201 Comments Posted by dme

Kirkbride's proposal for psychiatric hospitals specified that corridors be 12 feet wide, and that ceilings be 12 or 13 feet high. In the center building the main corridors were to be 16 feet wide, with ceilings of 18 feet. In some places, the corridors were used as sitting rooms. The alcoves were also a feature of his plans, with the recommendation that they be on the sunnier side of the building (if only on one side) to get as much natural light as possible.

Kirkbride's original specification for psychiatric hospitals was gas lighting, because (at that time) it was the "safest, neatest, and most convenient."

These photos are so illustrative of depression--the being alone, face hidden, back turned on the world, the emptiness, loss of hope, wanting to get away from the pain...and yet, reaching, struggling to get out, with the wings symbolizing a purity of spirit and remnants of faith. When I imagine the pictures that represent my own battle with depression, this is what I see. I also see mental health from a social work perspective, and sense the attempts to connect with the patient, to restore some trust in life and people, to guide the person back to health.

I'm not defending any real abuse or brutality, but a good deal of past treatment that we consider abusive today, was considered "state of the art" in its time. These hospitals were founded with the intent of helping people, not dehumanizing and warehousing them. But then the "system" (which is ALL of us), with its lack of financial support, took over.

Yes, the screens were put there for safety reasons, for protection from accidental falls and deliberate pushes or jumps. They were probably installed after a change in the building code prohibited open stairwells. Buildings were sometimes closed after codes required elevators and other mechanisms to increase accessibility because it was cheaper to close the building and move the people living or working in it than to make the required modifications.

Usually (or at least I thought so until seeing this and other photos on this site) one of the big questions a state has to answer when closing down at institution is where to store all of its records. Then every social worker/psychologist/nurse etc. has to try to keep track of where the state has Hospital X records this year (they tend to move them around as other institutions shut down, or departmental space is re-allocated). That's why I always asked for a copy of a person's entire institutional record upon discharge, and when the DD center here was being closed I requested the records of any person we served who had ever been there.

I wonder if any of the agencies serving people with developmental disabilities near where this facility is located know about all this equipment that has just been left here. If they do know, I wonder if they have asked the state about acquiring it. Sometimes all it takes is someone asking for it, or letting advocates know about it, and letting them work to get it to the people who need it.

In my state, and I would think in most other states too, the law mandating the closure of the institution contained specific procedures for the community placement of the residents. We were required to ensure that the community placements included all services at least equal to the services the people were getting in the institution. There was a court monitor and very close follow-up after each person's discharge until all services had been in place for 18 consecutive months after discharge from the institution. The state provided start-up money to the community agencies. In some cases people were moved to vacancies in existing homes, but in most cases we set up new 3-person homes for them. I think when institutions for psychiatric patients were closed or downsized, there was a lot less planning and follow-up, and people may have been just "pushed out." There was so much planning and oversight for the resident of institutions for the developmentally delayed because most of them had very intense medical and behavioral needs and very involved families (the people who were "easy" to place in the community were discharged in most cases between 1975 and 1988).

When I was involved with the closure of an institution for people with developmental disabilities, we were allowed to take the pieces of equipment used by the individuals we were moving to community group homes. So we got their wheelchairs, shower trolleys, and other pieces of positioning/mobility equipment, which helped reduce our start-up costs. Whatever was not being used by the last individuals living in the institution, or what was being used but was not wanted/needed by the community agencies, went to state surplus property and is probably still sitting in a warehouse somewhere 11 years later. The facility itself was turned into a prison, and it made me so angry to see how, on my last few visits there, all the maintenance that had been "deferred" while the disabled lived there was now being done by the Dept. of Corrections, even before the facility was closed for good.

When I would get a new person on my caseload, I would request all of his/her records and complete a new comprehensive social history. For people who had been in the system for decades, this was boxes and boxes of info and hours--sometimes days--of work, but it was worth it. It was amazing to rediscover things that at one time had been known about the person but had been "lost" or "forgotten" in the intervening years, had come to be considered (and documented) as "unknown," but really it was there in the record all along. It just hadn't been brought forward appropriately, and then it became easier to assume that it was unknown than to search for it. Sometimes the lost information explained lots of aspects of a person's behaviors.(I have some compulsive tendencies and always wanted to know all there was to know about each person with whom I worked, so I dug until there was no digging left to do.)

I can't speak for this facility, but at all the places I've worked with people with developmental disabilities, the doctors and dentists prescribed whatever sedation the patient needed, whether that was a benzo before the appointment, nitrous, IV sedation, or some combination. However, as these were considered "chemical restraints," we also had to implement a dental desensitization program, which is great in theory but not if a person needs immediate dental treatment and doesn't have the several months or more that it might take for him/her to get comfortable with dental treatment. I think that the dental clinic in the institution also had some means of physical restraint to use when required, called a "papoose board" if memory serves me. this would be used only in emergencies, not for routine care.

Toys were considered "demeaning" because they were not "age appropriate," meaning appropriate to the person's chronological age, not his/her mental age. There were ways around this, such as having a "collection of model cars" rather than "toy cars" or using large-piece jigsaw puzzles of animals instead of preschool puzzles of cartoon characters. It's mostly about respecting each person as an individual and offering choices. Sometimes the rules change from day to day and it all seems very arbitrary.

One of the most poignant conversations I had was with the mother of a middle-aged woman who had mental retardation. She had taken care of her daughter alone for years after her husband's death, then let her move to a group home so that she could live with people closer to her own age, rather than just with her mother, and so that it wouldn't be so hard for her if her mother died or became too sick/weak to care for her. The mother still picked her up every Friday and took her home until Monday morning. She was included in all family events. Her mother never really trusted that anyone else would properly care for her if Mom wasn't around to make sure Daughter was treated right, and said that she wanted her daughter to have as long and happy a life as possible, but that she prayed that Daughter would die just one minute before Mom did, so that Mom would never have to know that fear of leaving her disabled child alone in the world. As it turned out, Daughter became physically ill, had to have surgery in the hospital, and had to go briefly to a nursing home before she was well enough to return to her group home (thanks to Medicare restrictions on hospital stays and only a certain number of days being allowed for a given diagnosis). Complications rapidly developed, within a couple of days she was back in the hospital, and shortly after that she died with Mom and family at her side (and group home staff, too). A few months later her mother died, at peace. The impossible choices some of us are forced into...

All old (maybe pre-WWII?) fixtures had separate hot and cold faucets. I guess mixer faucets (not sure if that's the correct plumbing term) are a relatively modern invention. My grandma's bathroom had a sink with faucets like this and still does, as far as I know.

We are quick to denounce the institutions, but I started in the field 20 years ago, during one of the big pushes for deinstitutionalization in my state. We wanted to set up a 6-person group home (now that's considered too large, but at the time it was considered optimal) with 24/7 staff. We went door-to-door in the neighborhood, talking to each household individually, then had a public meeting to share our plans. We explained that these people had mental retardation--they were not psychotic, sexual predators, drug addicts, or dangerous. In fact, most of them used wheelchairs and were not independently mobile. Several were blind and/or deaf. Staff would ALWAYS be with them. After this presentation, an educated man, with a high position in a local corporation, still stood up and said (and was quoted in the newspaper the next day), "What if IT (emphasis mine, but his actual word) gets out and rapes one of our women?" A few years later, in another neighborhood, our plans to open a home for a similar group were met by a local coalition who distributed fliers decrying "the cancer spreading through our neighborhood."