The Norwich Hospital for the Insane opened in October, 1904. By September 30, 1905, 151 patients had been admitted. Ninety-five had been committed by probate court; fifty-five men and women had been transferred from Connecticut Hospital for the Insane; and one, was transferred from another hospital. Because only one building was ready for occupancy the Board noted that at the end of the year the Hospital was already crowded beyond the limits of safety.
Admissions continued to exceed discharges for the next twenty-five years peaking to a high of 1,115 during the fiscal year 1929. During the FY 1941, for the first time the discharges, 917, exceeded the admissions, 626. This difference of more than 46 percent might be attributed to and directly correlated with the administrative competency and expectations of Dr. Bryan. After 1941 admissions continued to accelerate and exceed discharges. This trend persisted until 1969.
The impact of decentralization in the late 60s was a vital factor which reversed the ratio of admissions to discharges. Another contributing factor was the transfer of many long term geriatric patients to local nursing homes. In FY 1969 the annual discharges, 4,659, exceeded the annual admissions, 4,471, by more than 4 percent. Thereafter the discharges exceeded admissions each year: by more than 7 percent in FY 1970; by almost 3 percent in FY 1971; and by 6.5 percent in FY 1972.
The daily average census ranged from a low of 120 during the first fiscal year ending in 1905 to a high of 3,186 patients at the close of FY 1955. There was a gradual annual decrease to 2,685 by June 30, 1960. During the next five years the daily average census fluctuated with a mean of 2,698 patients and thereafter steadily decreased to 1,148 patients by June 30, 1972.
The Hospital expanded from a single patient building located on approximately 100 acres in 1904 to a complex system of many buildings on hundreds of acres by 1972. Two patient buildings were added in 1905 and another in 1907. During the next eight years, thirteen buildings were erected for patients; the daily average census in 1913 was 998. By this time an administration building, three cottages for physicians, a carpenter and maintenance shop, a main kitchen, garage, laboratory, staff house and an employees' club house had also been erected and the inebriate farm and the Colony had been established. Between 1920 and 1930 seven new buildings for patients were completed and another building was purchased for patients' use. By 1930 the average daily census had reached 2,422.
In addition to the new patient facilities, two more cottages for physicians, a female employees' home, a paint shop, a greenhouse, a superintendent's residence, and two garages were built. From 1931 to 1939 only one patient building, Seymour, was constructed to house all the tubercular patients and the 'Pines' was closed. However, two more cottages for physicians, a male employees' home, and a nurses' home were also built.
For the next eleven years no construction took place. By the end of 1950 the average daily census had climbed to 2,799. Between 1950 and 1962 many new buildings were added to the already complex hospital. However, during this period whenever a new patient building was constructed, an old building was closed. After the Lodge Building was completed in 1956, patients from Butler, Cutter and Dix were transferred and these obsolete buildings were no longer used for patients. The Kettle Building was opened for patients in1959. During this same period a powerhouse, laundry, pumphouse, fifteen cottages for physicians, an incinerator, an Occupational Therapy Building, an employees' building, a chapel and a research and clinical laboratory building were also constructed. By this time the Norwich Hospital sprawled over 900 acres. By the end of 1972 only seven of the original buildings and one former employees' residence were in use for patients for a daily average census of 1,148.
Norwich Hospital over the years has been fortunate in having superintendents who were well qualified and interested in patients as people. The philosophy, attitudes and objectives of each Superintendent, to a great extent, determined and influenced the roles and functions of the staff. As a result innovative programs have been developed for both the patients and the staff. This has been accomplished in spite of the traditional budgeting problems inherent in any state hospital system where political and governmental priorities may change with each new administration. Public attitudes influence the legislators and have always played a major role in the ability of state hospitals to secure the necessary monies to implement changes.
From the time the Hospital opened, the Superintendents stressed the importance of education, if patients were to be treated effectively, and the necessity for having qualified staff. They tried to recruit experienced nurses and attendants with potentials for serving the mentally ill. Al- though they were not always successful, it seemed that adequate custodial care was provided by the nursing staff. During the early years emphasis was placed on the control of the patient's behavior. One of the first superintendents expressed the belief that the judicious use of mechanical restraint to protect the patient was preferable to chemical sedation. He also advocated hydrotherapy as an effective treatment measure.
During the next decade the number of personnel increased gradually to a high of 500 in FY 1932. More than 300, or 61 percent, were nursing employees and fifteen, or 3 percent, physicians. During this same period the daily average census steadily rose to 2,562, an increase of almost 85 percent. The associated increase in staff was more than 177 percent.
Although the total hospital staff figures are not available for the early years, by 1913 the staff numbered 180 for 918 patients, about one employee for every five patients. In1919, whereas the census had increased to 1,334, or by more than 45 percent; the total number of employees, 206, had increased by less than 15 percent. By FY 1921 the total number of staff had been decreased to 180: at that time, more than 69 percent were nursing employees; 5 percent, consisted of seven physicians, one social worker and one occupational therapist (a nurse); and 26 percent, supportive personnel. The daily average census during that year was 1,386. During the 1920s the number of social ser- vice workers fluctuated between one and four .
By FY 1941, the number of employees had increased to 641; almost 65 percent, nursing employees (52 nurses; 363 attendants); and slightly more than 2 percent, physicians. By FY 1938, the daily average census exceeded 3,000; by FY 1941, the census had decreased to 2,388.
World War II had considerable impact on the staff at Norwich State Hospital. By FY 1945, the nursing staff had been reduced by more than 57 percent: this represented a loss of thirty nurses and 146 aides and nursing employees for the first time accounted for only 44 percent of the total staff. Non-nursing staff during this same period increased by more than 32 percent. Meanwhile the daily average census fluctuated slightly and by FY 1945 increased to 2,574. Following the initiation of an affiliation for occupational therapy students in 1941, the number of occupational therapists increased and reached a peak of twenty-eight by 1945.
During FY 1942, three psychologists were employed; during the war years the number was reduced to one. By 1952, fourteen were employed; during the next decade the number was gradually reduced to nine.
During the next decade the total staff steadily increased and reached 1,078 by FY 1955: almost 56 percent were nursing personnel; this number included seventy-eight nurses and 522 aides, a ratio of one nurse to 6.7 aides. Other professional staff included twenty-seven physicians, ten psychologists, eleven social workers, eleven occupational therapists, one dentist and one pharmacist. The daily average census reached its highest peak at 3, 186 at the end of FY 1955.
During the decade ending on June 30, 1965, the total number of employees increased to 1,351. More than 58 percent were nursing personnel; this group included 110 nurses and 682 aides. During this period the number of nurses increased by more than 41 percent and the aides, by almost 31 percent. The number of physicians had increased to forty-seven; the psychologists had decreased to six; the social workers, to seven; the number of occupational therapists remained at eleven, and two pharmacists and one dentist were on the staff. The daily average census decreased by more than 17 percent to 2,635.
During the next three years the number of employees reached a high of 1,426; this number included 826 nurses and aides, or almost 58 percent. Physicians, psychologists, social workers, occupational therapists, pharmacists, and dentists accounted for almost 6 percent of the total staff employed on June 30, 1968. The daily average census had dropped to 1,973, or by slightly more than 25 percent since FY 1965. This was the lowest recorded census for more than two decades and was directly attributed to the reorganization of the Hospital in 1967. However, by FY 1969 the nursing staff had increased to 867; this number included 158 nurses, or slightly more than 18 percent, and 709 aides.
The decentralization of Norwich Hospital continued to have a significant impact on the average number of patients hospitalized. By June 30, 1972 the daily average census had decreased to 1,148, or by more than 49 percent since 1967. During this same four year period the total number of staff also steadily decreased to 1,248; a loss of almost 12.5 percent. On June 30, 1972 the staff included thirty-one physicians, a loss of 34 percent since 1965; eighteen psychiatric social workers, a loss of almost 22 percent since 1971; nine psychologists, a loss of almost 36 percent since 1963; eleven occupational therapists, a loss of almost 27 percent since 1963; thirty-two therapy aides, a loss of 36 percent since 1969; 120 nurses, a loss of almost 26 percent since 1970; 504 psychiatric aides, a loss of almost 29 percent since 1969. The clinical staff composed slightly more than 57 percent and the supportive staff, less than 43 percent of the total employee group. However, the number of non-clinical employees had increased by 9 percent since June 30, 1968. One may assume that the austerity program of the early 1970s was largely responsible for the appreciable decrease in the clinical staff and the increase in the lower salaried supportive staff.
Although following decentralization the daily average census had decreased by more than 49 percent, the increasing numbers of admissions and discharges, the shorter period of hospitalization, the development of special programs for alcohol and drug dependent and geriatric patients and the increasing emphasis on crisis intervention, day treatment, rehabilitation and aftercare services significantly increased the demands on the clinical staff. In addition the advent of the multidisciplinary teams created new pressures and forced the staff to assume new roles and responsibilities for which they were not always prepared.
Sporadic attempts were made for more than sixty years to provide educational programs for nurses and aides. The establishment of a Training School at the Norwich State Hospital in 1905 was an early attempt to increase the number of trained nurses on the staff so that more skilled nursing care and treatment could be provided for patients. This school had a turbulent history for the twenty-five years of its existence and was finally closed in 1930 because of its inability to comply with the standards established by the State Board of Nurse Examiners. Thereafter emphasis was placed on providing programs for the attendants who continued to administer most of the custodial care. These programs ranged from a few hours of orientation during the early years to seventy-five hours in the 1930s and early 1940s, given over a twenty-five week period. During the late 40s the program was increased to eighty hours which were given during a twelve week period. It wasn't until the sixties that a sophisticated pre-service thirty-four week integrated educational and clinical program for psychiatric aide trainees was implemented and continues to the pre- sent. The psychiatric aides who complete this program are prepared to give therapeutic nursing care to patients and develop meaningful interpersonal relationships with them. The emphasis remains on mobilizing the patient's healthy resources and helping him cope with daily problems.
Because of the psychiatric nursing program for basic nursing students Norwich Hospital has been able to recruit and retain many registered professional nurses. It is expected that they will function as effective therapeutic agents and serve as role models in the therapeutic milieu. However, intensive inservice educational programs and clinical supervision are provided to help them develop increased skill in their interactions and transactions with both the patients and the staff.
Since Dr. Martin was appointed Superintendent in 1966 his primary concern has been directed toward providing quality care for patients. All that he has endeavored to accomplish has been based on this concern and is reflected in the diversified programs which have evolved under his administration. Long a proponent for new and dynamic programs and for increasing freedom for patients, he has supported and encouraged innovative changes. He believes in a democratic administration and is responsive to both patients and staff. Requests to meet with community and hospital groups are always honored; he enjoys sharing his philosophy and his ideas with others. No student group is too small to warrant his attention and time. Because of his leadership and his advocacy for the mentally ill, Norwich Hospital is a place where people like to work and where the care of patients is given the highest priority.
Nurses at the Norwich Hospital have had a significant impact on the care of patients. Roles have progressed from one of a custodian to that of a therapeutic agent. Concomitant with the changing roles has come new and diversified responsibilities with accompanying accountabilities. The psychiatric nurse today is an active member of the multidisciplinary team and contributes to the creation and maintenance of the therapeutic milieu. She may also assume the role of a group therapist. If qualified as a nurse clinical specialist, she may function as a primary therapist or as a teacher and supervisor of other staff.
There are many who believe that State Hospitals have outlived their usefulness; that patients should be treated and maintained in the community. While this is a desirable goal for many patients, others, who require long term care and treatment, still can utilize the programs pro- vided within the State Hospital. Meanwhile the community has a responsi- bility to develop the kinds of supportive services that the discharged patients require. Traditionally the State has been expected to provide most of the services for its mentally ill citizens. However, it seems that the time has come when citizens and consumers in communities must collaborate with the State providers of mental health services to develop multi- dimensional treatment programs along the continuum for those who need them.
Today there are four nurses assigned full-time to three out-patient clinics where, in addition to the traditional nursing roles, they also participate in group and family therapy.
Norwich Hospital was the first state psychiatric hospital to initiate a formal referral program to Public Health Nursing Agencies for services to its patients before, during and after hospitalization. Four liaison nurses on the Norwich Hospital staff conduct this referral program which pro- vides continuity of services for the patients.
Two nurses work closely with the Social Service Department in preparing patients for placement in convalescent homes; they also provide consultation services to the staff in these facilities following placement.
Nurses at Norwich Hospital are involved in intensive rehabilitation programs and are active with other staff in preparing long-term patients to leave the Hospital. They work closely with various agencies in the community who also provide services for these patients. They also provide supportive services to discharged patients and, when necessary, visit their homes or places of employment thus helping to prevent rehospitalization.
These changing roles and responsibilities are a part of the community mental health center movement in general and also reflect modern philosophy of psychiatric nursing. These roles offer a greater challenge to the psychiatric nurse. Educational programs in psychiatric nursing also afford nurses greater opportunities to prepare for extended roles that will enable them to participate in the delivery of mental health services in varied settings.
Carini, Douglas, Heck, and Pearson, The Mentally Ill in Connecticut, 1974, p. 253