Lost Patients: Episode "Opening" – A Detailed Summary

Introduction

In the inaugural episode of the six-part docuseries Lost Patients, hosted by Will James and produced by KUOW News and Information in partnership with the Seattle Times, listeners are introduced to the intricate and often flawed mental healthcare system in America. The episode delves into the historical and systemic challenges in treating serious mental illness, particularly focusing on Washington State's Northern State Hospital and the broader implications of the deinstitutionalization movement.

Historical Context of Northern State Hospital

Will James opens the episode by painting a vivid picture of the Northern State Hospital, a psychiatric institution in the valley north of Seattle. He contrasts the hospital's past horrors—such as insulin comas and transorbital lobotomies—with the gradual improvements seen in the 1960s.

Will James [00:00]: “A sprawling house in which every room, doorway, and hall passage was designed by a different architect. Doorways don't connect.”

Testimonies from Joanne McInnis

Joanne McInnis, a nurse at Northern State Hospital since the 1950s, shares her harrowing memories of the institution's darker days but also acknowledges the progress made with the advent of psychotropic drugs.

Joanne McInnis [00:43]: “I'm talking about the development of the first psychotropic drugs. And then there was a lot of research that was going on, and I felt good about Northern's part in that.”

The 1960s Revolution in Psychiatry

The 1960s marked a revolutionary period in mental health treatment with the introduction of antipsychotic drugs, which reduced psychiatric symptoms and fostered optimism about curing psychosis. This era also saw the introduction of the open door policy at Northern State Hospital, a significant shift towards viewing patients as fully human and facilitating their reintegration into society.

Sidney Brownstone [01:35]: “You see just more progressive ideas about what mental health treatment should look like coming to the fore.”

Deinstitutionalization Movement

As optimism grew, so did the push for deinstitutionalization—the movement to close large psychiatric hospitals and shift care to community-based settings. Governor Dan Evans of Washington State played a pivotal role in this transition, citing both national trends and economic pressures.

Dan Evans [04:44]: “With respect to mental illness, our chief aim is to get people out of state custodial institutions and back into their communities and homes without hardship or danger.”

The episode highlights the drastic reduction in state psychiatric hospital beds—84% over 50 years—and the ensuing challenges as community care systems lagged behind.

Governor Dan Evans and the Closure of Northern State

Facing a severe budget crisis in the early 1970s, Governor Evans decided to close Northern State Hospital, the smallest of Washington's three psychiatric hospitals, aiming to save approximately $14 million over two years. This decision was met with resistance from the local community of Sedro-Woolley, the hospital's location, due to concerns over job losses.

Chris Hudson [11:05]: “I think a lot of politicians started calculating out what could be saved.”

Despite assurances that community care would adequately support discharged patients, the reality proved otherwise. Joanne McInnis recounts the fragmentation and inadequacy of support systems post-closure.

Joanne McInnis [16:19]: “I felt like the patients weren't taken care of. There wasn't the follow up and the support systems knocked out.”

Personal Story: Phil Dyro

The episode introduces Phil Dyro, a former patient of Northern State, whose life exemplifies the failure of deinstitutionalization. Committed as a teenager and later subjected to a lobotomy, Phil's struggle continued long after his release, highlighting the systemic gaps in care.

Phil Dyro [19:02]: “He talked continually. He just went on and on and on.”

Phil's story underscores the cyclical nature of the system, where individuals with serious mental illnesses find themselves repeatedly cycling through shelters, jails, and hospitals without receiving the necessary support.

Consequences of Deinstitutionalization

By the early 1980s, the promise of community mental health centers had not materialized. Funding issues and inadequate infrastructure led to increased homelessness and incarceration among the mentally ill.

Dan Evans [24:22]: “They have become the asylum of the 80s. After more than two decades, deinstitutionalization has yet to be carried out as it was first planned.”

The episode discusses how the removal of single-room occupancy buildings (SROs), affordable housing options for the homeless, exacerbated the crisis, leaving many without stable living conditions.

Sidney Brownstone [29:57]: “Here is an era of massive change for the most vulnerable people in our society. And yet that wasn't really felt by middle class or otherwise comfortable people at all.”

Interview with Former Governor Dan Evans

In an in-depth interview, former Governor Dan Evans reflects on his role in the deinstitutionalization movement. At 97 years old, Evans acknowledges the complexities and unintended consequences of closing Northern State Hospital.

Dan Evans [35:48]: “Probably a little bit of all. But we were at a point where we were at the beginnings of a more localized attachment to mental health and its treatment.”

Evans expresses regret over the lack of preparedness in community care services and the challenges in addressing the needs of the mentally ill.

Dan Evans [37:05]: “I don't think there was a lot of really good knowledge about alternatives. So it was a time of recognizing that we had a problem, but not really knowing exactly what the best answer to the problem was.”

Reflections and Ongoing Challenges

Will James and Sidney Brownstone conclude by reflecting on the enduring legacy of deinstitutionalization. The fragmentation of mental health services has led to ongoing cycles of neglect, as seen in the stories of Phil Dyro and others like Adam Urant, who remain marginalized and without adequate support.

Sidney Brownstone [40:49]: “It is recording. I think he did acknowledge though, he said no one really wants responsibility for this thing. It's something people in power don't want responsibility for.”

The episode emphasizes that deinstitutionalization, initially a movement driven by civil rights and humanitarian ideals, became a convenient escape for governments to avoid the costly and complex responsibility of caring for the mentally ill.

Conclusion

Lost Patients Episode "Opening" offers a compelling exploration of the systemic failures in American mental healthcare, using historical analysis and personal narratives to illuminate the human cost of policy decisions. It sets the stage for the series by highlighting how well-intentioned reforms can lead to unintended and devastating outcomes when not properly supported by infrastructure and sustained commitment.

Notable Quotes

• Will James [00:00]: “A sprawling house in which every room, doorway, and hall passage was designed by a different architect. Doorways don't connect.”

• Joanne McInnis [16:19]: “I felt like the patients weren't taken care of.”

• Dan Evans [24:22]: “They have become the asylum of the 80s.”

Key Takeaways

• The deinstitutionalization movement significantly reduced psychiatric hospital beds without establishing robust community care systems.
• Economic pressures and political incentives often overshadowed the needs of the mentally ill, leading to increased homelessness and cycling through institutions.
• Personal stories like Phil Dyro’s illustrate the profound human impact of systemic failures in mental healthcare.
• Former leaders reflect on the complexities and regrets associated with past policy decisions, underscoring the need for accountability and comprehensive support systems.

Lost Patients sets a critical foundation for exploring solutions and envisioning a more effective mental healthcare system in subsequent episodes.