(Brief

Reports

continued

from

LOMBARD FARM: THE SUMMER OF

Milton

Greenblatt,

page

585)

‘68

M.D.

SOne of the most charming chapters in the history of American psychiatry was the development of the student volunteer movement on behalf of the mentally ill. Of all the student exploits in the field of mental illness, the rehabilitation of chronic patients at a poorhouse on Cape Cod was one of the most noteworthy. Decades before, the mentally ill had been moved by public decree from poorhouses to mental hospitals. In the summer of 1968, a group of undergraduate students from colleges in the Cambridge area used a poorhouse as a site for the ‘ ‘ treatment’ of supposedly hopeless mental hospital patients. The students generally felt that mental patients in state hospitals needed a richer, more interesting life; needed to be outdoors, engaged in work and in play; needed companions committed to a close, enduring relationship; and needed the example of persons who were struggling with everyday problems but who were not giving way to maladaptive, self-defeating behavior. The students were resourceful. They raised approximately $30,000 from several charities and foundations. They renovated an abandoned poorhouse in West Barnstable called Lombard Farm. They convinced townspeople that the idea of moving patients from a state hospital to the farm was reasonable, that patients would not attack them, and that sanctions had been given by responsible authorities such as the superintendent of Boston State Hospital, the commissioner of the Commonwealth, and authorities at Harvard University. The superintendent of Boston State Hospital agreed to supply food and linens. Authorities in social relations at Harvard agreed to assign a professor to teach psychopathology and give the students credit for the course. Local plumbers and carpenters helped the students renovate the structure. The students then moved 25 chronic patients from the hospital to the farm for a seven-week period during the summer. Having been superintendent of the hospital, I knew well the patients who were selected. They were chronic patients, mostly schizophrenics, who had been hospitalized for ten or more years. Patients and students were assigned to the small bedrooms of the poorhouse, each patient living with a student. Mornings were spent doing chores, afternoons at the beach, and evenings in social therapeutic activities. During that summer there were many intensive ‘

Dr. Greenblatt is chief of staff of the Brentwood Veterans Administration Hospital, Wilshire & Sawtelle Boulevards, Los Angeles, California 90073. He also is professor and vice-chairman of the department of psychiatry at the University of California at Los Angeles. He formerly was commissioner of the Massachusetts Department of Mental Health.

individual and group sessions that sometimes lasted long into the night. Patients showed improvement, and before the summer ended the students were facing an unanticipated crisis-the patients did not want to return to the hospital. There was frantic activity to set up new halfway houses in Cambridge and Somerville. Most of the patients were transferred to those houses after the summer season. The houses in Cambridge survived, but the house in Somerville met serious and destructive political opposition and eventually had to be abandoned. A student who lived at Lombard Farm during that summer, now a psychologist in a child guidance clinic in California, remembers well her subsequent frustrating experiences on the political front. The incumbent mayor of the city was running on a ticket that said he had closed seven halfway houses; his campaign promise was to close the rest. “It was harassment. We would get the health inspector every day. He would get the fire inspector. At one point the building inspector said to me, ‘Off the record, don’t you understand that we just don’t want you here? We do not want you in our town.’ We spent so much time fighting the political thing that we were really of little value to the patients. During the next year, 1 1 of the patients returned to the hospital.”1 Nevertheless, despite the turmoil around the student’s search for accommodations for the patients in the community, and the successful undermining of a halfway house in one city by political leaders, more than half of the original group of patients did not return to the back wards. In 35 years of experience with the mentally ill, I have not seen a more valiant rehabilitation effort than that made by essentially untrained undergraduate students, living and working together with chronic schizophrenic patients in a renovated poorhouse during seven weeks of summer vacation on Cape Cod, without the close collaboration or supervision of the traditional members of the mental health team. “



H. May

Sullivan,

Sepulveda,

California,

personal

communication,

1976.

THE USE OF TRAVEL IN A VA HOSPITAL’S REHABILITATION PROGRAM D. Sullivan, F. Thomas,

Thomas Myron

J.

Michael

Schaefer,

M.S.W. M.S.W. M.S.W.

UThe Veterans Minnesota, has

Administration been using

Co-authors

paper,

Hospital,

health about

of are

this Jerome

technician,

Hospital,

VOLUME

St.

28

who

work

with

the

authors

at

the

VA

C. Dahlager, M.S.W., Gerald W. Muntifering, and William K. Daly, M.S.W. Further information

is available

VITAL

Hospital in St. Cloud, as a form of therapy

travel

Cloud,

NUMBER

from Minnesota

Mr.

Sullivan,

Veterans

Administration

56301.

8 AUGUST

1977

589

for several years. Initially trips were limited to day or evening outings within the state, such as to the state fair, baseball games, or ice shows. Then in 1972 three outpatients expressed an interest in joining a guided tour of the Middle East and the Holy Land offered by a local priest. Although the priest initially was somewhat apprehensive about taking the veterans along because he did not know them very well, the trip turned out to be a great success. During 1973 nine other outpatients asked to accompany the same priest on a tour of Europe. As on the previous trip, hospital staff, friends, relatives, and guardians were supportive, and the trip was completed as scheduled. However, the priest indicated that he would not take outpatients along on future tours unless they were accompanied by hospital professional staff. The hospital administration and the social work service staff felt the trips were valuable because they gave the men a unique experience in interpersonal relationships that would help them function more appropriately in the community. Thus the hospital decided to include staff supervision as part of future trips. The outpatients taking the trips had been living in the community for varying periods of time and were in different stages of adjustment. The average age of those taking the trips was 49. Most either had been hospitalized for long periods of time or had a history of repeated hospitalizations. Travel therapy was used to motivate the veterans to be more socially functional and more responsible for their own adjustment to the community. During the summer of 1973 planning began for the first trip in a program we called ventures in travel and leisure (VITAL); it was to be a mid-winter holiday. Two social workers suggested visiting Hawaii and quickly found 30 outpatients who wanted to go. VITAL offered a potential growth experience for the participants by providing opportunities for making decisions, planning, assuming responsibility, socializing, and learning about different cultures and customs. We encouraged participant involvement as much as possible so that the men would learn about planning and taking trips and would feel more confident in taking excursions in the future. A local travel agency made arrangements for the Hawaiian tour; two hospital staff members, both social workers, accompanied the group, acting as supervisors and escorts. The men paid for all basic travel and personal expenses. Staff accompanying the men were on duty and were salaried accordingly. The men were not charged extra for the supervision by staff-the staffsupervised and the public tour rates were identical. We held meetings before departure to give the men an opportunity to make choices about their accommodations and to plan their itinerary. The principle of self-determination was applied to the group, and the group as a whole made decisions about roommates and hotels. The men made their own decisions about how much spending money they would need, whether they

590

HOSPITAL

&

COMMUNITY

PSYCHIATRY

would need a camera, and what clothes to take. The group’s level of anxiety mounted before departure; the staff viewed such anxiety as a growth and learning process. The group spent eight days enjoying the beaches of Waikiki, the Polynesian Cultural Center, and the International Market Place, and even took a tour of the USS Arizona National Memorial. The veterans asked questions that tourists generally ask, took pride in their personal appearance and manners, and used the buddy system to help each other through various phases of the itinerary. During the trip most of the veterans were responsible for taking their own medication; for a few of them supervision was required. In those cases the men went to an escort’s room and took the medication at a prescribed time. Generally the veterans used the escorts for support, guidance, and general information. When the 30 suntanned outpatients and two escorts left Hawaii to return to Minnesota, the concept and the benefit of an annual escape was no longer questionable. The improvement noted in the men’s communication skills, interest in their surroundings, pride in their accomplishments, and awareness of themselves and others had given validity to the experience. The participants’ response to a questionnaire about the trip was overwhelmingly favorable. There have been several subsequent trips, including one to Nashville that attracted outpatients interested in country-western music and one to Florida. The staff members involved in each trip kept a daily diary for discussion and review during and after the trip. The behavioral changes and observations the escorts noted throughout the trip were shared with the men, other staff members, family-care sponsors, guardians, relatives, and friends. The positive response of the participants to this type of therapy has been both professionally and personally gratifying to staff. As a direct result of their experiences with VITAL, several individuals have planned their own trips without the assistance of hospital staff. The skills they gained in decision-making and problem-solving and the confidence they acquired from previous traveling experience have enabled some outpatients to travel on their own.N

The use of travel in a VA hospital's rehabilitation program.

(Brief Reports continued from LOMBARD FARM: THE SUMMER OF Milton Greenblatt, page 585) ‘68 M.D. SOne of the most charming chapters in the h...
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