Psyche Ward Institutional Change
Psyche Ward Story
This is a story of a young woman—me—who had a great passion for thinking that we needed to improve things in communities. I was very concerned about people who had been diagnosed as being mentally ill and committed to a state mental hospitals and to the institutionalization of people of any age, but this particular unit was in a psychiatric hospital of about 4,200 patients—huge, rambling, and where most people had been there more than 35 years (many of them throughout their adult life and young people as young as 7 and older people indefinitely more than that).
I came to the job because I had a boyfriend at the University of Michigan and that was a job that was available. It was a job that was on a unit with all-male staff and all male patients, all of whom had ben their together for some period of time. There were some people that had some interest in making things a little big more comfortable in the living environment in the hospital, and I was interested in seeing them leave,so I felt that my passion maybe could be served in that way. So my first job to try to work with the staff to make some change to make the environment better and the make people feel as one.
Change: Individual Expression through Personal Clothing
The physical plan of the unit was that people sat on the sides of the wall, didn’t speak to each other, wore the same kind of institutional clothes that went to the laundry so that they would always come back and they were one size fits all. So I decided that the thing to do was to do my best thinking to say, “What would be the natural thing to do?” So my first job was to say, “We’re going to have everybody be able to wear different clothes, whatever they kind of want and make that work.” Well that met with some resistance, but then after a while everybody kind of thought that was interesting to see what everybody was doing.
Change: Starting Conversations
So when that worked, then I decided that the next step really needed to be that people could then begin to have conversations. Well, how people went to the dining room was in a long line of between 60 and 100people. They went into the dining room, sat down – well – picked up their food, ate it, got up and left in the same line and came back. So we then convinced people that it would be okay for people to have conversations. We had to make conversation get started on the unit itself, so we developed small groups in which I was the primary person because I was the only one that I could get to do it. But pretty soon people started talking and having kind of some fun.
Change: Enlisting Others
I decided that couldn’t be the object of all of this nor could I do all of this. So I decided that it would be quite fun to have some student interns from the University of Michigan and primarily wanted them to come from Social Work in Psychology and Nursing because they were the people that were most likely to have jobs in these kinds of areas. So we had a great exciting young group of people who had all kinds of interesting things to say and do who then led the groups and talk to people…about life and times and all kinds of other things and shirts and ties and how you talk, and wouldn’t it be nice to go out and see some of the places that students talked about? Well that was unheard of—nobody got outside the units to go anywhere and see anything that was going on. So the students loved to talk and be with people and do things and so pretty soon it got approved. People wanted to take people out so they began taking people out. Well, when people got the taste of being in the community again, they thought that was grand.
Change is Contagious: Male Staff Join In
The male staff in the unit thought it was really spectacular that everybody was having so much fun, and they thought maybe they should be part of the groups, too. So pretty soon the staff was also working in the groups and doing things and having side discussions with people and so on. In the group people changed and they noticed that people changed and that they talked. Then we introduced the idea of the student nurses who were on the unit all the time and had more opportunity for personal discussions with staff. They decided that they were having a lot of fun in these group meetings and then when they got to the group meetings, they learned very interesting things about people.
Discovering the Complexity of Others
They learned that people who sat in the corner and didn’t speak to anybody had once been successful businessmen, attorneys, physicians, professors, and became very interested. [They] couldn’t believe that these were people that were sitting in the corner and doing nothing and saw them come to life and all of a sudden it was a community; it was no longer staff and patients, even though people formerly called themselves those titles. The whole culture was changed by that.
Thinking Outside the Box
Well, we needed to have something happening on all the shifts and not just in the daytime, so that meant we had to have staff that came into the unit to introduce new ideas. So we were able to hire some people who were conscientious objectors who were very interested in having peace and having people make transitions to other kinds of living and knew something about that because they knew how tough it was to make that transition themselves and gain acceptance. So the first group of people that came as conscientious objectors that came as conscious objectors dove right in. Conscientious objectors who needed to have a place where it was important to promote peace and of respectfulness. Those people as staff then spread that as part of the culture, and they spread it not just on one shift, but on all shifts. That then became the next step of presenting ideas for people to leave the hospital and think about living in the community again.
Change is Contagious: Other Wards Join In
Once that happened, everybody could feel good. That led to a change of the whole culture of not only that unit, but other units, because people on other units, said, “why couldn’t we do that too?” We said, “don’t know, but we’ll help you if you want to.” Pretty soon there were widespread programs throughout the place and people were leaving. We began to place the first people in community placements outside of the hospital.
Ripples of Change
Now this is also a psychiatric hospital that trained psychiatrists. So the psychiatrists weren’t too excited about some of this. They kind of thought it was a little bit of nonsense, but after a while, they began to see,too, that it was really very nice to be able to treat some short-term illnesses and to see people leave. To do that for a few times, we had little get-togethers in the community with people who had done “well,” and then everybody was on board. Then as new people came into be trained in psychiatry, we began seeing people after they left the hospital in public health departments, some of our people went to the University of Michigan as students because they knew the students and the students mentored them and became their friends. The local churches became involved, and it just sort of rippled and spread.
Powerful Stories
We had a number of dramatic stories and my favorite story about that was from the dining room. You remember that I’d mentioned that people began to eat and talk together and no longer required to stay in one area? And one day in the dining room, one of the persons said to another, “You know that guy over there? He looks just like you.” And the other one said, “No, where?” And said, “Well, over there. Don’t you think he looks like you?” And the man said, “Well he does look like me.” And he said, “Why don’t you go over and talk to him?” And he did.
Well, they visited, and in time and in a couple of conversations they discovered that indeed, they were father and son. They had both been in the hospital for a number of years. The father had come there because the mother, his wife, had said that he was violent. So he was committed indefinitely to the hospital and no contact with the family. The son came at age 18 after he had been in some violent and street scrapes and so on, and had been there for 20 years. So another dramatic change came in which two people were allowed to live in the same unit so they got to know each other. Happily, a short time later, they were able to be placed together and lived together and as far as I know, had a very happy life. That story made the difference between when people could mingle with people from other units. It opened up a whole new area of people all over the whole hospital to being able to talk to each other and eat in the same place and move around and visit with each other. [Me: Wow.]
What Change Agents Do With Stories
Sometimes it’s one story that people unite around. I said, usually it’s a very emotional one. That’s where you make your hay if you’re a change agent. If you’re not a change agent, what happens is, you say,“That’s a nice story” and that’s the end of it; you don’t talk about it. If you’re a change agent, you talk about it everywhere. You talk about it over coffee. You talk about it in your administrative meetings and say, “Boy, that was just amazing. You know, imagine, a son and a father getting together after 20 years in the same hospital. Yeah.” [Me: It’s just mind-boggling.] It makes you want to cry. [Me: yeah, it does.] AndI used to. [Me: yeah.]. It did. Yeah. [Me: Yeah, wow- it’s beautiful, actually, it’s just beautiful.”]. And you know what people used to tell me? “You’re too involved.” They didn’t like the changes. “You’re too involved. You shouldn’t be doing that. You’re a professional person; you should stand apart.” No. I’m a person.
Substantial Changes
Those were the kinds of things that fueled the passion of people who are doing this work and helped everybody to grow and to understand and to refine their skills and to grow on to learn indefinite things. To tell you how dramatic it was, the first year that I went there, there were two people who left this 4,200-bed hospital, and they left by way of the morgue. Within five years, we had placed approximately 1,800 people in the community and more to go. In addition to that, we had open bed vacancies for people to come in for shorter treatment because we’d had a waiting list in that hospital for up to 10 years before people could even come in for treatment and they were living at home or in jail. So there was a dramatic change in the communities that were served by this hospital and the families that were served who were told “Don’t bother to come and see your family member because they’re never going to get out of here and it’s going to be a lifetime of sadness.” Or the person in the hospital had a story told about them from their family that they had deserted them and that was the story told to children, so if children would not wonder about their parent, those stories were gone.
