By Alan Sorensen
It was hoped that the staff and patients of Montana State Hospital would celebrate a big unveiling at Warm Springs in time for Christmas.
For now, though, the patients will have to be happy with the gifts they'll receive from family, friends and the Gifts With a Lift Program tonight and tomorrow.
A month or two from now, even Alan Arkin would be hard pressed to recognize the location of one of his more harrowing films.
Its location along I-90 between Anaconda and Deer Lodge and the oversized wooden sign at its entrance would probably be sufficient reminders for Arkin of the hospital from which he escaped in "The Other Side of Hell."
While about 25 years have elapsed since Montana State Hospital at Warm Springs was captured in Arkin's movie, little has changed in the physical appearance of the hospital until now.
Within a month, workers are expected to be finished putting the final touches on a building that has yet to be named but that will be the new centerpiece of the hospital's 388 acre grounds.
Located just behind the Multipurpose Building at the entrance to the state hospital campus, the building will house four of the hospital's five wards.
Each ward offers specific treatments for a population with mental conditions different from the others. The wards are acute, forensic, geriatrics, intensive treatment, and psychosocial.
"There are five separate treatment programs; each targets a specific population group," Ed Amberg, director of quality improvement and public relations, said. "Most patients are admitted to the acute psychiatric program which focuses on rapid stabilization of symptoms and preparation to return to the community.
"The average length of stay on that program is about 50 days."
There are two primary ways for people to be admitted to the state hospital and both are court-ordered by a judge. They can be ordered into the hospital as part of a civil action for treatment of a mental disorder or they can be ordered by a judge as part of a criminal proceeding.
Patients also may be admitted voluntarily after screening by staff to determine whether the admission is necessary and appropriate.
"Almost all patients are ordered by the courts through civil involuntary commitment procedures," Amberg said. "Those differ from criminal procedures in that a person is committed for treatment rather than because they have committed a criminal offense."
The hospital only serves adults of all ages. "An 88-year-old person was admitted the other day," Amberg said. The hospital is prohibited by state law from admitting people under 18.
The patients suffer from a wide range of disorders. The most frequent are schizophrenia, bipolar illness and major depression.
Elderly patients most often suffer from conditions associated with the aging process, such as Alzheimer's disease and other forms of dementia. It's not the conditions that require patients to be housed at Warm Springs, Amberg said, but their symptoms.
"The symptoms that result in behavior that causes the individual to be dangerous to themselves or to others," he said.
The hospital has been downsizing ever since Amberg arrived on campus almost 21 years ago.
"We have 168 patients today," he said. "They come from all across the state.
"When I got here in 1979, we had about 400 people on campus here and another 200 at Galen. We're hoping this downsizing will come to an end after we move into the new building.
"It is our hope that this will stabilize our organization and enhance our ability to provide quality patient care."
The downsizing has resulted from efforts to move mental health care from institutional-based to community-based programs.
The purpose of the hospital will never be completely negated by community programs because it affords levels of care that are not available in community programs or in community hospitals.
The hospital currently has five full-time psychiatrists on staff and one locum tenens psychiatrist working at the hospital on a temporary basis. There are also two primary care physicians on staff to help with the residents' physical health needs. Those needs are significant, Amberg said.
Total staff at the hospital consists of 398 full-time employees. That number is down about 50 from a year ago. Plans call for another 70 jobs to be cut when the staff move into the new building and other remodeled buildings.
Amberg said that hospital personnel encourage visitation by relatives and friends and that patients have a number of rights. They can receive and send mail and have access to telephones, just as patients in other health care facilities have.
"The hospital is very supportive of family visits and recognizes that many people have to travel a great distance to visit. We work with them to meet their needs."
The hospital is hooked into the statewide MetNet televideo system that Amberg said reaches into every corner of the state. It can be used to coordinate aftercare service, for family visits, and occasionally is used with the courts in the commitment processes.
The forensics program is a program for patients admitted through criminal court proceedings who may or may not understand the nature of their crimes. The security in the facility housing these patients -- Xanthopoulos Building -- is similar to that found in correctional facilities.
"Southwest Montana Regional Corrections has proposed using it for a regional jail which may also provide housing for state prisoners," Amberg said.
Approximately 25 percent of the patients at MSH are under criminal commitments or evaluations for competency.
"These are people deemed unfit to proceed with trial," Amberg said, "or found not guilty by reason of mental illness or guilty but mentally ill."
Amberg said the hospital used to conduct about 150 competency evaluations per year, but now processes only about 15 to 20 a year. Many of those who used to be sent to Warm Springs for evaluations are now evaluated locally by psychologists and psychiatrists.
When the hospital vacates the Xanthopoulos Building, that facility by law will become the property of the Montana Department of Corrections.
The forensic wing in the new hospital will have higher security than the other three wings, but will only have three secure cells. The nurses' station and reception desk in that wing also contain added security features included a sealed desk area. The rooms also provide extra security with steel mesh in the ceilings and extra secure glass in the windows.
"The hospital's rehabilitation programs focus on skill development that will teach people to live in the community with their disability," Amberg said. "The symptoms may not completely go away, but the individual can still live independently with treatment and support from aftercare providers in the community."
Among other buildings undergoing facelifts are the old geriatrics building which is being converted into a psychosocial treatment unit, the multipurpose building, and one patient unit that is being converted to administrative offices.
While the no-smoking policy for employees will remain in place on campus, some patients are allowed to smoke in certain outdoor areas because of the threat of violence.
Once the new building has been completed and the hospital has moved to the new facility, another major construction project will be proposed to the state.
Amberg said the campus contains numerous buildings, many which are already unoccupied and others that will be vacated when the new building opens for business in late spring or early summer.
"As the final piece of our campus redesign plan, we will be presenting a request ... for demolition of 15 unoccupied buildings," Amberg said.