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(Phillips Brooks House, Harvard's social service organization, is continuing work this summer on a number of programs, including the Mental Hospitals project. In these articles, to volunteers tell what it's like to live only briefly in a mental hospital ward.)
Boston State Hospital is known as a leader among state institutions ill. Over the past ten years, its census has been cut in half as the staff has realized that more can be done for patients than simply caring for their basic needs and has taken an active, creative role in helping patients recover.
In a fact sheet it publishes, the hospital boasts of the following statistics: "The present hospital census is below 1300 patients although there is an annual admission rate of about 2400 persons and more than 500 patients and their families have made use of the facilities and services of Boston State Hospital in the past year."
When volunteers first see the hospital, they are not impressed with what it is doing. They see dingy building a lot like Radcliffe dormitories from the outside, with halls that so obviously need a new coat of paint, and barren rooms furnished only with the poorest assortment of tables and chairs. The wards they work on house the chronic patients, who have been in the hospital much too long; often they work in a ward where the ratio of attendants to patients is as low as one to twenty, where attendants just don't have time to talk to patients at any great length.
As a volunteer begins to care about the patients he sees, he also begins to see beyond his first impressions of the hospital. On one side, the inadequacies he first saw as negligence now become more understandable. State hospitals just don't have the funds to remodel their buildings, hire 100 more doctors or raise the wages of attendants above the minimum level. It also becomes evident that the staff does not sit back and accept these limitations. For example, there is a large work program, where patients can get jobs ranging from housekeeping to masonry to work in a large greenhouse. The hospital saves a lot of money this way; the pay is low, but for a patient living in the hospital, five dollars a week is plenty of spending money. Furthermore, having a job within the hospital is one of the best ways to help someone readjust gradually to the life they will have when they leave. In fact, the degree to which the hospital gets around its limitations is phenomenal.
Once the volunteer has been around for a while, he can cite numerous programs going on within the hospital; reading classes for retarded patients, art therapies, group therapies; medications, dances, etc., etc., etc. But it is not these things that are the most impressive to him. He has felt the frustration and occasional pangs of hopelessness in working with someone who clings tenaciously to his problems. He can understand the tremendous demands placed on attendants and doctors alike, the energy which is required to understand and help a patient. To see a staff working in the fact of these odds is impressive. There is a strong, gamey spirit among the staff; they know the frustrations of their work and they know how to laugh when the problems threaten to undermine their belief in what they can do. And if you can convince them that you are willing to work hard, they will take a chance on you and your ideas of how to improve things.
This year, the hospital gave the "Harvard volunteers" a building, and let us set up our own ward. As it is nearing its end, a good many of its patients will not be returning to their old wards. There is the woman who just began to confide in others about "her problem," but clings to the idea that she is "not ready for rehabilitation." And then there is the man who couldn't hear (he threw away his hearing aid). No one thought we could do much for him. but after many ping pong matches he began to hear questions and answers them with words instead of a nod. He will be moving out of the hospital into a half-way house. And there's the woman who never moved into our ward, probably because it might have meant that she would try again to get a job, to leave the hospital's security. Her volunteer happened to be one of the people who doesn't let himself give up on people; her "progress" wasn't a concrete thing to be measured, and yet the strength of their friendship and the degree to which she trusted him affirms that there is no limit to what can be done for a patient.
The following stories/impressions are results of a project for volunteers to see what it is like to live on a ward. The first is an account of a chronic, the second of an admitting ward. The latter is one where patients typically are coming and leaving all the time. The former is a ward filled with people who have not been helped by the efforts of many different people; and yet they are by no means forgotten, and a fair number of them can and do leave the hospital.
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