Intellectual Disability Rights and Rehabilitation at an Indiana Psychiatric Hospital, 1986–93

The Dual Diagnosis Unit (DDU) at Indiana’s Central State Hospital served patients with mental illness and intellectual disabilities. Unlike other hospital units, The DDU was accredited as eligible for Medicaid funding. To qualify for Medicaid, patients had to undergo “active treatment,” aimed at the “acquisition of the behaviors necessary for the client to function with as much self-determination and independence as possible.” Many DDU staff interpreted “active treatment” broadly, and patients were able to assert bodily autonomy and exercise their rights under the guise of rehabilitative programming.

This paper examines how patients and staff worked together to advance patients’ rights in three areas: the right to vote, to smoke cigarettes, and to engage in consensual sexual relationships. To flesh out each miniature case study, the paper draws on archival sources, interviews with former Central State staff, and the DDU Review, a newspaper co-produced by DDU patients and staff.

These victories for patients’ rights were limited, of course, by the context of institutional confinement. The same siloed nature of the hospital units that fostered progressive policies also made possible multiple cases of abuse and neglect that would lead to the hospital’s closure in 1994. While deinstitutionalization represented a more decisive shift in international disability policy, and for Central State patients in particular, this paper demonstrates that institutions themselves could be sites for the expansion of rights. Local studies such as this can reveal how interactions among federal policy, state law, hospital administration, ward-level governance, and patient-staff relationships affected conditions of life for people with intellectual disabilities and mental illness. Ultimately, this paper provides a detailed look at the desires, needs, and agency of patients and their caregivers in an institutional context.