Manteno Mental Health Center From the August 1978 report from the Legislative Commission to Visit and Examine State Institutions On September 27, 1977, the Charitable Subcommittee of the Legislative Committee to Visit and Examine State Institutions held a hearing at the Manteno Mental Health Center at Manteno. While the hearing represented a follow-up visit to an earlier hearing held in January of 1976, it also served as an examination of criticisms including poor patient security, understaffing and inappropriate utilization of facilities. Representing the Center at the hearing was Mrs. Ella Curry, Superintendent. The Manteno Mental Health Center had undergone a great deal of change since its establishment in 1928 as Manteno State Hospital. Built on 1,200 acres of farmland, the hospital complex required only 400 acres. The remaining 800 acres were used for farming and worked by staff members and patients as a form of therapy. With the introduction of new therapy techniques, farming was phased out, and the land was leased to provide revenue for the State. The hospital received an ever-increasing number of patients intil by 1955 the total exceeded 8,000, making it at the time the third largest mental hospital in the U.S. The Center's rated capacity is 5,531 but the actual number of patients has now stabilized at approximately 1,000, most of who require long-term care. One of the reasons for the shrinking population at Manteno has been programs instituted by the Federal and State Governments to put mentally ill patients into private nursing homes in the local communities. If the patient is not in need of psychiatric care and not actively psychotic, but still in need of supervision, he is then transferred bach to the local community. The program in Illinois was instituted because of Federal funding. The Federal Government would only reimburse the State if these patients were moved back to local areas. Today, a change is taking place because the Federal Government now reimburses the State of Illinois at a rate of $85 per day for patients kept at Manteno, and only $30 per day if they are kept in local area nursing homes. It is less expensive for the Federal Government to have patients in the local community, but there has been much concern as to whether patients in local communities are receiving adequate health care. Of the approximately 1,000 patients at Manteno, there are 80 *mittimus patients because after court hearing they were found innocent by reason of insanity, but need of psychiatric care. Those in the Alcoholism program number 43; those over 65 years of age are intermittent to long-term chronic patients. Most in this catagory are non-violent. The Manteno facility is a mental health center designed to car for these non-violent patients. Consequently, since Manteno has started receiving mittimus patients, security has become a problem at the institution. Chapter 38, Section 1005-2-2A of the Illinois Revised Statutes provides as follows: "If the defendant is found unfit to stand trial or to be sentenced, the court shall remand the defendant to a hospital, as defined by the mental Health Code of 1967 and shall order that a hearing be conducted in accordance with the procedures, and within the time period, specified in such act." Such is the definition of a mittimus patient sent by the criminal court to the Department of Mental Health and Developmental Disabilities until the defendant is found fit to stand trial. Most of the mittimus patients were tried for major felonies and tend to be substantially more violent than regular patients. Community fear over the presence of these violent mittimus patients at Manteno Mental Health Center has been aggravated by the frequency of patient walkaways from the institution. Within the last year there have been some 336 walkaways at Manteno. Of these, 38 were mittimus patients, and all but one of the mittimus patients has been returned to Manteno. Unfortunately, the average escapee is in the community for 72 hours before being returned. Obviously, this has caused great concern among the residents in the communities surrounding Manteno Mental Health Center. Another problem the Subcommittee found was that most of the mittimus patients were housed with the regular patients. Since the mittimus patient is, in general, more violent and also more intelligent than the regular patients, they take advantage of average patients. This causes a problem which takes up valuable time and manpower from the security force since security personnel are in the wards more often. It also makes it more difficult to keep watch over the rest of the institution. The Subcommittee was very concerned as to why these mittimus patients were at Manteno since the Center is not equipped at the present time to deal with the security problem inherent to them. Members felt something should be done to keep residents from walking out into the nearby communities, and to segregate mittimus patients from regular residents. Under the law, which allows the criminal court to commit someone whom they may find unfit to stand trial to the Department of Mental Health and Developmental Disabilities, a judge may only commit the defendant to the Department of Mental Health, not offer him to any particular mental health facility, In the case of People vs Lang, 37 Ill., 2nd 75, (1967), the Illinois Supreme Court stated a criminal court judge had no authority to order a person committed to a particular institution within the Department of Mental Health system. However, until recently certain judges in the Circuit Court of Cook COunty were finding ways to commit mittimus defendants to Manteno under the justification that they were not long-term patients, and therefore should be kept close to their own community. But, since the time of visitation by the Charitable Subcommittee this practice has stopped. Superintendent Curry informed the Subcommittee that patients are first sent to the Chester Mental Health Center, although some mittimus patients are ultimately finding their way back to Manteno. Some still blame the courts and say judges continue to informally dictate where these patients are to go. The Subcommittee felt the Department of Mental Health had done nothing to correct the problem and was determined to meet with the Governor and the Director of the Department of Mental Health to try to find a solution wherein all mittimus patients would be placed together in a facility with sufficient security to prevent them from wandering into local communities. The Subcommittee members were pleased to be informed by Superintendent Curry of a facility at Manteno called Brandon which would provide proper security for 48 mittimus patients. This facility is isolated and more capable of being observed by the security force. However, this left approximately 61 mittimus patients integrated with the regular patients. At the Brandon facility, screens have been installed on the windows and a fence has been erected around the whole structure, with flood lights around the perimeter of the building. In addition, there are 2 security officers stationed at the door at all times. All ground pass privileges have been eliminated for those housed in the Brandon facility. Subcommittee members inquired if it would be possible to create another facility, such as Brandon, in order to house the remainder of the mittimus patients. The Superintendent informed the Subcommittee of the many buildings not being used because of the needed renocations. She noted, however, they could be remodeled for approximately $45,000. The Subcommittee felt this was a good suggestion and would recommend this to the Governor and the Director of Mental Health and Developmental Disabilities. An aditional recommendation by the Subcommittee was for a security fence to surround the entire facility to help the problem of walkaways. Another problem causing walkaways is the shortage of nurses at Manteno. At the present time a shortage of 50-100 nurses exisists at the Center. About 62 nurses are employed at Manteno and this leaves only 20 per shift to try and watch over approximately 1,000 patients, and thus the problem of walkaways is aggravated. However, present nurses pointed out that the Department will have a difficult time hiring adequate nurses because of the poor salary scale. At the time of the visit by the Subcommittee, Manteno nurses were paid $794 a month while nurses at nearby Oak Forest Hospital were receiving $1,000 a month. This makes it very difficult to hire an adequate nursing staff. In addition, they were unable to hire men to work on the wards because of a similar pay situtation. In reference again to mittimus patients, the Superintendent related that of the 109 mittimus patients, five a day would be transferred to Chester until all would be gone. The disclosure came as a surprise to members of the Subcommittee because they flet this would solve the whole problem of mittimus at Manteno. Supposedly, this was a new program instituted by the Department of Menatrl Health. But, after much discussion, the Subcommittee found this new program would not really make the problem much better if at all. As part of the transfer, Manteno would receive an equal number of patients from Chester. These patients, while not mittimus patients, are still problem patients who have been unmanageable disciplinary cases at other mental health facilities in the State. The Subcommittee felt there should be answers as to why there is a need to transfer the patients back to Manteno from the Chester facility, and why they will not be kept at Chester which has adaquate security facilities to handle these patients. In the alternative, the Subcommittee as well as administrators, felt these new patients should continue to be isolated in the Brandon facility or in the proposed additions to Brandon. Hopefully, the Manteno faility would never get these new patients, but if they did, they would be prepared to receive them. Of the unused buildings at Manteno, 17 are condemned because they are firehazards and generally unsafe. These facilities are being allowed to deteriorate through lack of use. This was of much concern to the Subcommittee since the buildings will eventually have to be torn down because they are not being kept in repair. The Superintendent estimated it would cost over a million dollars to repair the facilities so they could again be used. There was also concern that one day an official might order these buildings demolished as has happened at the Kankakee Mental Health Center. The Subcommittee felt they would rather see money spent to repair the buildings than to tear them down. A new type of patient being received at Manteno is the undomiciled patient, which was described by the Superintendent as a person who shows up at any of the Chicago facilities, such as Read, ISPI, etc., without a known address, family ties or location. If information cannot be obtained on these individuals, they are sent to Manteno. This constitutes an acute admission and may be their first episode of psychosis. The "undomiciled patient" concept was established by the Administration of the Department of Mental Health and has caused more short-term patients to enter Manteno. As a result of this hearing, the Subcommittee decided to meet with the Governor and the Director of Mental Health in Springfield. RECOMMENDATIONS As a result of its hearing at the Manteno Mental Health Center, the Charitable Subcommittee makes the following recommendations: 1. That the Legislature consider providing sufficient funds in the Manteno Mental Health Center budget to allow construction of a minimum security fence around the entire facility. 2. That funding be provided, and action be taken to increase the nursing staff at Manteno by 50-100 employees. 3. That the Director of Mental Health devise a system for maintaining closer scrutiny and more accurate records relating to the location and nature of all mittimus patients. 4. That a comprehensive meeting be held with the Governor and Director of Mental Health to more fully resolve the complex and interconnected problems besetting the Manteno Mental Health Center. *mittimus - In this case, an adjective or noun used for or in describing a person sent to a mental institution prior to (or instead of) a correctional facility due to being judged mentally incompetent. Other definitions: writ for committing to prison or removing records to other court 1. a warrant of commitment to prison. 2. a writ for removing a suit or a record from one court to anothe A warrant of committal to prison and is a name of a written percept issued from a court or magistrate commanding the sheriff or other officer to convey to prison the person named therein and commanding the jailer to receive and safely keep such person until he shall be delivered by due course of law.