When Michael Mays started out as a college student working at the old Weston State Hospital in 1972, the state kept thousands of people there. Some had been born there. Some had never left the grounds. Mays had a room in the attic. The rent was cheap. He was close to work.

He remembers rooms where dozens of people, mostly naked because they pulled their clothes off, idled away their days, some strapped or chained or otherwise restrained. Periodically, a worker would hose off the floor, washing the excrement and urine into a trough around the perimeter and down a drain. Disease was common.

When the "hospital" opened in 1864, you didn't have to have a diagnosis by a doctor to be locked up, sometimes for good. In addition to people who were genuinely dangerous to themselves and others, the original inmates of Weston were sent for reasons such as religious hysteria, or because family members didn't like the patient's solitary sexual activities.

It took a century for things to change. By 1958, West Virginia was keeping more than 5,000 people in 11 state hospitals. With court orders on one hand and advances in mental illness treatment and medication on the other, the state established community mental health centers designed to serve all 55 counties. If people got the help they needed early on and close to home, the state would need room enough for only about 240 people with the most severe problems at a state hospital.

Essentially, that's what happened between the late 1960s and 1990s. West Virginia combined state and federal money, first in grants, then through Medicaid, to pay for these services. While not perfect, West Virginia was recognized as a leader in the nation in moving people with mental illness and developmental delays out of institutions. Mays remembers going to conferences and hearing horror stories from other states. "West Virginia didn't go through a series of disasters," Mays said. The state planned and funded the change. By 1988, the state considered the process 95 percent successful.

Then, the rules changed. Federal officials stopped allowing the state to spend Medicaid money on anything not "medically necessary," even if it was a service that helped people to function more independently and to avoid the need for more costly kinds of care.

 Mays, now the executive director of one of those community health centers - FMRS Health Systems in Beckley - saw his services wither and vanish in the name of managed care. Lacking funds, he closed group homes, where people learned to live independently. Day treatment programs ended and so did services to teach low-functioning people how to perform daily tasks of grooming, shopping and basic housekeeping that most of us take for granted.

The same thing has been happening at the other 12 community mental health centers around the state.

So when we hear that the newer Mildred Mitchell-Bateman Hospital in Huntington was holding 120 people when it is meant for only 90, it is hardly a surprise. The same thing is going on at William R. Sharpe Jr. Hospital in Weston.

This crisis-only system of mental health care costs the state more money than helping people sooner. Every day, about 100 mentally ill West Virginians are in other hospitals at twice the rate the state would spend at Sharpe or Bateman.

It's hard on staff, who are being pressed into longer, more difficult hours. It's also dangerous. The state Office of the Ombudsman for Behavioral Health called conditions at Bateman "an accident waiting to happen." Patients were assigned to cots in makeshift rooms without bathrooms.

He remembers rooms where dozens of people, mostly naked because they pulled their clothes off, idled away their days, some strapped or chained or otherwise restrained. Periodically, a worker would hose off the floor, washing the excrement and urine into a trough around the perimeter and down a drain. Disease was common.

When the "hospital" opened in 1864, you didn't have to have a diagnosis by a doctor to be locked up, sometimes for good. In addition to people who were genuinely dangerous to themselves and others, the original inmates of Weston were sent for reasons such as religious hysteria, or because family members didn't like the patient's solitary sexual activities.

It took a century for things to change. By 1958, West Virginia was keeping more than 5,000 people in 11 state hospitals. With court orders on one hand and advances in mental illness treatment and medication on the other, the state established community mental health centers designed to serve all 55 counties. If people got the help they needed early on and close to home, the state would need room enough for only about 240 people with the most severe problems at a state hospital.

Essentially, that's what happened between the late 1960s and 1990s. West Virginia combined state and federal money, first in grants, then through Medicaid, to pay for these services. While not perfect, West Virginia was recognized as a leader in the nation in moving people with mental illness and developmental delays out of institutions. Mays remembers going to conferences and hearing horror stories from other states. "West Virginia didn't go through a series of disasters," Mays said. The state planned and funded the change. By 1988, the state considered the process 95 percent successful.

Then, the rules changed. Federal officials stopped allowing the state to spend Medicaid money on anything not "medically necessary," even if it was a service that helped people to function more independently and to avoid the need for more costly kinds of care.

 Mays, now the executive director of one of those community health centers - FMRS Health Systems in Beckley - saw his services wither and vanish in the name of managed care. Lacking funds, he closed group homes, where people learned to live independently. Day treatment programs ended and so did services to teach low-functioning people how to perform daily tasks of grooming, shopping and basic housekeeping that most of us take for granted.

The same thing has been happening at the other 12 community mental health centers around the state.

So when we hear that the newer Mildred Mitchell-Bateman Hospital in Huntington was holding 120 people when it is meant for only 90, it is hardly a surprise. The same thing is going on at William R. Sharpe Jr. Hospital in Weston.

This crisis-only system of mental health care costs the state more money than helping people sooner. Every day, about 100 mentally ill West Virginians are in other hospitals at twice the rate the state would spend at Sharpe or Bateman.

It's hard on staff, who are being pressed into longer, more difficult hours. It's also dangerous. The state Office of the Ombudsman for Behavioral Health called conditions at Bateman "an accident waiting to happen." Patients were assigned to cots in makeshift rooms without bathrooms.

On top of all that, says Mays, is the wear and tear on people before they even make it into an overcrowded hospital.

You cannot just voluntarily check yourself into a state hospital when you need help. Nor can your exasperated family drop you off when they're fed up, like in the old days at Weston. A court has to determine that someone is a danger to himself or others.

For that to happen, each person's condition has to deteriorate to the point that no other kind of help is suitable before they even qualify for treatment at a state hospital.

Many, if not most, of the people waiting and crowding into the hospitals did not have to slide so far into despair, violence or other dysfunction.

"We've lost our community system of care," Mays says.

A simple day-treatment program, he says, can make a big difference. Day treatment gives patients an opportunity to become more socialized and for staff to monitor behavior and medication. It gives family and other caregivers a couple of hours of respite, an important ingredient in maintaining care relationships. Staff could also check on those who need closer monitoring.

Today, Weston State Hospital looks like someplace they take the Joker at the end of a Batman movie. For decades, rainwater has drained down the window frames and stained the stone, giving the impression that the building is weeping.

While straitjackets and leg shackles have long since fallen out of frequent use in mental health, they have not disappeared altogether. When paranoid delusions cause people to thrash and kick at everyone around them, the restraints come out. This is happening to people where it could have been prevented.

When people do become stable and are ready to leave state hospitals, there are too few services to help keep them on track. Discharge plans today include one-way bus tickets or a ride to a homeless shelter.

"It's starting to sound like things I saw as a student," Mays says.

Miller is the Gazette's editorial page editor. She can be reached at 348-5117 or d...@wvgazette.com.