If there's so much money in prisons, why were so many psychiatric institutions closed?

In My Humble Opinion
1

To be callous about it, it seems like there’s lots of money in crazy. Like prisons, these institutions bring lots of jobs to a community. Typically when I see U.S. incarceration stats, people make the case that it is a perpetuating system – keeping non-violent drug-related criminals behind bars to necessitate a large workforce. With a mental facility, it seems it wouldn’t even be necessary for the committed to have a criminal record.

I do think there’s an honest need anyways with guys like Loughner, Holmes, and Lanza seemingly becoming more frequent and dangerous. But mostly I’m surprised it’s not a bigger business.

2

Most private prison companies have found out there really wasn’t as much money in prisons as they imagined. They apparently just assumed that as private businesses they would automatically be more efficient than government run institutions. But when they opened prisons, they discovered this wasn’t the case and they were spending just as much to operate the prisons as the government had been. When the expected profits didn’t materialize, investment capital moved on to other areas.

3

mental health care is covered by insurance, the quicker you are out the less they pay

I think even 'privatized" prisons get taxcmoney to some degree, so it can work for them

4

A couple of thoughts with regards to stereotypical state mental hospitals

The trend it to put people in less restrictive settings, whether or not that’s in their best interest, whether small group homes, living on their own with extensive help, or even winding up on the street.
Drugs have gotten a lot better in the past few decades so there’s less need.
It’s harder to be judged not guilty by reason of insanity, so many of these people wind up in prisons instead.
These tend to be older buildings that are extremely expensive to run.

As far as private psych wards, there’s a lot more money in things like maternity or cardiac care, so that’s the direction private hospitals are headed. And then trend is still shorter stays with drugs and outpatient care instead. Susanna Kaysen would have never spent a year at McLean nowdays.

5

You realize all the money for prisons is coming out of your taxes, right? Prisons don’t make money (well, and maybe a little bit of it from prisoner labor, but not much), they use it up. Even where they are managed by a private company, the money is still coming from the government. There are certainly many more efficient ways that government spending could bring jobs to a community than building a prison there.

There are lots of prisons and money for prisons because lots of politicians find they can successfully sell themselves to voters as being “tough on crime” (especially, but not only, right-wing types are dead set against most other types of government expenditure). There are not many votes in mental asylums. (Even fewer than there are in building infrastructure of subsidizing private industry, which are much better ways of creating job growth through government expenditure.)

6

Yes, I just didn’t express it well enough. I know that it is the state essentially turning over money as a visible way of creating jobs. As for there not being a politically viable “tough on crime” sales pitch for asylums, in light of recent violence, I could see that changing. I’d like to think that I’m ahead of the curve on this, and that politicians will soon be vocal proponents of this and make it a key part of their re-election platform. It seems like an issue that could draw in a lot of votes from both left and right.

7

Asylums were closed for reasons other than money; that was at best a secondary concern. People simply didn’t like the idea of them, so in a lot of cases they just ignored or didn’t want to understand that they existed for a reason. And the Asylums were really unpleasant, but they were unpleasant because it had a lot of extremely sick people who needed a lot of care and nobody much wanted to work there. You’d have to offer tremendous pay to get good people to voluntarily work at asylums, because good people have lots of nicer places to work.

So the asylums closed, and we mostly ended up leaving the sick people to their own devices, because there were still no people available to help them.

8

//Rant ahead:
Smiling Bandit’s got it. In the 80s, “Institutionalism” and Institutions AKA “Asylums” sorta became a dirty word. The idea of patients being locked up for 30-90+ days or even longer just wasn’t appealing. There came a shift in public policy and in psychiatry for patients to be more functional, and to transition back into the “real world”, so the push was made to cut down on long term chronic stays, where patients were basically being kept isolated from society, and to try to incorporate them back into their communities, requiring them to go to group living facilities, family homes, or simply just living in assisted living facilities. This was to be the idealized version of what should have happened.

In reality- more difficult patients, violent patients, chronically ill patients, psychiatric and medically ill patients all of them were difficult to manage and most outpatient facilities felt overwhelmed and tend to refuse to take them. So they ended up back in hospitals. However, the government was rolling forward this policy, and many states already had started cutting back on psychiatric facilities, as it’s an easy cost saving area and one that doesn’t tend to have loud lobbyists. So psychiatric facilities were closing, and the remaining ones were taking in the chronic patients that were not able to find housing. Thus, most inpatient hospitals psych wards are “acute stabilization centers”- the length of stay goals are either 3-5 days, or 7 days with the intent to acutely stabilize a patient (a patient with suicidal, homicidal thoughts or acutely manic/psychotic), and to transition them to another (lower) level of care in the outpatient to treat them.

It’s rough. And it sucks because it’s not glamorous, and it doesn’t have a lot of advocates and lobbyists out there promoting mental health. Psychiatry and Mental health budgets tend to be neglected in most states (at least those I’ve been around), and even in Hospitals tend not to get the largest cuts of the budgets, because they’re not a procedure heavy unit that generates revenue (ECT might, and sleep studies if the psychiatric unit actually is involved in it), otherwise, it tends to deal with chronic patients, and if it’s inner city, it’s usually the one dealing the most with indigent populations and the uninsured by it’s very nature. So again, not exactly the area to build up if you’re looking for profit.

My personal hope is that people start to pay more attention to mental health, especially with the influx of veterans returning from Combat with PTSD and trauma related syndromes. Mental Health needs more resources, more advocates, and just plain more attention. Hell, even potential future doctors don’t tend to view psychiatry as an appealing future- it’s not particularly high paying (unless you privatize), your patient population can be a difficult and challenging one (but ultimately rewarding I believe), and it’s not particularly “well-respected” amongst Clinicians- at least in Medical school often being stereotyped as a place for those “not good enough for REAL medicine” to go into. I believe it was routinely told to me in 2011-2012 that something like 2% of the United States Medical Graduates go into the Match (for matching to residency/specialty programs).

/Rant.

Sorry. Just a personal soft spot in my heart for Psychiatry.

-R