Opening

Summary

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.

Transcript

[Will James]

A warning to lost patients is about serious mental illness. It's true that horrors unfolded at Northern State Hospital, the psychiatric hospital run by Washington state in the valley north of Seattle. Insulin comas, transorbital lobotomies. We heard about some of that from Joanne McInnis, who started as a nurse at Northern state in the 1950s. Now in her 90s and living in a retirement home near the hospital, she still wrestles with those memories. But there's one thing Joanne's sure about. As the years rolled on, as the 1950s became the 1960s, Northern State got better.

[Joanne McInnis]

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.

[Will James]

These new antipsychotic drugs seemed to calm people with psychotic disorders and reduce their symptoms. As these drugs swept the country, the more brutal treatments faded away and a new optimism set in. For decades, the best psychiatrists could hope for was to contain psychosis. But now they believed they might actually cure it. The doctors were evolving too. This was the 1960s, a revolutionary time. And the little gods who ruled over the campus were open to new ways of thinking.

[Sidney Brownstone]

You see just more progressive ideas about what mental health treatment should look like coming to the fore.

[Will James]

Sidney Brownstone, an investigative reporter with the Seattle Times, spent months delving into Northern States history to try to understand how our modern approach to psychiatric care took shape.

[Sidney Brownstone]

The 60s at Northern State included something called the open door policy, which allowed patients freedom of movement, which wasn't always the case. I remember Talking to Joanne McInnis when she started in 1954, most of the wards were locked. Did that change over time?

[Joanne McInnis]

Oh, yes. Yeah. Eventually, almost all of them were open.

[Sidney Brownstone]

Why do you think that change happened?

[Joanne McInnis]

I think it went back to the education of staff. We wanted it to be different. We wanted to be proud of what we were doing.

[Will James]

For supporters of this open door policy, it wasn't just the act of physically unlocking doors. It was a fundamental shift in thinking, finally seeing the patients as fully human, giving them enough freedom and responsibility that they could more easily reintegrate into society. But just as Northern State was changing, this same revolution in thinking set the stage for Washington state's leaders to shut the asylum down just a few years later, in 1973. The idea was that after a century of treating patients in these psychiatric hospitals, and it was time to turn away from this model entirely and build a new system that cared for patients closer to home in their communities. This Movement called deinstitutionalization has erased 84% of state psychiatric hospital beds in the US over the past 50 years. A near extinction of a whole style of medical care. Most of those beds vanished during a single decade from 1970 to 1980. Today, deinstitutionalization is widely viewed as one of the most disastrous policies in US History. As a reporter, when I talk to regular people about the rise of seriously mentally ill people on the streets, it's conventional wisdom that deinstitutionalization is to blame. That we once had places for these patients to go, but then we shut them down and set everyone free. But the real story of deinstitutionalization goes so much deeper than just we used to have beds and now we don't. This story is about exactly how and why it failed, how a set of values and incentives set in motion massive disruptions to the way the poorest and most vulnerable people in our society survive. It's about how deinstitutionalization is the origin story of the churn. I'm Will James from KUOW and the Seattle Times. This is Lost Patients, Episode four. Opening.

[Dan Evans]

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.

[Will James]

In the 1960s, two ideas of mental health care were colliding. For decades, society had leaned on psychiatric hospitals to hold patients it saw as having little hope of getting better, to separate them from everyone else, sometimes hide them for the rest of their lives. This is called custodial care. But President John F. Kennedy was pushing a new model, getting patients better and returning them to society as quickly as possible with the help of these new antipsychotic drugs. When Kennedy's Sister Rosemary was 23, she underwent a lobotomy, leaving her mostly unable to walk or talk. She spent the rest of her life in institutions. Kennedy, informed by this family history, challenged states to get people out of custodial care and treat them closer to home. Even he envisioned a country where the cold mercy of custodial care would be replaced by the open warmth of community. Kennedy's 1963 Community Mental Health act set aside $150 million to build and staff 1500 community mental health centers around the country.

[Dan Evans]

If we launch a broad new mental health program now, it will be possible within a decade or two to reduce the number of patients now under custodial care by 50% or more.

[Chris Hudson]

Here's a piece of copy that was.

[E. Fuller Torrey]

Rushed to me and was torn off from the United Press in Dallas.

[Will James]

President Kennedy has been shot. Kennedy was assassinated three weeks later. This was the last bill he signed.

[Dan Evans]

President Kennedy died at 1pm Northern State.

[Will James]

Hospital embraced Kennedy's vision. It wasn't just the open door policy. The hospital shifted its entire purpose to getting patients discharged and back into their hometowns as quickly as possible. A Seattle Times article from the 60s summed up this new way of operating. Patients are admitted, given drugs, stabilized, allowed some freedom over their daily routines, some visits home, then as soon as they're ready, released. The rhythm of the hospital changed. In 1955, a little after Joanne started as a nurse, Northern State was at its peak with 2,200 patients at any one time. By 1970, that number was down by almost 2/3, to 700 patients at a time. There was almost one employee for each patient, and the numbers kept dropping. Washington had three state psychiatric hospitals in three corners of the state, Northern, Western and Eastern. And all three saw their daily populations shrinking.

[Chris Hudson]

With the advent of new treatment techniques, medications, and increasing emphasis on prevention and early treatment in the communities, drastic changes began to occur.

[Will James]

State leaders took stock of these developments at a Senate committee meeting in 1973.

[Chris Hudson]

Average daily populations dropped from a high of 7,500 in 1955 to the present level of 1934 on January 26th.

[Will James]

To psychiatrists, this was all part of the plan of deinstitutionalization. There were still thousands of people admitted to the state psychiatric hospitals every year. They were just cycling back out much more quickly. So there were fewer patients on the campuses at any one time. But their bosses in state government saw it differently.

[Chris Hudson]

The Northern State hospital staff complement remains at 481, serving approximately 300 patients. The per diem costs at Northern have risen correspondingly from $22.45 last year to $35.78 now.

[Sidney Brownstone]

It's the classic tension between the people with the green eyeshades, the bean counters, and the people providing the care. Because state officials were just looking at the declining numbers and the rising costs of care and going, we're not getting enough bang for our buck. And the people providing the care were going, no, you're getting bang for your buck. You're just not seeing it.

[Will James]

The person presiding over all this transformation in Washington state was Governor Dan Evans.

[Dan Evans]

He is the kind of man who makes us proud to be Republicans.

[Will James]

Around this time, Evans was in his early 40s and having a moment. He gave the keynote speech in the 1968 Republican National Convention.

[Dan Evans]

He is attractive, he is articulate.

[Will James]

Oddly enough, his background by training and education is that of a civil engineer. Evans was an engineer before he was a politician, which fit with Washington state where the economy revolved around the airplane manufacturer Boeing. He was known as cool headed and soft spoken, a moderate Republican. Back when Washington was more of a swing state, both Richard Nixon and later Gerald Ford considered Evans a possible running mate. It's fair to say no politician from the Pacific Northwest has come closer to being president.

[Dan Evans]

Let those who offer old promises step aside and let those who promise new opportunities, opportunity step forward.

[Will James]

But by the early 70s, Evans was just trying to hold Washington state together. Because of problems in the airline industry. Boeing laid off more than half its workforce. So many jobs disappeared that two real estate agents put up a billboard that said will the last person leaving Seattle turn out the lights? Washington's unemployment rate hit 4 14%, the highest in the U.S. all this added to what the Seattle Times called the toughest budget crisis in state history. As tax revenue cratered. It wasn't long before Evans, trying to balance the budget, started eyeing Northern State, the smallest of the state's three psychiatric hospitals with a shrinking patient population and the highest per patient costs.

[Sidney Brownstone]

So you have the governor in particular saying it's time to wind this down. It's a massive cost and it's time to transition to community healthcare, which is supposed to be better for the patients. The biggest opposition to that argument comes from the residents of Sedro Woolley, the town where Northern State is located. And their opposition is an economic argument. They're saying the hospital is the biggest employer in our area. What are we going to do if it closes? Hundreds of jobs will be lost.

[Will James]

When Governor Evans argued for closing Northern State, he cited both the national movement away from psychiatric hospitals and toward community care and the potential cost savings. The issues of deinstitutionalization and money blended together.

[Chris Hudson]

I think a lot of politicians started calculating out what could be saved.

[Will James]

Chris Hudson is a social worker and academic who spent decades at Salem State University in Massachusetts studying our systems for caring for seriously mentally ill people. He says deinstitutionalization started with a civil rights agenda, freeing patients who were warehoused at psychiatric hospitals. But soon a second motivation got mixed in as leaders in state governments saw an opportunity to free themselves from a financial and political burden. Burden. Chris says these incentives acted like fuel, accelerating the push to close psychiatric hospitals.

[Chris Hudson]

Beginning in the early to mid-60s and 70s. Those dramatic declines in the psychiatric beds, it was precipitous. There was a rush to get people out.

[Will James]

Governor Evans plan was to transfer some of Northern State's patients to one of Washington's remaining psychiatric hospitals, Western State, and send the rest to Community Care. Washington had been building out a system of local treatment centers for a few years and by 1973 had a program in every county of the state. But the system had never been tested in this way and some lawmakers started to wonder whether it would hold up.

[Dan Evans]

I just personally cannot buy the fact that the community mental health program is at this particular point in time ready and able to accept the caseloads mentally ill, the people that really need the care.

[Will James]

State Senator Lowell Peterson was a Democrat whose district covered Northern State.

[Dan Evans]

And I frankly can't readily adapt myself or my thinking to the fact that we're going to displace some four or five hundred people and automatically transpose them overnight from Northern to Western. And the community mental health centers are going to take care of all of our problems at a less expense.

[Will James]

People in Governor Evans administration were adamant. Community Care was ready to pick up where Northern State left off.

[Chris Hudson]

For the purposes of our budget discussion now, we again recommend the closure of Northern State Hospital as a state psychiatric hospital by the end of calendar year 1973.

[Will James]

In the state archives and old newspapers, there's not much evidence that a patient rights movement clamoring for Community care was driving the closure of Northern State. Instead, the historical record is dominated by the national attitude that moving away from psychiatric hospitals was inevitable. Plus state officials concerns over money.

[E. Fuller Torrey]

This is a detail of the projected.

[Will James]

Savings of the Governor Evans got his wish. Northern State Hospital would shut down by the end of 1973. According to newspaper stories from the time, Evans's administration thought closing the hospital would save something like $14 million over two years. And of those savings, some went back to Cedra Woolley, the town where Northern State was to ease the economic pain of the closure. And only a fraction was reinvested back into mental health.

[Sidney Brownstone]

Let's just be clear. $14 million would not have saved the mental health care system at all. But it does speak to our priorities. I mean, granted the state was going through a period of austerity. It was slashing social service programs left and right. But you would think because such a fuss had been made about creating this new system of community healthcare that we would prioritize putting whatever money we had towards that promise.

[Will James]

A front page story in Sidra Woolley's local paper marks the hospital's closure. Most of the article is about employees scrambling to find new jobs. It says nothing about the fates of the patients.

[Joanne McInnis]

It was kind of sad. I Hated that it was of kind closed.

[Will James]

Joanne was part of a group of nurses who got transferred to one of Washington's two remaining state psychiatric hospitals, Western State, about a two hour drive to the south.

[Joanne McInnis]

I felt like the patients weren't taken care of. There wasn't the follow up and the support systems knocked out. I wish it would have stayed open and we could have done more.

[Sidney Brownstone]

What happened to the patients?

[Joanne McInnis]

They were dispersed. We had patients from Northern that went to Western. We didn't get a chance to follow through with them or anything, but they did. And some went to Eastern. It depends too on where they were originally from or where there were beds available. Some went into the cumulative, some were put on the streets.

[Will James]

It would be years before people started taking stock of what happened to the lost patients of Northern State. As Sydney sits with former nurse Joanne in her retirement home in the same valley as the ruins of Northern State, on a whim, she asks about a particular patient, one among thousands who passed through the hospital while Joanne was there more than half a century ago.

[Sidney Brownstone]

Did you ever know anyone named Phil Dyro?

[Joanne McInnis]

Oh, yes.

[Sidney Brownstone]

You do?

[Joanne McInnis]

Oh, absolutely.

[Sidney Brownstone]

Oh my gosh, yes. Okay.

[Will James]

Sidney had read about Phil in old Seattle Times stories. He was the exact sort of patient deinstitutionalization was supposed to rescue. Phil's parents committed him to Northern State when he was 16. Hospital records say he had above average intelligence, but he was, quote, overly talkative and overly concerned with other people's business. Phil would later tell a reporter he was sent to Northern State on a bum rap just for being noisy and talking a lot.

[Joanne McInnis]

He talked continually. He just went on and on and on. And how he managed to cram so much information into that head of his and where he got it, we do not know. But you could walk on the grounds and I swear he knew what your name was, who you were married to, how many kids you had, no matter what, where you lived. It just had a. This appetite for knowledge about each individual employee. It was just amazing.

[Will James]

Three years after he was committed, Phil was lobotomized. He was 19 years old. It didn't stop him from talking a lot, but it did give him lifelong neurological problems.

[Sidney Brownstone]

He got seizures and had trouble holding his bladder as a result of that operation. In some ways, his case was kind of a classic case of someone who could probably be independent but was stuck in an institution and couldn't get out and had been there for his entire adult life.

[Will James]

Phil would stay at Northern State for 26 years until he was in his 40s, in the waning days of the hospital, Phil wrote letters to lawyers begging to be released. Finally, the American civil liberties union took up his case and he was freed in 1971, as politicians debated whether to close Northern state.

[Sidney Brownstone]

Do you know what happened to him when Northern was closed?

[Joanne McInnis]

I understood that he went to Seattle someplace, but I. Other than that, I don't know.

[Will James]

Phil kept popping up in news stories once he was released, but the focus of the articles changed. He was no longer a symbol of someone who didn't belong in a psychiatric hospital. He was a symbol of the lost patients trying to survive in the world deinstitutionalization had created.

[Sidney Brownstone]

Even when you have someone who's relatively high functioning, like Phil Dyro, it's still a struggle on the outside of the institution. Not because the institution let him out, because of the world and the conditions that we created outside of the institution.

[Will James]

In 1979, a reporter caught up with Phil. Phil was living in a $100 a month apartment in a building he had nicknamed the heartbreak hotel. It was on a man made island in the middle of Seattle's port, surrounded by industrial plants, train tracks and parking lots. Phil was becoming a fixture of Seattle's streets. A local character in photos. He has a mustache, thick glasses, a fedora, and a pipe sticking out of his mouth. He spent his days wandering the city, chatting people up, carrying a bag that had 17 pipes in it. When one pipe got too hot, he said he'd put it away and pull out a new one. Phil was struggling to live on $226 a month in Social Security. A caseworker spent weeks trying to connect Phil with resources. But Phil's particular problems didn't fit need with any of the help that was available. Each agency just referred him to another agency. The caseworker said Phil was one of the toughest cases he had ever seen. At one point, Phil's friends threw a Halloween party to raise money for him. Phil dressed up as a mafioso. The party raised$370.5. Years after Phil left Northern state, this is who looked out for him. Not any kind of system, just a cobbled together network of people he had managed to charm. What does Phil Dyro's story represent? What does it tell you?

[Sidney Brownstone]

I mean, it kind of tells of hardship on both sides of the institutional question, right? He was someone who was locked up, lobotomized, didn't need to be there probably for his whole life. Like he lost out on so many years of his life and I mean, he was left with permanent damage. As a result of the lobotomy and then on the other side of being let out. He had his freedom, but it was a very marginal existence. He didn't have a lot of money. His he had to move every so often. He was thrown out into a world that had very few resources for the problems that Northern State gave him.

[Will James]

Phil's saga is just one example of a whole new genre of article that appeared in newspapers after Northern State closed. A string of stories by journalists trying to figure out where the patients ended up, like this one from 1974, about a year after Northern State closed. Parents of a 22 year old woman who had been a patient at Northern State struggled to care for her at home. Her parents were assured that help for her would be available in the community. Her father was told glowing stories about community based mental health centers, but he had no idea where to find them. Desperate, he called Northern State for help even though it had been closed for more than a year. The call went to the campus's electrical plant. By the early 1980s, it was clear all around the US that deinstitutionalization had gone disastrously off course. From National Public Radio, this is Horizons. This NPR story from 1984 documents a phenomenon people were seeing in cities all around the US at that time, a rise in people who seemed seriously mentally ill and were living on the streets. In this edition of Horizons, Frank Staccio reports that some experts fear the streets.

[Dan Evans]

Have become the asylum of the 80s. After more than two decades, deinstitutionalization has yet to be carried out as it was first planned. While hospitals have emptied their beds, follow up care is erratic and often neglected.

[Will James]

By the early 80s, state psychiatric hospitals had been shrinking and closing for two decades. Meanwhile, the rollout of community care was slow and eventually those efforts stalled because of funding problems. A decade and a half after Kennedy called for 1,500 community mental health centers, only half of those were built.

[Dan Evans]

Patients left the hospital for locally operated halfway houses and community mental health centers, but the dollars never followed. Deinstitutionalization's been going on for an awful long time. There's been a lot of time to figure this out, isn't it? Well, you think we'd figure it out, but in fact, the deinstitutionalization has been a horror.

[Will James]

Psychiatrist E. Fuller Tory spoke with NPR in 1984. Fuller Torrey would later become a leading voice calling for more involuntary commitment and a foil for patient rights groups. But back then he was reflecting what a lot of mental health workers were seeing.

[Dan Evans]

Deinstitutionalization itself was perfectly legitimate. A lot of these people can live outside the hospital. However, we failed to set up programs to take care of them.

[Will James]

In 1980, President Jimmy Carter tried to revive Kennedy's vision by signing the Mental Health System act, which set aside more federal money for community mental health centers. But less than a month later, Carter lost reelection to Ronald Reagan, who repealed Carter's bill and slashed funding for mental health care. The community mental health centers that did exist provided a mishmash of different types.

[Dan Evans]

Of care, the latticework of agencies, rules and entitlements.

[Will James]

While these centers technically treated mental illness, many of them catered to people who were very different from the patients who had been at state psychiatric hospitals. Chris Hudson, the social worker and academic, says they focused on treating what some call the worried well, people who live pretty normal lives but want treatment for things like depression and anxiety.

[Chris Hudson]

Seriously mentally ill, they often had to chase down. They would miss their appointments and it was a hassle and they were very difficult to serve. For lots of different reasons, the seriously mentally ill and the people coming out of the state mental hospitals were not popular patients. So seriously mentally ill tend to fall by the wayside.

[Dan Evans]

The community mental health centers, with only rare exceptions, have never picked up and taken care of the seriously mentally ill.

[Will James]

Fuller Tory again talking with npr.

[Dan Evans]

The community mental health centers have been middle class psychiatry for people with problems of living. They have not confronted the problem of people with schizophrenia, manic depressive disorder, and the severe mental illnesses.

[Will James]

It was clear by this point that the antipsychotic drugs that had given psychiatrists so much optimism decades earlier, the drugs that set the stage for deinstitutionalization, did not work as well as they had hoped. It turned out these drugs were useful tools for managing psychosis, but not a cure. By the 80s, there had been no major advances in these drugs for three decades. In some cases, the side effects were so brutal, patients couldn't tolerate stiffness, trouble walking, uncontrollable restlessness, feeling sedated, weight gain. And the drugs could only work if patients took them. Some suffered from anosognosia not believing they were sick, and others couldn't make or keep appointments. In these cases, community care was not designed in a way that actually reached the people who needed it. There was something else going on too, something that's often unappreciated in the story of how deinstitutionalization contributed to people with serious mental illness ending up on the streets. Kennedy's vision was to treat patients in their communities and Homes, Community care assumed that seriously mentally ill people could find places to Live. From the 1970s onward, in many cities around the US homes for the poorest people were disappearing. Kim Hopper, an anthropologist who has studied mental illness and homelessness, also talked with NPR in 1984.

[Dan Evans]

The difference between the absolutely abject marginal.

[Will James]

Population today and the absolutely abject marginal population of 15 years ago is that 15 years ago they could afford crappy housing. And today there isn't even any of that. Here in Seattle, the city's center was home to canyons of residential hotels, where for decades, thousands of the city's poorest people could rent a room for a few dollars a week. These were called single room occupancy buildings, or SROs. Many were fire traps and poorly maintained. But SROs were a reliable source of housing someone could afford on government assistance or poverty wages. Just as deinstitutionalization swept the country, these residential hotels got regulated and redeveloped out of existence, sometimes transformed into more upscale apartments. Newspapers documented these closures well, it was.

[Sidney Brownstone]

Interesting because the reporters would trace these patients to group homes, or SROs, for example, and then a few months later, they'd follow up with another article saying that the group home is closing down. And so you see this story over time of the refuges outside of the institution disappearing too. This 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. So even during this time of great change, it kind of was like motion under the surface. It went by without a lot of comment, without a ton of political strife. And we carried on as if things were normal until we fast forward 20 or 30 or 40 years and all of those decisions that we made are breaking through the surface.

[Will James]

Sydney was searching in the Seattle Times archives for evidence of what happened to the lost patients of Northern State when she stumbled on a missing link connecting the era of deinstitutionalization to the world of today.

[Sidney Brownstone]

Lets go to December 27, 1981. Oh, wow. The headline of this piece is the mentally Ill victims of an Experiment that failed. And this is a piece by an editorial writer. Crowds. This is how it begins. Crowds rush past them on downtown streets, pretending not to hear their confused or angry chatter. They are studiously avoided when they wander through neighborhoods. Occasionally, when they become a nuisance or create a disturbance, the police are called.

[Will James]

Sidney noticed this story from 1981 had some of the same language she used in her reporting on homelessness. More than four decades later, even the Institutions were the same.

[Sidney Brownstone]

Oh my God. This paragraph was written in 1981. Many mentally ill people fall, find themselves caught in a revolving door that leads them from Harborview Medical center to Western State Hospital to a place like the downtown emergency center in the Morrison Hotel, and then back onto the streets where the cycle begins again. It froze me. A lot of things were flooding my brain at once. Like, holy shit. The exact same thing is happening now. People are bouncing from the Morrison to the downtown King County Jail to Western and back again. We've been stuck in the same calcified loop for 40 years. And it's also like, what is even the point of my job then if I keep writing the exact same sentences that someone 40 years ago was writing? Why do I exist? Why are we doing any of this? Because clearly, presenting people with the same information over and over and over again isn't doing anything. It's like we have made a decision as a society to not care about this or that we are okay with this. And then what does that say about us? That we have been reading these same stories in our newspapers in every American city for 40 years and we've decided that that is okay.

[Will James]

It raises a How do the people who made these decisions half a century ago look back on them now?

[E. Fuller Torrey]

Hello. Well, this is Dan Evans calling. I understand you've been trying to get in touch with me regarding your story. I'd be happy to talk with you.

[Will James]

The man who almost sort of might have been president, the man responsible for the most obvious act of deinstitutionalization in Washington State's history, lives in a house you can just drive up to in a suburban looking part of Seattle. As Sidney and I walk down the driveway and stand in front of the door, our hope is to ask former Governor Dan Evans how he views his decision to close Northern State today in light of what's going on in Seattle's streets. Hi there. Hi. Governor Evans.

[Chris Hudson]

How are you?

[E. Fuller Torrey]

Good. Great to see you.

[Will James]

Good to meet you.

[Sidney Brownstone]

Nice to meet you. I'm Sydney. Brought your newspaper.

[E. Fuller Torrey]

Okay. All right, good.

[Will James]

Evans leads us into a living room with high ceilings and tall windows looking out onto a lake. The former governor, wearing shorts and a collared T shirt, settles into a high backed chair near the fireplace. And if it's not too rude, what. What is Your age today?

[E. Fuller Torrey]

97.

[Will James]

Nice. So we brought some pictures of Northern State Hospital. This is the campus. I wonder if you recall ever, if you'd ever been there or visited or walked the grounds.

[E. Fuller Torrey]

Oh, yes, you did. Just part of my responsibilities as governor, I made visits to various state institutions to see physically just what they were.

[Sidney Brownstone]

Like back in the early 70s, around the time of your decision to close Northern State Hospital. That was a really fraught time. And I'm wondering, when you look back on that decision, what emotions does it bring up for you? Is it a source of pride? Is it a source of pain or confusion?

[E. Fuller Torrey]

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. And we were beginning to see the end of centralization and the very large multi hundred patient institutions that we had when I became governor. So it was a time of real change, and the change was one that was not without controversy.

[Sidney Brownstone]

So the historical narrative is one where this change began in the 60s with the Kennedy administration to transfer mental health care to these community clinics. But then it's also widely acknowledged across the country that this system of community care never fully materialized. It was impartial measures. I'm wondering on a local level here in Washington State, what were the obstacles to creating that system of community care?

[E. Fuller Torrey]

Well, there was a lot of interest and I think a lot of recognition that just housing mentally ill patients in a very large institution, impersonal institution, was not very good treatment. But 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. And so it was a time of change. But during a time of change like that, you start down a different path or different multiple paths, seeking better answers. Sometimes you find them, sometimes you don't.

[Will James]

What Evans remembers most about this period is the national movement away from psychiatric hospitals like Northern State, and how in light of that movement, it made sense to close the hospital. But Sydney and I came with letters from Washington residents from around the time Evans was making that decision. And those letters foreshadowed some of what was to come decades later. This one really just stuck out to me, and so I just wanted to read it. It's a letter a Washington mother sent to Evans while deinstitutionalization was going on. My son and daughter have had three complete mental breakdowns and have been committed to Western State Hospital, and after four to six weeks have improved to the point where they could get along nicely at home. But they have stopped taking their medication and soon after have had recurrences. Approximately a year ago, my son had another relapse and was in a horrible condition. He kept driving his car around crazily, had many arrests. It's a miracle he didn't kill someone. No one can understand the suffering I had with him prior to this. How does that make you feel today to hear that?

[E. Fuller Torrey]

Well, you have hundreds and hundreds of problems, challenges when you're governor, many of which you can see the problem fairly clearly and find and have a solution that really is a solution. Mental illness is one of the more difficult challenges we have because it occurs in so many different ways. And it is not something, I think that people who are in positions of authority where they have that responsibility, are not happy with that responsibility. It's difficult and generally not rewarding in any direct way. Mental illness is a lot tougher than most other challenges that you face.

[Will James]

As Sidney and I drive away from Evans's house, we agree it's really hard to hold one man to account for decisions politicians all around the country were making at the same time as him. Decisions his successors had half a century to fix if they wanted to. But that last thing he said about responsibility echoes in our heads. It's recording.

[Sidney Brownstone]

It is recording. I think he did acknowledge though, he said no one really wants responsibility for this thing. It's something that everyone struggles with, responsibility.

[Will James]

What Evans said to us about that, that the care of seriously mentally ill people is something people in power don't want responsibility for. I think that's the real story of deinstitutionalization. It started as a civil rights movement, but ultimately it created an opening for people in government to escape a responsibility they didn't really want. A responsibility that cost a lot of money, was complicated to manage and never delivered satisfying political wins. And once people in government saw that opening, they slipped through it. Once you understand those motivations, it's clear why all of this unfolded as haphazardly as it did and why these mistakes echoed for decades without anyone fixing them. Here's how I see deinstitutionalization now. For a century we lived in a country where pretty much one entity, the state, took responsibility for seriously mentally ill people. And deinstitutionalization was the moment that ended. The state, which was once a provider of care, with its own army of psychiatrists and nurses in state run hospitals, became more of a funder of care, giving out money to non profit contractors and local programs to handle things. They each oversaw their own piece of it, but it was nobody's job to make sure the sickest patients, the ones who needed long term day to day care, ever got that.

[Sidney Brownstone]

After Northern State closed social services, including mental health care, just became totally atomized. So now we have all these nonprofits that are directly treating people and caring for them. But government is several steps away.

[Will James]

Today you can see this fragmented responsibility spread out across jails, prisons, emergency rooms, what's left of the state psychiatric hospitals, and in homeless shelters like Seattle's downtown Emergency Service center desc, a perpetually stretched nonprofit known for taking on the city's most difficult cases of mental illness and substance use. On the sidewalk outside desc, you can find a bronze leaf embedded in the cement with a name etched on it. Phil Dyro advocates put it here to memorialize him after he died in 1999. By then, Phil was a sort of legend on Seattle's streets, a character who talked himself into lots of people's lives and memories. And it fits that his saga would start at Northern State Hospital and end here, outside one of the many broken up islands of refuge that replaced it. Just a short walk from here is the spot where Adam Urant, who he met at the beginning of this series, was dropped off after he was released from one of Washington State State's remaining psychiatric hospitals. What Happened to Adam next shows the depths of our failure to build something new after deinstitutionalization. Coming up on Lost Patients, we return to Adam in 2023, half a century after Northern State closed, mentally ill, homeless and ejected into a world we created. Lost Patients is a production of KUOW Public Radio and the Seattle Times in partnership with the NPR Network. You can support Lost Patients by investing in the local newsrooms and specialized beats that make this sort of storytelling possible. Please consider joining and [e-mail] and seattletimes.com this episode was reported, written and produced by Sidney Brownstone, Esme Jimenez and me, Will James. Our editor is Liz Jones. Additional editing by Diana Samuels, Jonathan Martin, Brendan Sweeney and Marshall Eisen, project development by Laura Grenius. Our music is by BC Campbell, mixing by Jason Burrows, logo and branding by Alicia Villa and Michaela Giannatti Boyle. Thank you to Seattle Times videographer Lauren Frone for sharing the tape she gathered, and to Seattle Times photographer Karen Ducey, who illustrated Northern State in the Seattle Times. Thanks as well to NPR for sharing tape from 1984, to former NPR reporter Frank Stacio for reporting that story, and to former Seattle Times journalists Marjorie Jones and Steve Johnston for their 1970s reporting on serious mental illness, homelessness and Phil Dyro. Thank you finally to Joanne McInnis, Chris Hudson and Dan Evans for sharing your stories and expertise.