hopes its connection
with community will help it survive
(July 2001) Madison, In Two white
brick entrance gates have long stood at the entrance to
the Madison State Hospital, located at 711 Green Rd. on
the Madison, Ind., hilltop. But few of those motorists
who pass by each day have ever entered the world that
lies beyond this narrow, tree-lined driveway.
The 1,265-acre property has not only served
as a hospice for patients, but also a home for the many
employees who have dedicated a great deal of their lives
to the hospital and its mission.
Though the hospitals primary mission has remained
the same, the evolution of both mental health practice
in America and the state of Indianas involvement
at the Madison facility have challenged its operation
and its very existence. Recent obstacles have included
staff downsizing and the possible closing of the facility.
In recent weeks, state legislators have debated how to
address Indianas rising cost of caring for mental
patients. Republicans argue that more patients should
be moved out of state facilities and into private homes
or into apartments and houses to live on their own.
Indiana Gov. Frank OBannon recently announced his
decision to close Muscatatuck State Developmental Center
in Jennings County by December 2003 and downsize Madison
State Hospital. The decision prompted a series of June
demonstrations at the State Capitol.
Such moves concern those who care for mental health patients
not only for the sake of the patients but also
for their own future employment and their communities
But the Madison State Hospitals long history and
its function to serve those in need are among the main
reasons why many believe the local facility should continue
Establishing a place of moral treatment
By the 20th century, four mental institutions operated
in Indiana. All were overcrowded, causing state officials
in February 1905 to establish a fifth one in the southeastern
region, based in Madison. The attraction to Madison included
its beautiful and remote hilltop location overlooking
the Ohio River.
The concept of moral treatment was a popular
one at the time, based on the premise that environment
and productive activity could be therapeutic to the disturbed
mind. This opposed the 18th and 19th centuries treatment
of the insane, which often included caging patients and
physically beating them in order to keep them in line.
The $1.172 million new hospital was initially called the
Southeastern Hospital for the Insane. It admitted its
first patients on Aug. 23, 1910. By the end of the first
fiscal year, the facility housed 544 patients with a staff
Even though the land had a natural beauty to it, it lacked
paving, trees and shrubs, and other luxuries made possible
by artificial landscaping. Hence, its first two superintendents,
Dr. Edward P. Busse (1910-1915) and Dr. James W. Milligan
(1915-1944), turned to using hospital resources, such
as patient labor, to beautify the land. This proved particularly
helpful in a day when money was scarce.
The asylum became a communal opportunity, where
the occupants grew their own food and even made their
own furniture, said Jerry Thaden, who served as
the hospitals superintendent from 1979 to 1996.
Other services that made the hospital self-sufficient
included a patient-run canteen, a dairy and chicken and
turkey farms. Due to the efficiency and impact of the
patients work and the growing recognition of mental
illness as a disease, the state Legislature on May 16,
1927, changed the facilitys name to the Madison
Shortages of money became a problem in the 1930s during
the Great Depression. The staff-to-patient ratio suffered
a tremendous imbalance, with 110 attendants caring for
1,585 patients. As a result, some treatments, such as
shock and hydro therapy, could not be given because of
high costs. Many patients were staying at the hospital
longer than necessary as a way of keeping it operating
to meet state funding requirements. Administrative changes
also had an impact on the facility. During the 1940s,
the hospital saw five different superintendents.
Advancements in medical care
The 1950s marked a decade of significant change for the
hospital. Medical advancements of the time helped provide
more medical care. Dr. M.W. Kemp started the hospitals
nursing department in 1949, bringing trained registered
nurses to the staff.
Many patients had not had physical examinations
for years, said Dr. Robert Snodgrass, who served
as an medical extern in 1952 and returned in 1990 to work
as a psychiatrist. Some of them hadnt had
physicals for 20 or 30 years. There were no medicines,
and the place was full of patients.
When Dr. Ott McAtee became superintendent in 1952, even
more nurses were brought to the facility. Snodgrass said
he has McAtee to thank for this because he eventually
When Dr. McAtee came, it became a totally different
place, said Nancy Fisher, who worked in the hospitals
administration department from 1950 to 1997. No
strait jackets, no restraints. He went to Indianapolis
to recruit more people and get more money.
He was a humanitarian from the word go,
said her husband, Bernie, who worked at the hospital from
1955 to 1997, first in the physical and sewage plants,
then later as director of fire safety and security. McAtees
first act at the hospital was requesting money for an
on-site fire engine and department.
Assistant superintendent Vernay Reindollar also joined
the staff about that time. Reindollar came to the hospital
in 1956, initially to obtain two years of administrative
experience. But he stayed after meeting and marrying Dotti
Inglis of Madison.
Just about that time, anti-psychotic medicines were
coming into use, said Reindollar. That was
a breakthrough in treating mental illness. That is when
the behavior in patients could be modified enough so that
they could exist in residential programs.
Complementing the rise of these medications was the increase
in outpatient psychiatric care, particularly among those
involved with military mental health practices during
World War II. The positions of psychiatrist and social
worker expanded as independent public professions. This
decreased the patient population, according to Thaden.
As the population began to decline, we found ourselves
including more human-related services, Thaden said.
Buildings became empty, so we brought in programs
like Head Start, Point in Time and special education programs.
Thaden, who had been appointed to the hospital by Indiana
Gov. Matthew Welsh, had also been responsible for initiating
many of the changes that took place in the 1960s.
One of the reasons I was hired was to move out of
the agrarian society. The state had created the Department
of Mental Health as the concept of treatment became more
important. Society had developed a large cadre of social
workers, doctors and psychiatrists.
We had been taking (the patients) out of the community,
and now we were putting them back in to the community.
We thought, Why cant the hospital be more
a part of the community? We made a strategic plan to become
more community oriented. Since then, the hospital has
always enjoyed a positive relationship with the community.
Working with the state of Indiana
Recent discussions regarding the future of the hospital
are not the first time the staff has faced uncertainty.
In 1974, the state Legislature recommended reorganizing
the statewide mental health department based on the premise
that less was more. State officials suggested that closing
three of the six hospitals at that time would allow for
better quality concentration on the remaining hospitals.
Madison State Hospital was one of the three the Legislature
and the Department of Mental Health considered closing.
An economic impact report, initiated by Republican Sen.
John Mutz and Republican Rep. William Latz, however, showed
that the aftershock of the 800 local jobs lost in the
Madison area would be too detrimental to the overall state
About the same time, the Fair Labor Standards Act was
enacted, prohibiting patients from working without pay.
This created 61 more jobs in Madison.
Asked if todays crisis is any different, Thaden
replied, Its an economic question. The ratio
of employees have increased, so cost is something politicians
are very concerned about.
He added that because of recent closings in state facilities,
such as at Central State Hospital in 1989 and the impending
closure of Muscatatuck State, has mostly likely lowered
the confidence level of todays employees.
Also, what was once strictly the Department of Mental
Health for Indiana is now just a small component of the
Family Social Services Administration. Snodgrass argued
that this lessens the political involvement of mental
health experts in major decisions.
I think mental health in Indiana should be under
the supervision of a board-certified psychiatrist,
he said. There used to be a Commissioner of Mental
Employees agree that in recent years, Family Social Services
Administration officials have not indicated much knowledge
of patients mental vulnerability and the treatments
I think it is very necessary to have a place like
(the State Hospital), said Bernie Fisher. There
are many people who cannot function outside the setting.
Indeed, the remote but beautiful setting of the Madison
State Hospital has been a facility that its employees
have come to find therapeutic in their treatment of patients.
The land was bought as a therapeutic environment,
but more for the isolation, said Thaden. The
thing is, you have to be isolated to have an asylum.