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Uncertain Future

Madison State Hospital
hopes its connection
with community will help it survive

Ben Fronczek
Staff Writer

(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.

Madison State Hospital

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 hospital’s primary mission has remained the same, the evolution of both mental health practice in America and the state of Indiana’s 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 Indiana’s 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 O’Bannon 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’ economic livelihoods.
But the Madison State Hospital’s long history and its function to serve those in need are among the main reasons why many believe the local facility should continue to exist.
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 of 74.
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 hospital’s 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 facility’s name to the Madison State Hospital.
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 hospital’s 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 hadn’t 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 married one.
“When Dr. McAtee came, it became a totally different place,” said Nancy Fisher, who worked in the hospital’s 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. McAtee’s 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 can’t 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 economy.
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 today’s crisis is any different, Thaden replied, “It’s 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 today’s 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 Health.”
Employees agree that in recent years, Family Social Services Administration officials have not indicated much knowledge of patients’ mental vulnerability and the treatments needed.
“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.”

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