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Working in a mental hospital

2012-07-30T00:47:58+00:00

Last week I was working in a mental hospital in Portland, Oregon. A real mental hospital, not the usual lunatic asylums masquerading as corporations or governments.

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It used to be a state hospital, serving both regular patients and psychiatric patients, but now it’s part of a non-profit network. The psych wards are on the upper floors. That’s why the stairwells have their cores fenced off, so that people can’t leap to their deaths.

I had an interesting discussion with one of the employees. She said the whole network of hospitals was doing very badly, financially. They had had lots of layoffs, because so many of their patients had no insurance and couldn’t pay for the services.

I had a chance to see a little bit of Portland the week that I was there. It’s somewhat picturesque, like a lesser version of San Francisco, with the hills and the bridges, crossed with the iron, brick and clapboard construction of Cleveland. Both Portland and Cleveland have similar architecture and are of a similar age. But Portland was a bit surprising. I have never seen so many unkempt young people in my life, even the ones who had jobs. They made Cleveland’s remaining residents seem positively preppy. And I have never smelled so much marijuana smoke, either, not even in Northern California. A significant percentage of the people  in Portland are young, jobless and stoned.  Of course they don’t have insurance.

“Why do you treat people who can’t pay?” I asked.

“You can’t just let someone die,” she said.

“I doubt most of the patients that you treat for free are in any danger of dying, and even if they are, are you running a business, or a charity? How many people do you treat for free until you go out of business?” I asked.

“We’re a non-profit,” she said, shrugging.

“Yes, I can see that,” I said. “That’s why you’re in such trouble.”

The conversation languished after that. They’ll keep treating people for free until they go bankrupt and get bought by another chain of hospitals. That’s how it goes in the hospital business.

I wonder how much of the hospital’s management works on those upper floors, in the psych ward. It might explain a few things.

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