Mental Health Association of Portland

By Kirk Johnson, The New York Times, March 31, 2013

Museum of Mental Health, Salem, OR

Nurse Ratched slept here.

The punctiliously cruel psychiatric ward tyrant in the book and movie “One Flew Over the Cuckoo’s Nest” was brought to cinematic life by the actress Louise Fletcher during filming here at the Oregon State Hospital in the 1970s.

But the melding of real life and art went far beyond the film set. Take the character of John Spivey, a doctor who ministers to Jack Nicholson’s doomed insurrectionist character, Randle McMurphy. Dr. Spivey was played by Dr. Dean Brooks, the real hospital’s superintendent at the time.

Dr. Brooks read for the role, he said, and threw the script to the floor, calling it unrealistic — a tirade that apparently impressed the director, Milos Forman.  Forman ultimately offered him the part, Dr. Brooks said, and told the doctor-turned-actor to rewrite his lines to make them medically correct. Other hospital staff members and patients had walk-on roles.

Now jump cut to the present: the office and treatment rooms of the hospital, which opened in 1883, have been turned into a Museum of Mental Health — one of only a few around the world that are part of a still-functioning hospital, which sprawls behind the old brick structure.

In the museum, a steel examination table sits near a photograph of the Oregon State Insane Asylum baseball team, which once played against local challengers in and around Salem, Oregon’s capital. A straitjacket and a spilled bag of handcuffs fill another display, with a notation from the night watch book recorded at 2 a.m. on Feb. 25, 1913. “Mrs. Bernard would not remain in bed,” an attendant wrote. “Restrained her with jacket and belt.”

The juxtaposition of real and celluloid, truth and fiction, that emerged on the “Cuckoo’s Nest” set continues. A photograph of Fletcher’s character, steely smile and nurse’s cap in place, adorns a wall near a television that blares the movie itself on a continuous loop showing the movie’s patients watching that very television, which was retrieved from a hospital trash bin and saved after the filming ended.

A straitjacket is displayed.

The result — physical evidence of the hospital’s past alongside the Hollywood portrait — creates questions that McMurphy and his cohorts might have asked. What is real and what merely seems real? Was the hospital, which had a large number of voluntary admissions in its early years, a place of sanctuary, an old definition of the word “asylum,” or of confinement? Darkness and dread, or escape?

Dr. Brooks, now 96, and living near the hospital in a retirement home, minces no words when he says that mental health treatment in years past had its flaws. But anyone looking back, he said in an interview, should also look hard at the present. Institutions like the Oregon State Hospital, which he supervised for nearly 30 years — from the mid-1950s to the early ’80s — might not have been perfect, he said, but they were at least out there and trying to help. Today, he said, prisons have taken over the job, with barely a pretense of treatment. “Three-fourths of all mentally ill people are in jails or penitentiaries,” he said.

Shock therapy paddles

But the new museum raises questions about what the hospitals themselves were created to do, and how many patients were actually mentally ill by modern definitions.

In its early days, the museum’s records suggest, there was no pattern to admissions at all. Alcoholics, dementia patients, syphilis sufferers and others given the catchall diagnosis of “mania” were all taken in. And for part of its history, in the early 20th century, a majority of patients were women, at least a few of whom would occasionally leave for visits with their families. That suggests, museum volunteers said, that domestic trouble or abuse, in a time before easy divorce and when officers spent little time on marital violence cases, may have created a sense of safety for women behind the hospital walls that has since been forgotten in the wave of harsh imagery in films and books like “Cuckoo’s Nest,” which was written by Ken Kesey and published in 1962.

The old model of an “insane asylum” coincided with an era that revered the value of work. Patients were expected to sew or cook or grow the food they ate — not just to make the place self-sufficient, which it mostly was, but because work itself was considered elevating and therapeutic. Patients even made their own leather restraints, said Kathryn Dysart, a museum volunteer.

A scene from “One Flew Over the Cuckoo’s Nest” is shown in continuous loop.

In the new hospital, music and art therapy areas line a corridor that includes rooms where patients can practice skills they will need when they are released, like handling money. One was created to look like a bank and allows patients to withdraw funds that their families have deposited — money that can then be used to buy clothes at a room made to look like a store.

“As real as possible,” said Rebeka Gipson-King, a spokeswoman for the Oregon State Hospital, in describing the mimicry, which she said was aimed at making the outside world less alien after a patient’s discharge.

Other preconceptions about the outside world do not hold up so well. Fletcher, who won an Oscar for her portrayal of Nurse Ratched — the film won five Oscars, including Best Picture, in 1976 — came to the Mental Health Museum’s opening last fall, and turned out to be, in reality, very nice.

“Charming lady,” said Hazel Patton, the president of the museum’s board of directors.

Salem Statesman Journal, March 18, 2012

View Full Size   (Danielle Peterson | Statesman Journal)

Stava Rikai, a patient in the transition program, talks with Sara Slack, a board certified art therapist, outside an art therapy room at the Oregon State Hospital in Salem, March 15, 2012.

For decades, the Oregon State Hospital was mired in misery.

Behind the Salem hospital’s crumbling facade, mentally ill Oregonians were packed into a bleak, antiquated and unsafe asylum.

New state-of-the-art facilities are now in place, but opinions are divided when it comes to a key question: Are patients receiving better treatment in the new hospital?

Doubts are expressed by some patients.

“I don’t know if the treatment we’re getting is that much better, but it is definitely a nicer place,” said patient Renee Putnam, 31.

Patient Stava Rikai said he is reserving judgment on the quality of care delivered in the new facility. But he said the push for improved treatment has gained momentum in recent years with the creation of treatment malls, where patients gather during the day for therapy.

Development of the treatment malls ended the outdated practice of keeping patients cooped up on crowded treatment wards for therapy.

Therapists and mental health activists describe the treatment malls as a significant reform.

Maggie Bennington-Davis, a psychiatrist who runs Cascadia Behavioral Healthcare, a non-profit agency that provides community-based services for people with mental illness, sees signs that patients coming out of the hospital after stints of treatment are better prepared to resume their lives.

“It seems like people are readier, further down the road, in terms of thinking about their own recovery and being engaged in treatment,” she said. “So I think the treatment within the walls is probably improving. Certainly a new facility helps along those lines, especially when you’re moving out of a pretty awful old facility.”

As many people tell it, Greg Roberts, superintendent of the hospital since September 2010, has played a key role in turning around the hospital.

“Greg Roberts is persistent,” said psychologist Daniel Smith, who has worked at the hospital for eight years. “He is working with both unions here at the hospital and with the management staff to bring about change. In 18 months, he has brought more change than occurred here for quite some time.”

During Roberts’ tenure, the hospital has slashed the number of internal committees, filled long-vacant administrative posts, streamlined how patient privileges are determined and given patients more say about their own treatment.

Roberts also has pledged to reduce and eventually eliminate mandatory overtime, a promise that appeals to staffers who long have complained about mandated double shifts.

The hospital chief also has won over mental health activists who describe him as a skilled catalyst for positive change.

“He doesn’t accept pat answers, and he’s got some real social skills in terms of leadership that I haven’t seen in a superintendent previously,” said Beckie Child, executive director at Mental Health America of Oregon.

Unlike past hospital leaders, Roberts is no stranger to patients and staffers on the front lines of care, Child said.

“Greg is out walking the wards,” she said. “He comes at odd hours to see what’s happening at the hospital. That thrills me.”

History of Neglect

State leaders long turned a blind eye to institutional decay. They also neglected the human anguish that piled up like dirty laundry at the same hospital where “One Flew Over the Cuckoo’s Nest” was filmed in the 1970s.

Now, though, many people say the 129-year-old psychiatric facility is on the upswing.

“I think the most outstanding thing is that we’ve done away with the old Cuckoo’s Nest and replaced it with something that is more beneficial and more humane,” Rikai said.

Rikai, 29, moved into the new hospital this week, along with about 180 fellow patients. They made up the last wave of patients to exit old hospital units and settle into the new 620-bed facility.

For Rikai, preparing for the switch revived memories of the former hospital’s prison-like look and feel.

“It was just very oppressive,” he said. “There is no way that razor wire can be humane.”

Living conditions in the new hospital provide patients with more privacy and dignity, Rikai said.

Staffers agree.

Joe Thurman, a nurse who has worked at the state hospital for 15 years, described the new facility as “a godsend.”

“I’m glad they have it done,” he said. “I think our patients deserved better than (conditions at) the prisons, and we do have some good programs.”

Smith, the psychologist who has worked at the hospital for eight years, said staff morale has rallied amid the shift to modern facilities and a push to provide each patient with individualized therapy.

“As would happen with any facility, there’s some growing pains as we find out that there are some flaws,” he said. “Overall, it’s a tremendous benefit. We are better able to provide services. The environment itself is physically safer.”

With full occupancy of the 870,000-square-foot complex, Smith envisions the psychiatric hospital entering a progressive new era.

“We have, in general, more resident freedom on the grounds than at any other time in the history of the hospital,” he said. “We have more opportunities for community integration. And we are moving more toward a recovery model. And staff are embracing that model as they see it be successful.”

Talk of a turnaround at OSH is noteworthy, in part, because of its long-troubled history. Until recent years, state leaders ignored a litany of hospital problems, including severe under-staffing, high rates of patient-caused violence, security breakdowns and dangerous conditions in run-down buildings.

A multitude of flaws and failings were spotlighted in January 2008, when the U.S. Department of Justice issued a blistering report that criticized nearly every facet of patient care and hospital conditions.

Federal investigators urged the state to make sweeping improvements or risk being hit with a civil rights lawsuit that could put the institution under federal court control.

The harsh federal critique prompted state officials and legislators to allocate extra money for additional staffing and speed up other improvements.

Construction of the new hospital was green-lighted by legislators before the damning federal report. The building came on line in phased fashion, culminating in this month’s last round of patient moves into the completed facility.

Chris Bouneff, executive director of NAMI Oregon, short for the National Alliance on Mental Illness, expressed mixed emotions about the new facility.

“The Salem campus is not ideal,” he wrote in an e-mail to the Statesman Journal. “Congregate care for 620 people is never ideal. But without the reconstruction of the state hospital, providing any care would have remained impossible. You cannot heal when the physical environment is in shambles, nor can you provide proper care if your physical workplace is in such disrepair that it works against you.”

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by Chris Lehman, from National Public Radio, March 1, 2012

The tree in this courtyard was preserved when the previous State Hospital building was torn down to make way for the new one in the background. (Photo by Chris Lehman)

The Oregon State Hospital is just weeks away from opening the final wing on its newly updated Salem facility. But many of the beds will remain empty because of budget cuts pending in the Oregon legislature.

The new State Hospital includes common areas designed to maximize natural light. (Photo courtesy of the Oregon State Hospital)

About 180 patients are scheduled to move into the new wing later this month. The building largely replaces a crumbling brick behemoth that dated back to 1883. It became famous as the filming location for the movie “One Flew Over the Cuckoo’s Nest.”

State Hospital spokeswoman Rebeka Gipson-King gave me a tour of the new building. She says it’s designed to look less like a prison and more like a place where people get better.

“I think that really helps, for the recovery oriented environment, to not see that cyclone fencing and razor wire,” Gipson-King says. “Instead you have these very nicely landscaped outdoor areas where patients can go to have fun and relax.”

The new hospital is designed to house as many as 620 patients. But about seven dozen beds would remain vacant for the next year under a budget-cutting proposal in the Oregon legislature.

Hospital officials say the cut would reduce their ability to place new patients in the unit most suited to their needs.

The new wing of the Oregon State Hospital will be open for public tours Friday March 2nd from 1 until 6:30 pm.

See also:

Statesman Journal: State Hospital Nears Finish of New Facility

Oregon State Hospital Replacement Project: Oregon State Hospital – The Story of Baby Hercules

Mental Health Association of Portland: Oregon State Hospital Opens New Wing, Offers Public Tours, and More

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