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By Phyllis Hanlon
Editor's note: Last month, New England Psychologist provided
a brief overview of three historical psychiatric hospitals in the
Northeast region of the country. In this issue, three other hospitals
are featured.
Originally known as the Vermont Asylum for the Insane, The Brattleboro
Retreat was created in 1834 at the behest of Anna Hunt Marsh. Marsh
designated $10,000 of her estate for the creation of a hospital
for the insane, one of the first of its kind in the country. Her
generosity was prompted by a young relative's mental illness as
well as the death of a man who overdosed on opium during treatment
for insanity.
Based on the concept of moral treatment - practiced by only four
in 10 psychiatric hospitals nationwide at that time - the hospital
treated patients with respect and attention in a family-like setting.
Patients were involved in meaningful work in accordance with their
background and capabilities. They were also exposed to cultural
activities and engaged in daily outdoor exercise.
In 1893, the facility's name was changed to Brattleboro Retreat
to clarify its status as a private hospital. A pioneering institution
in many ways, the Retreat was known for a number of "firsts," including
the first dairy farm that supported the philosophy of purposeful
work, the first continuously published patient newspaper and the
first gymnasium, outdoor therapeutic camping programs, swimming
pool, bowling alley and golf course.
According to Richard Palmisano, president and chief executive officer,
the Retreat prides itself on its staff who he calls "early adopters."
He says, "The medical staff members are not reluctant to take what's
known and utilize it in patient treatment." Looking ahead, Palmisano
anticipates participation in more research studies, particularly
with brain-related issues. He also foresees building stronger relationships
with academic programs, including those at nearby Dartmouth Medical
School.
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In 1840, Maine opened the Augusta Mental Health Institute (AMHI)
across the Kennebec River from the state capital. During the next
160-plus years, AMHI served innumerable patients, grew its professional
staff and expanded services. The patient population increased until
the push towards de-institutionalization began and overcrowding
gave way to community placement.
This October, AMHI in its present state will no longer exist. A
new 92-bed civil and forensic psychiatric treatment facility, Riverview
Psychiatric Center, will replace the dark, granite historic hospital,
although the mission and commitment to patient care will remain
the same. According to Superintendent Lisa Kavanaugh, FACHE, AMHI
will remain a public hospital and will continue to accept patients
from community hospital emergency rooms and county jails. Many of
the existing services will be expanded, including an electronic
medical record system as well as the treatment mall concept, which
uses a bio-psycho-social approach to therapy.
The new state-of-the-art building was designed with input from
staff, patients and family members and contains many distinctive
features. "All patient care areas are humidified," says Kavanaugh.
"There is also a heat radiant ceiling." A search for functional,
but unique, furniture led hospital administrators to a local prison
where inmates designed and built one-of-a-kind, natural maple furniture
for the new structure. "We saved a lot of money and got a unique
product," Kavanaugh says.
The new hospital is built around a central courtyard and windows
have been placed wherever possible. "Windows keep patients oriented
to time of day as well as to seasonal changes," says Kavanaugh.
"They add to a better treatment environment." Additionally, the
basic infrastructure is designed so that if the need arises, two
more units can be added without changing the basic heating and electrical
systems.
Affiliated with Dartmouth Medical School, AMHI hopes to become
a leading center for treatment, education and research, according
to Kavanaugh.
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In 1842, New Hampshire Hospital was established. It was the seventh
state-run psychiatric facility in New England. For the next 50 years,
a four-story building with two three-wing stories was the only building
to occupy the beautifully landscaped grounds. By 1909, this structure
had grown significantly with the addition of 12 major sections,
including a chapel, dorms and two areas for highly excitable patients.
Soon, other buildings sprang up to house the booming influx of patients
as well as female nurses, hospital personnel, transitional patients
and certain medical specialties.
The early 1980s signaled a trend toward downsizing. Many of the
old, dark and dreary buildings were closed or converted to office
space for state agencies and in 1989, New Hampshire built a new
facility to serve the mentally ill. According to Chester Batchelder,
superintendent, the current hospital is bright, pleasant and makes
patients feel comfortable. The 200-bed, short-term care facility
serves children from the age of four to adults.
In addition to providing a welcoming atmosphere for patients, family
and the general public, the hospital also focuses on staff wellness,
according to Pat Cutting, assistant superintendent. Regularly scheduled
wellness fairs offer blood pressure and cholesterol screenings as
well as information on key health issues such as smoking and obesity.
Cutting reports that the hospital recently opened its Wellness Path,
an outdoor walking trail for staff, patients and visitors.
According to Batchelder, one of the buzzwords in psychiatric care
is recovery. "Before you thought you'd be ill always," he says.
"You heal differently from physical illness. It's the same thing
with a psychiatric diagnosis. A person with mental illness can lead
a normal life." New Hampshire Hospital is focused on delivering
quality care to help patients transition back into the community.
Affiliated with Dartmouth Medical School of Psychiatry for more
than 15 years, the hospital is academically minded. "This relationship
allows us to provide state-of-the-art medical treatment," says Batchelder.
Additionally, the facility's grand rounds draw national speakers
who bring the latest treatment innovations and theories to New Hampshire.
In these days of shrinking state budgets and federal cuts, the hospital's
greatest challenge is to become more efficient with the same resources,
Batchelder says.
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