order to be successful. When this happens, too often, the result is reemerging acuity requiring repeat hospitalization or behaviors requiring imprisonment.

Of course we need something in between. The gap has turned into a chasm.

Over the last few decades some philanthropically-driven residential therapeutic communities, similar to Gould Farm which is today’s model, have been created. They are about as expensive to operate as some hospitals and prisons, because of the high number of staff that is required. Most have been established in rural settings and, increasingly, some are opening in urban settings. Some do indeed resemble residential community colleges for mental health recovery.
Since all of these initiatives have been nonprofit, they have the ability to raise donations to provide scholarships, reduced rate for families who are unable to pay for the full cost. Increasingly, medical insurance is also paying their fees. The philanthropic world has prototyped these initiatives; politicians in the publicly funded world have not yet paid close attention to them as efficient and effective alternatives to imprisonment and the increased cost of recurring hospitalization.
As with the asylums in the 1800s, some of these therapeutic communities are able to work with seriously mentally ill individuals who are able to move to higher levels of functioning and fulfillment within about six months to a year of residency. Some residents benefit for much longer term stays.
These programs also pay attention to the mix of mental health science and milieu therapy, which assures a higher level of respect, compassion and relationship-centered care within the environment. Perhaps the time has come for politicians and public policy makers to pay attention again to the alternatives of the ‘asylums’.
Some of today’s initiatives have shown how the old concept can be modernized. Instead of calling them asylums, how about if we develop “residential therapeutic communities” for people with serious mental illness? Some of these would be designed somewhat like “community colleges for mental health recovery”. Some would be designed as longer-term sanctuaries. Taken together, I believe they would help to fill the gap between A and Z and provide not only better mental health care but also at cheaper overall cost to families and society.

Virgil Stucker

…empowering mental health decision-making with families, philanthropists and program leaders
About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.