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There is an alternative “Perhaps we can’t stop the world from being one in which children are tortured, but we can reduce the number of tortured children.” Albert Camus, quoted in testimony before the House Human Resources Committee by Patricia Tompkins Austin Critics of the Texas Department of Mental Health and Mental Retardation are often told that the problems they point out are the results of a shortage of funds and that failures of the system are insufficiencies of buildings, of attendants, of equipment and not malevolancies. More and more, those outside the department who are concerned with the problems of mental retardation and with the quality of care for the retarded are emphasizing the idea of 14 The Texas Observer IDA PRESS 901 W 24th St Austin Multi copy service. Call 477-3641 in-community residential care, as opposed to institutionalization, as a means of treating the retarded. From their point of view, MHMR’s that is, society’s failure is in a lack of imagination and therefore a lack of real concern. That was the message Rep. Carlos Truan’s Human Resources Committee heard from numerous witnesses. Ben Standley of Free the Slow, Inc., told the committee that institutionalization is exactly the wrong approach to the problem of retardation. Retardation, he said, is not simply a matter of damaged or diseased persons, but is .a “functional representation” of the distress retardates feel when they encounter stress they .cannot effectively handle. The crowding, disrepair, locked doors, odor, medication, and lack of purposeful activity, communication or interaction that characterize institutions are symptoms of the failure of facilities to reduce stress and encourage retardates’ abilities. Standley compared the conditions inside institutions for the retarded to those used by researchers in “sensory deprivation” experiments. He pointed out that when exposed to “prolonged periods of unvaried stimulation” even “normal” individuals adopt behavior which provides different stimulation, including hallucinations. Patricia Thompkins, senior social worker at the San Antonio Children’s Center, went after the same point in her testimony. The central fact about an institution, she argued, is the separation between it and the outside world. Four other typical characteristics mark institutions as well: an environment aimed at a low common denominator among residents, larger groups than occur outside, an emphasis on regimentation rather than autonomy and a limitation of activities to one area, involving one group of people. The alternative, Tompkins suggested, is to end the use of institutionalization and care for the . retarded in community-based programs. Not only would such programs work more directly toward the goal of “treatment” for retardates enabling them to function in the real world but, contrary to conventional wisdom, they can be less expensive than institutional maintenance. Tompkins quoted figures from a study done by Evelyn Shafer of Bexar County MHMR to show that projected costs for a community-based program there would be between $8 and $12 per day per person. State schools, according to MHMR figures, cost about $12 per day per person if they have over 500 residents and $16-17 per day per person if less than 500 residents are served. Shafer helped establish such a program in Nebraska: in Omaha, which has a population about half that of Bexar County, the program ended all applications to State Schools. A similar project in Bexar County, Shafer estimates, would cost about three million dollars for the first biennium if it served 1,200 people. Tompkins noted that “a State School serving only 500 people costs $2,190,000 per year to operate, and this figure does not include construction costs, or upgrading of institutional care. For the facility to meet national standards, cost would be doubled.” Tompkins went on to detail some instances of the success of community-based treatment programs in Connecticut, Nebraska and California. Despite the existence of these models, she testified, the emphasis on institutions continued this year in the Texas MHMR budget. In a year when “people programs, not bricks and mortar” was a shibboleth throughout the appropriations process, $9.5 million was authorized for institutional construction in the area of mental retardation, while all community-based programs including those for alcoholism, drug abuse and mental health as well as for mental retardation were allotted $16 million. Nonetheless, there are signs that the idea of programs located in the community is taking hold. Last session, Rep. Ron Bird of San Antonio introduced HB 613, which would have set up a pilot program for Bexar County. \(Shafer was an important influence in preparation of the bill, Bird a late-session death in the Senate State Affairs Committee, the bill lost its funding. But Bird is optimistic: “We succeeded in getting Dr. [David] Wade [MHMR commissioners] interested in implementing the idea in Bexar County, and we may not have to do it by legislation next session. But we have the legislation ready.” J.F. -a
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