It took filmmaker Lucy Winer several decades to come to terms with having been locked up in a mental institution in 1967 after several hospitalizations for suicide attempts.
Between the ages of 17 and 19, Winer was committed to Kings Park State Hospital, in Kings Park, N.Y. -- today a long-abandoned campus on Long Island -- which at its height warehoused more than 9,000 patients in towering brick buildings.
Like many other depressed patients at the time, she was given an amorphous diagnosis: chronic differentiated schizophrenia, a condition psychiatrists thought was caused by bad parenting or psychic conflict and was considered untreatable.
"I was placed in the violent ward, for starters," said Winer, who buried her memories until she neared 50. "All my possessions were taken from me.… I was highly medicated. There was no place to sit, maybe five or six chairs, so we all slept on the floor all day."
She showered once a week in a group stall and lined up naked with others to wash at a row of sinks. There were no activities and no television.
"It was neglect and neglect is abuse," said Winer. "We were not considered to be human -- that's an experience you never forget."
In her 2011 film, "Kings Park," director Winer portrays the dark side of mental health care before most of the nation's state hospitals were shuttered down one by one over several decades to provide more humane care for the mentally ill within the community.
But, as her documentary reveals, that never happened. New medications allowed patients to be more independent and federal programs stepped in to help, but states never fully funded community-based care.
The failure of states to implement integrated programs for the mentally ill is still playing out today in a national conversation on mental health care after the death of 20 children and six adults at Sandy Hook Elementary School in Newtown, Conn.
In the last 60 years, the number of patients in state mental hospitals decreased from 600,000 to less than 60,000, according to the National Institutes of Mental Health.
But today care for the mentally ill is largely fragmented and poorly funded. Many with serious conditions fight to get access to services as others are homeless or warehoused in the prison system.
And the stigma persists, according to Winer.
"The secondary tragedy is that it takes a tragedy of this proportion to wake us up and see how inadequate our system is," said Winer.
An estimated 45.9 million adults in the United States age 18 or older were diagnosed with a mental illness in 2010, but more than 11 million of those adults say their needs for care were not being met, according to the Alliance for Health Reform, a nonpartisan, nonprofit organization that advises Congress and the media.
Those who are mentally ill "pay a huge price," according to Winer. "They lose their jobs, insurance, their friends, associates. People stay silent and don't seek treatment."
The film, which premiered at the Woodstock International Film Festival in 2011, has been screened by numerous mental health organizations. The American Psychiatric Association and the American Association of Social Workers featured the film at their annual conferences this year. Several Washington policymakers have also viewed the film, according to Winer.
It is also being shown in limited general release around the country.
Winer, now 62 -- whose previous films include "Positive: Life With HIV" and "Silent Pioneers," about lesbian and gay seniors -- said her motives for making "Kings Park" were at first "personal," to share her own experience. But after interviewing numerous former patients and doctors, including her own psychiatrist, she became an advocate for others.
What she found was that many of their experiences at Kings Park had been even worse than her own.
She heard stories of patients running around the ward naked, covered in feces. Others were tied down for months at a time.
Man Sent to Mental Hospital as a Child
Ron Jackson, a runaway foster child placed in the ward in the 1940s for "disturbed young adults," says in the film that he was hung from a high window in a straight jacket where he swung back and forth for hours.
He can't remember exactly how old he was when he arrived at Kings Park -- "I was seven or eight years, nine years? I really don't know exactly. But I know when I came here I was very young. I must have weighed about 60 pounds," he told Winer.
Jackson had never been taught to read or write or use a telephone, so when he was released at 17 without any skills, he got into minor trouble and landed briefly in jail. Later, he grew up to be a successful sanitation worker.
It was not easy on those who worked there either, according to the film. Staff psychiatrist Dr. Hannelore Lehnhoff, who worked at Kings Park from 1960 to 1985, but has since died, reported a dangerous practice that was used to restrain patients and when she spoke up, she was reasigned to another area of the hospital.
Staff would place a wet washcloth over the face of a "disturbed" patient, says Lehnhoff, causing them to lose consciousness so they could be put in restraints. One died of suffocation.
"The staff was also oppressed by the system," said Winer. "Everyone just tried to survive."
Institutions such as Kings Park emerged in the 19th century when society struggled with what to do with the mentally ill.
"Basically, there was no place for you," said Gerald Grob, author of the 1994 book, "The Mad Among Us: A History of the Care of America's Mentally Ill," and professor emeritus at the Institute for Health, Health Care Policy and Aging Research at Rutgers University in New Jersey.
"Oftentimes, the family couldn't cope," he said. "It was very disruptive -- so they moved toward institutional care with the assumption that a hospital could break with the environment that caused the illness."
Though characterized as "evil places," at the time hospitals provided a range of therapies and did "many good things," according to Grob, the least of which was to offer food, clothing and shelter.
Attitudes changed after World War II. Doctors began to notice that soldiers exposed to continual combat suffered from neuropsychiatric symptoms. But if they were taken off the battlefield to wash up, eat and sleep for several days, they could recover and go back to fight.
"From that came the notion that in treating people with mental illness, it might be good to do it in the community, rather than in a hospital," he said.
In the 1950s and 1960s, patients were being let out of the hospitals in the hopes they could reintegrate and at the same time, newer psychotropic drugs were being developed to help them. Institutional populations were sharply declining, according to Grob.
"The argument was that people were better off outside," he said.
By 1965, when Congress introduced Medicare and Medicaid, about half of all mental hospital patients left were the elderly, according to Grob. "Before, the state was responsible for their total support, but with the creation of nursing homes and chronic care facilities, instead, the state sent them there, and federal government paid the bill."
With the advent of Social Security Insurance (SSI) and Social Security Disability Insurance (SSDI), federally subsidized Section 8 housing, there were now federal resources to help an individual make an independent life.
This "lateral transfer," shifting the financial burden from the state to the federal government, precipitated today's mental health care crisis, he said.
"That would have worked, but there was no way of integrating these programs," he said. "You tell somebody who has a mental illness that they have got to negotiate between a half dozen programs, they will get lost.… And people with severe mental illnesses float around."
At the same time, states that had pledged to commit resources to local mental health programs did not follow through. "Most simply absorbed savings into the general budget," said Grob.
"The federal government is not in a position to run programs," he said. "It has to be the state and localities, and their budgetary problems are so severe, there is no real interest."
Kings Park, which had been operating since 1885, shut down in 1996, and since then, "history is vanishing," said Winer.
"These hospitals were torn down all over the country," she said. "Their stories are being lost -- cemeteries where thousands of patients were buried are erased. It's hard not to believe that it's not rooted in the fear of mental illness and a distaste, almost as if it is infectious."
Winer suggests that even though society has more tools at its disposal to treat the mentally ill, it has "circled backwards" since the 19th century.
In the final part of her three-part film, she explores ways in which existing community organizations on a small budget can reach out to the mentally ill through education and supportive services so they are not isolated.
Patients still need a place to live and to have transition services and work-skill training.
"We can save lives," said Winer.
As for Winer, she struggled to adapt back to civilization after receiving little training at Kings Park.
"It took me years to learn how to do things," she said. "It was frightening dealing with money and how to go from point A to point B in public transportation, how to use a credit card."
Winer said she is still a person "in recovery" after her early struggles with depression.
"I work every day to stay grounded," she said. "There is no question, I am not standing in front of the medicine cabinet with a stomach full of barbiturates. But at the same time, I don't take my peace of mind or ability to show up to life, for granted. It's a wonderful challenge, but I didn't know that as a kid."