Oh yes, the "poor tortured people who never got a decent life"! Life in the community with so-called "normal" people is not a cakewalk for someone with mental illness or developmental disabilities, either. When I've been eating in a restaurant with some of the people I work with, I've heard insensitive, RUDE comments along the lines of "Why do they bring *that* out in public? We shouldn't have to look at *that* while we're eating. Don't they know there are places for things like *that*?"

A couple more examples of how charges of "neglect" are more often related to noncompliance with regulations than with actual patient harm:

I had secured a home to become the community residence of four adults who were virtual lifetime residents of an institution slated to close. Funding was in place to make needed structural modifications, purchase appliances and furniture, a van for their transportation in the community, etc.

Although they had significant orthopedic and medical problems in addition to sensory deficits and severe/profound mental retardation, we wanted to have an open kitchen so that the residents could participate in some meal preparation commensurate with their abilities. The fire marshall and one state licensing board came in and said that we had to close the kitchen off from the rest of the house due to the residents' disabilities.

Because each of the people used a custom wheelchair and had a 24-hour positioning schedule with side-lyers and other devices, we chose to furnish the living room with mat tables and the positioning devices. Then we were cited by another group for having "institutional" furniture and floor plan. None of the residents could sit in a regular sofa or chair, and we did have some chairs for visitors, but they said we needed a typical living room sofa, coffee table, etc. We eventually prevailed on that as the regulators got to know the people better, but were cited for the kitchen's enclosure on every review. There would have been no community residence at all had we not enclosed the kitchen. As it was, the residents were being driven down the interstate on the last day the institution had been open while the fire marshall was making his final inspection of the new home, and we were all on pins and needles, just praying that he would issue our certificate of occupancy before they arrived and found themselves homeless. The fire marshall also required that in addition to the standard two exits, each of the two bedrooms have a direct exit to the outside. This was so that if there was a nighttime fire, the residents could be safely evacuated in their beds rather than having to take the time to position them into their wheelchairs. Of course we also had sprinklers, exit signs, emergency lights, an alarm wired directly to the fire department, etc. We were not allowed to refer to the exit ramps as "porches" or "decks"--they were purely "egress ramps." On this, we were cited for not having any swings or planters or other "homelike" furnishings for the people to enjoy (but had we put such items there, we would have been in violation of the fire code and therefore "neglectful" of our residents). So it's not even just that there are multiple standards with which to comply; it's that one regulator requires one thing and other regulators demand different, mutually exclusive things.

On another review at a different home, we received a very serious citation because a bottle of medication was stored improperly. It was a controlled substance (Schedule IV) but was inaccessible to any of the residents, so no "harm" was done. But the citation, on its face, sounds like the bottle was open on the dining room table and being passed around during dinner.

We also had conflicts regarding use of antidepressants. A lady who had been with us for years had been diagnosed with depression and treated by one of our psychiatrists. When her case was reviewed, the reviewed concluded that we did not have baseline data that warranted the use of "behavior-controlling/altering drugs." We argued that the medicine was not to control her behavior, that depression was a medical condition, and that the medication was to treat the illness, just like a blood pressure pill or thyroid pill. We lost, and had to taper her medication, document symptoms of depression as they re-emerged, and then re-start her medication. Even our argument of "ok, we agree, we messed up, but don't make her go through this" did not help us. We did monitor her mood very closely, to document the tiniest observable change, so hopefully we got her back on her antidepressant before she suffered too much.

I've looked at so many pictures of abandoned hospital auditoriums recently that when I went to vote at my neighborhood school today, I thought *it* looked oddly different, with all its signs of active use by a bunch of active children.

When those of us who work/worked in the mental health field talk about patients and signs like this, we are not in any way intending any disrespect to the patients or to their memory, if they are now deceased. We are sharing what it is like, how things have changed, how things still need to change, trying to cut through some of the sensationalism around mental health care and discuss the reality of it. It is in NO WAY intended to be demeaning to the person. We do not "blame" the patients or resent the care we provide. We know that we would not have jobs if people didn't have problems, and if people didn't need help with daily living, they wouldn't be in our care. We know better than most people that it is the illness, not the person, causing problems. We want to help. There are always more needs than we can meet, so it is not in our interest to "force" treatment on someone who doesn't need it or to keep someone in treatment any longer than necessary (and today, with managed care, the problem is usually being able to keep someone in treatment long enough to really make a difference as opposed to just getting through a short-term crisis).

In addition to what BigEd (thanks, BTW, "impulse control problems" is what I was trying to say in my post on another picture and couldn't manage to remember it) and Lynne said about "extreme precautions," for me they would also include no rings, watches, or bracelets, long hair tied back, keeping an "escape" route between the patient and myself, and having a means for requesting assistance if I needed it. Sometimes we had to assign two staff to work with one patient in especially extreme cases.

I would imagine that "violent" wards used to see much more violence than today because there was so much overcrowding and there were no medications to help reduce aggressive behavior.

Most patients in a state hospital, especially in a "violent" ward, were not "fine" and just in need of "a little help." I care very deeply about each person I have worked with, and try to always focus on his/her strengths. But that doesn't mean I can ignore the symptoms of paranoia, delusions, extreme irritability, lack of coping skills, lack of ability to foresee consequences of their actions, etc. that require closer supervision and more intensive treatment. This sometimes requires involuntary commitment to a locked psychiatric facility.

When I worked with facilities that were closing, the closure took a number of years, with intermediate targets to be met on the way to final closure. The institution's population was gradually reduced, first by ceasing new admissions of children (under age 18), then by ending all new admissions, then by setting up community placements for the current residents. The residents with the fewest and least complicated needs would be placed first. Population also declined due to patient deaths--many of the patients had very complex physical needs in addition to their mental health/developmental needs. As people moved to their new community homes, the remaining units would be consolidated, with more and more of the campus being closed, until finally the very last patients moved to the community (in some cases it is part of a closure plan to move some patients from the institution closing to another state institution that is still open). There were court orders involved, so there was regular oversight by a court monitor as well as by various state agencies and the legislature. The last, and most difficult-to-place group, became part of a special legal "class" that provided additional funding due to the cost of their care in the community. At the very end, it really was a case of "Will the last person here please turn out the lights."

I love the perspective of this shot! When I start at the bottom of the photo and scroll upward, I feel like I'm walking down the hall (or conversely, backing away from something if I start at the top and scroll down).

Personal items weren't taken from patients to be mean or to make them feel bad. It was done for safety reasons, to prevent access to anything that could be used as a weapon against oneself or another (belts, drawstrings, shoe strings, razors, glass containers, pocket knives, any mouthwash or perfume that contained alcohol--yes, many people do drink mouthwash if that is the only alcohol available).

Many, perhaps most, patients came to the hospital with next to nothing in the way of personal possessions. Often they had nothing other than the clothes on their backs. A person ends up in a state psychiatric hospital because s/he is unable to live in the community and has no other place to go.

On several occasions I have responded to crisis referrals and gone to the individual's home to obtain needed personal items for a hospital stay. Usually I ended up at a local store to buy what s/he needed for a few days because there was nothing remotely clean or wearable in the person's home. The rest could be provided by the residential site or obtained from thrift stores, but I wanted him/her to have some new things, things that had never belonged to anyone else before. It came out of my own pocket, even winter coats and shoes if that's what was needed. No one asked me to do it, it wasn't part of my job, no one expected it, but it needed to be done, one human being to another. If it was within my ability to do, then it was my responsibility to do. I think most staff feel this way.

One thing that's very important to remember is that not everything we read is true. Even things in textbooks.

"Inmate" is a very old, archaic term for people being treated in a mental hospital. In the decades since it faded from common usage in that sense, its meaning has narrowed to refer specifically to a person confined in a jail or prison due to either being charged with a crime or having been convicted of a crime.

Personally, I find it offensive to even refer to persons with mental illness as "they" and "them." Terminology like that reinforces the idea that people with these types of problems are somehow "Other" and that "we" who are not so affected (at least not at the present time) are different from "them" and we can therefore not be concerned about patient rights/treatment/housing. As long as "they" live somewhere away from us.

Oh, to be young and idealistic, knowing it all and out to reform the world! Then reality intrudes, and you learn how very little you know :-( (maturity is not when you finally know everything you need to know; it's when you realize how much you have left to learn)

The baths, the wrapping in sheets...we think those are horrible methods today, but at the time when they were in widespread use, they were considered state-of-the-art therapies. Of course, as with anything, there were some staff who used them coercively, as a threat or punishment. As wrong as that was, in most cases it was not because the staff were sadistic. They were overworked, underpaid, inadequately trained, and inadequately supervised.

Involuntary treatment in a locked facility is sometimes required for the safety of the patient and the community. Even in community settings, I have had jobs where I went to work every day knowing that I would be met with what, in any other setting, would be considered a criminal assault. The only question was the form of the assault. It might be having my hair pulled, getting a bite that broke the skin, being kicked, hit, punched, head-butted, pinched, scratched, having my clothing torn, having the interior of my car damaged in the course of transporting a patient, etc. Other patients have assaulted (even murdered) others in much more extreme ways, including arson. We cannot do away with institutions altogether. If we did, the only alternative for some patients would be jail. The symptoms are not the person's fault, but safety must be maintained while treatment alleviates the symptoms.

There are safeguards in place today to guard against "unfair" treatment. Individual program plans, behavior support plans, psychological services, human rights committees, mandatory review of all adverse incidents, oversight by advocates and guardians, required staff training in client rights, sensitivity, abuse and neglect all help to make programs more person-centered/client-focused.

As for leaving people as they are...if all you could do was yell/scream/cry, would that satisfy you??? Wouldn't you want help to teach you additional skills and to help you be more independent? Should we not help a child with autism learn to use a communication device, a picture exchange communication system, or some other means to better express his/her wants and needs? Should we really just say "that's the way he is, we don't want to change it"?

Or someone who has schizophrenia and walks around town all day talking to the voices in his/her head--should be not provide antipsychotic medications in an effort to help the person interact with others, maybe have a job or go to school? Should we really just decide that he should stay that way?

Most people do want treatment to improve their health. If a person has diabetes, does that mean that's how they are, and they should forgo treatment and stay that way? Even when a person doesn't want treatment, sometimes that refusal is a symptom of their illness. Often, people in a manic phase of bipolar disorder feel great--lots of energy, little need for sleep, exaggerated sense of their own abilities, etc. What they don't see is how they are alienating those closest to them by their extreme irritability and/or risky behaviors (spending too much money, driving recklessly, using street drugs, sexual promiscuity, etc.).

If we stipulate that institutions are undesirable, then we, as a society, have to be willing to provide and PAY for the costs of adequate community-based treatment.

Most patients with a mental illness or developmental disability, if they are sufficiently self-aware, do not want to be left as they are. They want to have their own homes, drive a car, manage their own money, have a job, get married, go out with friends...just like everybody else. Some of the most heart-wrenching words I have heard from clients have been from those with mental retardation who asked "Why am I like this? Why did I have to be born this way?"

A patient's records would not be given to the family upon the patient's death unless a formal request was made by the family. Medical records (including all of our own, not just those of patients with mental illness) belong to the doctor, therapist, hospital etc. that provides the treatment, not to the patient. While the records are *about* the patient, they are *owned* by the provider.

Although these records have patient names on them, they are not necessarily clinical records. They could contain the monthly bank statements for the trustee accounts the hospital maintained for each patient, with receipts for all the funds spent for or by the patient. Other possibilities--personal property inventories, correspondence from Social Security, etc.

Besides the people who smear feces because of their developmental level, and some others who do it for attention, I've also known people who used smearing feces to keep others *away* from them, as a means of self-defense. ("don't bother him unless you want poop thrown on you") But most of the time it just means the person needs more activities .

As unpalatable as it is now, the truth is that the eugenics movement began in the United States. To quote Edwin Black in his book "War Against the Weak:" "Using the power of money, prestige and international academic exchanges, American eugenicists exported their philosophy to nations throughout the world, including Germany. Decades after a eugenics campaign of mass sterilization and involuntary incarceration of 'defectives' was institutionalized in the United States, the American effort to create a super Nordic race came to the attention of Adolf Hitler. ...Only after the secrets of Nazi eugenics horrifed the world, only after Nuremburg declared compulsory sterilization a crime against humanity, did American eugenics recede, adopt an enlightened view and then resurface as 'genetics' and 'human engineering'."

Maybe the lower one is an emergency light that comes on in the event of a power outage? Or it could be a soap dispenser--you know how many germs there are from all those hands touching the railing.

It isn't so much that "they" wouldn't think about entertaining people with mental illnesses on this scale today, as it is the price of such entertainment. Most patients have very limited incomes, with even less money available for entertainment. They cannot afford to go out very often, even to the movies. We sometimes received free tickets to events, or were able to make arrangements for our patients to get in for student rates. Staff salaries are so low that it is hard for staff to come up with the money needed for their own tickets so they can accompany the patients. Most patients enjoyed movies, pretty much the same type of movies anybody else does (with some common sense, such as no pornography or slasher films). In general, everyone's behavior was socially appropriate. Doing normal things in normal settings seems to bring out normal behavior (what a novel thought--you get what you expect!)

A few notes on what it's like to work in a mental hospital:
--every day is different
--there's always more to learn
--don't take anything too personally
--every patient is first of all a person with a unique story and unique needs and gifts
--humor goes a *long* way
--tons of rules, and tons of paper work!

Are there really UNmental people?? What are they like? Where can I go to see them?

I wonder how many people with mental illness--the so-called "crazy" "insane" people-- a person who makes comments like this has known in real life.

I've seen plenty of "normal" people break things in anger. Tables tipped over, cupboard doors dented, cars kicked, telephones thrown, books ripped up, vases knocked down, even one or two television screens kicked in and numerous golf clubs smashed into the ground.

One Christmas in the early 70s stands out because my brother got an Atari game set with "Pong." We thought that was really something! We played it in the family room in the basement (freshly remodeled with dark wood panelling and shag carpet) on our parents' old black and white tv. Another aspect of the remodeling had been the purchase of the family's first color television. The first television I owned personally was a 10" black and white bought at a garage sale, for my first home outside the college dorm--a single rented room with shared bath down the hall.

The summer I moved there I took one summer session class. I selected it mainly because it was held in the afternoons in the computer building, one of the few campus buildings that had air conditioning back then. The mainframes took up an entire room. All printing was also done there, no matter where the computer you used was located on campus. You sent your file to the printer, then walked to the computer center, where there was a giant clock showing the "turnaround time"--how long it would take for your document to be printed after you sent it to the printer.

The first personal computer I used was a Tandy 1000. My husband got it via one of those "30-day free trial" offers. I used it to type his final project for his master's degree, then he returned it to the store because we had a new baby and couldn't afford to keep the computer.

Another present my brother got the same year as "Pong" was one of the first hand-held calculators. It was the size of a small notepad, did nothing other than add, subtract, multiply, and divide, and cost about $85.

How times have changed! I think about all the advances of technology I have seen in my life, but even those are nothing compared to what my grandmother saw. She was born in the days of the horse and buggy, when telephones, electricity, and indoor plumbing were novel luxuries. Airplanes, television, even radio were unheard of. When she died, we had been to the moon and back, had supersonic jets, satellite phones, nuclear power and weapons, organ transplants, 24-hour television and shopping, computers and the Internet...

to denny b and all others who worked in hospitals with psychiatric patients: thank you very much for your dedication and service to so many people who often had no one else to care about them. You did so much with so little.

It saddens me to hear so many people today condemn the hospitals and the treatment they provided, talking about patients being mistreated and staff being cruel. What seems to be forgotten or not realized is that the people who worked in the hospitals were the same people who lived in the towns where the hospitals were located. They were our neighbors, parents of classmates, fellow church members, shopped at the same stores, went to the same parades and holiday celebrations, etc. Yet too often some of us are ready to think that these neighbors and friends became sadistic abusive tormentors of patients with mental illness when they went to work at the hospital??

My problem isn't lost "soles" screaming, it's the darn socks that just won't stay with their partners. One runs off and I never do see it again. Its poor little partner is almost useless after that, relegated to being nothing more that a dusting rag for the rest its life. :-)

Guitorman, what kind of medals are given today? I know about the medals that Alcoholics Anonymous has for people celebrating milestones of sobriety, but is that what you mean?

The word "senile" makes me think of an elderly person whose memory and ability to live independently are failing due to an organic process in their brain. But "deranged" and "demented" conjure images of sociopaths, serial killers, mass murderers. I know that "demented" derives from "dementia" and refers to the loss of abilities many elderly people experience, especially after the age of 80-85. But I think in common usage, "demented" has a connotation of evil that "dementia" doesn't have. If I'm remembering correctly, there is a type of dementia caused by long-term alcohol abuse (Wernicke-Korsakoff syndrome). I'd be interested to hear what others think of when they hear the various words used to describe mental problems.

Thanks, old timer. Your voice of wisdom and truth, as well as your past service, is very much appreciated. I'm sure the patients did pray that their condition would improve so they could return home, escaping not the hospital, but the problems caused by their illness. A person who believes in God knows that there is no "god forsaken" place or person. A person may turn away from God, but not the other way around.

Hopefully the police, the governor, the protective service agency, etc. were called whenever the screams of the patients were heard. If people really thought the patients were being tortured and just sat back and let it happen....at least the residents of the towns around the Nazi death camps claimed to have never had any idea of what was going on.

But I'd probably scream too, if someone tried to do any "expire-mnts" on me. I'd like to live a few more years. :-)

I'm sure the escape attempt made the local paper. How about a citation for the article so the rest of us can also be enlightened? (even the most psychotic person I've ever known would know that jumping off the roof of the hospital building would only result in landing at the base of the same building!) Not everything has to be a horror story. All the sensationalizing diminishes the truth of the lives of the people who lived and worked here.

I don't find the morgue shots at all disturbing, aside from the knowledge that they mean a life in this world has ended and there is sadness associated with that. On the practical side, they are nothing more than a temporary and necessary storage space pending transfer of the body to a funeral home. From a medical perspective, the autopsies help further our knowledge and hopefully lead to advances in treatment that prevent deaths in the future. I don't associate them with evil or patients having been tortured or bodies being forgotten in them. People go to hospitals because they are sick, some sick people die, therefore hospitals have morgues. In the rare event that abuse or neglect did cause or contribute to the patient's death, the autopsy can reveal that and the person responsible can be prosecuted.

Really now...if they stored bodies in that safe, they would have had to miniaturize them first, with that invention from "Honey, I Shrank the Kids." If the results of the experimentation were really such a road to scientific fame, we would all know about it by now. So I have to conclude that this insistence on the reality of non-existent experiments is an example of what "they" call a fixed delusion.