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Community Exposure An Innovation in Treating the Mentally Disordered Offender By David L. Jewell If this man were moaning with pain from a mangled hand, any of us would have pity on him because we could see blood and tendon. But because his pain is internal and because he has injured others, he gets little pity. He needs treatment; he begs for it. But where shall we treat him ? Karl Menninger, M.D. INTRODUCTION: LOCATED AT CHESTER, on a scenic bluff overlooking the Mississippi River, is the State of Illinois' only maximum security hospital. Illinois Security Hospital has remained in the same location since its construction in 1891. However, it has alternately been under the jurisdiction of the Department of Public Safety, (now Department of Corrections) and the Department of Public Welfare. The Hospital is presently under the administration of the Department of Mental Health. Even though the facility has continually been referred to as a hospital, this was until recently a misnomer. As recently as the early 1960's, initial endeavors were made to develop the hospital or treatment concept and to eradicate the prison concept, or total emphasis on custodial care. The Hospital's leaders, by overcoming the obstacles of inadequate funding, lack of staff, and grossly inadequate facilities, have succeeeded in developing numerous progressive, therapeutic programs.
Front entrance to the Illinois Security Hospital located on a scenic bluff overlooking the Mississippi River of Chester, Illinois. Hospital Description: Illinois Security Hospital is structured to provide care and treatment to all adult males of the State of Illinois who are thought to be in need of a level of management and security which cannot be adequately provided in other Department of Mental Health facilities. The Hospital's present population of approximately 300 residents originates from two major sources: Those individuals being treated in other state hospitals or region centers who exhibit behavior and/or thinking processes perceived as being dangerous or potentially dangerous to themselves or others (Non-Mittimus) and those committed by the courts as incompetent to stand trial for a feloneous offense (Mittimus). Such offenders are committed to the Department of Mental Health for evaluation and treatment, to be returned to the courts for disposition of their charges when found to be competent. Also, a small percentage of residents are received from the Department David Jewell is Director of Activity Therapy at Illinois Security Hospital, Chester, Ill. and sits on the 1TRS Board of Directors. Illinois Parks and Recreation 8 July/August, 1972
of Corrections, Adult and Juvenile Divisions. A detailed description of Illinois Security Hospital's patient population is depicted in Table I. From such a population as described in Table I, individuals are selected by means of a highly structured screening process to participate in the Off-Grounds Trips Program. Admittedly, this may initially sound "old hat" to long term mental health and correctional professionals, but after considering the population involved the Program's uniqueness is apparent. In keeping with the Hospital's Behaviorally Contingent Unit System, only patients from the two higher level units, Units 4 and 5, are considered for participation in the Program. Patients are on these Units because they have developed behavioral controls which denote they no longer need the level of security of lower units. On these two Units, the residents are provided with a marked increase of privileges, namely, patient government, increased commissary, telephone calls, freedom to shower and shave as they wish, downtown food orders through the A. T. Department, radios, coffee pots, personal toiletries, color television, increased recreation, personal magazine and newspaper subscriptions, supervised shopping trips, remunerated work assignments, and, lastly, consideration for Off-Grounds Trips. Screening Procedures: The initial step in the screening of individuals for the Off-Grounds Trips is the selection of individuals deemed deserving by the Unit staff. The selection by staff is based primarily on behavior, including participation in Unit program, with no consideration of charges at this level. This list is then submitted to the Director of Activity Therapy, who in turn, submits a typed copy of the recommended patients, along with a list of confirmed staff to supervise the patients, to the Superintendent, Assistant Superintendent, Director of Programs, and Staff Psychiatrist. Some or all of these individuals will then review each patient recommended considering, not in order of priority:
1. Type of admission
An individual is usually disapproved if objections exist in any one or more of these areas. Occasionally, a patient who does not meet all of the criteria for participation may be allowed to go on a trip, depending on the staff assigned and the willingness of one of them to assume full responsibility for only this patient. A patient with charges, however, is not permitted to participate in out-of-state trips because of legal ramifications. Once the patients are selected from the list, the list is then returned to the Director of Activity Therapy for final drafting and distribution to other personnel. Other individuals involved in the preparation for the trips are the Unit Director, Mental continued on page 24 Illinois Parks and Recreation 9 July/August, 1972 CHESTER continued from page 9 Health Specialists, Unit Security Therapy Aides, Food Supervisors, Clothing Room Supervisors, Trust Fund Officer, Nursing Administrator, and the Unit Activity Therapist. These are key individuals in preparing the patient in terms of alleviating anxieties, necessary medications, clothing, finances, and food. Staff for the trips are selected with consideration of their physical condition, knowledge of the patients, and their willingness to participate in the trips. The supervisory staff usually consists of two Activity Therapists and three or four Security Therapy Aides, except on special trips which involves a large number of patients. The standard procedure is to have a one to one ratio of patients to staff. Objectives: The Off-Grounds Trips are structured to appear to the participant as a fun activity. This is not to demean the therapeutic benefits of fun. However, there are other specific therapeutic objectives inherent within the Program. These are: 1. To provide a situation by which to evaluate the patient's ability to tolerate the unstructured environment in another hospital or community. 2. To create an environment in which patients and staff can relate as people to people rather than in the patient to staff dichotomy. 3. To assist the patient in deminishing the hospital-community gap. 4. To make the patient aware of existing community recreational facilities and programs. 5. To make the patient aware of community life-styles, which in turn will hopefully motivate him to cooperate in other hospital programs. 6. To provide the patient an opportunity for "normal living" activities. 7. To provide the patient an opportunity for the development of proper social etiquette. 8. To provide the patient opportunities to benefit from cultural enrichment available in the community. 9. To develop within the individual patient an appreciation of his natural and national heritages. 10. To enrich the total institutional environment and provide a "natural" corrective to potential disciplinary problems. To summarize the objectives of the Program, two quotes are appropriate. The first quote is by Dr. Karl Menninger in his book "The Crime of Punishment." The second quote is by Dr. Maxwell Jones in his book "Social Psychiatry in Practice." What we want to accomplish is the reintegration of the temporarily suspended indiviual back into the mainstream of social life, preferably a life at a higher level than before, just as soon as possible. The high frequency of commitment procedures to state hospitals in America and the relative segregation of patients from the community must tend to keep alive in the public mind the fantasy of the dangerous lunatic and to heighten the feelings of rejection and despair in the patient. The quote by Dr. Menninger denotes the major goal of the Off-Grounds Trips Program. The quote by Dr. Jones denotes still another goal, which is to deminish within the patient the feeling of rejection and despair. Participating Patients in the Program: During the 1971 Off-Grounds Trips season, beginning in April and ending in November, ninety-eight individual patients participated in the Program. Of these, fifty were Mittimus and forty-eight were Non-Mittimus. Table II specifically defines the patients participating. The ninety-eight participants represented approximately 30% of the total hospitalized residents during the period from April 1, 1971 to November 30, 1971. This statistic is more significant since only patients from two of the Hospital's five treatment units are eligible for the Off-Grounds Trips Program. Description of Trips: During the 1971 season, a variety of trips were provided for the patients of Illinois Security Hospital. The forty-six trips were within the six categories of fairs (6), sight-seeing (18), fishing (13), St. Louis Cardinal Baseball Games (4), zoos (2), and Southern Illinois University Convocations (3). Fair trips were to two county fairs and to the DuQuoin State Table II: Summary of Patients Participating in Off-Ground Trips, 1971. Total Participants ........................................................ 98 Mittimus ........................................................................ 50 Non-Mittimus .............................................................. 48 Average Ages Total ............................................................................ 32.6 Mittimus .................................................................... 35.1 Non-Mittimus ............................................................ 29.9 Nature of Mittimus Charges Murder .......................................................................... 27 Attempted Murder ...................................................... 5 Sexual Offense ............................................................ 7 Assault or Battery ...................................................... 4 Burglary or Robbery .................................................. 4 Illegal Drugs ................................................................ 3
Illinois Parks and Recreation 24 July/August, 1972 Fair. The Activity Therapy Department received a great deal of cooperation from both county and state fair officials in terms of approval, free admission, and free seating for participants and supervising staff. The same cooperation was received from the zoos, St. Louis Cardinal Baseball Club, and Southern Illinois University Officials. On the trips to the zoos, the ballgames, and S.I.U., meals were in restaurants. For some of the participants, this was a first, especially for those from the ghetto areas. The sightseeing trips took advantage of the numerous points of historical interest and the many points of natural beauty characteristic of Southern Illinois. On these trips, the noon meal was usually a picnic at an area state park or conservation area. Occasionally, the meal would be in a restaurant. Chester is located in Randolph County, which fortunately has a lake and conservation area. Consequently, most of the fishing trips were to Randolph County Lake. However, a few fishing trips were to other area lakes such as Crab Orchard Lake and Little Grassy Lake, both located near Carbondale. On several occasions, Hospital staff volunteered the use of their own boats at no expense to the Hospital. Boat rides were another first for several of the participants. Life jackets were either provided by the boat owner or rented at a nearby dock. On all of the fishing trips, the noon meal was served picnic style. On all of the trips, however, participants were given the opportunity to make a side trip to a nearby drive-in or restaurant for refreshments. Evaluation: To contribute a patient's separation from the Hospital or his successful post-separation adjustment solely to the Off-Grounds Trips Program would be extremely difficult, even if attempted in the most judicious manner. That is, due to the intensity of the total institutional treatment framework, it would be rather presumptuous to contribute the patient's successful transition from Illinois Security Hospital to a hospital of lesser security, to court, or to the community solely to any one program. One measurement of the success of the trips were patient responses. Responses were recorded on a Patient Trip Evaluations Form on which the patients remarked about how they enjoyed the trip; how they felt about getting away from the Hospital; whether they noticed anything unusual; whether they would like another trip; and, what could be done to make the trip better. Some comments reported on these forms led staff to conclude that the trips met the stated objectives. Some of these comments were: 1. "The staff seemed to grow closer to the patients; more friendly in a way." 2. "I felt we all knew one another." 3. "I really felt like I again belonged." 4. "I enjoyed just being able to see open fields again." 5. "I felt a wonderful sense of freedom and pleasure." 6. "It gave me an opportunity to belong to society and to forget my problems for awhile." 7. "I had forgotten what it was like to spend real money." 8. "It was as though a huge weight had been lifted from my shoulders." 9. "Seeing other people have fun—that's what I really enjoyed." 10. "I met people I knew, and you know, they were friendly." 11. "It gave me incentive to work to get out; it makes you think." 12. "Seeing staff this way makes you trust them more." Not all comments were of a positive nature. Some patients recommended that more cultural activities be planned and that the Security Therapy Aides wear street clothing without their name tags. These patient recommendations were taken under advisement by the Director of Activity Therapy and favorably acted upon. One other evaluative measure of the trips was a Progress Note entry in each patient's Clinical Record by the Director of Activity Therapy. The Progress Note entry was made from verbal and written staff observations relative to the patient's personal appearance, general attitudes, interactions with other patients and staff, etcetera. In summation, Illinois Security Hospital's Off-Grounds Trips Program is unique by virture of the population it serves, the intensity of the Program, and the Hospital's not too distant past which emphasized only custodial care. The program began in 1968, with a steady yearly increase in the number of trips and participating residents. In relation to maximum security facilities, the Program apparently is the only existing one of this nature. It is a breakthrough for this type of individual—the mentally disordered offender. References Irvine, Lynn M., Jr., et.al. Program Description and Study, Part I, Descriptive Data, 1970 Treatment Programs. Unpublished Report. Illinois Security Hospital, Chester. January, 1972. Jones, Maxwell. Social Psychiatry in Practice, Penquin Book, Baltimore. 1968. Menninger, Kari. The Crime of Punishment, The Viking Press, New York. 1968. BIOGRAPHICAL INFORMATION PERTINENT TO ARTICLE 1. Currently Director of Activity Therapy at Illinois Security Hospital in Chester, Ill. 2. Currently serving on the NTRS Task Force on Correctional Recreation 3. Currently serving on the Illinois Department of Mental Health Activity Therapy Advisory Committee. Illinois Parks and Recreation 25 July/August, 1972 |
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