Mental Health Treatment Strides into the 18th Century

By the end of the 17th century, madness was viewed as a physical phenomenon rather than a spiritual or moral issue. But “treatment” of the mentally ill included the use of chains and the whip, as well as diet and exercise, in order to suppress the passions of those regarded as wild animals. The nickname given to the notorious “Bedlam Hospital of Saint Mary of Bethlehem in England, “Bedlam,” became a common noun for scene of pandemonium and violence.

In the 19th century, asylums were created to store the mentally ill, but “mental illness” was defined indiscriminately to confine those manifesting any condition that disquieted society, despite the fact that many of these maladies were little more than responses to oppressive societal and economic circumstances. Therapy was almost nonexistent. The asylums practiced seclusion and minimal caretaking of patients by largely untrained personnel.

In the Islamic world, as early as the 8th century, institutional care was based upon the belief that God loved the sane and insane alike, and patients were treated with special diets, baths, music, and felicitous surroundings

The asylum concept for the treatment of mentally ill seems to be thriving well into the 21st century, as evidenced by institutions such as Hotel Pawnee in North Platte, Nebraska. The facility has been cited by the Department of Health and Human Services for multiple violations of DHHS regulations, including hiring of uncertified staff, lack of safety in food preparation and administration of medications, and failure to conduct background checks of applicants. Recently Hotel Pawnee was placed probationary status and ordered to correct numerous deficiencies within the next year.

The DHHS investigation, conducted in May of 2012, disclosed a situation of peeling ceilings, moldy walls, broken light fixtures, dirty corroded bathtubs and thick piles of dust everywhere. Residents’ rooms were found to be littered with clothing and trash, and cluttered hallways contained cat litter boxes spilling feces onto the floor. Residents were being served sparse amounts of food, and nurses were administering injections without washing their hands or wearing gloves. Random examination of residents’ files by DHHS indicated that none of those suffering from mental illness or behavioral disorders were receiving specialized training in behavior management.

Hotel Pawnee was built in 1929 as the “Hotel Yancey,” and later became designated as the “Pawnee Hotel.” The eight story brick building, with its Georgian Revival architectural style, featured prominently in the history of North Platte, hosting celebrities and political figures and offering elegant receptions in its second-floor ballroom.

Disability Rights Nebraska, a non-profit organization dedicated to the protection of the legal rights of the disability community, conducted a nine-month investigation of Nebraska assisted living facilities for individuals with mental illness that included Hotel Pawnee. Photographs of the interior of Hotel Pawnee confirm the previous reports of appalling conditions, and documentation of food service operations have disclosed the restrictions on food and other necessities disclosed in the DHHS report. Ironically, the walls and ceiling of a ballroom that so characterized the opulent appointments of the past, collapsed several years ago, and have never been repaired. Disability Rights Nebraska has characterized the conditions at Hotel Pawnee as “dangerous and inhumane,” and has undertaken efforts to require DHHS to enforce its legislatively mandated responsibilities by closing down this facility and relocating the residents to environments less inimical to their health and safety.

Eric Evans, Chief Operation Officer of Disability Rights Nebraska, has described the conditions at Hotel Pawnee as a “soul killer.” It is difficult not to regard Hotel Pawnee as a reincarnation of Bedlam Hospital.

Amazingly, Hotel Pawnee is a “private pay” institution, which means that the residents pay over $1,076.00 per month for the questionable privilege of living there.

The squalid conditions of the facility are not the most tragic aspect of the situation. Of greater significance is the isolation of the residents and their seclusion from the world. The State of Nebraska is mandated to provide not only for treatment of those suffering mental illness and behavioral disorders, but also establish the means for allowing them to integrate into the community. For example, the DHHS Division of Behavioral Health is charged with ensuring “the public health and safety of persons with behavioral health disorders” and to provide Nebraska citizens with “an appropriate array of community-based services,” a “continuum of care” and “high quality behavioral health services.”

Unfortunately, in one of her final actions as Chief Medical Director of DHHS Public Health, before leaving the agency for Blue Cross Blue Shield, Dr. Joann Schaefer issued a decision allowing Hotel Pawnee to stay in business.

Bruce Mason, Litigation Director for Disability Rights Nebraska, regards this and similar state statutes, as well as regulations promulgated by DHHS itself, as binding promises made by the State of Nebraska to provide an opportunity for all of its citizens to live decent, secure, productive lives, free of isolation and restraint. Mr. Mason says that Disability Rights Nebraska will exert all of its efforts to assure that the State honors its promises and fulfills its legal and equitable duties.


About Tom Ukinski

Tom Ukinski is an attorney in state government in the Midwest. He's been writing plays, novels, short stories, comedy sketches and screenplays for many years.
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