A Personal Glimpse into Our Woefully Inadequate Mental Health System
Lucy Winer can recall when mental health care was a chaotic system designed to punish instead of providing service now required of U.S. insurance plans under ObamaCare. It was the age when warehousing warm bodies was too often as good as it got.
Winer’s new documentary, “Kings Park: Stories from an American Mental Institution,” which debuted on Long Island in December, chronicles her improbable journey beginning in 1967, from a 17-year-old suicidal patient padlocked behind the hospital walls of the “women’s violent ward,” to a 30-year veteran of movie-making. Her latest creation casts a wide lens on the continuing neglect of people with serious mental illnesses, while applauding the progress that’s been made in awareness and insurance coverage of medical treatment.
Off-camera, Winer also lauds various legislative mandates including ObamaCare. “The Affordable Care Act can really make a difference for people with mental illness and specifically for women with mental illness,” Winer said of the mandated mental health coverage for people insured privately or publicly through Medicaid and Medicare.
Women are more likely to suffer from depression and anxiety than men and are more likely to attempt suicide, she said. “And those disorders are much more likely to persist in women.”
Luckily, Winer didn’t succeed at suicide, and now at 62 she is adding public speaker to her long resume of feminist projects. At Kings Park as a girl of 17, she was misdiagnosed as schizophrenic after several suicide attempts and isolated without benefit of talk or group therapy, much less any compassion for her situation. Her experience was part of the massive “warehousing” of people living with mental illness which ended with deinstitutionalization in the 1970s—one massive failure replaced with a string of broken promises to provide community and family support. Instead, patients were unceremoniously discharged out into a society that was unprepared for their medical and social needs.
"Saying the hospital was closed down because the bulk of the patients found other alternatives gives quite an idealized version of how these people fared," Winer said. Today, at least 25 percent of incarcerated people have serious mental health issues, she said, and similar numbers show up in the homeless population.
A 2008 federal law requires equality for mental health under private insurers but not for public insurance. It’s an important distinction, she said, since two-thirds of adults on Medicaid are women and more than half of Medicare recipients are women, according to government statistics. “Women rely more on public programs like Medicaid and Medicare and those programs are being threatened by federal and state budget cuts,” Winer said.
Numerous risk factors are present for women that aren’t there for men—gender-based violence, domestic violence, socio-economic disadvantage, income inequality, lower social status, and “unremitting responsibilities for the care of others,” according to a United Nations report. Women also make up the largest group of people affected by post-traumatic stress disorder (PTSD).
Winer added that under mental health treatment, women are frequently charged more for the same condition and service, and are routinely charged higher premiums than men. The Affordable Care Act now bans this practice.
Winer is used to mulling over these issues. “A part of me has never left,” she states in the movie, while exploring the dilapidated interiors of the now-shuttered Kings Park State Hospital during the first moments of the documentary. Surrounded by paint chips on walls and floors, Winer sits down on the floor. "This is what you did," she says, laughing. But at 17, there was nothing funny for Winer or other patients. Languishing in open rooms and being pumped with powerful anti-psychotic drugs comprised "treatment." The patients, who were clothed in gray uniforms called "state dresses," were unable to use a restroom without permission and banned from going outdoors.
In the film, Winer recalls being told by another patient, “ ‘Do not cry. They'll hurt you.’ And I stopped, for 25 years.”
There are also strong no-talk rules—still—about mental health, which she hopes her film, which is to screen at the American Psychopathological Association next March, will break through. She said, “Our movie provides a wonderful catalyst for much needed dialogue about the stresses exerted on women by a sexist society, which play a role in undermining women’s mental health. Whether we are talking about poverty, sexual violence, lack of family support, or the myriad demands of confining gender roles, these external pressures continue to compromise our safety and well being despite all the progress we have made in the last 30 years.”
She has high hopes for the next 30 years through new promises made via ObamaCare, with its guarantees of insurance coverage for mental health treatment and other programs that sound like the unfulfilled promises of deinstitutionalization: support, education and research for post-partum depression, Centers of Excellence for depression, a Medicaid Emergency Psychiatric Demonstration Project, and community mental health centers.