Psychiatric hospital

“ A study of 70,987 first admissions to state hospitals shows that the psychoses associated with this condition constituted only 1.12 per cent of the total number. On the other hand, the reports of the Phipps Psychiatric Clinic show an admission rate for psychopaths of over six per cent during a five-year period. When they reach a state hospital it is usually owing to the development of manic-depressive insanity or some other well-defined psychosis. The important and troublesome cases from a social point of view are those that do not reach hospitals. ”

“ Most health insurance programs cover most of the costs of inpatient psychiatric hospitalization, for several weeks or months. Public psychiatric hospitals must be relied on by many people for longer stays, unless they bear the costs of private hospital treatment themselves. ”

“ Nothing is more important in the modern hospital than the training school for nurses. It is the nursing care of the patients more than any other one thing perhaps that has made the difference between the old time asylum and the psychiatric hospital of the highest type. The state hospital training school of the present day offers its pupils a three years' course of instruction, including a year of practical experience in an affiliated general hospital. ”

“ Placement in a psychiatric hospital of the special type may be designated by the court with respect to a mentally ill person who, by reason of his mental state and the character of the socially dangerous act he has committed, represents a special danger to society. ”

“ The medical study and treatment of the mind is no longer so exclusively confined within the walls of institutions nor to the type or degree of disorder which necessitates compulsory seclusion. Psychiatry is extending out from the institutions into the communities by means of out-patient clinics and social workers, through newly created organized agencies, through informed individuals, physicians, nurses, and lay workers, and through the general spread of psychiatric knowledge. ”

“ And you begin to see psychiatry, with its methods of study and management of life problems as well as of specific brain diseases, infections, and gastrointestinal and endocrine conditions, become more and more helpful, even a necessity, in the wards and dispensary of the General Hospital on 16th Street. The layman cannot, perhaps, delve profitably into the details of such a highly and broadly specialized type of work. ”

“ By creating for this Hospital a liberal foundation, by completing its equipment so as to make possible a free exchange of patients and of workers from the Hospital in the city and this place in the country, much has been done and more will be done to set a living example of the very spirit of modern psychopathology and psychiatry. ”

“ This organization can show that it is not mere insanity but the working out of life problems that such a hospital as this is concerned with. The conditions for which it cares are many. Some of them are all that which tradition and law stamp as insanity. But see what a change. Seventy-five per cent of the patients are voluntary admissions; and more and more will be able to use the helps when they begin to feel the need, not merely when it becomes an enforced necessity. ”

“ We have today more sick and defective minds than there were soldiers killed in all our wars from the Revolution through World War II. More than half of all beds in all hospitals—whether equipped to handle them or not—are occupied by sick minds. Yet, for every sick mind in a hospital, there are 18 or 19 out of the hospital but who need psychiatric care. ”

“ The importance and need of some system whereby uniformity in reports would be secured have been repeatedly emphasized by officers and members of this Association, by statisticians of the United States Census Bureau, by editors of psychiatric journals, and by administrative officials in various states. We should know accurately the forms of mental disease occurring in all parts of the country; we should know the movement of patients in every hospital for the insane; we should know the cost of maintenance of patients and the amounts spent for additions and improvements in every state hospital ”

“ The mental symptoms of disease now receive attention in hospitals and in private practice and at a much earlier stage than formerly. Even the courts, the prisons, and the reformatories are awakening to the importance of scientific psychiatry; before long penology may be brought more into accord with our newer and juster conceptions of the nature and origin of crime, dependency, and delinquency. That schools of hygiene and the public health services must soon fall into line and consider mental hygiene seriously is obvious. ”

“ We have met to-day to celebrate the hundredth anniversary of the founding of a hospital that, in its simpler beginnings and in its evolution to the complex and highly organized activities of the present, has served an eminently practical purpose and has played an important rôle in the development of the science and art of psychiatry in America. ”

“ Its graduates, moreover, are trained not only in psychiatric and general nursing, as well as the care of neurological cases, but in hydrotherapy, occupational therapy, reeducational, industrial and social work. The nurse of the future who has had no psychiatric training and experience is one whose education is not complete. Every effort should be made to encourage the training schools of general hospitals to send their senior nurses to a hospital for mental diseases for a service of at least three months. ”

“ Although hospitals expect patients to choose to remain until they are discharged, few hospitals actively confine voluntary psychiatric patients to prevent them from leaving early—and then generally only in cases judged to be very serious. The only restrictions and rules you would likely encounter are those of any hospital: to respect the rights of others, to be considerate, to refrain from taking drugs unless they are prescribed, to smoke only in smoking areas, and to maintain socially acceptable behavior. ”

“ Most hospital admissions for psychiatric conditions today are voluntary. Usually, either your own judgment leads you to accept hospitalization, or you are persuaded by family, friends, family doctor, minister, or psychiatrist that doing so is in your own best interest. Involuntary hospitalization is legally difficult and occurs primarily in cases in which, over a period of time, there is evidence that a person's behavior is not responsible, that he cannot take care of himself, or that he may injure himself or others. ”

“ The internist shares with the psychiatrist the desire that knowledge of the facts regarding care, cure, and prevention of mental disorders may become widely disseminated among medical men and at least to some extent among the laity. Experts in psychiatry firmly believe that at least half of the mental disturbances now prevalent could have been prevented, if, during the childhood and adolescence of those afflicted, the facts and principles of existing knowledge and the practical resources now available could have been applied. ”

“ It is only recently and only in a few schools that psychiatric clinics have been established as parts of the teaching hospitals, that medical students have been able to come into direct contact over an appreciable period of time with the objects of psychiatric study, that the psychic manifestations of patients have received any direct and particular attention in the general medical and surgical wards, and that there has been any free and constant reciprocal exchange of thought and opinion between students of the somatic on the one hand and students of the psychic on the other. ”

“ Owing to their limited size, the necessity of treating large numbers in a short space of time, and the fact that institutional care is already amply provided for in the existing state hospitals, the obvious field of the psychopathic hospital is primarily the acute and recoverable psychoses and the milder forms of mental disorder which may or may not require a residence in the wards. ”

“ Those who have not followed the evolution of the modern psychopathic hospital with the lowering of bars to the admission of patients and the extension of its benefits to a group of sick persons far removed from the medicolegal concept “insanity” may not soon grasp the general nature of psychopathic hospital material. Psychopathic hospital practice stands, in fact, almost midway between asylum practice in the classical sense and private practice. ”

“ They are quite inclined to feel that if no medicines are being prescribed nothing is being done for the patient and that he could be cared for just as well at home. In considering this question it should be borne in mind that the persons under treatment in a hospital for mental diseases are there, either because they appreciate the need of hospital care themselves, or because, as a result of mental disorders, they are incapable of directing their own affairs, or are, in the eyes of the law, dangerous to themselves or others. ”

“ The clinic must do the work for at least one limited district, with its out-patient and social service and consultation department, and with its hospital wards. Everything must be done to make help in mental disorders more acceptable and convincingly helpful. More patients must learn to look to it for help and the organization must be so as to give the patient and the physician and the public at large a conception very different from that to-day associated with insanity. ”

“ Mental hygiene societies are no longer viewed with suspicion and curiosity. We are approaching a time when mental diseases can be dealt with, as other conditions are, without prejudice or unjust discrimination. Psychiatric wards promise to become integral parts of a completed medical organization. Psychopathic hospitals will soon be found in all of our great centers of population. The outlook for specialized institutes for purely research purposes, unfortunately, is not so encouraging at this time. ”

“ The hygiene of childhood, in which line great advances are made, is still not adequately represented in most of our medical colleges, and the study of psychiatry and nervous disturbances in general is not sufficiently lifted from the realm of quackery. "Not only," says a correspondent, "should psychiatry be taught in every medical school, but it should be taught from a clinical standpoint. Every city in which there are medical schools should have a psychopathic hospital for the reception of all cases of alleged insanity and for their study, treatment and cure. ”

“ Scientific and public opinion tend towards the establishment of mental hospitals to which all acute cases of mental disease should be first relegated for treatment and diagnosis before they are consigned to a permanent lunatic hospital. Too little attention on an organized plan has been given to the continuous study of mental disease in its clinical and pathological aspects. It is probable, therefore, that the advent of the mental hospital may lead to important developments in treatment in many ways. ”

“ It is, of course, true that there are innumerable cases of mental diseases outside of institutions. There were 18,268 patients at home on visit from the state hospitals alone on January 1, 1920. Those not requiring hospital treatment or custody in an institution can, however, be eliminated for the purpose of comparative studies. The fact that an analysis of death rates alone does not throw any light whatever on the frequence of psychoses for reasons already given will, I [25] think, be conceded. ”

“ In New York City a medical examiner or nurse from the psychopathic wards of Bellevue Hospital, or both, may be sent "to the place where the alleged insane person resides or is to be found." If in the opinion of this examiner medical care is necessary, the patient is taken to the psychopathic ward for observation for a period of not to exceed ten days. When a person has been committed to a state hospital in New York, the Superintendent is required by law to send a trained nurse or attendant to bring the patient to the institution. ”

“ To-day the tendency of the State care act, though noble and generous in its inception, has been to make the hospital treatment of the curable insane almost impossible, or at least most difficult. It has crowded all the State hospitals with a mass of patients for whom nothing medically can be done, thus essentially interfering with proper classification. It compels the placing of recent, curable, maniacal, and suicidal cases with old chronic patients who are violent, destructive, and filled with all kinds of delusions of persecution and various hallucinations. ”

“ The existing system of asylum structure, management, and treatment makes this almost unattainable. No class of cases requires the attention of trained nurses more than subjects of recent insanity."
Can the present State hospitals provide such accommodations and give such care as Dr. Tuke claims the acute insane for their proper treatment need? I believe they can, and also that the accommodation and care there provided could be made far better than any that might be furnished in an institution established exclusively on the lines of a general hospital. ”

“ The psychopathic hospital in the city gives easy and speedy access to persons taken suddenly ill with mental disease, aids in early diagnosis, places the patients within reach of the best specialists in all departments of medicine, and associated, as it should be, with a medical school or university, affords facilities not otherwise available for scientific research and for instruction in an important branch of medical learning. ”