Complete Annual Report of the Illinois Department of Mental Health Manteno State Hospital - July 1, 1966 - June 30, 1967 Harold C. Piepenbrink, Superintendent The fiscal year 1966-67 involved many changes in this hospital.  In March 1967, the present superintendent, Harold C. Piepenbrink, was appointed.  Total reorganization of the structure of the clinical programs was completed.  Before the end of March 1967, the executive staff of the hospital decided to eliminate dual responsibility of program directors and discipline service chiefs.  The hospital was reorganized into autonomous programs to allow the program director to direct multi-discipline staff and to assume total responsibility for the care of all patients within a unit. This decision necessitated the physical movement of approximately 5,000 patients.  The move was accomplished the morning of May 24, in approximately thr33 hours.  Patients ate their noon meal in their new location and were physically placed in programs which consisted of already established admissions unit, the forty bed intensive treatment unit, the Hykelawn catchment area program, the Unit A "School for Living", and the Dix program utilizing operant conditioning. The 300 bed geriatrics program was enlarged to 2,900.  A new unit for approximately 1,800 adult continued care patients was established and headed by three former service chiefs, the chief nurse, the chief social worker and the chief psychologist. A medical unit also was established.  It includes the acute hospital, tuberculosis services, service for infirm patients under sixty, and paramedical services - dentistry, laboratories, X-ray, pharmacy, etc. Activity and other therapy programs enlarged The alcoholic treatment program was begun prior to the reorganization but greatly enlarged when the move was made. A rehabilitation service was established to serve all programs in the hospital.  THe activity therapy program was reorganized into  a "community center" to serve all programs.  It provides wards with specialized types of programs they are not able to provided themselves because of the physical limitations and lack of skilled staff.  Co-ed units were developed by use of male and female wards with connecting dining rooms. The non-clinical areas of the hospital were not directly involved in the reorganization and will continue to administered centrally. New programs developed prior to the reorganization have been highly successful in relation to the number of patients treated, discharged and readmitted.  The Hykelawn catchment area program has approximately thirty admissions per month on a forty-bed unit has not transferred, in the entire fiscal year, any patients to the general hospital population.  This indicates the unit's ability to treat and successfully return patients to the community. The Dix operant conditioning program admitted seventy residents described as long-term, chronic regressed patients.  Twenty long-term patients were discharged and only three have been readmitted.  The program uses "token economy" milieu therapy. 350 alcoholic patients treated in three months The alcoholism program assigned two staff people to the hospital July 1, 1966.  During April, May and June, 1967, the program admitted 350 patients and reduced the rate of delirium tremens from twenty per cent to less than one percent.  It is planned to enlarge both space and staff of this program which accounts for approximately 40% of the hospital admissions. The admissions unit seeks through intensive, short-term care to prevent long-term hospitalization.  With separate admissions to the alcoholic and geriatrics programs, the number of patients admitted centrally has been considerably reduced. The geriatrics program is developing small intensive treatment units designed to de-institutionalize patients above age sixty, many of whom have been in the hospital for many years.  A federal Hospital Improvement Project grant has been helpful in establishing and demonstrating the worth of such a program. The vocational rehabilitation program includes a sheltered work-shop, vocational training and is coordinated with day labor agencies, community employers, and community agencies.  Contracts for the sheltered workshop have been obtained in the community to help patients develop work habits and work tolerances.  This program will be enlarged as it is an important means of getting patients ready to move outside of the institution.  Without work it is very difficult for most patients to maintain themselves in the community. Plans are being made to use four cottages for a patient village to develop re-socialization programs within a home living environment.