Still Crazy After All These Years: Psychiatric Lock-Down Returns to the US

By Janet Phelan

Without a lot of fanfare or explanation, new psychiatric hospitals are being built in droves across the United States. Facilities are springing up in Indiana, in Delaware, in Missouri, in Dartmouth, Massachusetts, in Colorado, in Washington, and in North Carolina, to name just a few.

This reverses the trend and policy of the last seventy years, which promoted de-institutionalization and community based care.

The question is: why are these hospitals being built? What new policy is going into effect?

Seventy years ago, there were around 550,000 inpatient psychiatric hospital beds in the United States. With the movement towards community based care, these beds were reduced to roughly 40,000, country-wide. In the place of the large institutions, board and care homes and community based outpatient clinics became the norm for housing and treating those with psychiatric problems.

And if the federal government has its say, this trend will shortly reverse.

The Pendulum is Swinging Back

Some of the de-centralization of mental health care was accomplished through the passage of what is known as the “IMD exclusion.” The IMD exclusion is a part of the federal Medicaid statute and bars the use of Medicaid funds to pay for psychiatric care in a facility with more than sixteen psychiatric beds. The IMD exclusion is seen as one of the most potent factors in reducing inpatient hospitalization for psychiatric disorders.

And now, the pendulum is swinging back. The IMD exclusion faces substantial amendment in a bill which just passed the House of Representatives. HR 2646, colloquially known as the “Murphy Bill,” zinged through Congress with a nearly unanimous vote of 422-2.The author of the bill, Tim Murphy, is a Republican Congressman from Pennsylvania who is a psychologist.

The repeal of the IMD exclusion has disability rights advocates concerned. According to the Legal Action Center, “…potential risks associated with a full or partial repeal by Congress could be to encourage inpatient treatment when outpatient treatment is preferable.”

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