Complete Annual Report of the Illinois Department of Mental Health Manteno State Hospital - July 1, 1963 - June 30, 1964 The Manteno State Hospital continues to be the largest mental hospital in the State of Illinois, with an average daily population of 7,269 for fiscal 1964, or 1,552 more than the next largest hospital. Admissions declined by some 500, with approximately 300 fewer voluntary admissions. At this time, no forecast can be made concerning the impact of the new Mental Health Code on admissions but the variety of forms of admission under it should facilitate the process. A large number of aged infirm and semi-infirm patients remain in residence. Approximately 3,600 patients are beyond the age of 60 and about 2,200 of these are beyond the age of 65. Other long-term patients are chiefly chronic schizophrenics. The request for a federal grant to evaluate aged patients has been approved. The objective is to remove many of these patients to appropriate facilities in the communities and to their own homes where possible. Such a program is vital not only for this hospital, but for other hospitals in the Department to alleviate the problem of the ever-increasing numbers of aged persons in these hospitals. Efforts have been made to upgrade treatment philosophy within the limitations of staff. The pilot unit, established last year, shows some promise of increased therapeutic activity in this group of patients. The consultant staff has been actively involved with it and problems that have arisen are being resolved on the basis of greater experience. It should provide information which will be valuable for other units when staff is available. Ideally, it would be desirable to break down this large hospital into at least six administrative units, with the chief of each responsible not only for the therapeutic effectiveness of the unit, but also for proper administrative procedures. All standard and accepted forms of treatment continued to be used, with some decrease in the use of electroshock therapy and hydrotherapy. The various tranquilizing and stimulating drugs were used to great advantage. Acute medical and surgical problems seem to be increasing. Consultants in medical specialties were available and provided much needed service, although handicapped by inadequacy of facilities and resident staff. The medical and surgical building, when complete, will provide many needed facilities. Public health for all patients and employees was adequately controlled, and the prescribed immunization programs were always fulfilled. No epidemics of contagious diseases developed. Medical staff training programs were provided in a limited degree by psychiatric consultants. Small groups of medical students from the University of Chicago visited the hospital one day a week. Doctor Nathaniel Apter, psychiatric consultant, was in charge of this program, which oriented medical students to psychiatry in large public hospitals. Consultants also provided some training for the psychology staff and additional in-service training and supervision were given by the resident staff. Social service also had the advantage of a number of consultants who provided some direction and supervision. This hospital continued to provide the Activity Therapies School for the entire Department. Personnel from all of the other institutions received intensive training here. Besides having the advantage of the Activity Therapies School, the activity therapies staff carried on in-service training on a continuing basis. The in-service training program for psychiatric aides continued on a year-round basis for all new psychiatric aides, and advanced classes complemented it. A particular need in this area is the addition of more clinical instructors. The inability to obtain professional and sub-professional people was frustrating. Medical staff continued to have a high ratio of foreign-born and foreign-educated personnel. Recruitment efforts at the recent American Psychiatric Association meeting were entirely negative. No pathologist has been available for over a year. Psychology and social service added some staff in the past year, but still remain below accepted standards. Only 39 graduate nurses were available for the entire hospital. Intensive recruitment efforts, including community newspapers and radio, have shown no results. The geographical location of this hospital is a main factor in its inability to secure adequate professional help. The community attitude toward the hospital is relatively good. The village of Manteno has become increasingly aware of the economic impact of the hospital upon it. The recent organization of a Chamber of Commerce showed the interest of the village and indicated that the Chamber of Commerce was sympathetic to many of the problems. Radio and newspapers in the surrounding communities were helpful on many programs and very fair in the handling of hospital news. Steps are underway to secure an information representative who could strengthen the program. The volunteer services program provided many valuable community contacts and continuous efforts were made to expand it. Personnel problems continued to plague the hospital. The total number of employees increased somewhat, so that the average regular full-time workers are now about 1,700, but the ratio of patients to employees is still the highest for all of the state hospitals. Turnover was somewhat over ten per cent. Fiscal and business office management was satisfactory, and all audit reports and inspections were favorable. Stores operation conformed to Department standards and procedures. The position of business administrator has been vacant for five months. Social service offices were transferred from the Administration to the Annex building to provide additional space. This building now houses business office operations, social service, chaplains' offices, and the in-service training school for psychiatric aides. The medical records section was transferred from the second to the first floor of the Administration building. This provided slightly greater space, but once again the hospital is faced with the necessity of expanding this operation. The death of Mrs. Mary T. McGinnis, medical records librarian and consultant in this field for the Department, occurred during the past year. Mrs. McGinnis was a long-term employee, well known throughout the State for her excellent work in the field of medical records. An addition to the Carriel infirmary building was provided through Bond Issue funds, and installation of the two boilers in the power plant is approximately 90 per cent completed. The laundry building should be completed in early 1965. Construction of the medical and surgical building is expected to begin in the fall of 1964 and to require more than two years to complete. Plans are rapidly developing for the construction of a patients' service center and commissary to be financed through the assets accrued in the hospital Amusement Fund, supplemented in a small measure by Department funds. It is hoped this construction will begin in the fall of 1964. Further work was accomplished in the modernization of the central kitchen and dietary facilities. The construction of the 3,000,000-gallon water reservoir is well under way and should be completed in seven months. It will provide some safeguards in the event there is interruption of the water supply from the city of Kankakee. All safety precautions are taken to provide a safe water supply for the hospital. The capping of one of the old wells, in accordance with Public Health instructions, will be completed very shortly. Additional chlorination of water used by the hospital is on a continuous basis. It was necessary to discontinue the use of the garbage and refuse dump near the village of Manteno since it had become a public nuisance, and to contract with a commercial company for the removal of refuse throughout the institution. This plan has proved satisfactory, since the contractors furnish all the containers, trucks, and manpower. Other plans include modernization of the sewage disposal plant, repairs to porches and additional office space in ward buildings, replacement of the wood floor and changes in the ventilation system of Hinton Hall; provision of a new Activity Therapies School classroom area in the building now used as an employees' dormitory; renovation of the cold storage and refrigeration areas; addition of fire escapes to the two-story buildings and the laundry; extension of the tunnel system; and road repairs and resurfacing. Maintenance, modernization and rehabilitation should continue to maintain the physical plant in good condition. The hospital administration is grateful for the loyal efforts of all employees, the support of the Department and the various organizations and individuals who have been most helpful during the past year.