Failure to Care: Investigative Journalism and America’s Mental Health Crisis
I’d like to take some time to discuss the mental health crisis America faces, both today and in the distant past. Over the past two weeks, I’ve taken a deep-dive into the misconduct of America’s mental health institutions and the legal consequence of their actions through newsprint. I take comparison between reports printed about Blackwell’s Island Asylum in the late 1800s and Lima State Mental Hospital for the Criminally Insane in the 1960s.
Blackwell’s Island Asylum was the first mental health institution in the city of New York. Established in 1834, it housed “lunatics,” and had become extremely overcrowded within the first 30 years of its establishment, holding 1,300 patients (both women and men) by the year 1870. It became known for its unsanitary conditions when it was visited by both Thomas Story Kirkbride and Charles Dickens, who wrote of the “horror” he found there (Asylum Projects, 2019). Nellie Bly (born Elizabeth Cochran) became known for her investigative journalism for her work at Blackwell’s Island as assigned by her publisher and well-known sensational journalist, Joseph Pulitzer. She published her findings in a book published in 1887 titled Ten Days in a Mad-House.
Lima State Mental Hospital for the Criminally Insane (Lima State) was opened in Ohio in 1915 and used to house “those found guilty of crimes while insane” (Asylum Projects, 2019). When tasked by his publisher with entering the Hospital in 1965 as a staffer and under a pseudonym as well as a “fictitious background” (Foreman, 2016), Donald L. Barlett found that the hospital did indeed house the criminally insane (Barlett, May 24, 2019). In his articles with the Plain Dealer, he noted the hybridization between prison and hospital: “sometimes the persons under the institution’s care are called patients. Sometimes they are called prisoners” (Barlett, May 26, 1965). For a time the Hospital shared land with the Allen-Oakwood Correctional Institute, which was built in 1987, but Lima State closed its doors in 2004, leaving the medium-security Correctional Institute in its stead (Wikipedia, 2018).
Regarding Lawfulness of Printing Identifiable Information:
During each time period, there were different understandings surrounding the disclosure of patient information. The Health Insurance Portability and Accountability Act (HIPAA, “establishing a set of national standards for the protection of certain health information” [US DHHS, 2013]) was not signed into federal law until 1996, therefore the publishers of works prior to the Act could determine what medical information they wanted to publish in their work. Publishers today would not be able to disclose nearly as much information as was disclosed in either the Plain Dealer articles or in Ten Days in a Mad-House.
During Nellie Bly’s time, 100 years before HIPAA was signed by federal officials, she herself took on a false name, “Nellie Brown,” as was published in the papers surrounding her appearance in New York City. On the 25th of September, 1887, The New York Sun published the following article title: “Who is this Insane Girl?” During the time, much information was disclosed about her pseudo-identity: “A modest, comely, well-dressed girl of 19, who gave her name as Nellie Brown, was committed by Justice Duffy at Essex Market yesterday for examination as to her sanity.” In that statement alone, they disclosed more medical information than would be allowed by HIPAA today.
During her ten-day stint at Blackwell’s Island, Nellie herself determined that it would be best to disclose the names of the patients close to her, that she made friendships with. She gave names of every person she encountered that she believed was relevant to her story — the women who worked at the women’s home she stayed in (in order to be deemed insane), the nurses at Bellevue Hospital, the halfway point between New York City and the Asylum, the fellow patients, and the doctors and nurses at Blackwell’s Island.
In the Plain Dealer articles, Donald L. Barlett referred to himself in the third person as well as spoke as in the voice of The Plain Dealer. While the newspaper disclosed that these reports were “first-hand observations of Lima State Hospital for the Criminally Insane […] based on the findings of Plain Dealer reporter Donald L. Barlett” (Plain Dealer, May 25, 1965), it was clear he was trying to keep his identity and the identity of the patients at the Hospital secretive. He disclosed numbers of patients, noted conditions of the Hospital and interviewed certain patients and hospital workers. While HIPAA was not in place at this time, we can assume he kept identities under wraps in the interest of journalistic integrity (we should keep in mind his fictitious background and pseudonym, in order to do what his employer considered good work) as well as for the investigation that proceeded from his findings.
The Findings, Blackwell’s Island:
It took very little effort for Nellie “Brown” to assume an ‘insane’ identity — she had to lie a little bit about where she came from, and that she couldn’t remember a thing; however, she had lost her trunks and needed help finding them. The Judge determined she had been drugged, and that she should go to “the Island” (Bly, Chapter IV). When she arrived, she made no effort to appear insane, but was still treated as such by the doctors and nurses, who assured her she was crazy. She found some women (one by the name of Tillie Maynard) just as sane as she was, but found her “condemned to an insane asylum, probably for life, without giving her one feeble chance to prove her sanity” (Bly, Chapter VI). Some women had been sent to the Island on account of the inability to speak English, some sent for the illness of the body, and some sent for the institution’s intended purpose: insanity.
During her time at Blackwell’s Island, Nellie Bly took note of happenings of daily life. From the open windows and absence of heating in the chill of autumn (they were not allowed to turn the heat on until October) to the lack of blankets in the bedrooms, as well as the rotten food and stale bread, she noted it all. At one point the women were taken to a “cold, wet” bathroom and were forced to bathe in ice-cold water used by everybody else in the asylum, after which they went to bed. She has deep thoughts while in bed about fire hazard in the asylum: “every door is locked separately and the windows are heavily barred, so that escape is impossible. […] A fire is not improbably, but one of the most likely occurrences. Should the building burn, the jailers or nurses would never think of releasing their crazy patients” (Bly, Chapter XI). The nurses cared very little about the patients’ well-being, to the extent of letting them potentially burn to death; she noted that any other offenses should come to little surprise to the reader. During her time on the Island, Nellie watched “sick patients grow sicker,” all helped by the meager food and the mistreatment by the staff, which extended to greater misdemeanors, like choking and beating patients who did nothing offensive but cry (Bly, Chapter XIII). According to another patient known as Bridget McGuinness, nurses were aware of the wrongs they committed, including injecting patients with morphine and chloral to make the patients crazy. Nurses would “keep a quiet patient stationed at the window to tell them when any doctors were approaching” (Bly, Chapter XIV). The crimes committed at Blackwell’s Island were beyond anything Nellie Bly could have ever expected, and when the lawyer came to release her, she was beyond glad to be done with her experience.
The Findings, Lima State:
During Donald L. Barlett’s time spent as an attendant at Lima State Mental Hospital for the Criminally Insane, he recorded extreme offenses against the inhabitants of the Hospital from hospital staff as well as from other patients. He disclosed much about the inner-workings of the Hospital in his news articles published in 1965. Conditions at Lima State were no better than at Blackwell’s Island. Similar to the people sent to the Island, patients were cited as having extreme difficulty proving their sanity so as to move out of the Hospital; first referred to the Hospital on the “discretion of individual judges,” the tests for sanity “done on an assembly-line basis,” which meant individuals charged with molestation could either be sent to Lima State or be sent to the county jail (Barlett, July 18, 1965). Barlett further supported his claims of patients’ hardship in the June 2, 1965 edition of The Plain Dealer: staff and workers expected to perform physical and psychological examinations were only required to be high school graduates; duties that would usually be performed by registered nurses were being fulfilled by untrained personnel.
In Barlett’s almost daily articles in The Plain Dealer, he noted the unclarity of the purpose of the Hospital. Like many mental wards of the time, men were kept on lockdown the majority of the time, but pamphlets and legal documents called the institution a “Hospital”: he noted that “the 50-year-old brick institution thinks of itself as a hospital. Consciously, it is a prison,” disclosing its prison-like qualities, citing iron bars over the windows, electrically-controlled doors, and heavily armed guards (Barlett, May 26, 1965). Barlett placed an impactful juxtaposition in the pages of the May 26, 1965 edition of The Plain Dealer: if Lima State were a hospital, it would not house “armed robbers and muggers and drug addicts and murderers,” but if it were only a prison, it would not house “teen-age and mentally ill patients who have never been convicted of any crimes in a court of law.” While the majority of Ohio thought of Lima State as a prison for sex offenders, it was not: four out of 28 wards housed “sexual deviants” in separate cells (Barlett, May 29, 1965); although that was not always possible, as sex offenders were scattered throughout the remaining 21 wards. Barlett was discouraged to find little to no distinction between “psychopathic” sexual predators and first-time offenders; he found that an 18-year old boy who had an affair with a consenting partner was treated the same as a middle-aged man who was charged for molesting small children (Barlett, May 29, 1965). Teenagers with no crimes to their name were placed with grown men, and were often assaulted by them (Barlett, May 23, 1965). Boys as young as 13 or 14 were placed with hardened criminals, shackled by stifling regulations from which “the only freedom allowed was the right to breathe.” Men and boys were cruelly mistreated by workers as well as other patients. Some were beaten by other patients as well as by the attendants, one such case involving a patient with four broken ribs. Any pleasure of life outside of Lima State was yanked from their grasp; at one point, instruments were banned inside the walls, and one patient had his guitar taken away. Whereas the Hospital boasted rehabilitation programs, Barlett argued that it was a “dead-end street.” Patients were forced to sit for hours and make rugs as a portion of the ‘therapy program’ as well as go to a school five days a week without organized classes or professional teachers; Lima had “an obligation, by law, to rehabilitate its prisoner-patients” and to make whatever effort they could to rehabilitate them enough to join the outside world as free men (Barlett, May 24, 1965). While Lima State had systems set up to rehabilitate by name, they made little such effort.
In the tenth and last chapter of Ten Days in a Mad-House, Nellie Bly details the “Grand Jury Investigation” proceeding from her findings. Bly answered all questions the jury asked, however, when called to visit the Island with them, they arrived to find a “clean new boat,” the boat she originally boarded “laid up for repairs.” The asylum had been cleaned up, nothing amiss, and the food had been brought in fresh, as the nurses had approximately an hour of warning before the jury landed. In their testimonies, the nurses made contradictory statements to one another, as well as to Nellie’s story — the doctors confessed they had no means of knowing whether the bath was cold or the water murky, or whether the nurse beat the patients, but knew the poor quality of the food, as the Island lacked proper funding. Many of the patients she remembered — and named — had been removed from the premises, but one woman remained. “Although I had left her only two weeks before, yet she looked as if she had suffered a severe illness,” Nellie wrote. The patient in question had come into the institution around the same time as herself, and had only lived in the institution for a month. Thankfully, her story lined up with Nellie’s. Following the trial, the committee of appropriation provided an extra $1,000,000 to the Asylum. No other legal consequences proceeded.
In the pages of the July 18, 1965 edition of The Plain Dealer, Donald L. Barlett wrote an article specifying the reform measures considered by the director of the Department of Mental Hygiene and Correction. The Director urged the Legislative Service Commission to consider the following: “examine the possibility of abandoning Lima State, […] study the problems created by the growing number of sociopathic offenders, [and] launch an exhaustive study of [the act… that] was designed to keep mentally defective felons off the street.” He also called for a $31.8-million capital improvements program, detailing a halfway hospital, as well as for separate facilities and rehabilitation programs to be built for adults and teenagers, among other additions. As detailed by Jerry M. Flint in a Special to The New York Times, on the 27th of November, 1971, 31 ex-employees of Lima State appeared in court, resulting in charges for offenses including but not limited to: “the use of electric shock treated as punishment; the beating of prisoners after they were tied to their cell doors and after they had been sedated by drugs to make them docile; [and] homosexual attacks, by attendants of both sexes, on patients.” The active Director of the institution, Dr. Gerald Wilson, was forced to resign his position in May 1971.
While legal proceedings were vastly different in each time period and the charges dissimilar, if neither Nellie Bly nor Donald L. Barlett had been willing to enter mental institutions, long-term change may not have occurred. In Bly’s case, money would not have been allotted to taking care of the welfare of the patients at Blackwell’s Island Asylum. In Barlett’s case, the State would not have taken a second look at the institution or been willing to change its direction.
Today in America, we’ve lost a majority of our psychiatric hospitals, creating a massive shortage of inpatient care for those with mental health challenges, and putting many Americans with psychiatric disabilities on the streets. According to the Center for Prisoner Health and Human Rights, the percentage of people with serious mental illnesses in prisons rose from 0.7 percent in 1880 to 21 percent in 2005, a time period witnessed by both Nellie Bly and Donald L. Barlett. In a 2014 survey of twenty-five cities, the U.S. Conference of Mayors found that mental health was the third largest cause of homelessness in single adults (mentioned by 43% of cities). In the same report, 28 percent of homeless adults were severely mentally ill. While we are in need of extended psychiatric care in America’s mental health wards, it’s safe to say the abuse and mistreatment of patients can stay in the past. Mental health wards are staffed with qualified nurses and doctors, and patients engage in frequent individual and group therapy sessions so as to alleviate their psychiatric concerns. While it was common at one point for people without mental illness or with criminal charges to be housed in psychiatric facilities, those in mental wards today receive the attention and care they require.
“Allen-Oakwood Correctional Institution.” Wikipedia, Wikimedia Foundation, 17 Dec. 2018, en.wikipedia.org/wiki/Allen-Oakwood_Correctional_Institution.
Barlett, Donald L. “Inside Lima State Hospital.” The Plain Dealer, 24 May 1965.
Barlett, Donald L. “Janis Asks 5 Lima Reforms; 2 Urged by PD.” The Plain Dealer, 18 July 1965.
Barlett, Donald L. “Lima Hospital Suffers From Split Personality.” The Plain Dealer, 26 May 1965.
Barlett, Donald L. “Lima Life a Dead-end Street With No Rehabilitation Plan.” The Plain Dealer, 24 May 1965.
Barlett, Donald L. “Lima Series Reporter Worked as Attendant.” The Plain Dealer, 25 May 1965.
Barlett, Donald L. “Sex Deviate Unit at Lima Has Self-Government.” The Plain Dealer, 29 May 1965.
Barlett, Donald L. “Teen-agers in Criminal Dump at Lima.” The Plain Dealer, 23 May 1965.
Barlett, Donald L. “Untrained Lima Hospital Aides Practice Medicine.” The Plain Dealer, 2 June 1965.
“Blackwell’s Island Asylum.” Bicêtre Insane Asylum — Asylum Projects, 2019, www.asylumprojects.org/index.php/Blackwell%27s_Island_Asylum.
Bly, Nellie. Ten Days in a Mad-House. N.L. Munro, 1887.
Flint, Jerry M. “31 Ex-Employees at Ohio Hospital Appear in Court.” The New York Times, 27 November 1971.
Foreman, Gene. The Ethical Journalist: Making Responsible Decisions in the Pursuit of News. Wiley-Blackwell, 2016.
HHS Office of the Secretary, Office for Civil Rights, and Ocr. “Summary of the HIPAA Security Rule.” HHS.gov, US Department of Health and Human Services, 26 July 2013, https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html.
“Incarceration and Mental Health.” The Center for Prisoner Health and Human Rights, www.prisonerhealth.org/educational-resources/factsheets-2/incarceration-and-mental-health/.
“Lima State Hospital. Bicêtre Insane Asylum — Asylum Projects, 2019, http://www.asylumprojects.org/index.php/Lima_State_Hospital.
“Lima State Mental Hospital for the Criminally Insane” Asylum Projects.
“New-York City Asylum For The Insane (Women), Blackwell’s Island.” Wiki-commons.
Raphelson, Samantha. “How The Loss Of U.S. Psychiatric Hospitals Led To A Mental Health Crisis.” NPR, NPR, 30 Nov. 2017, www.npr.org/2017/11/30/567477160/how-the-loss-of-u-s-psychiatric-hospitals-led-to-a-mental-health-crisis.
Unsigned. “Who Is This Insane Girl?” The New York Sun, 25 September 1887.
US Mayors. “The United States Conference of Mayors Hunger and Homelessness Survey.” December 2014, https://www2.cortland.edu/dotAsset/655b9350-995e-4aae-acd3-298325093c34.pdf.