Hospitals & Asylums    





State Mental Institution Library Education


To treat upon Title 24 USC Chapter 4 Saint Elizabeth’s Hospital §161-230

By replacing repealed Subchapters I Establishment And Management; Pensions, Moneys, And Appropriations and; Subchapter II Inmates; Burden Of Expenses Thereof; Detention Of Insane; and renumbering Subchapter III Mental Health System for the District of Columbia to Article IX


Be it enacted in the Senate and House of Representatives, Assembled, Referred to the Senate Committee on Health, Education, Labor and Pensions (HELP) and subcommittees on Health of the Ways and Means Committee, and Committee on Energy and Commerce supplemental to the Children’s Health and Medicare Protection Act of 2007 H.R. 3162.


1st Draft August 2004, 2nd May 2005 3rd 28 February 2007, 4th 30 July 2007


1. This chapter fulfills Title 24 USC Chapter 4 Saint Elizabeth’s Hospital §161-230 by replacing the repealed Subchapters I Establishment And Management; Pensions, Moneys, And Appropriations and; Subchapter II Inmates; Burden Of Expenses Thereof; Detention Of Insane; with new laws pertaining to human rights in the Mental Health System and renumbering Subchapter III Mental Health System for the District of Columbia without changing the section numbers.  The purpose of this Chapter is to free the alleged mentally ill (ami) and help the severely mentally ill (smi) smile without drugs.  


2. St. Elizabeth’s Hospital, in §255-h of this Chapter was founded by Dorothea Dix in 1855 with a maximum capacity of 250.  However by the 1940s, the Hospital complex covered over 300 acres and housed 7,000 patients. It was the first and only federal mental facility with a national scope. Politicians were importing mentally ill people.  In 1987, the National Institute of Mental Health (NIMH) acting in behalf of the federal government transferred the hospital operations to the District of Columbia, while retaining ownership of the western campus. Under the regulation of the District of Columbia Council the patient population steadily declined, and the Hospital now houses only 600 patients in 1992.  The Hospital needs to be limited to Dix’s 250.  State mental institutions, private psychiatric hospitals, general hospital psychiatry wards and corrections programs are encouraged follow the example to reinvest in lower cost and friendlier community shelters for both the mentally ill and the convicted populations.


3. The Surgeon General’s Report on Mental Health of 1999 stated that 55% of Americans suffered from mental illness at some time in their life and 1 in 5 Americans experience a diagnosable mental disorder in any given year.  Mental illness is the second leading cause of disability, costing disability insurance an estimated $24 billion and medical insurance $65 billion annually.  Mental illness is clearly a part of the human condition.  Everyone has emotions other than happy.  Most people medicate themselves with alcohol, drugs and friends.  There is however a time when mental illness or drug withdrawal becomes overwhelming for certain people and professional treatment is sought to protect them and others from harm and speed recovery. It is generally more effective to treat upon the socio economic factors disrupting and depressing a person’s life because psychiatric hospitalization has a long history of abuse, the community mental health system is not fully implemented and stigma is a real threat. 


4. Psychiatric medication has become an accepted method for treating mental illness since the deinstitutionalization movement began in the 1950s.  Mental illnesses are among the most common conditions affecting health today.  One in five American adults suffers a diagnosable mental illness in any six-month period. According to the National Institute of Mental Health, though, some 90 percent of these people will improve or recover if they get treatment. Psychotherapy is a general term for a way of treating mental and emotional disorders by talking about the condition and related issues with a mental health professional. It’s also known as talk therapy, counseling, psychosocial therapy or, simply, therapy.  Through psychotherapy sessions, one may learn about the causes of the condition to better understand it. Learn how to identify and change behaviors or thoughts that adversely affect your life.  Explore relationships and experiences. Find better ways to cope and solve problems. Learn to set realistic goals for your life.


5. Suicide is the 3rd leading cause of death among 15 -24 year olds. In 1997 30,535 people died from suicide in the U.S.  It was the 11th leading cause of death in 2000 for all age groups.  The highest suicide rates are found in white men over the age of 85.  The diagnosis and treatment of mental illness is performed by 40,000 psychiatrists and over 1 million mental health professionals.  The most prevalent Mental Diseases are; 1.“major depressive disorder” affecting 9.9 million people or 5% of the U.S. population every year; 2. “Bi-polar disorder” is a mental disorder affecting 2.3 million U.S. adults or 1.2 % of the U.S. population; 3. “Schizophrenia” is a mental disorder affecting 2.2 million U.S. adults about 1.1% of the U.S. population; 4. “Anxiety disorders” are a category of mental disorder affecting 19.1 million U.S. adults; 5. “panic disorder” is an anxiety disorder that affects 2.4 million U.S. adults, 6. “Generalized Anxiety Disorder” is an anxiety disorder affecting 4.0 million or 2.8% of the populace, 7. “Social Phobia” is an anxiety disorder affecting 5.3 million or 2.8% of the populace.  9.5 million people suffer from agoraphobia and specific phobia.  8. “Attention Deficit Hyperactivity Disorder” is a disorder that affects 4.6% of school age juveniles.  9. “Alzheimer’s disease” affects an estimated 4 million senior citizens.  10. According to US Army reports the suicide rate for American soldiers serving in Iraq is 17.3 per 100,000, nearly five time the rate for the Gulf War and 11% higher than for Vietnam.  Over 19% of OIF veterans and almost 12% of OEF veterans reported some mental health concerns (e.g., PTSD, depression, and anxiety).  Nearly 10% of OIF veterans and 5% of OEF veterans reported symptoms of PTSD.  Even when using a strict definition of anxiety, depression, and PTSD, they found that 8% of those surveyed reported anxiety, 8% reported depression, and 13% acknowledged PTSD-type symptoms.  The National Vietnam Veterans Survey (1990) found that 15% of veterans surveyed could be diagnosed with PTSD at the time of the survey, but that as many as 30% of veterans eventually developed PTSD at some point following their combat experience.



Source: Census Bureau, Department of Health and Human Services and Bureau of Justice Statistics; Harcourt, Bernard E. The Mentally Ill Behind Bars. New York Times. January 15, 2007


6. During 1999 there were 1.7 million admissions to inpatient psychiatric treatment. 424,450 were involuntary commitments.  Although the number of resident patients has gone down the overall number of admissions has increased.  In 1963, when the Community Mental Health Center Construction Act was passed, the median stay in a psychiatric hospital was 17 days and mean 20 days.  In 1975 the median stay was 6.7 days and the mean 11 days.  Since the 1950’s public funding policy has been to close state mental institutions in support of community based care.  The number of patient care episodes has both greatly increased and become increasingly directed to less than 24-hour treatment facilities.   In 1955 there were 1.7 million care episodes of which 77% were treated in 24-hour care facilities.  By 1971 there were 4.1 million cases of which 58% were treated in less than 24 hours, by 1998 11 million care episodes were treated only 24% of the time in 24-hour treatment centers.  The numbers show that de-institutionalization policies between 1970 and 1998 have been successful in reducing the supply of totally government funded psychiatric beds by a total of 376,704.  State and county mental institutions having reduced their number of inpatient beds from 413,066 in 1970 to 63,525 in 1998.  Likewise VA medical center psychiatric beds went down from 50,688 in 1970 to 13,301 in 1998. To compensate private psychiatric hospitals, non-federal general hospital and residential centers for emotionally disturbed children that are funded 68% by private clients’ HMO have increased 51,348 beds.  Between 1970 and 1998 Private psychiatric hospitals have increased in patient population from 14,295 to 33,635, Non-federal general hospital psychiatric wards have increased from 22,394 to 54,266, residential treatment centers for emotionally disturbed children increased from 15,129 to 33,483.  The total number inpatient beds of all “mental institutions” declined from 515,572 in 1970 to 198,195 in 1998.


Psychiatric Inpatient Population by Type of Institution 1970-1998


Source: Substance Abuse Mental Health System Administration


7. In 2000 at the Conference on the Report of the Surgeon General Ohio Director of Mental Health Mike Hogan Phd promised to, “close all state mental institutions and private psychiatric hospitals to provide unimpeded access to community mental health.”  The message seems to have gotten through, on June 18, 2001 President Bush signed E.O. 13217 Community Based Alternatives for Individuals with Disabilities to (1) commit the United States to community based alternatives for individuals with disabilities (2) community programs foster independence (3) unjustified isolation or segregation through institutionalization is prohibited (4) states must take responsibility to place people with mental disabilities in community settings (5) states must ensure that all Americans have the right to live close to their families and friends, to live independently, to engage in productive employment and to participate in community life.  The World Health Organization Report on Mental Health of November of 2001 estimates that mental illness and psychological disorders stemming from substance abuse affect a combined total of 450 million people, 7.3%, of the 6,137,000,000 global population.  WHO recommends that in the future, “governments take responsibility for providing treatment for mental disorders within primary care; ensuring that psychotropic drugs are available; replacing large custodial mental hospitals with community care facilities backed by general hospital psychiatric beds and home care support.”


8. Dr. Hogan was appointed head of the New Freedom Commission on Mental Health in April 2002 as a commitment to eliminate inequality for Americans with disabilities.  Mr. Hogan is now Commissioner of the New York State Office of Mental Health.  The Freedom Commission found. Stigma remains a significant problem.  A diagnosis of mental illness is often accompanied with fear and hostility by the general public not to mention a person’s own friends and family.  Stigma decreases the willingness of people with mental illness to seek or pay for services. People with mental illness need choice and availability of acceptable treatment options or they are unlikely to engage in treatment or to participate in appropriate and timely interventions.  Thus giving access to a range of effective community based treatment options is critical to achieving their full community participation. Despite the potential millions of people with severe mental illness lack housing to meet their needs.  Participation by people with mental illness in service planning should be a priority and policy makers should increase opportunities for participation.  Welfare programs create financial disincentives for the employment of people with severe mental illness.


9. Despite, or perhaps because of, the unprecedented attention to mental health at the beginning of the new millennium that went so far as to found a UN Department of Mental Health and Substance Abuse, unlike other medical specialties the quality of care for Americans with mental health problems remains as poor today as it was several years ago.  This comes after decades of political improvement. Patients on antidepressant medication are about as likely to receive appropriate care today as they were in 1999.  Similarly, patients hospitalized for mental illness are only marginally likely to receive appropriate follow-up care according to the National Committee for Quality Assurance in 2006.  Even more alarming, Joseph Parks of the Missouri Department of Mental Health reports that people with serious mental illness die at age 51, on average, compared with 76 for Americans overall.  Their odds of dying from the following causes, compared with the general population.  3.4 times more likely to die of heart disease.  3.4 times more likely to die of diabetes.  3.8 times more likely to die of accidents.  5 times more likely to die of respiratory ailments.  6.6 times more likely to die of pneumonia or influenza. Adults with serious mental illness treated in public systems die about 25 years earlier than Americans overall, a gap that's widened since the early '90s when major mental disorders cut life spans by 10 to 15 years.  There is clearly a public health crisis in the delivery of mental health care.  The quality of psychiatric medicine has deteriorated and it would appear that the stigma and discrimination of people diagnosed with mental illness now runs into bio-terrorism.  The federal government must reaffirm their commitment to community mental health treatment and shelters and eliminate the corrupt influence of institutional psychiatry in the drug approval process of the FDA and CMS financing must be adjusted to afford the reasonable cost of community care without requiring prior hospitalization in Part A. 


10. Torts are infractions of law from whence a substantial right to just compensation for actual or statutory damages is derived.  Torture is the cruel and wanton infliction of pain and physical or mental suffering on an individual in legal custody.  Institutional psychiatry has a long history of physical as well as mental abuse.  For reasons of financial self-interest institutional psychiatry is too judgmental of mental illness to impartially judge mental health on its socio economic merits for the benefit of the plaintiff, the alleged mentally ill person. The stigma and discrimination of a diagnosis of mental illness can haunt people for the rest of their lives, however many formerly mentally ill people have gone on to lead successful lives and many have taken the time to report and litigate the cruel and unusual treatment they received and many receive SSDI on the rational basis of their diagnosis of mental disability.  In general, it is a struggle to keep the day-to-day operations of the psychiatric institution at a first-degree misdemeanor level for involuntary treatment by a legal authority paying lip service to all due process requirements.  Felonies occur frequently. When former patrons hire psychiatrists to civilly commit their dependents.  When private hospitals falsely arrest people and sell their persona to CMS, state and local government.  When there are adverse reactions to enforced medication.  When patients are physically or mentally abused or killed by staff or other patients.  When patients are denied medical treatment. When patients are denied access to community shelters.  When biological experiments or court orders cause insanity or physical illness or death.  Public records shall be kept of all felonies and the Board of Mental Health shall be responsible for the discipline of the staff and the welfare of the alleged mentally ill.


11. The involuntary hospitalization of the mentally ill gives rise to the right to be speedily adjudicated.  Under 24USC(9)§326 (1&2) a psychiatric hospital must commence judicial proceedings for all involuntary commitments within five days.  These trials are however routinely found wanting due process under the VIII and XIV Amendments to the US Constitution by the federal court who takes great relish from wiping the State Mental Institution Library Education (SMILE) buildings off the prima facie of the Probate Court.  Sections 4-6 of the Justice of Peace Amendment at §41(D-) of Chapter 2 of this Title, would constitute Mental Health Review Tribunals nationally to guarantee the mentally ill the due process of adjudication by social workers trained in mental health with access to the outpatient beds and counselors in the mental health community.


Section 4 States shall abolish Probate Court on the condition the counties elect slavery free Justices of the Peace in every jurisdiction under the 13th Amendment


Section 5 States shall transfer responsibility for the adjudication of mental disability to the licensed, trained and certified professionals of the board of mental health and social security administration under Art. 4 Sec. 3 Clause 2


Section 6 States shall probate and parole criminal offenders to community correctional housing and equal employment opportunity programs to substantially and sustain ably reduce the prison population to meet international minimum standards of detention under the 8th and 14th Amendments


12. Hospitalization of Mentally Ill Nationals Returned from Foreign Countries statute 24USC(9)§326 Release of Patient, provides,


If a person who is a patient hospitalized or his legal guardian, spouse, or adult next of kin, requests the release of such patient, the right of 
the Secretary, or the head of the hospital, to detain him for care and treatment shall be determined in accordance with such law governing 
the detention, for care and treatment, of persons alleged to be mentally ill as may be in force and applicable generally in the State in which 
such hospital is located, but in no event shall the patient be detained more than forty-eight hours (excluding any period of time falling on 
a Sunday or legal holiday) after the receipt of such request unless within such time (1) judicial proceedings for such hospitalization are 
commenced or (2) a judicial extension of such time is obtained, for a period of not more than five days, for the commencement of such 


13. Torts regarding the timeliness of the release of patients create an enforceable Mental Institution Relative Release Order Request (MIRROR).  Should the timeliness of the MIRROR be broken by anyone clever enough to stare at himself or herself in it, it is evident that there is a health care fraud involving too many high priced inpatient beds and no community access.  The Board of Mental Health shall be compelled to review hospitalizations independently, free of charge, in a timely fashion, daily or not after 5 days.  The Board shall decide upon and manage the reinvestment of the psychiatric department into the community mental health shelters under 24USC(4)III§225


14. In pursuit of greater independence for the Court at 57 & 58, the United Kingdom Parliament Joint Committee on Human Rights Fourth Report of 4 February 2007 on the Mental Health Bill 2006-07 boldly advocates for “a need for some external safeguard of liberty that is more accessible than judicial review…We consider that the principal legitimate aim for which psychiatric treatment may be imposed is mental health wherefore a patient should be entitled to seek review of the conditions before a Mental Health Review Tribunal”.  Mental Health Review Tribunals staffed by the Board of Mental Health would be much more likely to provide the professional safeguards for selecting “appropriate treatment”, whereby it will not be possible for patients to be compulsorily detained if they are rational enough to voice their objection, reports, in pursuit of greater independence for the court. The Convention on the Rights of Persons with Disabilities HA-19-10-06 and the Poverty Reduction Obligation Under Deliberation on Human Rights Day HA-10-12-06 made great progress towards defining discrimination as a universal wrong whereby a person is denied equal rights.  Inequalities and discrimination may assume various forms, including explicit legal inequalities in status and entitlements, deeply rooted social distinctions and exclusions, and forms of indirect discrimination. The twin principles of equality and non-discrimination require States to take special measures to prohibit discrimination against the poor and disabled and to provide them with equal and effective protection against discrimination.

15. Barriers to community integration continue to exist primarily because CMS is not upholding interpreting the true spirit of the Scope of 
Benefits of Part A Medicare that provides coverage of extended care services shall be without regard to three-day prior hospitalization 
requirement and extended care services shall be without time limit under 42USC(7)XVIII-A§1395d (f,a,2).  Lifetime psychiatric 
hospitalization is limited to 190 days at (c), the Institution for Mental Disease exclusion.  Misinterpretations of the scope of benefits 
in Medicare literature amounts to discrimination.  Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112) prohibits discrimination 
on the basis of disability in programs and activities that receive federal financial assistance and in federally conducted programs. 
42USC§12132 of the American with Disabilities Act provides no qualified individual with a disability shall, by reason of such disability, 
be excluded from participation in or be denied the benefits of the services, programs, or activities of a public entity, or be subjected to 
discrimination by any such entity.  Groups representing residents and prospective residents of community mental health, community 
health and homeless shelters are entitled to recover threefold the damages sustained from local rules requiring prior hospitalization as 
the result of CMS’s failure to advertise community health and mental health in their literature, and the cost of suit, including a reasonable 
attorney’s fee in the US District Court.  They must show that CMS acted intentionally for delay, or otherwise acted in bad faith in 
regards to failing to finance lower cost community psychiatry while paying for cruel and expensive psychiatric hospitalization in 
violation of anti-trust laws under 15USC§15. 
16. To ensure that the community mental health system is sustainable in a democracy the County Boards of Mental Health is encouraged 
to lighten the burden on the judiciary with a tax levy on property on the County ballot to afford a Mental Health Review Tribunal and 
enough shelters to accommodate the urgent need for community counseling and mental health shelters by involuntarily hospitalized 
patients. The plan is for state mental institution and private psychiatric hospitals to close or treat exclusively upon forensic cases where 
the person has been convicted of a crime by a Court of Record, because the civil commitments of people who are able to voice their 
objections cannot be considered fair by anyone who has experienced severe mental illness, and is certainly not constitutional from a legal 
standpoint.  To enforce this final stage of de-institutionalization, community empowerment, the legislature shall obligate the Board of 
Mental Health to independently review all psychiatric admissions and adjudicate all involuntary admissions within five days, lightening 
the burden on the judiciary.  At the trial by a Board of Mental Health employee, not on the payroll of the general hospital with the 
psychiatric ward or state mental institution, would inform the alleged mentally ill person of their opportunities for care the community 
and question them as to whether they already live independently. The inpatient psychiatric population would be expected to dwindle by 
25% the first year and 50% within 5 years and as much as 75% in ten years when general hospital psychiatric department were fully 
diversified in the community mental health centers and shelters in fulfillment of the right to appropriate treatment in a setting and under 
conditions that are the most supportive of such person's personal liberty under the Mental Health Bill of Rights 42USC§9501 (a-1).       


17. Hospitals & Asylums (HA) would like to challenge mental health professionals to win the War on Terror.  The United States of America is in denial regarding six hallucinations that should have never been enacted as law but were and now cause widespread delusion that has manifested as an anxiety disorder with violent tendencies.  First, Title 22 Foreign Relations and Intercourse (a-FRaI-d) is not only sexually perverse but produces anxiety, fear.  Second, the Department of Defense (DOD) was founded in a morbid rebellion a month before the Geneva Convention that calls for a Military Department (MD).  Third, the USAID Bureau for Asia and Near East (ANE) is not only too large and the location of all of our nation’s wars since WWII but is psychiatrically discriminatory to more than half the world’s population and must be divided into the Bureaus for South East Asia (SEA) and Middle East and Central Asia (MECA).  Fourth, the Drug Enforcement Administration (DEA) is incompetently the jurisdiction of the Attorney General rather than the medical establishment.  Fifth, the Department of Health and Human Services (DHHS) dropped out of the utopian society of Health, Education and Welfare (HEW) without achieving their Public Health Department (PHD).  Sixth, the Court of International Trade of the United States (COITUS) continued the perversity in international affairs in Court of law that needs to change its name to the US International Tribunal (IT) whereas no Court could be expected to master the poison of the US International Court (USIC-k). 


Sanders, Tony J.  Hospitals & Asylums. Title 24 US Code. Chapter 4: State Mental Institution Library Education (SMILE). 4th Draft. 31 July 2007. pgs. 103