Guys, I know we’re all tired for many different reasons. But we should probably review what President Trump said today. During his press conference he talked about community psychiatry!
I’ll go over the transcript below, but if you want to watch the video, it starts at 51:34 on C-SPAN.
As he was listing his accomplishments, he said the following. My commentary follows in the numbers below.
Signed an executive order to bring back mental institutions and insane asylums. [1] We’re going to have to bring them back. Hate to build those suckers, [2] but But you got to get the people off the streets. [3] You know, we used to have when I was growing up. We had it in my area in Queens. I grew up in Queens. We had a place called Creedmoor. Creedmore. Did anybody know that Creedmore? It was a big, [4] I said, Mom. Why are those bars on the building? I used to play Little League baseball. They’re at a place called Cunningham Park. Who’s quite the baseball player, you wouldn’t believe, but I said to my mother, Mom, she would be there, always there for me. She said, uh, son, you could be a professional baseball player. [5] I said, thanks, Mom. I said, why are those bars on the windows? Big building, big. Powerful building. It loomed over the park [6] actually she said, well, People that are very sick are in that building. [7] I said, boy, I used to always look at that building and I’d see this big building, big tall building. It loomed over the park. It was sort of, now that I think it was a pretty unfriendly sight, but I, I’ll never forget, I don’t know if it’s still there. [8] Because they got rid of most of them, you know, they, the Democrats in New York, they took them down, [9] and the people live on the streets now. That’s why you have a lot of the people in, in California and other places, they live on the streets. They took the mental institutions down, they’re expensive, [10] but I’d say, why does that building have those bars, boy. It didn’t, it wasn’t normal, you know, you’re used to looking at like a window. But this one you’re looking at all the steel, vicious steel, tiny windows, bars all over the place, nobody was getting out. [11] It’s called the mental institution. That was an insane asylum.
(sigh) Okay, let’s go over this:
- The executive order he signed has the formal title of “Ending Crime and Disorder on America’s Streets”. There’s a major cognitive error in the order, which I wrote about here.
- Never before have I heard anyone refer to mental institutions as “suckers”.
- Are there people who are homeless who would be best served in a mental institution? Yes. Do all people who are homeless need to be in a mental institution? No. Another way—more humane and cost effective!—to “get people off the streets” is to create and sustain conditions where people can afford and remain in housing.
- It looks like the highest census at Creedmoor was around 7,000 patients in 1959. President Trump would have been 12 years old at that time.
- Of course, someone did a deep dive about Trump’s record as a baseball player. If he were that good, surely he would throw out a first pitch at a major league game? (He has not.)
- A quick peek at a map shows that Creedmoor does not “loom over” Cunningham Park. They’re three miles apart. There are two athletic fields nearby. Creedmoor is visible from Alley Athletic Playground.
- I wonder if Trump’s mother spoke of the “very sick” people with disdain, pity, or compassion. Is it possible that all 7,000 people were “very sick”? Maybe. Is it possible that some of those 7,000 people did not need to be in an institution? Yes.
- Yes, Creedmoor still exists. It’s unclear what the census is now (it’s certainly not 7,000), but it’s not just an inpatient unit. They provide an array of outpatient services, too.
- There are multiple reasons why psychiatric institutions closed. One major reason was the advent of antipsychotic medication, which allowed more people to be treated in the community. There were also reports of abuses within these behemoth institutions. Long Island, a suburb of New York City, was the site of three major psychiatric institutions. Around 1954 Pilgrim State Hospital was probably the largest psychiatric hospital in the nation; there were over 13,000 patients there. I don’t know the history of New York State well enough to know if “Democrats in New York… took them down”. Recall that Trump was a Democrat for much of his life prior to running for President.
- Historically, states had to fund mental institutions. Medicaid (federal money) could not be used to pay for hospital services. This is another reason why states shut down psychiatric institutions; they didn’t have enough money to keep them running. If this policy discussion excites you (…), learn more about the IMD exclusion here.
- Yeah, man. If you don’t like “steel, vicious steel, tiny windows, bars all over the place”, then you’re like everyone else who doesn’t want a proliferation of mental institutions.
Maria Yang, MD 