Times of change at State Hospital North

Certain aspects of mental health care at a state hospital - like evaluating patients for discharge, establishing follow-up care and providing recreational therapies - might seem like a no-brainer. But in 1956, those were all part of an era of innovations at State Hospital North aimed at improving patient care.

Myrick Pullen was the superintendent for State Hospital North from 1956-67 and did all of those things along with a few others to try to make the mental health hospital the best it could be. There were 435 patients at the hospital when he arrived. That number had dropped to around 237 by the time he left, in part because of the nationwide push toward deinstitutionalization, but also because of his policy changes.

"Most of the patients were pretty much chronic patients who needed care and attention," Pullen said.

Administrative Director Todd Hurt has been with State Hospital North for eight months and is working toward the same goal of improving patients' lives and care at what is now a 55-bed facility.

"We don't want to come and have these big, broad-sweeping changes that rock the world but we're really enhancing what I think is happening here," Hurt said.

Dr. Thadeus Koontz, medical director for the hospital, was hired around the same time as Hurt and described several ways they are working to move the hospital forward.

Koontz is developing an intensive inpatient trauma-focused therapy, which is a protocol developed by Veterans Affairs to help patients with post-traumatic stress disorder. He said when he worked in the outpatient world, his patients often felt they didn't get particularly active therapy at mental hospitals, which is a gap he wants to remedy.

"So this is an important part of my vision for what I would like to develop and implement here," Koontz said.

TREATMENT

In 1955, the first anti-psychotic drug Thorazine was the cutting edge of treatment. It was the first drug of its kind and Pullen said that medication - used to manage disorders such as schizophrenia - was the backbone of treatment during his time there.

He said they used electric shock treatment for patients with depression, but only rarely.

"If you had a patient who is in a deep, dark depression, that was an indication for an electric shock treatment," Pullen said. "It just lifts them right out of that depression."

He said in places like California, hospitals were abusing it - using it too often and improperly.

"It was terrible," he said, adding such abuses led to misunderstandings that still surround the therapy today.

The American Psychiatric Association, the American Medical Association and the National Institute of Mental Health all recognize the treatment - now called electroconvulsive therapy - as being an effective way to treat severe mental illnesses, although the association notes it should typically be used when other methods of treatment don't work.

Koontz said the hospital doesn't use electroconvulsive therapy and primarily focuses on medications to help patients manage their mental health.

There is one aspect of treatment he said that is under-appreciated at the hospital, though.

"For a lot of people just being in a safe place with meals and other people to interact with is very therapeutic," Koontz said. ''When you talk to other people about your problems you think, 'Oh, I'm not the only one with this,' or 'I'm not so bad.' "

PATIENT LIFE

One of the primary focuses of Hurt and Koontz is to develop a more holistic picture of patient health.

"Continuing to marry the mental health and the physical health," Hurt said.

The hospital has a wide variety of activities available for the patients, including a morning routine called "Rise-N-Shine," which Koontz described as an important part of the day for many people.

"They'll interact with staff, do their hair, do their makeup, get their nails done and feel like real people, not just patients," he said. "They get up and think about looking good and being clean and proud of who they are."

Available activities include supervised walks, yoga classes, music therapy and a gym for workouts.

Hurt said they recently upgraded their exercise equipment and as many as 25 patients will come out in the evenings to exercise, oftentimes with staff right alongside them.

"You cannot minimize the normalcy and the health benefits and the emotional benefits of just exercising," Hurt said. "Just to see that we are able to get that many folks out and motivated and interested in their own health is just amazing."

DISCHARGE AND FOLLOW-UP

State mental hospitals were once utilized as long-term care facilities rather than a short-term treatment option.

"Back in those days they just got the patients in and that was it," Pullen said.

Aiming to change that, Pullen hired a second psychiatrist and the two of them evaluated every patient in the hospital and decided whether they should be discharged.

He also instituted follow-up care.

"(At that time) there was no follow-up - if you discharged a patient, that was it," Pullen said.

He brought in public health nurses from around the region to meet with the patients from their communities.

"So when the patient was discharged, the public health nurse knew the patient, had seen the patient in the hospital and knew what the program for the patient was," Pullen said.

In 1963, 80 percent of patients were discharged "within a year," according to the patient handbook from the time. Today, the median length of stay at the facility is 44 days.

"I think there's a perception from the community that we are more of a long-term where we can keep them and treat them for a much longer term," Hurt said. "That isn't necessarily the goal at all. The goal really is to treat and transition back."

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Moroney may be contacted at kmoroney@lmtribune.com or at (208) 848-2232.