"A Place for Madness"

PBS, "Frontline," Tuesday, Jan. 18, 9 p.m. Channels 22 and 26

As America's streets become home to a burgeoning number of people with serious mental illness, it has become fashionable to blame deinstitutionalization, the social policy that over the past three decades has emptied state mental hospitals and returned patients to the communities.

The reality is that deinstitutionalization is not the abject failure its detractors claim, any more than the solution to the problems of the homeless mentally ill lies in reopening shuttered state hospitals.

These are among the themes that the PBS documentary series "Frontline" explores in a compelling but ultimately superficial hour-long program scheduled to air tonight. To examine the legacy of deinstitutionalization, producer DeWitt Sage focused on Northampton, Mass., a bucolic college town of 30,000 people that has served as a laboratory for the policy.

In the annals of law and psychiatry, Northampton has a special place. Until last year, it was the home of Northampton State Hospital, once one of New England's largest mental hospitals, an institution that in 1955 housed 2,500 patients. It was the subject of a landmark court case involving the rights of hospitalized psychiatric patients. In 1978, a court ordered that all but 50 of the hospital's then 650 patients be discharged to community programs. Northampton no longer exists. Last August, the 135-year-old hospital closed its doors for good.

As the show makes clear through an all-too-brief interview with a veteran nurse who worked at the hospital for 34 years, Northampton, like most state mental hospitals of the era, was little more than a holding tank.

"Shortly after I came here, I realized that this wasn't the Northampton State Hospital, this was the Northampton state warehouse," she said, recalling one patient who was taken to the hospital when she was 18 by her family and was discharged as a result of the court decision when she was well into her eighties. Like many patients of the time, she spent her entire adult life in a hospital where, the nurse notes, "patients had no purpose . . . they weren't going to get better. They weren't going to go home. They just stayed here."

The catalyst behind the closing of Northampton was Steven Schwartz, a soft-spoken Harvard-trained lawyer who filed the class action suit that resulted in the 1978 decision, one of a series of crucial rulings responsible for deinstitutionalization. Schwartz describes the indelible impression with which he was left in 1973 when, as a young lawyer, he was taken to the hospital to see if he would represent patients there. Many of them had spent much of their lives behind barred windows, milling around locked wards, where they received little or no treatment. Schwartz saw them as virtual prisoners whose only crime was mental illness.

"I came to the conclusion that what really had to happen was to have as many people as possible leave the hospital and live outside of the walls of the institution . . . where they could be visible. The largest and most heinous crime was that we had made people invisible," says Schwartz.

After effectively establishing that there were no "good old days" at Northampton State Hospital, the documentary loses focus, zigzagging from the issue of involuntary commitment to the rights of psychiatric patients to refuse treatment to the anguish of their families to the controversy over releasing those who have been found not guilty by reason of insanity. Each of these issues deserves a far more thorough exploration -- perhaps even an entire show. The unfortunate result of combining them in this fashion is to leave viewers with the distinct impression that mentally ill people are dangerous, an assertion that is not substantiated by research and is in fact contradicted by the narrator at the beginning of the program when he refers to the "occasional violence of the mentally ill."

Unfortunately "Frontline" skirts but never really addresses the reasons that deinstitutionalization has, for some patients, failed in Northampton and elsewhere. Patients who left the state hospital were too often dumped on reluctant and financially pinched communities unprepared for their return and unwilling to take them back. The failures of deinstitutionalization are in large part a reflection of inadequate and inaccessible community services, not of the fact that former patients were too sick to live outside hospitals.

This would seem to be the case in Northampton, where as many as 1,000 former patients have, over the years, ended up at Mrs. Shaw's Motel, a rundown two-story structure operated by an elderly, apparently kind-hearted widow who coaxes residents to take their medication and calls police when some seem to be growing sicker and perhaps becoming dangerous. As one Northampton official notes, "It's the Mrs. Shaws of the world who take care of these people." A profile of Mrs. Shaw and her motel would have revealed much about the successes and failures of deinstitutionalization in Northampton.

It is particularly hard to fathom why the producer has included the case of John Pavone, the so-called "Route 2 Sniper," who was found not guilty by reason of insanity after he shot and killed a motorist in suburban Boston in 1972. Pavone, who was diagnosed as a paranoid schizophrenic, was recently released by a state judge after spending 22 years at another state hospital in Massachusetts. There is no indication that he has even the remotest connection to Northampton. His case raises questions about the insanity defense, not about the policy of deinstitutionalization.

"Frontline" is to be commended for devoting an hour to a documentary about the fate of people with chronic mental illness, a population largely ignored by television. As a thoughtful and comprehensive exploration of the legacy of deinstitutionalization on the mentally ill, their families and one community, the show regrettably falls far short.