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By
John E. Miller

A 920320? 1‘““'

Submitted to the School of Social Work
Kichigan State University in
Partial fulfillment of the
Requirements for the
Degree of

g . ~Ifia;.-. (Q n. T g T '9? "A C
3:155. hum} 0.3 ‘JOCJ-J'XH 301413.

June 1952

Wm Pumfi 29ml

Chaifman. Reaearch Committee

 

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To,

Dedication:

my wife Peggy, my daughter Shelley,

and aon Timothy whose love,
understanding and sacrifice made this
project and obtaining a degree possible.

TABLE 073' CO ETLITTS

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Iv.-r““l DGLELLNTS .ICOOOOIIOIOOOOOIOOIOOI.IOOOOODUIOOOOO

LIST oF TABLESOQ....000000000'000000O.00......OIOIOIOOI.

Chapter

I.

V.

VI.

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Setting cocooo-ooaaooocaoococoon-noon...-oonce-noo-

III 3TC?IC AL I3 ‘ CITICUNU ANT" CURRENT OPIEIT‘N . . . . . . . . .

MMTY'I'UDS A??? P73033011???” EMPLOYED TN T75? JTL'?!’ ......

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A30 acoocooocuooooooacccoon...0.0000000000000000..-
Sex ooooocooooaooc-occacooco000.00.000.000000000000
Phyaical CharaCteriBtiCB 000.0coco-0000000000000...
Psychological Characteristics .....................
Pombincd Ihyaical find syc. :ological Characterictics.

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Staff Changes cocooacocaoooo-o009.coooooccooooocoo...

Program and SGrVicea ucoccooooooOOOOQonoococo-nos...

Changes in Building PI‘OEI‘RMS coo-Oooooo‘cccoooooocooo

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Bibliosraphy

Page

ii

28

48

SO

Acknowledgements

The author niches to express appreciation to the faculty of
the School of Social Work, Nichigen State University for their help,
intereet and underetending during the time he spent at the school.
Special thenkc go to fire. Rachel Smith. chairman of the project
committee for her help and assistance on this project. to
Kr. Arnold Gurin. committee member who assisted the writer greatly
with his knowledge or reeearch and statistics. and to Dr. Max
Bruck, the writer'o adviser, for his over-ell interest and
inapiration.

The writer also wieheo to acknowledge his indebtedness to
the staff and personnel of the Care State Hoepital for Epileptico
for their cOOperntion while collecting data at the hospital.
Special gratitude io exteLded to Dr. Willard W. Dickerson. medical
ouperintendent for sharing his knowledge of epilepsy and the
hoepitel, and for the epeciql interest shown to the writer.
Sincere appreciation is given to 4r. Floyd Echole, Director of
Social Service Department, Caro State Hoeritnl, whose interest and
encouragement prompted the writer to return to school; and to
Mr. Lutifali incari, Foychintric Social ficrkor at the hoopital for
his suggestions and the valuable service be rendered in typing

this project.

 

 

 

 

 

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Age Distribution of Patients Admitted in ?onre
19"?1 and 1901 cocoonsoooooooeooocooooooooeeoo

Sex Distribution of Patienta iimitted in years

:315‘1 and 11,31 ooeeoeeeoeo-oooooeoooOeoooeoooo

Thyaicdl Characteristics of Fationta Kdnitted
daring; {cares lel and 1:61 ooooeoo-oooooooooo
IeychQIOgical Claselfication of [etionto Admitted
in YO1I'B 131?]. (31111 1361 .eoceeecec-oooooooeoneeo

Physical And Psychological Characteristico of
Patients Admitted during Years lfiel and 1361 ...

Staff Members, Caro State Hoogital, Requested
in 1?“). arid 133133113301; .C.....Ot............

Actual Stuff Pooltiono authorized in 1341 nnfi
1:161 Bulfifit oooooeoooooone-oeooeeoooeoe-eoeeoe

Buildings in Operation and Projected Builfiing
Program for Caro Jtate Hospital in l§91 and
libl COCOCCOCOCOIOIIOOOOOOOOOOO0.......00...

Are no Phyoical Condition of Fationte admitted

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in 2.331 and iii-1 .00....OOOOOOOOODOOCOOOQIO.

A30 and I. v0 n}. i
Afimittcd in l?51 and

Page

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29

30

Chapter 1

T "'1 77a'711- ‘7
-1 iRCDvci JOI;

After being emoloyed at the Caro State “capital for Epileptica
for six years an an institution social worker, the writer became
impressed with the apparent change in the types of patients being
adaitted.‘ Those impressions were gained from admitting numerous
new patients and reviewing the once records of patients admitted
during previous years; It appeared that the yotionts being
admitted now were more physically and psychologically handicapped
than those admitted fifteen to twenty yearn ago. These impressions
were discussed with other eteff members, especially with the medital
superintendent who has been at the hoepitnl over twenty-five years,
and it was discovered that these peOple had the cane impression,
but that no formal study had ever been done to determine just how
ex.rome these changes have been. It was the conocncuo of the staff
that these changes were brought about by improved diagnostic
techniques and the use of new medication for seizure control.
Because of these improvements the majority of eyileptice could be
successfully treated in their home community and only those patients
that the community could not treat were admitted. These inpreeeiono

posed two interesting questions: Had the characteristics of patients

 

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admitted changed significantly reflecting a change in community
need: if eo. had the hoeyital changed or modified its services
to meet these changing needs. This research project was designed
to answer these two questions.

To answer the first question. the case records of two groups
of patients were reviewed and compared according to age. sex,
physical and psychological condition at the time of admieoion to
the hospital. The two groups chosen for comparison were those
patients admitted during the fiscal year 1351 (July 1. 1960-

June 29. 1961) and the fiscal year lfihl (July 1. lfiho - June 3Q,
1941). These two year periods were eeleeted for several reasons;
The lghl group did not have the advantage of many of the new drugs,
dilentin and phenobarbital being the most effective ones and
dilentin was not introduced until June 1938. The hospital did
however have facilities for the care and treatment of the some
types of patients that it had in 1561. The twenty year span was
chosen because it was felt twenty yearo were sufficient for the
importance of any change to be reflected in the characteristics of
patients. A preliminary survey also revealed that there were a
euffioient number of patients admitted during these periods

(360 in l9kl and 175 in 1961) for otatietical treatment.

The answer for the second question was found in reviewing
budget requests, administrative decision. policy changes from the

Department of Mental Health, changes in personnel and staff

 

All future references to the groups will be made a3 the 19hl
group or the 1261 group

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ratios and building programo for lth and 1961. It was felt that
these documents would reflect what services were being offered or

prOposed.

Setting!
The Caro State Hospital for Epiloptice was established in

1913 by on not of legislature of the State of Michigan for the
"Humane. curative. ociontific, end economic treatment of epileptic
persons"}

The medical superintendent of the hospital is appointed by}
the Director of the Mental Health Department with the opprcval o!
the flental Health Commission; He is responsible {or the employment
of all the assistants and employees necessary to Operate the hospital.
The Caro State Hoopital is organized on a cottage basin with eighteen
cottages or neoidence hallo which range in capacity from #2 to
145. In addition to the cottages, there are too infirmnrieo and e
one-hundred bed hospital. There is aloo a complement of other buildings
1.0. laundry, power plant and kitchen to house the nooeeaary
facilities for tho operation of the hoopitalt

In order to carry out the purpose for its establishment,
various departments have been oat up within the hospital. Those
deyartmenta that had a direct bearing on this research project
include the medical department, the dental dopartment, the

payohology department, the 500131 service department. the nursing

t'fitate of Michigan, Act 1&8. Public Acts of 1952 section I

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department, the academic school department. and the adjunctive
therapy department.

The medical department is responsible for the over ell medical
care of all patients. Included in the department are, the medical
superintendent. a neurologist. a resident neurologist, and four
stat! physicinna. The medical superintendent in reoponaiblo for
the over all operntion of the hospital, the neurologist deal the

out-patient examinations and many of the neurological examinations

on admitted raticnto. The resident neurologist yorformo neurological
examinations on selected admitted patients under the direction and
supervision of the nourolc int. The four staff physicians are
unsigned individual cottages and are responsible for the physical
well-being of the patientc living in these cottages. The staff
physicians also do all the ndnisaion ;hyoicnl examinations on

new patients on a rotating basis. They are responsible for
prescribing of anti-convulsive aruge which in a very important

aanact of the hospital treatment program.

The contul department is staffed by one dentist and his
enaistant. and during oumner two contal etuiento. The dental.
department offers the some services as those offered by a family
dentist plus treating opecial problems presented by the epileptic
patient, 1.0. hypertroyhicul guns caused by dilantin, broken teeth
and jaws caused by the patient falling in a seizure and the
inability of many of the patients taking proper care of their

mouths.

The psychology department is staffed by a chief psychologist
and I clinical psychologist and is concerned with the over all
mental health of the patient. The poycholosist uses all the
standard intelligence and projective tents in determining the
intellectual and emotional capacity of the patients. At the time
of admission or shortly there after every new patient is given
n battery of psychological teste. The reoulta of these tests
are used for diagnostic and treatment planning. The psychologist
also sees patients on an individual basis for therapy.

The nursing denartment. under the direction of a director
of nursing is reoponeible for all patients care. Included in
the nursing department are all the registered and attendant, f
nurses employed at tho hoopital. All in-oervice training programs
for nursing personnel come under the jurisdiction of the
department.

.Tho in-oorvice training grogram for attendant nurses consists
of one required 20 hour course and a voluntary 60 hour course.
These two courses have heen very instrumental in improving the
patient care standards throughtout the hospital.

. During the peat few years the registered nurses have
been given the opportunity to attend lectures and seminars
on psychiatric nursing techniques to better equip them to
perform their duties.

The social service department is concerned with offering

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psychiatric social work services to patients. prospective patients,
end their families. "Psychiatric social work concerns itself with
.helping people to maintain. develop. Ir restore their social
functioning to the best of their capacity"? The social service
department is composed of one director. four caseworkors, and
during the school year. graduate social work studentsea The social
Iorkere eorh directly with the patients. their families. relst1Ves.
end other social agencies while carrying out their funetieaee‘

The department cooperates closely eith e11 other departsente in
planning for patient vacations. convalescent status. fesily eere..
and discharge.

One of the primary duties of the sociel workers-is to
interview all prospective patients. new admissions and their families
to help them understand hospital policy end procedure. end in the case
of prospective patients. help them decide the question of commit-
nmonte

It was through the writer's association with this department
that he became interested in this project.

The academic school department is under the direction of
{our full time special education teachers and is responsible for
offering academic training to all patients of school see who are
capable of benefitting from it. The students are not di“ided
into classes but ere grouped eccording to their abilities and

their rate of learning. The subjects range from pre~prisery

2
' Gregory Moose; Information Sooklctlugaro Etato Hospital for

Epileptics, Caro Parents AssociationJFInc. 1959. p.5

 

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through junior high school and are comparable to those subjects
'taught in public schools. The student's 1.2.: range from the
mid sixties to average or above. Academic school assignments are
made as part of treatment planning.

The sdjunctivs therapy program, which conoicts of occupation.
recreational, and industrial therapy, conducts Irograms and
activities to help in the recovery from disease or injury. This
deyartment is under the direction of a registered occupational therapist
and all patients are assigned to the program by the medical staff
so a part of their treothcnt program.(3ee appeal: 1- Organizational
Chart) -

Patients are admitted to the Caro State Hoeyital by one of
two methods. The first and most widely coed method is the legal
commitment. A parent, relative or some other person deemed
suitable by the probate judge petitions the probate court of the
county of legal reindence for admission to the hospital. The
court then fixes s date for hearing the petition and appoints
two reputable disinterested physicians to examine the person.

The results of theoe examinations are then filed with the court
before the hearing date. The court will then investigate ell
the relevant facts concerning the cane and render its decision.
The hearing may be held before a jury if it is desired.

_ If the court determines that the person should be admitted,
an admission order is issued and e copy of the order is sent to
the hospital. This order is'good for a yorioi of one year.

Should the person not be admitted during this period a

renewal order has to be issued by the probate court which is

 

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good for another year. When a suitable vacancy occure the hospital
will then notify the responsible person that the person can be
brought to the hospital for admission. providing that the admission
takes place within twenty days from the date the hospital notified
the court? I! there is not a suitable vacancy at the time the admienion
order is received the person's name is placed on a waiting list
and is then ordered in when a suitable vacancy is available. The
other method used for admission is the voluntary admieeion.
restricted at Caro for the admission of minors only. The only
procedure necessary for a voluntary admission is for the llgaly
reopeneible relative to request voluntary admission by signing a
voluntary admission form. This form ie in turn approved by the
probate judge and medical superintendent. The ordering in and
the actual admission is the came as for the regular admission orders.
Since the hoepital opened in 1914 over 6&00 patients have
been admitted. Both sexes and all ages are eligible for
admission as long as the person in a legal resident of the dtate
of Hichigan. Admissions are accepted from the entire state.
Upon arrival at the hospital for admission the patient is
assigned a doctor and admitted to the receiving hospital for
initial treatment and observation. At the time of admission a

social worker meets with the persons concerned to gather any

in... _‘__ .

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h'ictual commitment procedure in given in detail by Act 151 public
acts of 1923, of the State of fiichigan as amended.

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rudditional information that is necessary and to answer any questions
'the persons may have concerning the hospital.

During the new pationt‘a stay in the receiving hoopi al
‘he is given a series of examinations and tests. When these tests
and examinations are completed the pcroon is then presented to the
general staff for diagnosis and treatuent planning. Representatives
of the various departments attend these general staff meetings to
aid in the diagnosis and programming. After the patient has been
staffed he is re-assigned to a suitable cottage for implementation
of the staff recommendations.

This study is directly related to the Operation of the hospital
in that the writer attempted to determine just what types of patients
have been using the facilities and how tell they meet the needs
of these patients and the comnunity. Because of the medical
advances made in the treatment of epilepsy, the community needs
for a state hospital for epileptico have changed. It was assumed
that trees changes would be reflected in the types of patients
admitted. It was then hypothesized that the patients admitted
during the your lihl were less physically and psychologically
handicapped when compared with patients admitted during the your
1351. It was further hypothesized that the hospital services

have shifted to meet these needs.

'v’

Chapter II

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"IT -J;\J£.J.a tL B. 1.9.1.3 10L)“: Jew” Vu.‘. 5-. 41.153.

"7pileps~ is a fairly connon disease and it affects ;eruona
in all walks of life. is many people suffer from it as
from diabetes or active tuberozlooie - about 1 in 230 in

\l

he United States, or about a million...

"Honoured in heartaches and wreck-d lives, the toll in
sorrowfully high. But much of the econo.;ic rain nL)
most of the hca rtaches cn.n be prevented. For doctors
now know that, gi"en adoouz1te no} icnl and social care,
80 out of every 103 “erncno cith seizures can lead
relatively normal limes.”3

c?;ilcr3" in {robnbly one of the oldest known diseases. It
was mentioned in ttzc cod 9 of Ha mur." ”ti 13°3 9.3.} and in the
earliest sanitary r1133 of the Hebrews? The definition of
epilepsy is derived from the greek word epilepsia which means
seizure or a "ta‘ing hold“? Through the ages the opinion rc 1rding

this "seizing" “ ”*.uin hold" ‘wa variei fro;n being taken hell of

o v

by demons or evil cgirito to being tzton hold of by a dirine being.
chollo ..t dose rirzti-n of seizures is found in the Sihlo, syecially

5.Her'bert Yuhraes: Low - A Brighter Future for the VPilflEEEE‘ (Pamphlet)

'Wilder Penfield, H. 3., ’ or.nz_ard the .unyuLorel initij of the

”‘2‘ —.--—.

Runa firein. Little, Lrown and v0., Ecston 1924 P0 4

 

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and Crigyl_m “ienesee in the Unit d5§§5
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in Hark and Luke. While many people wrote and sycculatcd on the
origin or cause of epilepsy, it was not until Hughling Jackson
wrote a caries of papers on the subject between 1861 and 1870 that
the first idea was put forth that epilepsy one caused by neurnal
dischargcs in the brain. E13 theories were not completcly accepted,
however, until it was experimentally demonstrated in the lat. 18003
that the cerebral cortex could be electrically excited. Since

then his ideas have bccomc the guide to present day thinking on

tho subject?

Medical ccicncc has classified epilepsy by colours types
into {our major groups. The type probably best recognized by the
public 1c the grand mal seizure, characterized by gross convulsive
movements and loss of consciousness? In about 50% of the cases
the person suffering from grand mal epilepsy has an aura prior to
the onset of the attack. ?hooc auras, or warnings, usually consist
of emells, flashes of light, burning or discomfort in the
abdomen, and so forth. Petit mal closures are minor non-convulsive
cttackc characterized by sudden loss of muscle tone or s momentary
lapse of fixation of the goes. The petit mal attack usually

loets lees than a minute and than the percon resumes hie activitygo

 

Lg'xathcrlno fibitneyo.§2$;2233 p. 1

9'A Psychiatric Glossary, American Psychiatric Accoclatlon

yaehington D. C. 1961- p: 31

olrcing K. Borbin, H.D., "A review of Some Elimentc of Neurology:
Part II", Social Caseworg, XXXYII, F0. 10 Dec. 1956 p. 428

 

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- 12 ~

Jackeonian epilepsy coneiete of recurrent epicodee of,
localized convulsive movements or spasms limited to a part or
region of the body without lose of consciousness%1 The psychomotor
seizure, or epileptic equivalent, is usually characterized by
strange, usually antisocial behavior such an undressing in public.
hostile rages, acaulte, regreceive infantile behavior, truncicnt loan
of memory and amnesia. After an attack the person doee not remember
what took place. I

A person may have one or all the types of epileptic seizures.
For some peeple the attacks occur at fairly regular intervale,fl
such as around the time or menace for some women or only nocturnally
for othorangut a large proportion have no indication when they
are going to have an attack.

There is no known cure for epilepsy, but with a prOper
medication and treatment seizures can be controlled or eliminated
in the majority of cases.

Before 360 there were no medications known for control
of convulsions or eeinuree. That year the bromides were
introduced and remained the only medicine until 1913 when
phenobarbital was introduced}3 The first major advancement in
medicine after phenobarbital nan dilantin, introduced in 1€35.

Since l?33 there has been a rapid increase in the number and

 

 

”30:2. 01?. 5 Psychiatric 9103M?!
,9

1"Berbin. P0 “98

1:3.

9. Bernard Foster, M.D., "mistaken Ideas about Epilepsy",
Henninger Quarterly, Summer Incue, 1953 p. 10

 

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types of druge available for the treatment of epilepsy. The list
includes .esantoin, Mycoline, Diamox, Coldntin, Elipten, Tridione,
Milontin, Kebnral, Pognnone and many others, some being no new they
are known only by numbers.

Advances made in the diagnosis of epilepsy have also played
an important part in improving the treatment of the disease. The
Electroencephalograph(3.3.0.) first used by Dr. Hans Berger in
1933 to record the electro—phyeiologicnl phenomena of the brain
has done much to aid in the initial diagnosis of epilepsy.

Dr. ficnez'e method of visualizing the blood vessels of the brain
introduced in 1934 was another important step forward as was the use
of radioactive isotopes, began in 1948 to diagnose brain tunoro§

While the advances made in diagnostic techniques were
very important in the treatment of epilopey, it was not until
otter the extensive use of dilentin that the change in hoopital
admissions began.

Dr. Footer writing on the mistaken idea about epilepsy,
states that there has been a decline in the number of state
epilepsy colonies (hospitals) because of these advances made
in the medical treatnont of epilepsy and a "result in that today
the epileptic colonies are empty of all the individuals of
average intelligence who are subject to seizures."15 However,

Dr. Footer'c etatenont was too strong because the results of this

1?.Ib1de Po 9

ls’Ibid. p. 9

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study showed that there were peeple of normal intelligence being
admitted to hospitals as late as 1961. Dr. flillurd W. Dickerson.
medical euyerintendent of the Caro State Hoopital for Bpileptics,
who has been associated with the ield of epilepsy ano other
neurological disorders for OVer twenty—five years, concurs with
Dr. Foster's ttatemcnt that the number of colonies in decreasing.
Dr. Dickerson personally knows of at least six colonies that

have been closed in the last decade.

Another indication that epilepsy no longer presents the
special problems that it did in the past can the closing of the
White Special school a fee years ago. ?he school was first
established by the City of Detroit Board of Education in 1355
to offer specialized educational facilities for the epileptic
school child. In lghz the school had an average enrollment of
one hundred pupilegg However, after the introduction of the new
drugs the enrollment dwindled until it was no longer feasible to
continue to operate the cchool.

The writer was unable to locate any studies that dealt
directly with the eubject of changing characteristics of persona
admitted to epileptic hospitals but there have been several
etudicc done regarding this subject in the related field of
mental retardation.

A study done by Herbert Goldctein published in 1959.

A _.~

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10“Loin Barge, et. a1. ThitefiSrecinl School Band Book, 19%2 p. 5

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in which he revoiwed the data contained in U.3. Censue Bureau reports

for 193%, 1910. 1333, and 1926 through 1952, regarding the mentally

deficient: in public institutions. revealed that the preportion

of children under five years of age at the time of first admioeion

began to increase following World flnr II while the preportion of

admissions over ten years of age began to dccrcuoo. The study also

revealed that through the depression and florld Ear I! morons accounted

for the largest prOportion at first admission, but following World

nar_II the proportion of morons in first admission decreaeed

sharply while the proportion of enbaciles and idiots increased,

and that the median age of all types have decreased in some degree

over the years. Er. Goldatein felt these changes were the result

of three factors: (1) increasing community provisions for the

mentally deficient, (2) increments in medical knowledge, and

(3) the activities of pressure groups}?
Robert Patton and Abbott Weinetein studied the changing

characteristics of the population in oil New York State schools

for mental deficiente. They found that the largest increase

in the number of recidont and vacation patients in the age groups

five to fourteen and 35 and over. They felt the number in the

age group under five would have increased markedly had there

been facilities for this age group at the schools. They found

 

__r—_f

l7'Horbert Goldetein, Ed. 3., "Population Trends in Uta.
Public Institutions for the,¥entelly Deficiente",
lggerican Hournol of Rental cficicngz, Vol. 63
1:0. h Jan. 19-59 p. 599 “

 

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as did Goldstoin that the greatest increases were in the mental
status groups of idiots and imbecileo. These two groups had a
percentage increase between the years 1950 and l§58 of 3Q.O

and 25.7 respectively while the moron group increased only

6.0 percent}8 while neither of theee stuaieo included inforoation ‘
regarding the physical characteristics of the admitted patients.
their results tended to agree with tho hypotboeio of thti otudy
recording the psychological characteristics of admitted patients.

Goldstein thought the changing characteristics of reoident

patients would lead to certain changes taking place within the
institutions:

"(1) The institutions would become lose a training
center for the return of a higher mental ctotun
patients to the community and more a custodial
center.

"(2) The decrease in turn-over of patients would reduce
the number of beds... to a result. the institutions
will become loos able to serve the community.

"(3) The per copito cost will continue to increase...

"(h) The increase in custodial cases will necessitate

an increase in professional peroonnel...nuraco
doctors, etc.

"(5) The institution school... change from a program
' designed for tho educable mentally deficient to
one for the trainoble mentally deficient.

"(6) Psychological and social service otaff will have
to be reduced in size and scone along with the

18.

Robert E. Patton and Abbott A. fioinoteln, "Changing Characteristics
of the porulation in the new York State Jchoolo of Mental
Defects”. American Jogrnnl of#flontal Deficiengx, Vol. 55
£0. 4. January 1363 pp. 635-537

 

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19

decrease in parolable pationts”.

The rcsultc of this study showed that many of Goldoteins’
rrojootcd changes have taken place at the Caro State Hospital
for Epilepticsu

Dr; Dickerson is of the opinion that the Caro State Hospital
is probably serving other functions than what it was originally
established for. He believes the hospital is now serving the same
functions as the state hospitals for severely retarded or tho
chronically mentally ill.

The results of a study by Buick havidzadchggubctantiato
Dr. Dickerson'o Opinions. In studying the characteristics of patients
additted to the Caro State Hospital during a ten year period 19%?
to $33 Hr. anidnodeh found that 86.3% of the patients admitted
during this period were retarded, with the largest groups, 1§3
hating an 1.1. of under 19. He also found that 23.53 were mentally
ill at the time of admission. Thea. findinga would indicate that
in only a small percentagc of cases was epilepay the only problem.

The writer did not intend to give a ccixntifio eXplanation
of epilepsy. The purpose was only to give reader a brief
deccription and historical background of the disease to aid in
underotanding the problem to which this research project was

addressed. In the following chapter a detailed description of

 

l“
7'fip. Cit. Goldctcin. p. 53#
2‘3.“ ‘ g Y‘ n 1 . M .1 he. v A ' '7
onion havidzadoh, laticnto Aomitted £0 QEPO otatc Hoopital low -
39$R, Unpublished Hastor's Thesis, School of Social Jerk,
a- 1.! ‘/"‘ r‘
dnivorsity of nichigan, laud. go fl;

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the methods and procoigrca used in collecting the data for this

otufij will be givan.

Chapter III

nzrnoos one reocsounns EHPLGYFD In ran STUD!

In collecting the data for this study the writer reviewed
the case records of all patients admitted to the hoeritnl during
the years 19h1 end 1961. Cnly those records that contained the
necessary information were used. The records of patients
transfered to other etate hospitals or inctitutiona'uere not used
because the comrletc case records were cent to the other facility.
In the 19h1 group there were 55 once recorde that were not
included and in the 1961 group fifteen. Fifty of the fifty-five
patients in the 19h1 group and ten of the fifteen in the 1961
group were transfered to the state homes for mentally retarded.
The absence of this date in the study did not effect the
intellectually normal or above group in either year because all
the patients transferred to the State Homes were mentally
retarded. The patients transferred in the l9hl group were all
physically intact and capable of caring for their own personal
needs because the homes to which they were transferred had
limited facilities to care for the physically and severely
poycholoaically handicapped and had requested the transfer of

troinable patients only. The presence of the data regarding

- 19 -

 

 

(a

this group in the study would have weighted tho results in favor

of the hypothesis that the thl group were less physically and
psychologically handicapped. The writer personally know the
physical and psychological condition of the patients in the 1961
group that were transferred because they were admitted during the
time he was employed at the Caro State Hospital. The patients

in this group euro transferred to one of the other state facilities
for the mentally retarded. One accepted only completely helpless
crib cases and the other ambulatory trainablo patients. The absence
of data regarding the completely helpless again weighted the results
in favor of the lfihl group and the number included in the
ambulatory group was so small that the writer did not feel the
exclusion of this data would materially effect the results of the
study. After omitting the transferred cases from the study there
remained 160 03303 in the 1951 group and 310 in the 1941 group.
Five or 1.5% more of the 1941 group had to be omitted boceuce the
case records did not include all the necessary information.

Because this group was so small an unknown group was not included
in the study. '

The data taken from the case records included the sex of
the admitted patients. the age at tho timo of admission. and the
physical and psycholOSicsl condition of the patient at the time
of admission. The physical condition of the patient was

classified into three groups: the physically intact. the partially

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-21._

disabled, and the completely disabled. On admission each patient
was given a physical examination and the examining physician's
statements were used to classify the patient according to the
following definitions:

(l) Physically intact: All petientc whose physical
development can each that they could care for their personal needs
and had no physical infairmcnts that restricted their movements.

(2) Partially disabled: All patients who did not fall
either in the above category or the following.

(3) Completely disabled: All patients whose physical
development was such that they could not walk, feed themselves,
had no self nobility and needed complete nursing care.

It was recognized that these groups or classifications

were gross but it was felt they were adequate for the purpose of

this study.'

The psychological condition was determined on the basis
of intelligence tentc given at the time of admission. The patients
were classified according to the claooification system of the
American Psychiatric Association. There were four groups:
"Severe“ - I.§. under 50; "Moderate" - l.;. from 50-65; "Hild" - I
I.Q. tron 70-85: and "Normal" or above - l.Q. above 5631 A

separate group for the intellectually above nornal patients was

not included because the score of this study was to determine the

 

")Al -
“ ‘Hentnl Disordqgg, Committee on homenCioturo and Statistics. The
9

American Psychiatric Association. finnhnigton 3.3. 195.

..

 

 

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’egree of psychological handicaps.
The hoopital services included all activities and programs
that were available to the patients to help then recover from
their illness. ?he data for the hospital oervicea were collected
from the budget requests, proposed building programs, personiel
records, administrative decisions, and policy etutemente from
the Deyartnent of mental Health. Only the data that applied to
the two years under study were used. The budget requests were
ctudied to determine only purposod or increuaeo in programs or
staff. The new building programs were studied to determine what
types of new buildings were ptojected and how these buildings
would affect the petulution churacteriaticu. The personnel
records were studied to pick up any staff changes that were not
included in the budget requests and to determine the actual patient
to employee ratio. The medical superintendent nae interviewed to
determine any administrative decision that affected programu and
services for the year 1961 and since he was on the staff and
closely associated with the medical superintendent in lfinl, his
knowledge of the situation at that time was relied on to determine
if there were any administrative decisionu male than that affected
programs and services. Share available the actual policy
statements from the Department of Mental fiealth were uned. Where
not available the medical superintendent's knowledge of such

deciaions was used.

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-23-

The Chi-equare method was applied to the two groups to test
{or significance differences using a confidence level of .05. It
wee felt that the method employed to collect the information
regarding the patients' physical and psychological conditions at
the time of admission gave a valid indication of their condition
and the statistical procedure need in interyreting end comparing the
data collected wee adequate for the purpoae of this study. While it
was true that the data regarding the sixty patients that were not
included would have altered the results in several of the categories
it was felt, as previously explained, that this date would have
weighted the results more in favor of the 19L1 groan and the
etatieticel differences would have been even greater. especially
for the physically intact group.

The methods and procedures used to determine changeo in
services could not be subjected to the some statistical nnelyeie
as were the physical and psychological conditions of the patients.
But, the results did tend to proVe that there were several very
significant changes cede in the services and programs offered

by the Caro State Hospital.

 

 

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Chaytct IV

file charter eeele etth the phyeienl end mildews].

auditions or the ednitted patient» The anemia: of cheap. in
union will be continued in the “new“; chemo"

and physical end-psychological dete wore broken dowu‘iuhe

7.31. lo

five eejor group” age; sex; phyeieel condition. Monologue)
condition. and a combination of the last two.

éfifit"
A03 DISTQIEHTION 0' PATXStTJ ADMITEBD IN

EARS 19a; A30 1961

 

 

 

 

 

 

 

Year.
1941
Age ii _ i A
R5; wjgfi ' Healen
Totals )0; 100
0:3‘r“ " 2.§’ *
5-9 28 8.5
19-1e so } 26.94 r
15-19 72 2’06
- 33.2“ 39 9051 1
25-29 3} 10.5
30‘3“ 15 l 505
35-39 1“ i he“
“0"“ 10 Be“
h5-h9 8 2.6
50-5‘ ‘ lefi’
55 and verh 1.5
14.8

 

 

 

 

 

 

 

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A short discussion of the age distribution table will be
given here and will also be discussed in conjunction with the
changing hospital services.

As seen in the preceding table, the greatest nunbor of
patients admitted for both years were in the age group lfi-lh.

Eighty yatiento or 86.53 of the total number admitted in l9hl and

)

(f

3: or 23.55 of the total admitted in 1961 fell into this group.
The greatest difference in number of admissions was in the 0-# year
group. In 19hl only 7 or 2.5) of the patients were h years old
or younger but in the 1961 group 33 or 23.6fi fell in this group.

An age differenco was also seen when the number of patients
under age 29 were compared. In the l?#l group 157 patients or
63.1; were under age twenty where as 117 patients or 73.7% in the
1361 group were under that ago.

The trend toward the admission of younger patients was also
evident in the difference in the median ages of the two groups.

The median age for the lghl group was 1%.8 years, for the 1961
group 13.2 years. a difference of &.6 years. This median age
difference can ba explained by differences in number of
patients admitted under age 33.

while no statistical procedure was applied to this data

a trend toward the admission of younger patients seemed to be

evident.

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Table -. 33x 213?:133TIPH or ran: KT; Aéxzrrzn
I? 12:33 l9h1 AHD 1331
Years

Sex lghi r 1961

no. :I No. I %
' Q
hale 123 to oz 51
Female 133 63 7a hg
Totals 305 100 ’ 163 130

 

 

 

 

 

The sex distribution of admitted patients was not a critical
factor in this yroject but was included only to help show the
general division between the number of male and female patients
admitted during the two years under consideration. In certain
age groups there were some striking differences between the
number of males and females admitted, especially in the 1941
group. These differences are due to the admission of 50 female
patients from the State Home and Training School in that year.

The renSOns for these di’ferenoes were not considered within the

ECCpB of this frojoct.

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Mr-‘-*~~uo

Table 3. PHYEICA on provafllsrzcs or Farriyrs newlrrzn
in" 1‘5"."3' ‘5‘!

Characteristics 1?h1 1061

 

 

I‘: 0 Q :3 :0 o ’ :5;
4 i
Physically intact 177 55.3 69 h3.0

Partially Disabled 10h 3a.o 65 a1.o

h.)
4.-

Completely Disabled 8.0 26 1 16.0

t)
\R

1&3 163 190

KM

Tota a

 

 

 

 

 

1

A study of table 3 revealo that there has been a change in

. V-u a... ' —_.

physical characteristica of the patients admittod to the Caro
stat. Hospital. In lQEI Ono-Hunfired-Seventy-Sovcn or 33% of the
patients admitted were physically intact, that is they had no
limiting physical impairccnto, whereas in 1561 only 69 or #Ifi

were physically intact.

moving from the physically intact croup to those partially

ud‘

Q,
()

disabled it was founfi that the numbers and percentage o rouse

greatly in the lghl group but remained fairly constant for the

lGSl group. The difference between tho two groups in this

'i

LY

catagory did not chow no a great variati.n, no did the yhysical

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intact group[ There was a difference of 153 in the intact group
but only a seven percent difference in the partially disabled
group. The significance of this difference was in that the
percentages shifted from favoring the 1941 group to favoring the
1961 group. This cifferonc e was also carried down to the last
catagory the completely disabled. In this catcgory it was fcund
that 24 patients or 83 in the 12%1 group were completely helpleoc
whereas 26 patients or 163 in 1361 group cube. In combining the
two disabled catagoricc in both groups it was found that in 1941
forty-two percent of the yaticnta were disabled to some degree
but in the 19-01 yroup 57? more disabled.

Statistically the difference between the two 5rougs w-o
significant at th- .05 level<actually the difference was
significant at the .01 level but the .05 level was chosen for
this rr03e6t).

It can therefore be accepted with little question that there
was a significant difference in the yhyr iccl cozd;§tic. of the

two groups studied.

‘ e l - . J_ .. ’.-v. .- 0. "V
A]. 2-31"C;1L)1£i:a.c.kl u 1.-.: .013: 1‘13 ti 6...):

 

‘L

An will be soon in the cht taulo, the greatest iii_
between the two grouyc in regard to inte1.ect u‘l abilitico was
found in the normal grout. In tho 19%1 group, #6 patients or 15.13
had ncr 1 ul or above normal intcllcctual abilities whereas only 13

patients or -..-. in the 1321 {group had {similar 0.31.15. ties. A

 

 

 

 

 

 

 

 

Table h. ?3:JijixZIJAE 3?:33'?I‘“TITH CF iiEIGFTS
ADHI?TBD IN -AR8 19Q1 AHD 1961
5 ‘A +— J. .
. Year
Classification 5 $41 :T 1961
no. a NO. 1%
Eorlnl or above 45 15.1 13 5.1
Moderate 53 13.0 35 22.5
3079!. 133 50.1 E? 51.)
Total ' 3:75 1 100 167) 193

 

revfiel of the'other three claeeificatione reveals that the two group.
were fairly eVen with no more than ;.5 points se5 rating them.

More than half of th gationto afiflittud fiuring be h years were
ceVerely retaréed.
The difflrence between the two grunge was not statiaticully

Q2 --9 fl 1 we "A c
significant( 3 i of 3.5% was neeoed, 3.3) was ostzined) but that.

was a strong iniication t35at the goycholo cwi e1 condition of the
yaticnts adhitted hid c'me: :;e:l. A factor that ’xfif QQUC@d the result-
of this phase of the etc 1 was the aimiosion of» nrominately
gatients from a State Home and 2rrinin‘3 3chool in lfihl. All of
thee. patiente ouffered from some degree of mental retardation and

therefore increased the number in the retarded Citngarioo

disproportionately.

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Table 5. PHYSI3K awn P YCHWLUGIC‘F \QKCTE753 G3 U9
PA 1‘1”"; 3 ML? '..) )1' 311311} f :1. 177:1
VGA“
Characteriscics 1331 1951
ED. 'J 1:;0. ’ a;

a. Enyaical intact, V 1 1

v I - a “7"» Q a.

boron: or aoch 1.2. )1 13.“ 12 7.5

Physical intact,

M111 retardation, #1 13.5 10 10.4

Physical intact,

Moderate retardwticn 35 11.5 31 13.1

Thysical intact,

Severely retarded £9 82.0 1o 11.h
b. Partially disabled,

Korsul intelligenco 7 1.1 1 0.8

fartially disabled,

£113 retardation 7 2.1 l) 0.0

Partially disabled,

Moderate rotariaticn 23 ?.7 17 11.0

Fthially disabled,

Severe retardation 61 t 83.3 3? 25.0
c. Completely disabled,

florral intelligence 0 O 0 0

Completely disabled,

V113 retardation O O 1 0.5

Completely disablci,

Moderate retardation O O O 0

Completely disabled,

severe retardation 13 7.7. 25 13.0

*9,- c-

Total

 

 

10

 

 

 

Table five shows thc qrouoirr of the zatiéntc when the hh'sical
\. .I. U c:

and psych0103ical characteristics were combined. A study of the
table reveals tha t the worc threo catcgcries ;"Ecro noticeable
dif'erences ox1i.t3d between the two groups. Ibooe were:
(1) Physically int1c t, normal or above intelli race; (2} Physically
intact several" rctar cod' and (3} Zoavlctcl* dic:tl:d ccvcrcl’

O J I . O
retarded. These results ccrrec:cndod closely mite the results of

V

the individual ccaractcricticc (tables

‘vi

and ‘4 ) o
In the firs t two cata arias, phjc-cc117 irt ct. nor .31 or
above intolli~erm o; and rhysic ally intxc t, ocvnrelv retarded. the
1751 troup bad a hither percentQNe of the E“ ttsi faticnts but
in t! a last cata:ory the 12 group had tho biggest bcrcentare.
There was a signi fic;rt statistical diftcrcnco between the
two grclpc at the 3.1 level. Ihcse results offered further
evlécnce that there wore sinnifi .cart crzrf cs fix tte characteriatics

of patients aimitted to the Caro State loc}it;l.

 

I“

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Q ~ ‘ .

staff cxangzc, Led
' f‘ 1

A. tiff .aqrgcs:

 

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a I? ‘l ‘l"'\")" "‘V‘V'_“' 't a? PHI ‘_ ~ A. r-fi
..°54 5)." 4J'.J.- '.)’..‘I"".. .L
,20 cTATE H91EITEL
n3 services was diviled into

., . _. n. , . t - fl -. - .\ u. s - ‘- . n
ma itl 3-?V1833 gnu Clllllfd {Puernho
-s r‘ '7‘ “ .4 s "1 --. \ -"“""V\‘.'

4 _ ‘ . . . _ ‘

i. h»: .t-. ' n... a. a .. - . .- . - .. .

f“-"".v‘jv§ 9- ‘ A111 1‘? r ,‘(1 '75- w "'m

.44).; ".U 1‘ .Lj’ ’ h! t 1:10 ....;IB.JL':L

 

ll" I
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chungo

 

Doctors, not
including mad-
1ca1 aupcrintenflent

 

Graduate turbos

 

Social “cruern

 

 

Paycgologists

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Teachers 13 5 -3
Adjunctivo tharapy
ST, ST, and If 2 3 +6
Attendant {Arsos El E5) ogiQ
"(C t .‘sl hon};- ital w
personnel lly COQ +ot§
Total budget

a”. r- . ”i
request 3;l,€;o .3,7h3,h,w
Iaticnt to enjloyeo
ratio 4.“) to l 2.62 to

l -012

 

 

 

 

». ~.o'A

 

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fhe budget

becausa tho refine

r quanta were used instead of actual budwfits

st: more accurately :Qrtrqy wh1t tyres of services

and rrugraus were pro A391. The legislature and availability of
money greatly influen a w‘z was actually recvivc’ but did not

{feet an gr eatly M1;t the d iristratsr of the hoayital ffilt was

I)

needc'.

A: the tublé 33053 tbcru were 111 “re 3:3 in all areas of

services requnnted except teachers where the number Geareasod by

liva. This decrenue can be explained by the refluction in the number

' §

of eiucatle aatisnts aflm1ttcw. In 1751, 32 gatiénts were nimitted
at 330 1’1 or yous-gr: thct has} an 3.1;. over I“. Tn l vnly 33
with these characteriuhic: ache 112‘ttcj.

The req1vst fzr a ductors 5H2 150 by fiva which

a
"_ "\r’I!
-§.“n

n'ufl‘. -

"aw qr
UA-‘uh “Aha. ~~‘

.+
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cannot be cclclv an ircronaed royalation

t

f‘.

becaJso the population 1ncreased only by 2.I whiln the rumber of
doctors raquesLod more tuan trigl ed. The most logical explnngtion
of this increase «13 that the tyge of p tients being afimitted

needed consiierably wore 1v1i¢al attention. The same e”1lanation
woul! 3013 :0? the increase in the number of registered nurses

." .w‘- 4' - ’ 42g '3’" v ')
21.49911J. -rud 1 1“ -241 t1 “1

M\

130 social aervice acyrzr tm;nt re ueatcd ucvcn sou ial

worLers in 2331, an:1uc:uase of 11x fxum tie nuuUtsl requested
in ljfil. This increase will be mogo £111] 0.:{Iairud under the

tion dealing wit M changes in progran services.

”I", 1

No p3 MEol 3t was requcatgd in 1y»; 003313e at that time

Q
v9

tha social worker was doinv the testing. Th9 two rquested in

1961 would therefara indiCLte an in: was in ncefl far :3 analogical

The adjunctivc thcrc:y 1c “rt? at, cccu:1t;cnal therapy.

- —, .q... ' ‘.; ' '1‘». o- —. -- , 0,. «w,- n "
recreationa; the;uyv, a3. lEuhgtSLul tlm1rj rzj_$hLud u staxf
4 .1 .‘l .l “ ~ . . h . . N ’. '. o. r- o . ~~ .~
uggbgzs in 1;”; Lomgared to tua 1n lywl, an JRCTPmSE 0L 01K. #3

. .a- - .. . 4 1.. .-‘~ L. .t . .... 3 -. <~ L. -.- ." v '
thf} ‘QL‘S ‘Lgr CL ‘ .Utfic..1.U-Lou EutJLU L24"; 'r‘i’Cé CJ-J‘p -\ tuo': ll-lnns 5:. Cl;- 13.3.3th
. I ... $ \ .- 1 1 -‘ .. 3 . ' .. ‘ '1 .. ... ,. J -. p ‘ ' .r-
HUBd‘nfi tub ua‘LV‘u L.a"..'rV1CCS, 23$...CC4.411.L.J Q»::l'.~:.zt 1.51.111 1:518:51, I,

increased

‘ 1‘ ' 1-..‘0'u . . .L 1 " ‘; 5
3.1.0 ntuto..'\.A 51 {Tatfinhbhw 31.1?333 "s'tzuSS'th 3. . a—l‘r‘J- bem5 3.

W‘ -- ‘ ~‘\ N "‘I 4- \I ‘1 1" 1‘1" .1", ‘ -. 1 ‘1: -~ 'I 1.. I"
t; UJLM‘LLIO 48 ...n»; but“! L- {221. l ."-l\,,-... for .. “3:; ix 3"... 3 1221‘ 1;”.
n. .. ,. ..-. 1-1.4 .. .. .,.. ...- .. . ~..-_ ..,;.. .9 .. . .
2L1. incrcase gun G'bu UL u-\. qty»; LuLh L-» n11»: o. e :.;lc;aes

.!. .: \,. -- ...'...‘. ,,‘.,_._ z. ,.
neeuad -n a ustdwbb .ur trdLuuc-c pALi: L3 -L Cumilied t9 L.o number
...-1" ' " ‘."'. . ‘. ...».3. ..-- , 5-. .1; -.-. v .. - I:
uncieu -u a LJLLULL LQJHLJ» a Jc rel Rabi! 33 :01L12t31_ d1sabled

?) ,J Jr 1 J.
1

. - ' ... Q 3: "3 ‘ . m ‘1," "I -~(‘ '_ "" rm“. ‘.,.\.‘ ‘~ . "- -- Ir'- fl ‘0
anLLRLs. -L ens u aLL.LnL “Lu91h$ ll} Lr1-x1t;c {atluILJ L; . M10 305

are needed. in a tnilLi.3 Lansing 13

PU

dizabicd gatfiants 70 La loyeea
. ‘ - . t 1‘.‘ .... -. , .. ...,» . “

ale needed. A ccxpign; cxylan1t10n of Law bu-l1brb irournmc L111

be included in the s ction unfier that hcaéing.

Another inn icaticn oi tLL changing

€31

tiff {uttzrns was found
when the cmyloyees to Iaticnt ratios wire coxyared. In 1
ratio was one evyloyme to %.33 patients, in L351 Llae ratio
deureaned to one emrlojce t; ;.63 latiants. Iain r& is 13
computed unuer the light of change in tcrhirg nears since 1957,

.1 1. "~ . 3 .5'. ' . a ‘ A

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9..”
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from two twe

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ITI F, v ‘Q " ”flew-W”. v -s‘\ N1?»~.n1.‘1 v M‘Y»‘~'\"PGT""1\ V 1
”hip ~ v, 71 ‘v 7. r‘ '4 'v T 4 j r g: ! . ' :' 1"
‘ l . 0V 5 v a L - A 4- 1~ .. h A. . ‘ -. m .. _ v - WV a . l

lfhl fflfi 1¢£1 3337‘?

(3

 

Stiff Rambrr~ { 1"”1 i l"€l cYatEa
l
r

Doctors, not irc21&1n5
mrdih*1 “figrrfrtrr‘drt ? F #h

 

 

 

Grafiuato nurses 5 l“ 3 +15

“ -‘ i w «0-. ..Immw ...--....JL....-—....-..~....-.~- -- cm.~¢..c--uo. gag-.... ‘L

 

i ,

Social r*rP:ra I 1 x D *5

r
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-— __ -1 I... .-.-....“ -H-» -

fl

'sychclaxists } a; 2

 

 

‘ ~wm~w~u~o~0w~oiro —- 1.. .... A A _

 

 

 

Tené‘lr-rfl .3
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Adjunctive therafista

.m tam mm
' -; 33!"! . .. 3" 7%

 

a.
[J

 

 

 

 

'\ ’ ’ - J i
" 3 .t "A" t I ff?
uttennent nurses ,; +10 "1 +,o

 

Table 7 thaws the actual ngmber 05 poaitiurs allotud for

thn tvo fiSCfil ”wars under confiideratinr. In 1?51 the 9&Zuted

1om5tinra 3rd requemtefi ynfiitinnm were thn Sana. This fact
weal? indicafie that tbe wragrxfia in oyeflatxcn in ,f;¢ Revs
considered nécqsanry aré the reocssary funds mere uvai able. In
1(7-51 the act'mf? ("lit-haunts“: ti._jf‘pr'r',-:(inflated the ‘~"~o'.=.’?t;‘3m'.s! requested.
And the $ositioxs wkcre the most noticean: reductdcns were made
I

wore the a$functive thera2y and attenfient rursec. This would ;ndicato

that the most of the new pregrams could ba put into Operation.

.. .. on p..o.~.- . u .
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~ ...-n ‘00--

 

 

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.4... . - ~. . a m -— . ,. -, ...-.... -.
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Dacisians to make prografi and Garvlca sting
fram several snuroea. The Japartnent of Mental Health, the main
adminiztrntive body for all state tental health facilities, the
Piental E19 . 1th Somnisaion. the mediéal sunshintenient a? the Sara
State Rosnital an:i the hoanltzal departzszrt heai3 , wlth the approval

1

of the medical anterinthient, all maxe'c23.;;ea in p.30r1m aril
servicea.

One of the program changeu male at the state level thn‘
rcflcctnd an o’er all change in the tr eat.nnlt of the mentally
ill, mantnlly rat." :1 d, and nrl‘nptvca and th. orefare had a direct
bearing on the yrojacted pragram and mervicea of thia heapital

, t
was the 601? unity £57: Mttzic $05131 flork yrngrau.

The Department of Rental He:ll th renu stedvthat the individual
state hospitals requeat in their lfél buiget adlitional social
work ponitians to provide snzial wurk services in galacted
conzrmu itiea to patiants on convalescent sta us. ”heae social
workers would also perform othar functions in the comma ity sach
as pre—admiaslon. pra-commlttmont interviews, refarrala to other

3

agencies and to help With an eiucntionnl Trogram rcrarainr

mental health.

3-}.

1935312 turn, but the 33:0

«‘9

fig fuhdz were rwro vided 3 th
State Hospital did request in its budget two additiona social
workers for this purpose. The request was raven sad in the 136

budget.

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c- 32 -

If the money hzi been apyroyriatad the hospital waa going
to Open a community of-ico in northern iayr? or oomtharn Oakland
county. Alqo in keefing with charging jvcgrqma cophaais at the
state level, the Jaro Stats Hosyital d ublad its request for family
care beds in l“fl from 25 to 5?. Thia increaeo woo yrograflfied
with an emphasio on the thorzzoutic TlchTCnt to aid the
rehabilitativo aervicea of the hoopi 31. To offar tho necessary
grofonsionql serviceu to those additional family care patients tho
hoeyital requwstefl another social worxor, bosiios the two requested
for the comau-ity service program, in the bldgct.

In l?§7-S? 1 new staffing wrogrum for :atlénto was initiated
at the hoarital under the direction of tho medical superintendent.

One of the resulto of this program was the uncovering of many

*‘3

atibntfi who no lonjnr had need for the hospital oerviceo. flame
of these ration 3 could be returned to thoir own homes, but for
others the community would havo to be involvnd. 1r. fiickorson,

tho m‘fiical superintcnfent, re1uestod that tho social service

department see what could ho done about removing these patients

i4

from the hospital rolls. t did not receive the full impetus until
l?60 when more than 60 pationta were discharged or placed on con«
valencent status. The aim of this program was to remove those

patients from the hospital rolls that could no longer benifit from
t3 services and to interest the communities in providing

services to Leoplg they warm lugally responsible for.

nitiated in the last few

34.

Several other new services were

H

\

years that the hosyital felt oroviiefi more adoluate services t
its clianta. In3111e1 in those new scrv;cco rcfic prc~ad;ission
and; ra-co.nnittaczzt ionrvioas with p1;lont5, th; axe o; the
voluntary algiasion order, wzltln; list survey: «no w5.der uao
of other agencies in the ouuouuity.

' C' ‘ ,';-' - --. . -..- J p. . n .- .‘ ..-...~.~. ,.
1.10:5) 0L tfie ..».-3C 1815(1'1 \jljai;v‘23 {"4“ :10 “b'- ..CC'\ (3“ 2.?O_T\L..-u "“04.

3h?n;es :_n_5u1‘~‘n~ “rotraqi:

~—.—---¢ o 4... -.

'"39 changes that took place 3n 350 bwilfilnj *rojrao m“:bly

' I I "n - - I‘ ‘ 1“ - \ vc ‘. as '. .‘ 3 ~ ' 'V '-"t o W .. "' ~‘ ' ‘ " ’V_ *I'. "a
3101' LYJ¢ ‘1’)8 t CL!- 1: J. " t-a“! C-u‘fi‘ <33 ,1.“ lulu“ I: '1 'v .- C “1-1. .zlfl'j {2.5 «’C -’.G..’.O * $9511
a. v v v A ..a .4 Lo

' .- - --. I. l ‘ ' u 1‘ h. - - ~" 'au " _u q ,‘ 4‘ . ,‘ ,A. - _ l . . ‘ . ... ‘ . - ‘4 - A
CJGA‘JC:U¢*JbiC~u 04'. (JIM: fidb...» “No-1 (“5-1 but} UU;$‘U-35'U11uwklws CW'LUYUZ‘S -.LI.

services ani progr; a.

"’- ‘H 1'5 --_~ ' v" - '-‘- -' "f ~ .1 .-,r"‘ 1 t x I“!“‘ -.. ‘ , . ‘7‘. .- I
.\ buddy 01 t-Lu-'.U ,’ U“ (ale A\’6‘.-‘--‘-’}J.‘.z.' (“.3, J’..V‘.'d.l':3 {2.5‘1t In

'J -I. \)

l'jlél t zero we re foen‘ :ti'o—sohuol mu} mchool nulls-1:.‘z-9-"3 in oyoration
uith a total capo); ty of .3;. .Lc CHilflroL -l ‘33 in tucso

buildings were between the age oi ILVo and seventeen, had an I. .
above 60 and were thfiiCfllly capable of carinc for thgir own
personal heads. It was p905:0t.1 that the hosnital usuld noel
four more oonool bailulndu ulth Space for SJ) moro children.
Ehcco buildings were never ersctex.

In lyol tuosc were atlll only four cu ldlngs in oysratiop

for pro-school and s-zhoJl children. 3h: only calm go that took
place was one builé4ng tnxt noun a; school girls wag convertal to

c‘

. I. J ' . . I 1. a .
quQu 31433 to Udlla

hOJBU school bOJs. There wore to pro

additional rsuhool chilir‘mz's

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Those male patients above age seventeen who were physically
and psychQIOgically capable of caring for their ycrsonal needs
were classified as trainuble males. In lTQI the heapital had five
buildings in agoration with a total capacity of #17 beds to hogs.

the trainable males. There were also Irojaccud 31333 to buLlfi

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type of
patients.
In 19Cl there were four b1 ifdlngs in oyeratfion 3133 a
mpa 1ty of 367 to hJu.3e trainable males with no trajected filan
for add Htio al bail 'Wix 3. Inclufiing the yyojected canacity there
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3310
Using the sum? definition for traiuaklc females as was used
for trainabla 33133 there 3 re tHrea bull d'3‘u in cgeration in
1631 hogging 3&3 traina‘le females. There were also yrajncted
plan3 to e: ‘e: t two anre bui lfi T";n wit? a capacity of 237. The
nuasar of b'ilfiisgs and a tota; C13; J . ,m..ur5; in paration
regained the 8330 in lfél. H0” or there were no pl 338 to build
any additional buildin s. The only dif ferencw in the bed cuy3oity
33' the 310 bcii included in the projected plans.
fione of the bu;ldinjs pro Jected i3 1F31 f0 trainable males
33% fumqles wire avg? erected.
fha custodial :Iules 3? d 1033133 included those patients who

to phym “a 1y and/or psycholotically unable to 03:9 for their

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patient in this group was approximately five years old.

In l9hl there were three custodial male and two custodial
female buildings in Optration with a capacity of 225 and 2h? patients
respectively. There were no custodial building plans projected
in lakl. The name classification in lfiél revealed three buildings
in each category in Operation with a capacity of 265 males and 265
females. The projected building plane for l§61 called for two new
buildings to be erected, one for males and one for females. each
housing 110 patients. Including the projected buildings the capacity
for custodial patients in 1961 increased 276 over lghl.

In lghl there was no nursery in operation» In 1961 there
was one in operation housing 62 male and female patients with
projected plane for another 253 bed nursery. The nursery building
bounce patients of both sexes between the ages of few monthe to
four or fire years of age. The patient'c physical or psychological
condition does not play an important part in determining the
placement of patients in the nursery.

No infirnariea were operating in 1941. In 1961 there were
two with n capacity of 27% beds. The infirmarioo houoe both male
and female patients of all ages. The vast majority of these
patients are non-ambulatory with very limited physical or
paychological abilities.

Because of Michigan'c recent financial condition none of the
buildings projected in 1961 were erected but funds for the

construction of these buildings were requested in the 1962-63 budget.

 

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Blun- can. 0! fit. .Ifld.0fi.‘»h‘1ldilfll‘$l 19k! 'tro countruotod
1: could to Wad flat flu not In buildup u and. an»!
flhtlflvllzlnd'inlinlbki ldulfil no 1033.! uztltodo ‘furiloii"
gamma towns ...“ um um m'mtmup
‘Ofifibi‘llllIILIthwiiil ulna tar .cvoroly phyltualmr“aud
payoholosionl}y rotnrdod patients. and all tha buildinsi productod
in 1961 nor. for tho same type of patients (see appendix 11 for
the schematio map otha 0 State Hospital). _

' tmctcdy‘ot ‘nbloo 9 and 10 that follow. will inlp'vllrfry“

the 300C to: ndditional beds for handicapped patientl. n-‘; . -n

fhelo tables rovtnled that over half. 56.87% 9! king plfitnlto
IdILtto‘ in 1961 wore phyuionlly disabled to some 60.90., thorq,n
ta.19h1 out: h2.0%-woro disabled. It! uses at the alnittol patient.
I‘. .100 an importnnt considaration in planning new building.-
Tho .0413: as! dlorcalod h.6 years. from 1h.8 your. in 19~1 .0 .
10.! you. in 1961. ‘1‘th factor nu again "that what. tin-bu-
I! phyuically lilnblod patients undo: the age of IQ Ian celparo§¢
titty-oh. patient. or 17.0% not. under ago 1“ nnd physionlly
itldllol in 19k1. In 1?61 fifty-nin- or 37% were in this cataairru
Th1. cxplninod thotlood for a new auteur: and partially expluinnd
why two not custodial bnildings wera planned. when this intbrnntion
uni oonlidofod in aonjunotion with table 10 the need for the n0! '
tutldsad boon-o .vor olonrer.

A; can be Icon in the following table. 63 or 40. E of SI.
patients Admitted in 1961 were of ago 1“ or younger and lateral:

nontnlly rotardod, whereas only 66 pationta or 22.0% in 19h1 tor.

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to rolnin hoopitaliaod for longer poriodo of time. tho no.4 for
Addtttonol bot Ipopo tor this typo of patient becomes ovidont.

_ Tobi. 90 £50 and physical condition of patients
odlittod in 1951 on‘ 1961

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3.9M; i961 .

A?“ ' 3:361“: Judi“; 1.; W mm}; Janina;

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5 - 9 15 8 5 9 10 1 7:
iouxt #9 at - 7 ' 22 14 a
15.19 M 25 a 9 13 o
20.2% 15 12 1 7 2 0
25-29 21 , 12' o 4 3 0
3o-5h 11 I h ‘ 1 5 5 0
35-39 7 J 6 o 2 3 1
to.“ 7 h o 2 1 o
“5&9 3 5 1 o o a i 0
50-51» 2 ' 2 ‘ o 2 1 0
0'0: 55 3 l O i over 55 1 a O
Totolo" ”177' “163 } 24 69 65 26

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1n 19#l and 1961
f w198.1 + _ 1961
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Chapter VI

GBHERALILATIQHS AND CORCLJSIONS

The original hypothecie for this study stated that because
of the medical advances made in the treatment of epilepsy. the
community needs for a state hospital for epileptioo have changed.
It was assumed that these changes would be reflected in the types
of patients admitted. It was then hypothesized that the patients
admitted during the year lfihl were lose physically and
psychologically handicapped when compared with patients admitted
during the year 1961. It wee further hypothesized that the
hospital cervicee have shifted to meet those necde.

The results of this study definitely supported that section
of the hypotheeic that stated that the patients admitted in 19%:
were lees physically and psychologically handicapped than thocc
admitted in 1361.

There was a significant difference between the physical
characteristics of the two groups with the 1961 group being more
handicapped than the 1941 group. There was also A significant
difference between the two groups when the physical and
psychological characterietioo were combined with the 1961 group
again being more handicapped. The paychological characteristics
of the two groups did not show a significant difference. But. the

trend to admit more severely retarded patients can established.

V.’ I

 

~16.-

The study did not attempt to demonstrate that these changes
were due to advanced medical knowledge. However, Dr. D. 3. Footer
of fienninzor Clinic and Dr. Gillard d. Dickerson. Hedical Super-
intendent of Care State Hospital did believe that improved diagnostic
techniques and new anticonvuleant medication were the two most
important factoro involved. Other factors hat could have been
involved were increaaed community understanding and acceptance
of the diocese and inprOVed community facilities for the education
and training of handicapped persona. This study did not attempt
to accertain just how much theoe factors were involved.

one changes in services and pregrnne were alao evident from
the results cf the study. There was an increase in the number of
adjunctiVe therapies personnel and a decrease in the number of
academic teachers. This indicated a reduction in the number of
educablc pationtu admitted and an increase in the number needing
occupational. recreational. and/or industrial therapy.

There was a change in emphasis regarding the social service
department's program with the eervicec being offered to the
parents. relatives and the community instead of direct services
to the patients.

The changes that took place in the building program also
indicated a change in the type of services needed by the
community. It could be concluded that the community was able to care
for the person whoee only problem was epilepsy but needed facilities

that offered care and treatment for the physically and

uh»?-

paychologically handicapped e: ilepticc.

The increase in the number of doctoro end nursing personnel
needed to Operate the hospital was also attributed to the increase
in the number of persons admitted who needed complete nursing care.

The results of this stud y corresponded cloeely with the

9,
“fictudies of the

res.lt3 of Goldstein'ozzend Patton and Teinotein‘n
mentally retarded in that the greatest increase in admissions

fell within the severely reatrded group. The reculte also agreed

with those found by? Jr.. ravidzadehahin hie etuly of the characteristics
of persons admitted to the Core State Hoe ritnl from 1947 to! 1993.

He found that 86.35 of the patients admitted were mentally

retarded to come degree. This study showed that 91.9% of the

patients admitted in 1961 were retarded. when these reculte were

compared to the 19h1 group in which 8#.9$ were retarded the trend

becomeo obvious.

“31.1 m:

The i:n;lic1t5 on:3 of this ct‘d: are:
1. float epilepticc are being diagnooed and treated successfully
in their home community. with the majority that are admitted to
State hospitals having accompanying physical and psychological

defects that are more handicapping than the epilepsy.

az'Op. Cit. Goldctcin p. 604
23.

2%

Op. Cit. Patton p. 627

'cp. Cit. Havidzndeh p. c9

- A8 -

2. The greatest need for social services to the epileptic 15
located in the community and not at a state hoopitcl.

3. It is questionable whether a large specialized etete facility
for the epileptic person is still needed. The majority of patients
now being admitted could be treated at the state facilities for the
mentally retarded. A smaller, more highly orecialioed facility
could be established to treat those persons who are not physically
and psychologically handicapped but whose eeizuroo have not
responded to treatment from their family physician.

Rocomocndatione:

 

The writer found a definite lack of information regarding
epilepey in the literature. especially social services programs
in present day epileptic hoapital where the majority of patients
are unable to use direct services. A question that could be answered
by a etudy in this area is. are the social service departments in
state hospitals for epileptico performing a worthwhile service or
could these services be offered noro advantageously in the local
communities.

Another study that would give reliable information would be
determining why epileptice with normal intelligence and no
accompanying physical dioabilitjoa are still being admitted to
state hospitals. and what happens to them after they have been
hospitalized and dioohargodo

It would also be helpful to know the current attitude of
social agencies in regard to offering casework services to

epileptioo. It has been the writer‘o cxoerienoe that agencies are

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not anxious to offer than services. One reason given is that many
epileptic: are brain damaged and it is almost impossible to effect
any meaningful change in these persona' afijuatment. The writer

suspects that the number of epileptica an agency case lauds wculd

be diaproportionatoly low.

>333? H

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Bibliography

Books:

 

Lennox, William G. Scionoa and Seisu
and Higraine. New York, Harper and Brothero. Rovicod
edition, 1950.

 

national Health Education Committee. Fgct§_on the Major Killing
and Orig;lingfvioeaoca in the Uniteq_§tatoa Todag. New
101.11. 1959.

Penfield, wilder. 3.M., C.W., 3.9.‘Egi1opoy and tho Functional
Anatomy of the Human Brain. Little. Brown & Company.

Boston 1&34.

Putnam, Tracy J. Convuloivo Seizures: i fianual for Patients, Thai;
Families and Prienfio. Fhiladelphia, J. 3. Lippincott. 19h5

------. Egilopoy! What it Ioand What To Do About It. Philadelphia.
J. B. Lippinoott. 1958

Yamghlotsa

Barge. Lois, ct. al._ޤito oncial School Handbook. Detroit 19h2.

Committee on Nomenclature and Statistics of the American Psychiatric
Association. fiontgl Disordcrgp fiashington 9, D. C. 1952

 

Committee on Information. A Poychiatric Glossarzp American Psychiatric
Association. 1957

Moose, Gregory. Infornotion Pooklet: Caro State Hospital for
Bgilogtico. Schiffer Printing Co. Detroit 1959

Periodicals:

 

Berlin, Irving N., H.3. "A Review of Some Elements of Rourology,
Part II”, Social Casework, Vol. KKKVII No. 10 December
1956 pp. 14-93-590

 

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,,

Caldwell. Bettye a Guno, Samuel B. ”A Study of tho Adjuatuont of
Parents and Siblings of Institutionalized and Non-
Inatitutionalized Retarded Children", American Jo
of Rental Deficieggx. Vol. 6“ Ho. 5 March 19‘0 p.

 
 
 

5-861

Footer. D. Bernard, M. D."Histaken Ideas about Epilepsy", Honnin r
{‘Luarterig;g Summer Issue 1953 p. 7-11

Goldetein, Herbert. "Population Trends in U.S. Public Institutions
for the Mentally Deficient“ American Journal of Mental
Deficienc , Vol. 63 No. b January 1959 pp 599-60#

Pattson, Robert E. & Abbott 8 Weinotein. "Changing Characteristicc
of the POpulation in the New York State Schools for Mental
Deficienta". American Journal of dental Defigiongl, Vol 65
No. R January 1950 pp. 5254535

------ , Eoile sia. Journal of the American Epilepsy Society. J. K.
Merlin, editor. Boston, Veterans Administration Hospital.

vgngubgiohed Work:

Havidzadoh, Buick. " Persona Admitted to Caro State Konpital.
1947-58". Unpublished Master’s Thecin. School of Social
Work. University of Michigan, 1960

Hhitney. Katherine M. "Epilepsy". Papaor read before the meeting
at State Hospital and Training School Social Workers,

Kalamazoo. Michigan, June 1950. Adopted by Fred Rough
in March 1963.

Egblic Documentq;

Annual Qaport on Program and Budget. Michigan Department of Mental
' Health, December‘lQGl. '

Caro State Hospital, how Construction PrOpooala. 1959-64

Plot Hap, Caro State Hoopital lfihO.

State of nichigan. Act 1&8 Public Acts of 1952. Sec. 1

State of Michigan, Act 151 Public Acts of 1923 as amended.

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