Lighthouse Reflected LII

The following essay serves as Chapter 9 of One Grew Up in the Cuckoo’s Nest.

What Else was Found on the Sidewalk of Life?

Recollected and Written

by

Mark R Ellsworth

In Chapter 8 I shared memories, snippets of life at Medfield State Hospital, if you will. Here are a few snippets I didn’t share in Chapter 8. My album of yesterdays growing up in the Nest is almost complete.

While living on the grounds of Danver’s State Hospital, I have a memory of older kids inviting me to explore their hay bale tunnels. The tunnels snaked through the cavernous hay barn attached to the milking barn. I have memories of riding my bike through the back hay fields and into the woods that lined the Ipswich River. I can still conjure up images of a wooden shack and rickety board walks on the bank of that river. Through the fog of time I can still picture times where I accompanied my father with his long bow in hand on late summer early evening walks through Danver’s fields. He practiced with that bow on targets that were sometimes feathered. Occasionally he would hand me his bow. I remember his smile as he watched me labor to draw the bowstring back. To my regret he never saw me grow enough muscle to finally draw that bow string. At Medfield I have more memories that are short with no follow through. Memories of a person who wanted to not only leave the hospital but leave life young. Arms and legs covered with multiple one inch healed scars my memory. Later as an attendant, I learned those scars were the results of many needles forcefully slid into veins evidently with the hope they would travel to the heart. I have another recollection of a middle aged person who walked with a sad countenance. I learned later that the concave indentation on this person’s left temple was the result of a bullet aimed and fired. No shyness about sharing one’s feelings of failure during weekly group sessions, or so my snippet memory wants me to believe.

All said and done! In the early 1970’s change was rapidly manifesting and mental health care shed the brick structures born almost a hundred years before. This wind of change at the state hospital was called de-institutionalization. The powers that be decided that government should not be involved on a large scale, running and supporting these centralized mental health hospitals.

Myself, my siblings and my state hospital neighborhood friends were leaving our lives on the grounds of the state hospital to follow our young adult dreams. Whether those dreams involved new marriages, college, military service, or whatever we inhaled to tickle our fancies, us baby boomers moved away. In a few years our parents followed. The services for mental health morphed into neighborhood settings along with ambulatory surgery centers and other modalities. Mental healthcare was leading the rush to strip malls. Supported by changes in the insurance models that looked to become administered by HMO models, health maintenance organizations. New networks were born and the state, for the most part, was not included. DRGs became the bureaucracy’s tool funneling private, insurance and public tax monies into a spreading splintering acute healthcare industry. DRGs, diagnostic related groups, had dollar reimbursement amounts assigned as the new normal. I don’t want to get too far into the weeds of the structures of these financial reimbursement systems but a new cliche was born. People were being discharged quicker and sicker. Maternity, surgery, rehabilitation, chronic illness, and mental health care had been fiscally capitated. Insurance actuaries, and government bureaucrats decided case mix formulas that capitated reimbursement by diagnosis for long term care residents too. Health care administrators, boards of trustees and doctors were quick to adjust length of impatient days as it became clear the dollars paid for a person with certain diagnosis were set not by the number of days of care but the diagnosis of a person upon admission. Health care in Massachusetts and across our nation exploded into a web of specialties and the birth of the Internet ushered in new ways to navigate, or for too many people, ways to get lost in the world of pre-approvals. We had to get used to the doctors taking back seats to insurance companies as they predicated what care we might be able to afford. Mental health care splintered too.

Medfield State Hospital’s first stop was as a downsized nursing home. I believe Medfield for a time held a few criminal’s too. That also was short lived. The expansion of Medicare and Medicaid financing ushered in new, (for profit), 100 to 150 bed skilled nursing homes throughout the state. My family built facilities in Washington, Lenox and Westfield Massachusetts. My college studies in Education, English, and US history were left behind as I took a 45 year detour into healthcare administration.

I remember the first twenty, or so, residents admitted into our new (1971) Westfield facility were from former state hospitals in Northampton, Belchertown and other locales. These residents were of an older age and for the most part institutionalized from their many decades of living in large state hospitals. They were destined to live the rest of their days in these smaller facilities.

In summary, many patients of state hospitals were living in smaller neighborhood centers, or, if fortunate, with family members, or newly built nursing homes, or tragically, on the streets lucky to have a moment of their day in the warmth of a local McDonald’s.

Medfield State Hospital was finally sold to the town of Medfield. As I understand it, decisions are still being made on what to do with the property. Danver’s State Hospital was sold to private developers and high end condo’s replaced the Kirkbride’s building’s bat wings. All this still visible from Route 1 in Danvers. Other Danver’s acres, where I lived as a youngster at the bottom of the hill, were developed by new brick and mortar health care under the auspices of Mass General Hospital. ( Note; Health care is morphing again. The tentacles of a few teaching hospitals are reaching across our region absorbing the identities of former community hospitals. I do not pass judgement on this development one way or the other. )

Today mental health issues are more visible. Finding the care for mental health issues is not as visible. To be sure, the state still runs Bridgewater State Hospital for those with a diagnosis that is encapsulated by the moniker of criminal insanity. Their are a few private smaller mental health hospitals located in larger cities such as Boston. A few clinics are around and a few psychiatric beds can be located in the back halls of smaller hospitals. Therapies are prescribed more and more by pill. Therapy sessions abound and can be found in the yellow pages of the internet. So what’s the problem and if there is a problem, what is a possible answer?

I do not believe socialized medicine is the answer. I do believe in healthcare research and technological innovation. I do not believe in financing research and innovation through the lobbying and the lining of politicians’ pockets. So little of the health-care’s dollar spent actually reaches the patient’s bedside. This has always been the case since I became aware in the late 1960’s. To most of us, the healthcare system is, at best, scary. At worst healthcare can bankrupt us financially and emotionally. Mental health issues are too apparent, our media and social media explode daily with the tragic results.

Mental health issues have grown exponentially along with the growing number of the homeless throughout our country. Are the old state hospital’s the answer? No. I believe the answer is always, always found by looking within. The road to better health starts with each and every one of us walking with new lenses allowing us to step forward with clarity. As we walk down our life’s sidewalk do we walk with compassion and empathy or do we walk with frustration, closed minds or worse, anger? I believe healthcare needs to morph into a critical thought process that looks to support people with a goal of increasing quality of life. Not the reality we face today of a standard of living that is devolving into a shrinking life expectancy.

Thank you for reading.

Be in peace and joy!

Mark