In the interest of those who need never lose their usefulness to society — ard in the interest of restoring the light to those who walk in shadow- lend, you will find reprinted here a series of articles regarding the pre- vention, cure and treatment of mental illness which appeared in The Daily Okichoman in January and February, 1947, Reprinted from THE DAILY OKLAHOMAN Mental Patients Get a Chance in Colorado Colorado Psychopathic hospital, located on the grounds of the Colorado General hospital in Denver. Since its founding in 1925, it has treated more than 17,000 mental patients. EDITOR'S NOTE: Colorado has the repu- tation of doing an outstanding job in caring of its mental patients. To find out just how our hospitals compare with Colorado's, The Daily Oklahoman sent Mike Gorman on tour. Here is the first of a series of articles report- ing on his findings. By MIKE GORMAN “The Colorado Psychopathic hospital is a monument to failure—the failure of society to create the necessary condi- tions for the full, healthy adjustment of individual minds.” With these words, Dr. Franklin G. Ebaugh, director of the hospital, greeted this reporter before leading him on a tour of his institution, one of the few west of the Mississippi emphasizing di- agnosis and treatment, rather than mere custody, of mentally ill people. 60 Percent Discharged Patients at Colorado Psychopathic are housed in an attractive, three-story brick building on the grounds of the Col- orado General hospital in Denver. There are only 78 beds, hard to believe when one sees a summary of the 20-year job the hospital has done in spear-heading’ an attack on mental illness in Colorado. Established in 1925, Colorado Psycho- pathic has treated more than 17,000. pa- tients in the last 20 years, almost twice as many as are now concentrated in all six of Oklahoma's mental institutions. This figure does not cover the vital work of both the out-patient clinic and the psy- chiatric department in the. Colorado General hospital. In the two-year period ending June 30, 1946, a total of 3,853 mentally sick were treated in all three departments, and many others by travel- ing mental clinics which blanket the state. Over the 22-year span, 60 percent of the patients have been discharged as re- covered or improved. This is a conserva- tive estimate, Ebaugh, one of the four or Page Four five top psychiatrists in the nation, bends over backwards before classifying a pa- tient as recovered. In the last two-year period on record, 944 patients, or 58 per- cent, were discharged as recovered or improved, with only 454 patients, or 28 percent, committed to the state hospital at Pueblo. The average stay of a patient at Colorado Psychopathic is 36 days. How was it possible back in 1925, when mental illness was something you didn’t talk about and when practically every state in the country shunted its “insane” behind strong walls and barred windows, for Colorado to establish a psy- chopathic hospital which started out with the then revolutionary premise that mental illness was a medical ailment which might be cured ? Doctors Draw Credit “Our psychopathic hospital was estab- lished by a popular vote in 1924,” said Ebaugh. “Full credit for the four-to-one majority it received must go to the Col- orado Medical association, which through letters and parnphlets, carried on a tire- less campaign convincing the people of Colorado that cure of the mentally ill was the state’s No. 1 health problem. “It is indeed a crying shame that many state medical associations in the country see fit even in 1947 to turn their backs on a sickness which fills more than half the hospital beds in the nation.” What does it cost to run a hospital like Colorado Psychopathic? The total in 1945 was $278,000, and in 1946 it rose to $324,000. Of this sum, the state appro- priated only $150,000 a year. Counties contributed $4.50 a day for any of their residents in the hospital, while a minor- ity of full pay patients contributed $7 a day. Additional sums were received from national and state fellowship grants. This $150,000 a year, for which the state obtains treatment for several thousand of its mentally sick citizens, is just a drop in the bucket in the yearly appropriations for Norman's Central State hospital. As Dr. Ebaugh has em- phasized in his writings, it’s a lot cheap- er to cure them and get them home than to build big institutions where they lie around for 20 and 30 years. 10 Residents Employed There are four full-time doctors on the staff. Director Ebaugh, author of many standard textbooks in the field of psychiatry, is paid $7,780 a year. His as- sistant, Dr. John Lyon, 38 and trained in Colorado, receives $7,200. Dr. Jules Coleman, also in his late thirties and for- merly a director of child guidance clinic in New York City, receives $7,500 as chief of the out-patient clinic. Dr. Har- riott Hunter, chief of the psychiatric de- apartment of the general hospital, re- ceives a little over $5,000. But the backbone of the hospital staff is its 10 residents, a brilliant group of psychiatrists whose salaries come large- ly from outside sources. Since 1928 the Commonwealth fund of New York has given the hospital $168,000 for the train- ing of physicians. With the recent dis- continuance of these grants, the state has set up funds for two fellowships each year. The veterans administration has approved the hospital for resident training, already has three men in resi- dence, and will eventually have 10. These men are all graduates of medi- cal school, many have had several years experience in psychiatry, and all are in their late twenties or thirties. Abreast of the latest developments in psychiatry, they are enthusiastic at the opportunity given them for constant research on the cure of mental illness. Doctors Seek Opportunity The contrast to Oklahoma's situation is painful. In all six of our mental in- stitutions we haven’t one resident in psy- chiatry. Even more painful, we have no chance of attracting young residents un- LET THERE BE LIGHT Again, the contrast to Oklahoma is painful. With more than 10,000 mentally sick people, almost twice as many as in Colorado, we cannot boast of one single student nurse learning the fundamentals of how to care for these sick people. Treatment, Not Restraint, Key In Colorado Walking through the wards of Colo-, rado Psychopathic hospital, you feel you are in an elaborate convalescent institu- tion rather than a mental hospital for acutely ill patients. It isn’t so much the fresh paint, the shiny linoleum on the floor, the crisp Women patients relax in one of the recreational rooms at Colorado Psychopathic hospital. All types of occupational and recreational therapy are used to keep the patients constantly busy. til our hospitals are brought up to mini- mum standards. It isn’t money that at- tracts these young doctors—it’s the chance to utilize the latest treatments they’ve learned in from six to 10 years of study. The nursing ‘service is something the head of any Oklahoma mental institu- tion would be pleased with. There are 12 head nurses, at salaries ranging from $180 to $205. Miss Stella Ackley, director of nursing services, trained in psychiatry at the finest schools and a veteran of 15 years at Colorado, receives $290 a month. There are 16 general duty nurses at $165 a month, and 21 student nurses. These student nurses, taking four-month courses in psychiatric nursing, come from all over Colorado and from several outlying states. In addition, there are five nurses taking six-month post-grad- uate courses in psychiatry. whiteness of the uniforms and the linen. It's the little extra things—bright paint- ings on the walls, flowers in every room, spacious living rooms with leather lounge chairs, radios and pianos, game rooms with pool and ping-pong tables, a large garden just,off the main recrea- tion room, a spacious sun room, large casement windows through which the sunlight streams. After a couple of days touring the place, you begin to understand what it is. It's a deliberately created atmo- sphere, designed to persuade these peo- ple that they are passing through a temporary illness. Striking to the ob- server is the fact that most of the pa- tients are cheerful and deeply apprecia- tive of their surroundings. In the recrea- tion room, with several women reading, several knitting, a number grouped around the piano, others basking in the bright sun, you begin to understand that these people, unable to stand the strains LET THERE BE LIGHT of modern living, have withdrawn into themselves, waiting to be shown the way back to satisfactory adjustment to life’s demands. There’s No Comparison Some might say that contrasting these conditions with those, let us say, at Ok- lahoma’s Fort Supply, is unfair. How can one compare an institution where filth reigns, where dirty linen is piled up in halls, where there are jagged holes in the floor, where the stench is overpower- ing, to Colorado’s Psychopathic hospi- tal? Yet both are state institutions set up to care for the mentally ill. Colorado, with almost a million less people than Oklahoma and with a much lower tax structure, set up this institutidn 20 years ago, having realized then what this state is beginning to learn now—mentally de- ranged people are sick, and it is both more humane and cheaper to create pleasant surroundings in which they can be cured. Treatment for patients at Colorado Psychopathic is extensive and unceas- ing. All of the standard shock treat- ments are given, and under the most careful supervision. This reporter watched insulin shock being given to eight patients, each separated from the next by a cubicle wall. In attendance during this dangerous therapy were one doctor and three nurses, all trained in insulin shock. At Norman, this reporter saw insulin shock given to 31 patients, all of them in full view of one another during their writhings, with one doctor and one nurse in attendance. Psychotherapy Stressed However, shock treatments are rele- gated to their proper role at Colorado. Major treatment given is psychotherapy, which involves a series of interviews, probing into the mental “blocks” of pa- tients. Hypnosis, drugs, suggestion and other devices are used to get the patient to talk out his troubles. For use in the hospital, Ebaugh has drawn up a sample series of interviews designed to explain the nature of a patient’s mental illness to him, desensitize him to any shame, and bring out all factors that thwart his progress. To give psychotherapy requires both a large and capable staff. At Colorado, with most doctors handling an average of six to eight cases a day, probing daily interviews are possible. After the first few interviews, the doctor usually has a complete picture of the patient’s back- ground and emotional “blocks,” and then can work out planned interviews. Meals Are Pleasant The contrast to Oklahoma institutions is vivid. Because of the many patients handled by each doctor in this state, psy- chotherapy is out of the question. How can a doctor get to know an individual patient when he has 700 to care for? And until you get to know every fact and quirk of a patient’s mind, how can you perform that most delicate of all operations—gently guiding that mind back to reality? There is very little restraint used on patients at Colorado. Take the case of the 200-pound football coach, a highly excited, destructive maniac. When he entered Colorado Psychopathic, his be- havior approximated that of a wild beast. First of all, he got seven to ten days continual sleep treatments. Follow- ing the sleep treatments, he was given a series of soothing hydrotherapeutic baths. Coming out of this, he was given a lot of occupational therapy. Finally, he was given the responsible job of eval- uating the hospital’s library. He was cured and out in two months with never a restraining device used. Ebaugh lists food and its serving as a therapy: Most mental patients enter- ing a hospital are badly undernourished, suffer from a severe loss of weight and have no appetite. Ebaugh prescribes a high vitamin diet, supplemented by ton- ics. Food is served in an appetizing man- ner. In the sun-lit, flower-filled dining room, patients are seated four at a table, with a name-plate in front of each patient. Patients select their meals a day in advance from menus passed out to them. To avoid monotony, patients are moved from one table to another every week. Soft dinner music adds a relaxing touch. This reporter hasn’t the heart to com- pare the food and its serving at Colo- rado with the system in vogue in Okla- homa’s mental institutions. Group therapy is also practiced at Colorado. A few patients are coaxed into a discussion led by a doctor. They are encouraged to tell each other about their illnesses, and most take delight in com- paring symptoms. At other times, they are encouraged to talk about interna- tional affairs or anything they want to discuss. Occupational and recreational therapy are practiced on a large scale. In the large, sunny therapy room, there is a wood-work section, an electric kiln for patients wanting to make pottery, and other devices. Recreation plays a great role because Ebaugh stresses what he calls “Sublima- tion” therapy—transferring into useful channels the potentially destructive en- ergies of his patients. There is a recrea- tion area adjoining the hospital, and all patients, including violently disturbed ones, spend several hours a day out- doors. This reporter watched a fiercely contested volley ball game in which a team made up of patients vied with a team of nurses. All activities are directed toward keeping the patient constantly occupied and away from brooding. Ebaugh, a col- onel in charge of psychiatry under Gen- eral MacArthur during World War II, is a great believer in the army psychia- tric division’s insistence upon complete patient activity. Yet in Oklahoma, in the year 1947, thousands of mental patients lie in bed or sit forlornly on benches day in and day out, constantly brooding, with little or no hope for a cure. Hospital Finds Psychiatry Unit Pays Dividends The most dramatic job of the Colo- rado Psychopathic hospital is that being accomplished by the psychiatric liaison Page Five division, a separate unit set up on the second floor of the Colorado General hospital. It was set up in 1934 to give consulta- tion service on medical cases in the gen- eral hospital. At first, most doctors and nurses were hostile, taking the position that cases in the general hospital were purely medical ones—only crazy people went to psychiatrists anyway. However, as the psychiatric unit ef- fected cures on patients whom staff doc- tors could do nothing, the entire hospi- tal staff swung over to an understanding of the necessity of psychiatry in a gen- eral hospital. The setting up of a psychiatric unit in a hospital is based upon the fact that an amazing number of medical admissions to a hospital are in reality suffering from psychiatric disorders. Dr. Edward Strecker, one of America’s leading psy- chiatrists, estimates that 75 percent of the clientelé of the general practitioner during the first 10 years of his profes- sional life consists of neuroses, psycho- pathological complications of chronic or- ganic diseases, mental aspects, of con- valescence, and psychopathological prob- lems in children. One of 13 Needs Care In a recent study of the medical serv- ice at Colorado General, it was found that one out of 13 admissions needed complete psychiatric care, and one out of six cases in the medical service of the out-patient department needed similar care. A case in point will show how the unit operates. A 28-year-old woman was admitted to Colorado General for an Ovarian operation. Her condition be- came worse after the operation. During the convalescent period, she suffered loss of weight, vomited daily, was ob- streperous and the operation wound be- came badly infected. After four weeks of this the psychiatric unit was called in. During the very first interview, the woman, amazed at the sympathetic at- titude of the psychiatrist and relieved at not being accused of malingering, blurted out: “You're a different type of doctor. I think you really want to help me.” Then she began to cry and tell her troubles. She had married a man twice her age. He had four children by his first wife, two of them almost as old as his second wife. He wanted a cook and house-keeper, not a woman to love, and when she became pregnant, he refused to speak to her. Severe emotional ten- sion resulted in her miscarrying. ‘A Pain Iga Pain’ The diagnosis, to a psychiatrist, was simple. The woman, subconsciously, did not want to get well, because if she did, she would have to go back to an intol- erable situation. Even the operation she underwent wasn’t necessary—all her physical symptoms were psychosomatic. Convinced of the correctness of the psy- chiatric analysis, she got out of bed in three days, broke off with her husband and got herself a good job in Denver. Page Six The case file at Colorado General is full of hundreds of similar cases. Cases diagnosed originally as chronic gall blad- der, acute appendicitis, high blood pres- sure and innumerable other diagnoses— nothing else worked, psychiatrists were called in, and the symptoms were tracked down to mental and emotional disorder. Dr. John Lyon, former director of the unit, puts it this way: “A pain is a pain, however, caused. A bowel spasm caused by a nervous conditions is just as uncomfortable as one caused through organic failure. Any medical man who denies the existence of a pain because he can't X-ray it puts himself in an un- tenable position.” That the Colorado unit has done a good job in propagandizing the staff as to the necessity of psychiatry in the general hospital can be seen in figures which show that close to 6,000 patients have been referred to the psychiatric unit since 1934, with the totals mounting every year. Dr. Ebaugh is not satisfied. In his annual report, he proposes that a full- time psychiatrist be added to every major departnient in the hospital so that every patient can have the value of a clinical personality study and treatment. He now has a full-time psychiatric in pediatrics curing many children whose illnesses were thought to be purely or~ ganic. A resident in psychiatry, a public health service doctor, is working full- time in obstetrics, concentrating his re- search in psychological problems of motherhood. Dr. Dorothy Case, a pediatrician who came to Colorado Psychopathic to take a year of work in psychiatry, is an en- thusiastic believer in the Ebaugh doc- trine. “J don’t see how any pediatrician today can be effective without at least a@ year of psychiatry,” said Dr. Case. “How can you artificially separate the physical illness of a child from the tremendous mental and emotional ten- sions he is constantly undergoing.” Oklahoma? Let’s take University hos- pital. Not one psychiatrist on the staff, not one bed devoted to psychiatric care, not one medical student training in psy- chiatry. A fourth major department of Col- orado General hospital which has hbe- come a major adjunct of Colorado Psychopathic is the University medical school. Medical students there pass through a rigid four-year course in which psy- chiatry is on an absolute parity with that given the illnesses of organs and systems. As Ebaugh puts it: “We wish our graduates to have an understanding of the prevalent nervous and mental disorders encountered in general prac- tice, especially the nueroses and psy- chomatic illnesses.” In addition to formal courses, each student is assigned a mental case from the preventive medical clinic which he follows throughout his four years in school, looking after the medical and psychiatric problems of the family group. Male patients at Colorado Psychopathic hospital work in the elaborately equipped occupa- thonal therapy voom. tional or recreational therapy. Erery patient at Colorado Psychopathic indulges in some form of occupa- LET THERE BE LIGHT Research Job Is Emphasized In Colorado The varied types of treatment given at Colorado Psychopathic hospital are of great importance, but not nearly as fas- cinating as the extraordinary research work being done on the cause and cure of mental illness. There are separate laboratories de- voted to extensive studies in neuropath- ology and electroencephalography. Neu- ropathology, the study of damage to vital organs as a result of disease, is headed by Dr. Karl Neubuerger, an Austrian expatriate with a brilliant background. During the two-year period ending June 30, 1946, Neubuerger and his staff conducted 214 autopsies in an attempt to relate physical disintegration to various classes of mental illness. Re- cently, studies have been conducted on brain damage in rheumatic fever and both physical and mental damage in selected cases of polio. Electroencephalography, the recording of brain waves, plays an important part in Colorado Psychopathic. It has proved of great value both in the diagnosis and treatment of psychiatric disorders, being of special importance in cases of epilepsy head injuries, delirious states and local- ization of brain tumors. Ail Have Research ‘Bug’ There is a Clinic “C” at the hospital devoted to a continuing series of ex- periments on the baffling disease of epilepsy. Dietal studies, new drug com- binations and extensive psychotherapy are a few of the lines of attack. The whole staff at Colorado Psycho- pathic is imbued with the research “pug,” with every doctor exploring some pet line of attack on mental illness. One of the residents is doing intensive research on psychological aspects of abortion. Another, a Canadian govern- ment fellow with 10 years of psychiatric experience, is concentrating on psycho- dynamics, the study of emotional repres- sions which produce mental illness and as a by-product, peptic ulcers. Research in Oklahoma? The jagged holes in the floor have to be filled: in first. So far, the discussion has been re- stricted to the Colorado Psychopathic hospital proper. However, its greatest work in the battle against mental ill- ness is carried out in four other de- partments—the out-patient clinic, the psychiatric ward in the Colorado Gen- eral hospital, the traveling mental clinics and the Colorado university medical school. Child Care Stressed The out-patient clinic, which handles adults and children with psychiatric problems, treated more than 1,000 pa- tients during the past two years, in- volving a total of 9,188 visits. Practically the entire emphasis of the out-patient clinic is upon children, who make up over 75 percent of the case load. Many of the patients are babies with severe emotional disorders. As Ebaugh puts it: “Nearly all mental il- LET THERE BE LIGHT Page Seven ness has its origin in childhood malad- justments. Here in Colorado, we don't wait for these childhood maladjustments to freeze into chronic adult illnesses— we thaw them out at the start.” The clinic is well staffed. There are two full-time psychiatrists, five fulltime psychiatric social workers, five psychi- atrists in training, one Commonwealth fund fellow, one public health service psychiatrist, one veteran trainee, one Canadian trainee, and one pediatrician, and psychologist and five students of the Denver university school of social work. A typical case will illustrate the work- ing of the clinic. A mother comes in with a 9-year-old boy. Johnny has run away from home twice, has refused to go to school, has daily vomiting spells, refuses to eat proper food. She’s taken him to five doctors, but Johnny is still a sick unreasonable boy. One social worker takes the mother, another the boy. They get every avail- able bit of data on family background, personal habits and school life. Then at the next interview, a psychiatrist is as- signed to the boy. After several inter- views, the whole business comes out— mother, an accomplished musician, had decided to make Johnny a great violin- ist. Since the age of 4, Johnny has had to play the violin. He is afraid to op- pose his dominant mother. The remain- ing interviews are devoted to working out a solution, with major effort de- voted to convincing the mother that she is the problem, not the child. None In Oklahoma Fanning out from the out-patient clinic are the traveling mental clinics. Which go out into the community to rout out mental illness at its source. A traveling team consists of a psychiatrist, a psy- chologist and a social worker. Commun- ities are visited by the clinics once a month, and a child welfare worker, a part of the team, goes along and learns how to handle the severe behavior prob- lems of her charges, Dr. Ebaugh, obsessed with the idea of taking psychiatry out from behind the barred window, is sold on the value of these traveling clinics, Oklahoma and the routing out of men- tal illness? Not one out-patient clinic, not one trained social worker, not one traveling mental clinic, not one mentally sick child being helped by the state. Colorado Finds Mental Work Real Economy What is the cost of the elaborate setup per patient at Colorado Psychopathic, covering the outpatient clinic, psychia- tric ward in the general hospital, med- ical school—the complete works? Dr. Ebaugh estimated it runs between $11 and $12 a day at this point, some legislators will emit squeals of pain. A little arithmetic may reduce the squeals. The average stay of a patient at Colorado Psychopathic is 36 days. The cost of treating 10 patients for this period runs under $4,000. The average stay of an untreated chronic in a state mental hospital is 20 to 30 years, at a cost of close to $6,000. Just cure one patient who untreated might develop into a chronic and you’ve more than paid for curing 10 patients. Proud of Readmission The savings are not restricted to com- plete cures, either. Ebaugh estimates that 10 percent of the patients dis- charged as improved come back as re- admissions in a few years. “Here at Colorado Psychopathic we're proud of our readmissions,” says Ebaugh. “We know that the great ma- jority of them were ticketed for the state institution when they came to us. Through the treatment they've gotten here, confinement at a state institution as a chronic has been avoided, society has gained their usefulness for many years, and families which otherwise would have broken up have been held together.” Even those discharged as unimproved are reassured in being returned to their homes, being able to return to the out- patient clinic for additional treatment at any time. Yet, the tremendous value of a psy- chopathic hospital cannot be gauged by statistics. If our legislators could see, as the Minnesota legislature recently did, the series of films made at Colorado Psychopathic showing the progress and cure of mentally ill patients, a lot of their skepticism would vanish. Before and After Case X was a woman suffering from hysterical convulsions. The first films show her in various hysterical states, exhibiting severe bodily tremors and unable to walk. Nineteen days later, she is just beginning to walk. Two weeks later, after a series of psychotherapeutic interviews, she begins to talk coherently. And so on, until 67 days after entering the hospital, the final film shows her walking briskly about the hospital gar- den, overjoyed at the possibility of re- turning home. Schizophrenics, alcoholics, manic-de- pressives—there are before and after studies on all of them, proving the miracle of modern psychiatry. There is no way to suggest the drama packed into a film study of just one of the hundreds of cases—a broken mind and body staggering into the hospital, and a month or two later, a fully integrated, mentally healthy citizen walking proud- ly out through the front gate. Ebaugh proposes, in his 1946 report, the building of an Institute for Com- munity Psychiatry on the grounds of Colorado General. The institute, to be built entirely from appropriations under the recently passed federal mental health act, will serve as a classroom in mental health for the entire state. Its central unit will be a mental hygiene clinic whose main pur- pose will be the setting up of treatment demonstrations for every school and wel- fare agency in the state. Liaison Staff Planned At the institute, workers from well- baby clinics, visiting nurse associations, public schools, juvenile courts, parent- teacher associations, religious and in- dustrial groups will be taught, in a basic mental hygiene curriculum, practical methods of handling all types of be- havior problems. On the full-time staff of the institute, in addition to four psychiatrists, four psychologists and 12 social workers, will be a full-time liaison staff consisting of an educator, a public health nurse, a personnel consultant from the industrial field, a vocational counselor, a public relations man and a minister. These six key people will bring psychiatry out into the community, and bring the commun- ity in through the walls of the psychi- atric institute. Is this all just the pipe dream of a visionary ? “The institute will cost $350,000 with an excellent chance of its entire con- struction cost being financed by the fed- eral government,” said Ebaugh. “The university board of regents has already approved the blueprints, so I see no reason why construction shouldn’t start soon. Is a psychopathic hospital like the one at Denver out of the question in Ok- lahoma? Dr. Jacques P. Gray, dean of the Oklahoma university medical school, is most anxious to set aside 50 beds as a psychiatric ward. He is disturbed be- cause his medical students and student nurses are receiving no psychiatric training. Funds Are Available The building cost would be small, since the ward would be part of the hos- pital. Funds under the federal mental health act would be available for con- struction and maintenance. A great deal of the staff work, at low cost, could be handled by medical residents and nurses in training. The veterans administra- tion, which is making Oklahoma City one of its chief medical centers, is anxi- ous to establish a number of medical residences at all psychopathic hospitals. In addition, the U. 8S. Public Health service has made large contributions to psychopathic hospitals for the training of doctors, nurses and social workers. Lest anyone think that the whole psychopathic hospital idea is something that Oklahoma can get around to some- time in the distant future, these words of Ebaugh’s are pertinent: “We feel that the psychopathic hos- pital movement is the natural outcome of many years of striving and earnest effort to place mental disorders on the same basis as physical disorders. We are approaching the time when general hos- pitals with their splendid delivery rooms, solaria for tuberculosis, excellent ortho- pedic appliances and apparatus and mod- ern facilities of all types will also have provisions for the adequate care and treatment of mental patients.” The above was written in June, 1925! Page Hight Colorado Uses Colors, Design To Aid Patients The Colorado State hospital at Pueblo, which handles the state’s 5,000 mentally ill patients is a rambling institution of 76 buildings covering over 300 acres in a beautiful location at the foot of the Rockies. To tell the full story of the Pueblo institution and the many amazing things it is accomplishing would require several volumes. In these articles, just those highlights which have relevance to the situation in Oklahoma, will be dealt with. Colorado hhas developed what more nearly resembles a college campus than a hospital. With the state law allowing only 100 patients per building, it was decided to build them in pairs so that they formed right angles, or large ‘‘V’s”. Where the wings join cafeterias have been built on the inner circle, and the day rooms are on the large outer circle. Exteriors Are Bright The exterior building walls are of bright, light-colored brick, and the doors are a beautiful brown oak. A specially glazed tile is used for the interior walls. The tile has the color baked into it so that it will never require painting, and the walls have colors to suit the types of. patients who occupy each particular building. Rose and cream are used in buildings where patients need stimula- tion, while greens lend quiet to the dis- turbed wards. All floors are of tile or linoleum- covered concrete. All corners, vertical and horizontal, are rounded so that dirt cannot collect. Since rooms and cor- ridors can be washed down with fire hose if necessary, the cost of keeping the buildings sanitary is low. There are no barred windows. Metal window frames are such that no one can crawl through, even if a pane is broken. There is an abundarfte of windows to admit sunlight. Buildings Set Far Apart The buildings are set far apart and are surrounded by lawns, flower gardens, and recreation facilities. Landscaping is provided by a nursery maintained by the hospital. Dr. F. M. Zimmerman, hospital super- intendent, points out that it has cost little more to take away the “institu- tional” architecture and furnish attrac- tive buildings and the effect upon the patients is apparent. The central kitchen, with facilities for preparing meals for 2,200 patients at a time, is probably the finest in any mental hospital in the country. Food from the kitchen is sent to various cafeterias in food cars that are an electric tractor, a stainless steel train as modern as any of today’s railroads, The Colorado State hospital was one of the first institutions in the nation to use cafeterias. Officials found that cafeterias took away much of the in- stitutional atmosphere, made the pa- tients more satisfied and pared labor costs. Patients do not have to eat what is put before them, but can select avail- able food with the same freedom as a customer in a restaurant. This reporter, at breakfast in one of the patients’ cafeterias, had his choice of half a grapefruit or red plums, corn- flakes or cream of wheat, buttered grid- dle cakes or fried eggs, biscuits or cin- namon rolls, coffee or milk. Patients sat four at a table. There were tablecloths, flowers, colored napkins and a name- plate for each patient. The maintenance features are so num- erous and so noteworthy only a few can be mentioned here. The hospital con- sumes 115,772 dozen eggs a year, all from its own poultry farm. There are extensive gardens producing most of its vegetables, and an enormous canning plant. Space permits discussion of only one of the many modern therapy buildings. The two-story hydrotherapy building, where patients requiring the various types of water treatment are sent, is op- erated 24 hours a day. On the first floor are the stimulating water treatments, such as sprays, showers, massage tables and Sitz baths. The upper floor has the sedative facilities, including 16 tubs and a raft of pack beds. Everything in the quiet section of the hydrotherapy building lends itself to sedation. Walls are green, cork ceilings absorb noises and a new type fluorescent light is used, with the beams illuminat- ing the aisles between the tubs without shining into the eyes of patients as they lie on their backs. Heat comes from overhead registers, which are placed above the windows so that the panes will not steam. Adjacent to the hydrotherapy building is the modern isolation unit where tuber- cular and contagious cases are kept. Bright rooms, flowers, a large solarium, high vitamin diets, not a speck of dirt anywhere—what a contrast to the fright- ful way tuberculars are kept in Okla- homa’s mental institutions. The reader should not deduce from this sketchy outline of Colorado State that everything is perfect. Far from it, as Dr. Zimmerman will readily admit. Its just the over-all impression you get after spending several days touring the institution. Whatever its faults may be, you know that Colorado State is abreast of the latest developments in the care of the mentally ill, and that every day it moves forward on a new front. 1,000 Employed to Aid Colorado Mentally Sick There are more than 1,000 employes at Colorado State hospital to run an enormous mental institution caring for 5,000 patients. There is a superintendent, an assistant superintendent, 11-psychiatrists, five doctors in the medical service and four specialists in pathology. The medical staff is an amazingly youthful one, most of the physicians and residents being in their 30’s. Dr. Zim- LET THERE BE LIGHT merman, who became superintendent in 1928 when only 34, wants no part of a staff made up of elderly psychiatrists who view work in a mental institution as a kind of pensioned existence. Staff Meets Daily Ewery day sees a staff meeting at which the psychiatrists sit around the conference table and present cases for group consultation, Zimmerman, who presides over most of them as a kind of restraining elder, has this to say: “The younger men on the staff go at one another like a pack of wolves. Sometimes, with four or five psychia- trists expounding their theories at the same time, the din is frightful. Then the medical men join with their theories, then the pathologists start pounding on the table. Its wonderful!” With pay scales not as high in most brackets as in Oklahoma, how is Colo- rado State able to attract so many young doctors? Certified For Training In the first place, Colorado State is certified for three years of resident psychiatric training, and has a reputa- tion as one of the finest training centers in the country. Oklahoma has no institu- tion where a young psychiatrist can train in his profession. Secondly, the money incentive has lit- tle appeal for a young psychiatrist. He wants a place where he can put all his academic knowledge into use, where he will have every facility for using the latest therapies on patients. Colorado has all this and a superintendent who goes all out for experimentation and re- search. This reporter asked one of the young residents in psychiatry, a former Okla- homan, why he wouldn’t come to Okla- homa and work in one of the institutions. Five Doctors On Staff “Because I wouldn’t really be learning anything,” he replied. “When you work in an institution where there’s severe over-crowding, and where you have a heavy case load, you’re licked before you start. I worked in one in Iowa, and Id never do it again.” One of the most important staff com- ponents is the medical unit, composed of five full-time doctors, the largest med- ical service section in any mental insti- tution in the country. “You can’t begin to treat a mentally ill person until you clear up all his phys- ical ailments,’ said Zimmerman. “Our medical unit not only does a tremendous amount of treatment, but is doing con- stant research on the close inter-relation between physical and mental illness. When a patient enters this hospital, he gets plenty of medical attention and plenty of good food before anyone goes to work on him.” There are 14 full-time nurses at Col- orado State 10 of them supervisors. They work an eight-hour day, receive a mini- mum of $156 a month plus outside main- tenance of $56 a month. In addition, there are 67 student nurses receiving LET THERE BE LIGHT Page Nine training in psychiatry, some of them from Colorado’s neighboring states. In the past two years, the hospital has trained more than 500 nurses from affiliate hospitals. These student nurses are a tremendous help to the over- worked regular staff and, in addition, form a source of supply for hospitals throughout the state. One of the greatest morale factors at Colorado State is the liberal sums given employes for outside maintenance. Over 700 of the thousand employes lived off the grounds, with over 60 percent of them owning their own homes. “Since I came to Colorado State, I’ve encouraged employes to live off the grounds,” said Zimmerman. “At most state mental institutions, the employes live beyond an isolation wall in hush- hush seclusion from the community. My employes build homes and sink roots into the community, and thus a close rela- tionship is established between Colorado State and the community.” Another key group on the staff is the dietitians. In July, 1944, a program for a 12-month dietetic interneship was put into operation, the first ever approved in a mental institution by the American Dietetic association. Two graduate dieti- tians and four assistant dietitians run the school, and this year there are 11 internes from five states. Zimmerman started this school be- cause he couldn’t get enough experi- enced cooks to feed his patients, and its an excellent example of the way the resourceful superintendent tackles the problem of recruiting persons. “Whenever I can’t get personnel any other way, I start a school and train them myself,” said Zimmerman. “When I ran short of attendants, I started one of the first schools in the country for psychiatric attendants. The hospital is approved for resident training for doc- tors and nurses, and this is a major source of supply for us. “Recently, we were approved for resi- dent training in pathology. I am work- ing right now with several universities in Colorado leading to the training of every type of employe in the hospital, with special emphasis on schools for both occupational and recreational ther- apists. Why don’t they do that in Okla- homa? If they can’t get them any other way, start a school and train them.” In addition to the standard shock therapies administered to patients, Col- orado State goes in for extensive occupa- tional and recreational therapy. Most. of the patients get outside several hours a day. All sorts of psychological tricks are used to help the patients. In the large flower garden, a sign says: “Please Pick the Flowers,” encouraging them to indulge in a positive type of activity usually forbidden. A whole set of de- vices are used to keep up the patients from feeling neglected. Doctor’s Spunk Key To Mental Hospital's Rise How much does it cost to operate Colorado State hospital at Pueblo, with its 5,000 mental patients and it staff of more than a thousand? For the years 1943, 1944 and 1945, the cost was a little over $1.5 millions a year, with the state making direct ap- propriations of just over $1 million a year. Additional monies were received from special ad valorem levy and earn- ings from care of patients and sale of goods. James Noonan, state budget commis- sioner, pointed out that Colorado, with a smaller population and a lighter tax structure than Oklahoma’s, actually had much iess to appropriate directly to its institutions than this state. The budget for Norman's Central State hospital, which handles 3,600 men- tal patients, ran close to $1 million a year for the same period. Considering the number of patients at each institu- tion, the figures for both institutions are almost identical. The question arises, why is Colorado State hospital rated one of the finest in the country, while the Norman institu- tion, like all the others in Oklahoma, is near the bottom of the list? Planning Gives Answer The answer lies in long-range plan- ning, timed to take advantage of fed- eral assistance, and construction of one building at a time, Dr. Zimmerman became head of Col- orado State in 1928 at the age of 34. He fell heir to an institution on a par with the institutions in Oklahoma today. But Dr. Zimmerman had one asset—he wasn’t afraid of the legislature. When the legislature met in 1929, it did what it had always done with the mental budget--chopped it to pieces. Zimmerman, hearing of the slashes, rushed up to Denver and amazed the legislature by offering his resignation unless several vital items, cut out of the budget, were restored at once. Psychology Works “T was kind of afraid they’d take me up on it, but I really meant it,” said Zimmerman, smiling as he looked back upon the incident. ‘When I went before the legislature, I had all the keys to the institution in my pocket. I teld them that I was a psychiatrist, and my job was to take care of these sick people. If they didn’t give me the money to do the proper job, they could have the keys and run the place themselves.” The legislature backed down, and Zimmerman got an appropriation for two new dormitories and a nurses home. Then, in the early thirties, came the PWA and the WPA and plenty of fed- eral funds. Zimmerman drew up a $4,- 500,000 program which he presented the legislature in 1931. The legislature balked. Zimmerman reached for the keys. The legislature gave in. The state bought 240 acres ad- jacent to the hospital grounds and pre- pared for expansion, appropriating a large sum to match the first PWA grant. In the next three years, the state and PWA. together erected five dormitories and a cafeteria. Keys Used Again In 1987, with the keys again dangl- ing in their faces, legislators adopted a 10-year building program for state in- stitutions, providing an ad valorem tax levy of one mill for that purpose. In 10 years the state institutions received $10 millions for building purposes from this levy, with Colorado State hospital get- ting close to $3 millions. By the end of 1941, Colorado State had concluded a $4.5 millions expansion program, making it a $7 millions plant. Is Zimmerman satisfied? He’s just completing blueprints on a $16 millions expansion program for the next decade. The legislature will probably balk, but —Zimmerman will have the keys ready. It’s been a tough fight to educate the legislature. Despite his constant bat- tling, Zimmerman always winds up with a deficit at the end of each biennium. During one stormy biennium, he ran the state almost $1 million in debt, then came up and presented the bill. Visitors Are Welcome The legislature “signed and appreopri- ated enough money to cover the defi- ciency.” A lot of the strength Zimmerman has when he appears before the legislature is the result of public relations pro- gram which has made the citizens of Colorado fully aware of every detail in Colorado State’s magnificent fight on mental illness. He also throws the gates of his hos- pital wide open to visitors. The general public can visit the hospital any time of the day. “Tt cannot understand the hands-off attitude so prevalent among state mental institution heads,” said Zimmerman. “Their holier-than-thou pose can be summed up in the words: ‘I am a psy- chiatrist, I cannot be bothered with sor- did details like getling enough money to run my institution decently.’ If they are such competent psychiatrists, why don't they practice some of their psy- chiatric techniques on the legislators. In- stead, most of them, having a psychotic fear of legislators, hide behind their wall of isolation, shedding crocodile tears about the neglect they bring upon them- selves.” The foregoing series of articles about Cola- rado’s mental institutions appeared in The Daily Oklahoman from January 17 to Febru- ary 6, 1947. The facts and figures presented were gathered by an experienced researcher and reporter from The Daily Oklaboman staff. Page Ten LET THERE BE LIGHT MENTAL LESSONS FROM COLORADO These articles on the Colorado Psy- chopathic hospital point up several im- portant lessons for Oklahoma in its future care of the mentally ill. The first is the immeasurable value of a psychopathic hospital in catching and treating mental illness in the early stages when it can be cured. With the state appropriating only $150,000 a year, Colorado Psychopathic is able to effect recoveries on 60 percent of its admis- sions. Hundreds of it patients, who might become lifetime institutional cases at a cost of from $5,000 to $7,000 per patient, are turned out as recoveries with an average treatment cost of less than $400 per patient. Just as important is the training pro- gram carried on by Colorado Psycho- pathic, which includes three year post- graduate courses for residents, exten- sive four year courses for medical stu- dents, and psychiatric training programs for nurses. Over the years, these teach- ing programs have supplied Colorado with a constant stream of young doc- tors, nurses, and social workers in the field of psychiatry, and at an amazingly low cost to the state. LONG RANGE Oklahoma can take several important pointers from the operation of the Col- orado State hospital. at Pueblo, which cares for more than 5,000 mental pa- tients. Colorado, with almost a million less people than Oklahoma, and with a tax structure which permits smaller ex- penditures each year out of current rev- enues for its state institutions, has nevertheless managed to achieve far bet- ter care of its mentally ill than this state. The answer lies in long-range plan- ning. As early as 1928, Dr. F. M. Zim- merman, Pueblo superintendent, studied the building needs of his institution and worked out a ten year expansion pro- gram. In 1937, the Colorado legislature, unable to finance Zimmerman’s second ten year plan out of current revenue, voted a one mill ad valorem levy upon real and personal property for the speci- fic purpose of constructing needed buildings at all state institutions. During the 1947 legislative session, Zimmerman will present a third ten year plan for a $16 millions building ex- pansion program. Present indications University hospital is ideally suited for the setting up of a 50 bed psychiatric ward. It is essential that this unit be established as soon as possible so that Oklahoma, which has emphasized costly custody of its mental patients in the past, can make the switch to a much cheaper program of prevention and cure. Med- ical students, student nurses, and gen- eral practitioners can also receive in- tensive training at this unit, eventually supplying the state with the psychi- atrists and psychiatrically trained nurses it so desperately needs. The second lesson we can learn from Colorado is the importance of mental health clinics in preventing mental ill- ness. Traveling clinics in Colorado have treated thousands of mentally sick peo- ple in the last decade, going out into every community to combat mental ill- ness at its source. Their work in straightening out emotional maladjust- ments in childhood, precursors of chronic mental illness in adulthood, is attested to by a case file bulging with the names of hundreds of children. These were referred to the clinics by parents, schools, and social agencies, who have been successfully treated.” As a start, Oklahoma should have at least three clinics set up this year, one for each mental hospital district.. These clinics, consisting of a psychiatrist, a psychologist, and a social worker, cost but $35,000 a year to operate. If each of these clinics prevented only seven cases a year from going to one of the state institutions, they would pay for their cost. Funds under the recently passed fed- eral mental health act are available for this work. This act appropriated $10 millions for the establishment of clinics. with matching allocations made to*the states on the basis of population, the extent of the mental health problem, and the financial need of each state. Okla- homa, one of the 15 states,in the coun- try without a single clinic, is in an ideal position to get federal funds. However, in order to obtain this money, the state must create a mental health authority and submit to the U. 8S. Surgeon Gen- eral planned budget for the develop- ment of the state’s mental health serv- ices. This should be done immediately. PLANS FOR MENTALLY ILL are that the legislature will vote an- other ad valorem levy to finance new buildings needed at Pueblo. What is the situation in Oklahoma? This state has never made a study of the long-range needs of its mental in- stitutions. At present, every one of its six mental hospitals is behind at least 10 years in construction of needed buildings. It is impossible to remedy this in one legislature, and it is almost impossible to finance this building expansion pro- gram out of current revenues. What is needed, first of all, is a care- ful study of the long-range needs of Oklahoma’s mental institutions. It has been estimated that a minimum of $20 millions will be needed to bring the mental hospitals up to minimum national standards. Then the legislature should sit down and work out a means of financing this vital program. A two mill levy would bring in approximately $2 millions a year, and if voted for a ten year period, would cover the complete cost of bring- ing the mental hospitals up to date. There is no substitute for this long- range planning and financing. If it is not done, Oklahoma will continue to lose at least a million dollars a year in un- economic custody of hundreds of pa- tients who could be cured and returned to society. It will continue to be unable to attract young doctors and nurses who refuse to work in institutions which em- phasize prison-like custody rather than intensive medical treatment. The 10,000 mental patients now cooped up in Oklahoma’s six mental in- stitutions are the dead-end result of a generation of callous neglect by their fellow citizens. The people of Oklahoma, aroused by the deplorable conditions in these institutions, are willing to bear the cost of extensive improvements so that the generation now growing up will not become dead-end products of an- other generation of conscienceless neg- lect. This year, right now, the legislature must take the first steps in a long- range building program to lift Okla- homa’s mental hospitals out of the pit of neglect. LET THERE BE LIGHT Page Eleven TO MEMBERS OF THE 21st LEGISLATURE As members of the. 21st Legislature, you have in your hands the choice of deciding not only the fate of the state’s 10,000 institutionalized mental patients, but also of shaping a program for the care arid treatment of mental illness in Okla- homa for many years to come. For a generation of more, the state’s mental institutions have been shamefully neglected, with the result that they are overcrowded, understaffed, and completely lacking in decent treatment facilities. By appropriating considerable additional funds this year, you can make a desparately needed beginning toward a long range program to bring these institutions up to minimum national standards. All this cannot be accomplished in one session — it is estimated that it will take $20 millions to bring our hospitals up to the level of better mental hospitals in other states. But a start must be made this year, and that start must include more doctors, more nurses, more attendents, and several million dollars worth of buildings to relieve the present inhuman over-crowding. Later in the session, there will be presented to you a new mental hygiene law designed to bring Oklahoma abreast of the latest thinking in regard to custody and supervision of the mentally ill. Its most important feature is the proposed employment of a mental hygiene commissioner to manage the state’s men- tal hospitals. According to the law, the commissioner must have had ten years’ experience as a practising psychiatrist, five of which must have been in a mental institution. There are some who will tell you that this commissioner need not be a psychiatrist, that he may be a layman or a general medical man. This is misguided advice. If you listen to it, you will destroy the whole purpose of the.new law. Mental illness is a psychiatric problem, and no one but a psychiatrist with years of experience can supervise state in- stitutions treating mental illness. By the same token that the superintendents of the institutions are psychiatrists, it natur- ally follows that their superior, the mental hygiene commissioner, should be equally or better versed in the vast psychiatric problem of treating mental illness. In this same session, you will be asked to appropriate a little more than $100,000 to set up three mental health clinics, one in each mental hospital district. These clinics, which travel into the community to rout out mental illness at its source, pay for their cost ten times over in the number of patients they deflect from confinement to state institutions for a lifetime. Funds under the recently passed federal mental health act are available to help in setting up these clinics. Yours is a great opportunity. The people of this state, aroused at the revelation of the conditions in our mental hos- pitals, have started a grass roots reform movement which has attracted national attention. This fact is worth considering. This state will go bankrupt in another 10 to 20 years if it continues to put up costly buildings for mere custody of mental patients. The emphasis must be switched to treatment, so that hundreds of these pati- ents can be cured and returned to society. You can signalize a new day for thousands of the state's mentally ill by spearheading an attack on mental illness during the early stages when it can be cured. By appointing a psychiatrist to run the mental institutions, you will establish the vital principle that mental illness is a medical problem, not a political football. By establishing mental health clinics, you will herald a change in the state's attitude from costly, uneconomic custody to prevention and cure of this dread disease which fills more than half of Oklahoma's hospital beds today. If you pass these measures, you will go down as the first legislature in Oklahoma history to blue-print a realistic at- tack upon the state’s number one health problem — mental illness. Gentlemen, it’s up to you!