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Issue Papers - Mental Hygiene [re: closing State Mental Hospitals] (2 of 3)
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Issue Papers - Mental Hygiene [re: closing State Mental Hospitals] (2 of 3)
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Ronald Reagan Presidential Library
Digital Library Collections
This is a PDF of a folder from our textual collections.
Collection: Reagan, Ronald: Gubernatorial Papers,
1966-74: Press Unit
Folder Title: Issue Papers - Mental Hygiene
[re: closing State Mental Hospitals] (2 of 3)
Box: P31
To see more digitized collections visit:
https://reaganlibrary.gov/archives/digital-library
To see all Ronald Reagan Presidential Library inventories visit:
https://reaganlibrary.gov/document-collection
Contact a reference archivist at: [email protected]
Citation Guidelines: https://reaganlibrary.gov/citing
National Archives Catalogue: https://catalog.archives.gov/
Department of Mental Hygiene
March 20, 1968
PART I
COPIES OF SOME NEWSPAPER ARTICLES
ABOUT THE ANNOUNCEMENTS OF THE
NEW STAFFING STANDARDS AND THE
GOVERNOR'S 14-POINT PROGRAM.
THESE ARE REPRESENTATIVE OF THE
COVERAGE RECEIVED THROUGHOUT THE
STATE, MOST WERE ON PAGE 1.
PART 11 EDITORIAL COMMENT
PART III COMMENTS BY HOSPITAL TRUSTEES
PART IV COMMENTS BY PSYCHIATRIC SOCIETIES
PART V COMMENTS BY CITIZEN ORGANIZATIONS
PART VI COMMENTS BY HOSPITAL STAFF
#
-
PART I
Newspaper
Articles
on
Announcements
THE SACRAMENTO BEE
Friday, February 23, 1968
Adopted 'In Principle'
Mental Hospitals Staffing
Rules Win Reagan's OK
The adoption "in principle" of
obsolete in the light of medical
cause one of the hospitals is lo-
staffing standards for state men-
progress and particularly be-
cated in his home town of Mo-
tal hospitals set last year by
cause of the increased empha-
desto, said he is "encouraged"
the California Commission on
sis on local treatment of the
by the governor's announcement.
Staffing Standards was an-
mentally ill," Reagan said.
However, he tempered his en-
nounced today by Gov. Ronald
"We will begin putting these
couragement with the comment:
Reagan.
new standards into effect par-
"I believe that to reach the ac-
James Shumway, assistant to
tially with funds saved by econ-
cepted standards
would re-
Spencer Williams, secretary of
omies in the department."
quire an over-all increase of ap-
h u m a n relations, said the
Significant Gain
proximately 35 per cent in the
standards represent a "goal to
"All mental hygiene organiza-
number of personnel.
work for" and will take consid-
tions and persons knowledge-
"Therefore, we have a ques-
erable time for full implementa-
able in the field of mental hy-
tion not only of finding the ade-
tion. He stated the standards
giene have enthusiastically sup-
quate finances but also of finding
call for increasing the ratio of
ported the n e W standards,"
the people to fill these additional
staff to patients and will mean
Shumway said. "Adoption of the
positions."
the employing of more people.
standards in principle repre-
Staffing Problem
The standards were proposed
sents one of the most signifi-
Last February the special
in February 1967 by the com-
cant forward steps in the treat-
commission studying the state
mission, which was created by
ment of the mentally ill and
hospital staffing standards re-
the legislature to make a study.
mentally retarded of any state.
ported a lack of adequate pro-
It included work by Aerojet-
"Furthermore, when imple-
fessional help was handicapping
General Corp., the California
mented, the standards, based on
the treatment of mental pa-
Medical Association and others.
the availability of personnel and
tients.
In Phases
facilities, will enable the Depart-
The commission, headed by
Implementation of the stan-
ment of Mental Hygiene to better
Dr. Stuart Knox of Los An-
dards, the governor said, would
understand what each individual
geles, represented the California
be carried out in phases con-
patient needs. They also will en-
Medical Association.
sistent with sound hospital and
able us to treat the hard-core
It called for junking the pres-
management practices.
mentally ill who will always
ent ratio system and said hos-
He stated he has instructed
need hospitalization. It will be a
pitals should use "a flexible
Spencer Williams and Dr. James
long-term program. It cannot be
system to permit staffing based
V. Lowry, director of mental
done overnight."
on patient needs to allow pro-
hygiene, to set up a timetable
Williams and Dr. Lowry were
fessional disciplines to be used
for putting the standards into
not available for comment.
interchangeably and to permit
effect.
Assemblyman John G. Vene-
particular services or time al-
"The existing standards should
man, R-Stanislaus County, who
lowances to be readily subtract-
be replaced by the new stan-
has followed the mental hospital
ed, added, adjusted or elim-
dards because they have become
staffing standards closely be-
inated."
Dr. Cook called the new pro-
Reagan
Plans
gram a "very good step forward
at least to set a standard, but
predicted it would "probably
be quite some time" before it
was fully implemented.
Gov. Reagan in his announce-
ment said implementation would
Changes
be conducted in phases based
on a timetable to be determined
by Human Relations Secretary
Spencer Williams and Depart-
ment of Mental Health Director
At State Hospi
James Lowry.
He also acknowledged that
"in the light of medical progress
and particularly because of the
r
increased emphasis on local
treatment of the mentally ill."
)
The new Reagan program also
New Staffing Ratio
The Reagan spending mea-
includes plans to increase the
sure for the next fiscal year
also increased the Department
space per patient ratio from
OK'd 'In Principle'
of Mental Health allocation $6.9
55 to 70 sq. ft. to conform
with national standards.
million to $224 million.
According to Dr. Butler, that
By PETER GOLIS
According to Dr. George But-
Dr. Butler predicted that the
would require a decrease of
Major revisions in California's
ler, associate superintendent at
new thrust would be geared
1,000 patients at Eldridge if
massive program for the men-
Eldridge, "over 400" additional
"primarily toward keeping the
present space was to be accom-
tally retarded and mentally ill
medical staff members would
staff rather than laying them
modated.
appear to promise significant
be placed on the payroll if the
off as the patient load de-
He also noted that that po-
improvement for patient - staff
recommendations were to be
creased."
tential 1,000 patient cut would
ratios at the state's 11 mental
implerzented immediately for
He expected no increase in
bring the staff size into agree-
institutions - and especially
the present patient load.
the staff's size - only in the
ment with the new staffing pat-
at Sonoma State Hospital in
The hospital for the retarded
staff-patient ratio.
tern.
Eldridge.
However. administrators at
Dr. Cook said a reduction of
But the timing on the changes
presently has some 1,400 nurses,
both state hospitals in the Red-
only 140, however, would meet
S not been revealed, and may
psychiatric technicians, physi-
wood Empire expressed satis-
the new ratio for the Talmadge
not occur soon.
cians, social workers, and psy-
faction with the new proposals
hospital for the mentally ill.
Gov. Ronald Reagan yester-
chologists earing for its 3.400
in the aftermath of a year of
And, Dr. Klatte, said, "be-
day disclosed the principal fea-
patients.
controversy.
cause of decreasing populations,
tures of the re-tooling, which he
There are close to 2,000 em-
It began last May with the
most hospital are already at the
called a "comprehensive pro-
ployes in total.
governor's highly publicized job
70-foot factor."
gram aimed at continued im-
However, Gov. Reagan said
cuts in the system. and climaxed
Other key features of the new
provement in the level of care."
that the changes would be com-
in October when a Danish of-
program are:
1
pleted "in phases consistent with
ficial lambasted the level of
1
--Establishment of two ad-
It includes "adoption in prin-
cipal" of staffing standards
sound hospital and management
care at Sonoma State Hospital.
ditional mental retardation cen-
recommended last year by the
practices.
Dr. Ernest W. Klatte, super-
ters. Their locations were not
California Commision on Hos-
Undoubtedly, that also means
intendent and medical director
disclosed in the report.
t
pital Standards.
implementation as money be-
at Mendocino State Hospital at
-A determination of which
comes available for development
Talmadge, said he was "quite
hospital facilities should be
The system is presently op-
of new programs at other hos-
pleased" with the governor's
y
phased out or eliminated ac-
erating on a set of staffing
pitals as well as at the local
action, but said he was not
cording to basic changes in the
standards enacted in 1952.
level.
patient load because of greater
sure how MSH fell in line with
a
That formula has long been
With the concurrence of medi-
emphasis on local care a n d
the 1967 commission standards.
1,
treatment.
the target of criticism from
cal experts, the governor said
He did say, however, that on
d
as early as last year that small-
-Gradual elimination of out-
state staff people and adminis-
an average the state hospitals
trators, and medical groups,
er and localized centers were
dated functions such as farming
were within 80 per cent of the
public and private, who believe
the financial and medical so-
operations at some hospitals.
new recommendation.
7:
it is totally out of date.
lution to the overburdened hos-
Mendocino State Hospital re-
pitals.
The Mendocino hospital for
i,
cently acquired the Napa State
Many have even said that it
the mentally ill has about 1.650
n
Increases
Hospital dairy, and also culti-
was inadequate when it was
patients. and 650 medical staff
L-
established in 1952.
Some $29.4 million - an in-
vates a few acres of orchards.
members according to the as-
i-
crease of $4.6 million - is in-
Sonoma State Hospital also
Most likely to benefit from
the new employe pattern pro-
cluded in his budget this year
sociate superintendent, Dr. W.
operates a dairy, although its
S. Cook
r
for state aid to local mental
hog ranch was phased out in
posal is Sonoma State Hospital,
Its patient load includes sev-
e
health programs under the
July, as were its chicken ranch
the largest mental institution
eral specialized programs for
d
the western United States,
Short-Doyle Act.
and orchards eight years ago.
alcoholics, drug addicts. geri-
h
-Creation of a board of medi-
which already has a payroll of
atric patients. and juveniles.
t,
cal visitors for each hospital
more than S1 million monthly.
h
for continued review, and cre-
SANTA ROSA PRESS DEMOCRAT
ation of an advisory committee
February 25, 1968
to the governor on mental
health.
-Inspection of hospital by the
department of general services
to insure proper maintenanen
Efficiency Discussed
A number of the points
in the program had to do
Los Angeles Times
SUN., FEB. 25, 1968.
with improving the effi-
ciency of operation of
For more than a year, mental
state hospitals.
Reagan Outlines
health leaders have been charging
Spencer Williams, state
that Reagan's actions in that field
health and welfare admi-
have done more to destroy than
nistrator, was instructed
improve the state's reputation in
to determine why there
14-Point Program
mental illness treatment.
are "major quality varian-
Questioned Saturday, some leaders
ces among the mental
interpreted the two announcements
hospitals and to find out
within two days as indications that
why some are not operat-
for Mental Health
the governor "may be beginning to
ed as well or as efficiently
see the light."
as they should be."
He also called for action
BY HARRY NELSON
Presidential Ploy Feared
aimed at determining at
Times Medical Editor
There was still considerable skep-
the earliest date "what
Gov. Reagan Saturday announced
ticism, however. Some felt he may
hospital facilities should
be seeming to warm up to mental
be phased out or eliminat-
a 14-point program aimed at tighten-
health only because the bad publici-
ed in the light of basic
ing up the efficiency and quality of
ty he has been getting could harm
changes in the patient
care at state mental hospitals.
his chances for the Presidency.
load because of greater
His announcement came as a
The consensus seemed to be:
emphasis on local care and
surprise to mental health authori-
"Let's wait and see what happens
treatment."
ties.
next. If he backs up his support with
Another goal is to eli-
Among the key points in the
more money, perhaps we can begin
minate outdated functions,
program are establishment of two
to believe he has really had a change
such as farming opera-
new mental retardation regional
of mind."
tions at some of the hospi-
One of Reagan's 14 new recom-
tals.
centers, plans to phase out certain
hospital facilities and services and a
mendations was "a reevaluation of
The practice of perform-
restatement of the importance and
the budget for mental health in the
ing surgery at some of the
desirability of local care and treat-
Please Turn to Page 15, Col. 1
hospitals, particularly
those where better treat-
ment.
ment for the patients can
Reagan last summer vetoed a bill
be obtained nearby at less
that would have created two new
Continued from First Page
cost, also will be phased
mental retardation regional centers.
out.
At that time he said he favored them
light of the most up-to-date
but lacked the funds.
information available,
Surveys Backed
Observers noted Saturday that the
based on need as well as
Reagan said that stan-
proposed 1968-69 budget contains no
dards requiring 70 square
resources available," ac-
provision for the two regional
feet of space per patient
centers.
cording to the announce-
bed will be immediately
Announcement of the program
ment.
established. (Actually, this
came immediately after an an-
Another recommenda-
order has already gone
nouncement Friday that his Admi-
tion emphasized the impor-
into effect.) For the past
nistration has approved in principle
30 years, the state stan-
new staffing standards aimed at
tance of local programs, in
dard has been less than 55
upgrading the quality of care in the
contrast with state hospi-
square feet per bed.
state's 14 hospitals.
tals, for the treatment of
He also called for
Old Criteria Replaced
the mentally ill and re-
streamlining of adminis-
trative functions and crea-
The new standards, which presu-
tarded. He reendorsed a
tion of a board of medical
mably are in effect now, junk
recommendation original-
the obsolete 1952 standards which
ly made last May which
have long been an object of criti-
called for the kind of
cism. The new standards were
recommended a year ago by a
treatment that will keep
special commission.
children patients in school
Mental health and mental retard-
and adults at home and on
ation leaders applauded Reagan's
the qob, whenever possi-
decision to adopt the new standards.
The commission found that the
ble, rather than "ware-
overall deficit of help was 32% in
housed" in state hospitals.
hospitals for the mentally ill and
The governor said these
38% for the retarded.
goals have been acclaimed
"It is apparent that if California is
by leaders in the mental
to remain in the forefront among the
health field.
states in its treatment of the
mentally ill, continued efforts must
be made to stay abreast of new
methods and changing standards,"
the governor said after release of the
14-point program.
CONTINUED
LA Times
2-25-68
Reagan Outlines Plan
to Improve Hospitals
visitors for each state
mental hospital to insure
surveys and inspections of
hospital buildings by the
state's share of the Short-
year-coupled with great-
moving forward with a
Department of General
Doyle Act budget. This is
er emphasis on local treat-
positive and progressive
Services. (Poor mainten-
the program that helps
ment financed in large
plan-one which expands
ance has been a major
support community men-
measure by the state-will
and further implements
complaint of hospital per-
tal health programs, with
now permit us to devote
the concept of local care
sonnel.)
25% of the aid coming
more of our resources for
for the mentally ill wher-
He also plans to set up
from the counties.
the more difficult cases
ever possible.
an advisory committee to
"Many of the problems
"Under this program,"
remaining in our hospi-
of our mental hospitals,
the governor on mental
Reagan said, referring to
tals.
permitted to grow in se-
health. There were no
his 14 points, "we will be
."We cannot be satisfied
riousness over the years,
details as to who would be
able to proceed on a solid
with outmoded programs.
are now catching up with
on the committee.
basis for even more im-
Rather, we must continue
us," Reagan said.
I
Reagan renewed instruc-
provements in the pro-
tions to Dr. James Lowry,
grams at our mental hospi-
director of the Depart-
tals-improvements in si-
ment of Mental Hygiene,
tuations that have needed
that he still has "complete
improving for years.
discretion in maintaining
"We have always known
the staffing requirements
that problems in our men-
and levels of care of
tal hospitals go beyond
patients."
mere budgetary factors.
This was interpreted by
Many of the economies we
some observers as mean-
have achieved over the past
ing that there probably
will be no further layoffs
of state hospital personnel.
In the past year, since
Reagan announced his
mental hygiene cutbacks,
the department has lost
2,200 employe positions.
Percentage Declines
A department spokes-
man said the hospitals for
the mentally ill are at 79%
of the nursing standard as
recommended by the 1967
California Commission on
Staffing Standards. By
last July the nursing level
had dropped to approxi-
mately 75% after having
been at 81% when the
commission made its re-
commendations.
Experts estimate that
the level of nursing care
would be at least 90% by
now if the cutbacks or-
dered by Reagan last year
had not occurred. This is
because the hospital popu-
lation has dropped approx-
imately 3,300 in the past
year to 19,779 patients.
Earlier this month, Rea-
gan announced that his
1968-69 budget includes a
$4.6 million increase in the
Reagan unveils program
for state mental hospitals
SACRAMENTO (UPD - Gov. Ronald
Reagan disclosed yesterday details of
what he called "a comprehensive pro-
RIVERSIDE ENTERPRISE
gram aimed at continued improvement
2-25-68
in the level of care for patients at
state hospitals for the mentally ill."
One of the principal features of the
program was announced earlier. This
was "adoption in principal" of new
staffing standards recommended last
year by the California Commission on
Hospital Standards.
"Implementation of these stand-
ards will be in phases consistent with
sound hospital and management prac-
tices," the governor's report said.
Some of the key features of the
program are:
SAN RAFAEL I NDEPENDENT-JOURNAL
Establishment of two addition-
al mental retardation centers. Their lo-
2-26-68
cation was not disclosed in the report.
A determination of which hos-
pital facilities should be phased out or
eliminated according to basic changes
Reagan Eases Funding
in the patient load because of greater
emphasis on local care and treatment.
Gradual elimination of out-dat-
Ax On Mental Health
ed functions such as farming opera-
tions at some of the hospitals.
SACRAMENTO (AP) - A
Increasing from 55 to 70
major reform of California's
year. he vetood a proposal for
three similar centers.
square feet the standard for space per
programs for treating the men-
patient bed to conform with nationally
tally ill has been announced by
Reagan explained the major
accepted standards.
Gov. Ronald Reagan.
overhaul "must be made to stay
Creating a board of medical
abreast of new methods and
The plan, announced yester-
visitors for each state mental hospital
changing standards. We intend
day. includes many recommend-
for continued review and creation of
to keep moving forward with
ations of volunteer mental health
the emphasis on modern. local
an advisory committee to the governor
groups, professionals in the field
on mental health.
treatment so that the mentally
and doctors. It came just as the
Inspection of hospitals by the
ill can resume their role as use-
California Medical Association
ful and productive citizens."
department of general services to in-
was putting the final touches on
Most of the efforts will con-
sure their proper maintenance.
its own study of treatment for
"Many of the problems of our
centrate on the 20,000 residents
the mentally ill.
mental hospitals permitted to grow in
of hospitals for the mentally
seriousness over the years are now
Reagan's holddown on spend-
ill - those who usually can be
catching up with us," Reagan said.
ing for the mentally ill last
returned to lead a reasonably
year and proposed continuation
normal life in society. This has
"The time is long overdue for action
of it in the coming fiscal year
been the chief target of the
designed to stop the warehousing of
the mentally ill. We must concentrate
has provoked one of the most
governor's economy program.
on helping them lead productive
vigorous battles of his adminis-
He also proposed, however,
lives."
tration. Since many of the plans
additional aid for the 13,500 men-
The governor said under his pro-
announced over the weekend
tally retarded - those who need
gram "we will be able to proceed on a
will carry a substantial cost, it
hospitalization and close super-
solid basis for even more improve-
appeared the administration
vision. Reagan's cost-cutting
was relaxing its economies in
campaign has not been aimed
ments in situations that have needed
the mental health area.
at this group.
improving at our mental hospitals."
"We have always known that prob-
For instance, the proposal
lems in our mental hospitals go beyond
calls for establishment of two
mere budgetary factors," he added.
new regional centers to treat
the mentally disturbed. Last
Feb. 28, 1968
tried to say this in the face of
Reagan Says No New Funds
screaming and wailing going on
but nobody seemed to want
Seen for Mental Hospitals
to listen."
Reagan added "now maybe
they'll find out the sky wasn't
SACRAMENTO (AP) - Gov.
said he would establish two
falling in after all."
Reagan said yesterday he will
more regional centers for the
He did not specifically say
not add any money to his 1968-69
mentally disturbed.
how his reforms would be fi-
budget for his major mental
Yesterday, he said his budget
nanced.
health reform program.
is adequate to pay for the new
His program was an extensive
"I don't think it's necessary,"
program. even though the spend-
one, announced just as the Cal-
he told his news conference.
ing program continues some
inornia Medical Association was
cutbacks in personnel at hospi-
putting the final touches on its
Sunday, the governor, under
tals for the mentally ill.
own mental health study.
fire for his mental health bud-
Reagan conceded that putting
He proposed increased in-
get cutbacks of 1967, announced
new staffing standards into ef-
spection of mental hospital fa-
he would overhaul mental
fect will be a "long and dif-
cilities; an early decision on eli-
health care.
ficult" job.
minating unneeded hospitals;
But he said the reforms were
cutting out farming and other
He junked old staffing stand-
his answer to those who criti- hospital industries he considers
ards criticized by mental health
cized his economies. He declared outdated: cutting down the num-
groups as not permitting enough
he had always said the cutbacks ber of beds in wards, and possi-
staff for proper care. And he were only temporary, and "Ebly increasing hospital staffs.
Riverside Enterprise
2-24-68
State adopts new staffing
rules at mental hospitals
SACRAMENTO (UPD) - Gov. Rea-
conducted in phases based on a timeta-
gan said yesterday the state has aban-
ble to be determined by Human Rela-
doned patient-staff ratio staffing stand-
tions Secretary Spencer Williams and
ards at mental hospitals and adopted
department director James Lowry.
new standards set by a special com-
He called the current standards
mission.
adopted in 1952 obsolete "in the light
The new standards are based on
of medical progress and particularly
how much care an individual patient
because of the increased emphasis on
needs as measured by the time neces-
local treatment of the mentally ill."
sary for his care and treatment, a De-
The spokesman said an aerospace
partment of Mental Hygiene spokes-
firm used computers to help determine
man said.
the nursing time actually needed for
Reagan, whose cutbacks in funds
patient care. The existing staffing
for mental hygiene stirred a bitter con-
standards are based on the number of
troversy last year, said implementa-
patients to number of hospital staff
tion of the new standards would be
members.
State Adopts
Bellflower,
Standards for
Vallejo Times Herald
Herald-American
2-25-68
2-29-68
Mentally III
La Mirada
Governor Ronald Reagan
Improved
Herald-American
announced the administration
has adopted in principle the
Downey, Pico
staffing standards for state
Rivera
mental hospitals set in 1967
Program
by the California Commission
Heald-American
on Staffing standards.
Implementation of the
For Care
North Long
standards, the governor said,
Beach
would be carried out in pha-
SACRAMENTO (AP) - Gov.
Herald-
ses consistent with sound hos-
Reagan's administration said
American
pital and management prac-
Saturday it has drawn up a new
tices.
program for improved mental
Governor Reagan said he
health care, including possible
has instructed Spencer Wil-
elimination of some hospital fa-
cilities.
liams, secretary of human re-
lations, and Dr. James Low-
The program included Rea-
ry, director of the depart-
gan's announcement Friday that
ment of mental hygiene, to
his administration will adopt "in
set up 3. timetable for putting
principle" the standards calling
for more staff members to care
the standards into effect.
for mental hospital patients.
The governor said the 1952
State officials said the cost of
standards should be replaced
the improvements and the num-
by the new standards because
ber of new employes needed
they have become obsolete in
could not be determined im-
the light of medical progress
mediately.
and particularly because of
Last year Reagan announced
the increased emphasis on lo-
cutbacks of 2,800 jobs in state
cal treatment of the mental-
mental hospitals. He said im-
ly ill.
proved treatment and increas-
"We will begin putting these
ing local care for mental pa-
new standards into effect par-
tients reduced the need for state
tially with funds saved by
hospital staff.
economies in the department,"
2 NEW CENTERS
the governor said.
The governor's new program
includes two new mental retar-
dation centers, surveys of each
mental hospital and "action
aimed at determining at the
Reagan OKs More
earliest date what hospital fa-
cilities should be phased out or
Pasadena
eliminated in the light of basic
Star News
Hospital Employes
changes in the patient load be-
2-24-68
cause of greater emphasis on
local care and treatment."
SACRAMENTO (AP) - An increase in the num-
The governor's report Friday
ber of state mental hospital workers per patient has
said the "obsolete 1952 standards
been proposed by Gov. Reagan, who last year
for staffing hospitals for the
slashed their staffs in a controversial economy
mentally ill" would be eliminat-
move.
ed in favor of standards advo-
A statement from Reagan's office said the ad-
cated in 1967 by the California
Commission on Staffing Stand-
ministration has "adopted in principle," guidelines
ards.
set last year by the California Commission on Staff-
A representative of the Cali-
ing Standard.
fornia Association for Mental
However, neither the number of employes to be
Health called the adoption of the
restored nor the cost of the additions were revealed
new standards "a critical step
forward to providing adequate
as Reagan administration prepared a comprehen-
care and treatment for a large
sive program for improving mental hospital care.
segment" of the mental ill.
"There will be an increase in the number of staff
The association had criticized
people per patient," said an aide to Spencer Wil-
Reagan's staff cutbacks last
liams, secretary for human relations. The aide add-
year. But the group had no im-
ed that the program wouldn't go into effect until the
mediate comment on the gover-
fiscal year starting July 1 as it will need legislative
nor's full program for mental
approval.
health care.
Major Reforms Urged
Reagan Plan
In Treating Mentally
Unveiled for
SACRAMENTO (AP) - A Reagan's holddown on spend-
Mentally III
major reform of California's
ing for the mentally ill last
programs for treating the men-
year and proposed continuation
Governor Reagan disclosed
tally ill has been announced by
of it in the coming fiscal year
Saturday details of what he
Gov. Reagan.
has provoked one of the most
called "a comprehensive pro-
The plan, announced Sunday,
vigorous battles of his adminis-
gram aimed at continued im-
includes many recommendations
tration. Since many of the plans
provement in the level of care
of volunteer mental health
announced over the weekend
for patients at state hospitals
groups, professionals in the field
will carry a substantial cost, it
for the mentally ill"
and doctors. It came just as the
appeared the administration
California Medical Association
was relaxing its economies in
One of the principal features
was putting the final touches on
the mental health area.
of the program was "adoption
its own study of treatment for
For instance, the proposal
in principal" of new staffing
the mentally ill.
calls for establishment of two
standards recommended last
new regional centers to treat
year by the California Commis-
the mentally disturbed. Last
sion on Hospital Standards.
year, he vetoed a proposal for
Some of the key features of
three similar centers.
the program are:
BURBANK REVIEW
Reagan explained the major
-Establishment of two addi-
overhaul "must be made to stay
2-26-68
abreast of new methods anc
tional metal retardation centers.
changing standards. We intend
-A determination of which
to keep moving forward with
hospital facilities should be
the emphasis on modern, loca
phased out or eliminated ac-
treatment SO that the mentally
cording to basic changes in the
$
ill can resume their role as use-
patient load because of greater
ful and productive citizens."
emphasis on local care and
Most of the efforts will con-
treatment.
centrate on the 20,000 residents
-Gradual elimination of out-
of hospitals for the mentally
dated functions such as farming
ill - those who usually can be
at some hospitals.
returned to lead a reasonably
-Increasing from 55 to 70
normal life in society. This has
square feet the standard for
been the chief target of the
space per patient bed.
governor's economy program.
-Creating a board of medi-
cal visitors for each state men-
tal hospital for continued re-
view and creation of an advi-
sory committee to the governor
on mental health.
-Inspection of hospitals by
the Department of General
Services to insure proper main-
tenance.
SACRAMENTO UNION
2-25-68
SAN MATEO TIMES & NEWS LEADER
2-26-68
Major Reform in Program
For Treating Mentally III
SACRAMENTO (AP) ****
A
Most of the efforts will con-
medical visitors for each state
major reform of California's
centrate on the 20,000 residents
hospital to keep an eye on day-
programs for treating the men-
of hospitals for the mentally
to-day operations.
tally ill has been announced by
Gov. Reagan.
ill - those who usually can be
Other Features
The plan, announced Sunday,
returned to lead a reasonably
Other major features of the
plan:
includes many recommendations
normal life in society. This has
of volunteer mental health
- Increased inspection of hos-
been the chief target of the
groups, professionals in the field
pital facilities by the state.
governor's economy program.
and doctors. It came just as the
- Orders to state officials to
California Medical Association
He also proposed, however,
find out why the quality of care
was putting the final touches on
additional aid for the 13,500 men-
varies among the 14 hospitals.
its own study of treatment for
tally retarded - those who need
- Early determination of
the mentally ill.
hospitalization and close super-
which hospitals can be eventual-
Reagan's holddown on spend-
vision. Reagan's cost-cutting
ly eliminated as the emphasis
ing for the mentally ill last
campaign has not been aimed
on local treatment increases.
year and proposed continuation
at this group.
- Eliminating outdated prac-
of it in the coming fiscal year
The governor noted his econo-
tices at some hospitals, such as
has provoked one of the most
my drive of the last year, and
uneconomic farming operations.
vigorous battles of his adminis-
said savings from it "will now
- Phasing out of surgical
tration. Since many of the plans
permit us to devote more of our
facilities at some hospitals.
announced over the weekend
resources for the more difficult
- Revision of the standards
will carry a substantial cost, it
cases remaining in our hospi-
on square feet of space per bed.
appeared the administration
tals that were developed in 1952
The state standard has been
was relaxing its economies in
and have been criticized bitterly
about 55 square feet for 30
the mental health area.
by mental health groups. In-
years. compared to the national-
New Centers
stead, Reagan said, the state
ly desirable standard of 70 feet,
For instance, the proposal
will adopt "in principle" stand-
which the state will seek to im-
calls for establishment of two
ards for care proposed in 1967
plement.
new regional centers to treat
by a blue-ribbon commission.
- Adoption of clear, defined
the mentally disturbed. Last
Another chief demand, espe-
goals for treating mentally dis-
year, he vetoed a proposal for
cially of volunteer groups who
turbed persons.
three similar centers.
have relatives in the hospitals,
- Permission to increase the
Reagan explained the major
also was granted by Reagan.
hospital staffs if required to
overhaul "must be made to stay
This is creation of a board of avoid a drop in quality of care.
abreast of new methods and
changing standards. We intend
to keep moving forward with
the emphasis on modern, local
treatment SO that the mentally
ill can resume their role as use-
ful and productive citizens."
ESCONDIDO DAILY TIMES ADVOCATE
2-26-68
Mental hospitals'
upgrading sought
SACRAMENTO (UPI) - Gov.
Creating a board of medical
said. He said his comprehensive
Ronald Reagan has drafted a
visitors for each state hospital
program is designed to reverse
14-point plan to increase the ef-
that would review the facility's
this downward drift.
ficiency and upgrade the care
operation, while also forming a
"The time is long overdue for
quality of the 14 state mental
governor's advisory committee
action designed to stop the
hospitals.
on mental health.
warehousing of the mentally
Two key points of the plan
0 Directing regular inspec-
ill," he said. "We must concen-
would establish two new mental
tions by the Department of
trate on helping them lead pro-
retardation regional centers
General Services to insure prop-
ductive lives."
while surveying the entire pro-
er hospital maintenance.
The governor also renewed his
gram to determine which hos-
"Many of the problems of our
endorsement of the importance
pitals can be phased out or
mental hospitals permitted to
of local programs for the treat-
eliminated.
grow over the years are now
ment of the mentally ill over
"It is apparent that if Cali-
catching up with us," Reagan
care in state hospitals.
fornia is to remain in the fore-
I
front among states in its treat-
ment of the mentally ill, contin-
ued efforts must be made to
stay abreast of new methods
and changing standards, Rea-
gan said in a prepared state-
:
ment.
Although he proposed the two
new regional centers, the gov-
SAN JOSE MERCURY-NEWS
ernor did not say where they
March 3, 1968
would be located, nor has he
di
made a provision for them in
y
his proposed 1968-69 budget.
Major Reform
Last year Reagan vetoed a
measure that would have estab-
A major reform of programs for
lished two centers. He said at
treating the mentally ill was announced
the time the state lacked the
by Gov. Ronald Reagan just as the
funds.
California Medical Assn. was putting
The governor's announcement
the final touches on its own study of
Saturday of the new 14 point
treatment.
program followed on the heels
The state plan includes many recom-
of Friday's announcement that
mendations of volunteer mental health
Reagan has approved new staf-
groups, professionals in the field and
fing standards for the hospi-
doctors.
tals.
Reagan's economy drive for the
The new regulations would
mentally ill has provoked one of the
repeal 1952 standards. They also
are geared to upgrading the
care quality. in state hospitals.
most vigorous battles of his adminis-
Some of the key points of the
tration. Since many of the plans
governor's new mental health
announced last week will carry a
program include:
substantial cost, it appeared the
O Gradual phasing out of cer-
administration was relaxing its econ-
tain work, such as farming, at
omies in the mental health field.
state facilities.
The proposal calls for establishment
0 Increasing from 55 to 70
of two new regional centers to treat the
square feet the area allocated
mentally disturbed. Last year, he
per patient to conform with na-
vetoed a proposal for three similar
tionally recognized standards.
centers.
Reagan explained the major overhaul
"must be made to stay abreast of new
methods and changing standards. We
intend to keep moving forward with the
emphasis on modern, local treatment SO
that the mentally ill can resume their
roles as useful and productive citi-
"
zens
SAN BERNARDINO TELEGRAM
2-26-68
2 Regional Centers Proposed
Gov. Reagan Apparently Relaxes Economies
In Proposing Reform in Mental Health Care
SACRAMENTO (AP) -
A
Reagan explained the major by mental health groups. In- about 55 square feet for :
major reform of California's
overhaul "must be made to stay
stead, Reagan said, the state
years, compared to the nationa
programs for treating the men-
abreast of new methods and
will adopt "in principle" stand-
ly desirable standard of 70 fee
tally ill has been announced by
changing standards. We intend
ards for care proposed in 1967
which the state will seek to in
Gov. Reagan.
to keep moving forward with
by a blue-ribbon commission.
plement.
The plan, announced Sunday,
the emphasis on modern, local
Another chief demand, espe-
includes many recommendations
cially of volunteer groups who
- Adoption of clear, define
treatment SO that the mentally
of volunteer mental health
ill can resume their role as use-
have relatives in the hospitals,
goals for treating mentally di
groups, professionals in the field
ful and productive citizens.'
also was granted by Reagan.
turbed persons.
and doctors. It came just as the
This is creation of a board of
- Permission to increase U
California Medical Association
Most of the efforts will con-
medical visitors for each state
was putting the final touches on
centrate on the 20,000 residents
hospital staffs if required
hospital to keep an eye on day-
its own study of treatment for
of hospitals for the mentally
avoid a drop in quality of car
to-day operations.
the- mentally ill.
ill - those who usually can be
returned to lead a reasonably
Other major features of the
Reagan's holddown on spend-
normal life in society. This has
plan:
ing for the mentally ill last
been the chief target of the
year and proposed continuation
governor's economy program.
- Increased inspection of hos-
of it in the coming fiscal year
pital facilities by the state.
has provoked one of the most
He also proposed, however,
- Orders to state officials to
vigorous battles of his adminis-
additional aid for the 13,500 men-
find out why the quality of care
t
tration. Since many of the plans
tally retarded - those who need
varies among the 14 hospitals.
TM
announced over the weekend
hospitalization and close super-
- Early determination of
will carry a substantial cost, it
vision. Reagan's cost-cutting
which hospitals can be eventual-
appeared the administration
campaign has not been aimed
ly eliminated as the emphasis
was relaxing its economies in
at this group.
on local treatment increases.
the mental health area.
The governor noted his econo-
- Eliminating outdated prac-
my drive of the last year, and
tices at some hospitals, such as
For instance, the proposal
said savings from it "will now
uneconomic farming operations.
calls for establishment of two
permit us to devote more of our
- Phasing out of surgical
new regional centers to treat
resources for the more difficult
facilities at some hospitals.
the mentally disturbed. Last
cases remaining in our hospi-
- Revision of the standards
year, he vetoed a proposal for
tals that were developed in 1952
on square feet of space per bed.
three similar centers.
and have been criticized bitterly
The state standard has been
CULVER CITY STAR NEWS
2-26-68
Reagan plans reform
of mental health care
SACRAMENTO (AP) -
A
treatment SO that the mentally
to-day operations.
major reform of California's
ill can resume their role as use-
Other major features of the
programs for treating the men-
ful and productive citizens."
plan:
tally ill has been announced by
Most of the efforts will con-
- Orders to state officials to
Gov. Reagan.
centrate on the 20,000 residents
find out why the quality of care
The plan, announced Sunday,
of hospitals for the mentally
varies among the 14 hospitals.
includes many recommendations
ill - those who usually can be
- Early determination of
of volunteer mental health
returned to lead a reasonably
which hospitals can be eventual-
groups, professionals in the field
normal life in society. This has
ly eliminated as the emphasis
and doctors. It came just as the
been the chief target of the
on local treatment increases.
California Medical Association
governor's economy program.
was putting the final tou: ches on
He also proposed, however,
its own study of treatment for
additional aid for the 13,500 men-
the mentally ill.
tally retarded - those who need
Reagan's holddown on spend-
hospitalization and close super-
ing for the mentally ill last
vision. Reagan's cost-cutting
year and proposed continuation
campaign has not been aimed
of it in the coming fiscal year
at this group.
has provoked one of the most
The governor noted his econo-
vigorous battles of his adminis-
my drive of the last year, and
tration. Since many of the plans
said savings from it "will now
announced over the weekend
permit us to devote more of our
will carry a substantial cost, it
resources for the more difficult
appeared the administration
cases remaining in our hospi-
was relaxing its economies in
tals that were developed in 1952
the mental health area.
and have been criticized bitterly
For instance, the proposal
by mental health groups. In-
calls for establishment of two
stead, Reagan said, the state
new regional centers to treat
will adopt "in principle" stand-
the mentally disturbed. Last
ards for care proposed in 1967
year, he vetoed a proposal for
by a blue-ribbon commission.
three similar centers.
Another chief demand, espe-
Reagan explained the major
cially of volunteer groups who
overhaul "must be made to stay
have relatives in the hospitals,
abreast of new methods and
also was granted by Reagan.
changing standards. We intend
This is creation of a board of
to keep moving forward with
medical visitors for each state
the emphasis on modern, local
hospital to keep an eye on day-
8 3L05 Singeles Times
WED., FEB. 28, 1968-Part I
3
Reagan Says New
Mental Health Plan
Won't Hike Budget
SACRAMENTO (A)-Gov. Reagan
said Tuesday he will not add any
money to his 1968-69 budget for his
major mental health reform pro-
gram.
"I don't think it's necessary," he
told his news conference.
Sunday, the governor, under fire
for his mental health budget cut-
backs of 1967, announced he would
overhaul mental health care.
He junked old staffing standards
criticized by mental health groups
as not permitting enough staff for
proper care. And he said he would
establish two more regional centers
for the mentally disturbed.
Tuesday, he said his budget is
adequate to pay for the new pro-
gram, even though the spending
program continues some cutbacks in
personnel at hospitals for the men-
tally ill.
Reagan conceded that putting new
staffing standards into effect will be
a "long and difficult" job.
Cutbacks Only Temporary
But he said the reforms were his
answer to those who criticized his
economies. He declared he always
had said the cutbacks were only
temporary, and "I tried to say this in
the face of screaming and wailing
going on
but nobody seemed to
want to listen."
Reagan added, "Now maybe they'll
find out the sky wasn't falling in
after all."
He did not specifically say how his
reforms would be financed.
His program was an extensive one,
announced just as the California
Medical Assn. was putting the final
touches on its own mental health
study.
He proposed increased inspection
of mental hospital facilities; an early
decision on eliminating unneeded
hospitals; cutting out farming and
other hospital industries he consi-
ders outdated; cutting down the
number of beds in wards; possibly
increasing hospital staffs.
An About-Face
58
San Francisco Chronicle Wed., Feb. 28, 1968
On Mental Health
By Carolyn Anspacher
Governor Ronald Rea-
reactivation of an advisory
gan, who last year
committee on mental
slashed $17.7 million
health.
from the budget of the
He has also recommend-
State Department of
ed creation of a board of
Mental Hygiene by elim-
medical visitors for each
inating 3700 jobs in Cal-
State hospital to watch the
ifornia's mental hospit-
institutions' day-to-day op-
als, has executed anoth-
erations.
er remarkable about-
Other major features of
face.
his plan include:
While, until a few weeks
0 Regular inspections by
ago, he lauded the State's
the Department of Special
institutions for the mental-
Services to insure proper
ly ill and retarded as
hospital maintenance.
among the best in the Na-
0 Early determination of
tion, he now has announced
which hospitals ultimately
a program of major re-
can be eliminated through
forms for the hospitals.
increased emphasis on lo-
The governor released
cal treatment centers.
his 14-point program on
o Elimination of archaic
Sunday, just hours before
practices at some hospi-
receiving a report on the
tals, such as uneconomic
State's mental institutions
farming operations.
from the California Medi-
cal Association. The study,
0 The phasing out of sur-
compiled by teams of spe-
gical facilities at some hos-
cialists who visited all the
pitals.
State hospitals for the men-
0 Increasing space per
tally ill and retarded, re-
patient from 55 square feet
portedly is highly critical
to 70 square feet - still
of many of the institutions.
well short of the 100 square
The new Reagan propos-
feet allotted to Army no-
als embrace most of the
cruits at Fort Ord.
CMA's recommendations,
o Permission to increase
which have not yet been re-
hospital staffs if necessary
leased.
to avoid a drop in the qual-
The governor said he
ity of care.
was adopting, "in princi-
Dr. Iriving Phillips,
ple," new standards of
spokesman for the State's
care for the mentally ill
psychiatric societies, said
and retarded proposed last
he was "pleased" with the
year by a blue ribbon com-
governor's 14-point pro-
mission named by the Leg-
gram, adding: "We feel
islature.
this is a major step in the
Among his 14 points, the
right direction for the care
governor has proposed es-
of the mentally ill and re-
tablishment of two regional
tarded in State hospitals.
centers for mental retarda-
"We hope funds will be
tion, one of them to be at
available to support these
UCLA; appropriations for
14 points."
neuropsychiatric institutes
He urged, however, that
at the University of Cali-
the governor give "close
fornia in San Francisco
attention" to the needs of
and at UCLA; the addition
local programs which at
of 300 new jobs at hospitals
present are inadequately
for the retarded, and the
financed.
PART II
Edi torial
Comment
EQUAL
RIGHTS
Dos
Times
LIBERTY UNDER THE LAW
TRUE INDUSTRIAL FREEDOM
HARRISON GRAY OTIS, 1881-1917
HARRY CHANDLER, 1917-1944
NORMAN CHANDLER
Chairman & Chief Executive, Times Mirror Company
OTIS CHANDLER
Publisher
NICK B. WILLIAMS
ROBERT D. NELSON
Editor
Vice-President & General Manager
FRANK HAVEN
JAMES BELLOWS
JAMES BASSETT
Managing Editor
Associate Editor
Director, Editorial Pages
4-Part II
WEDNESDAY MORNING, FEBRUARY 28, 1968
Other
Laudable Action on Mental Health
Gov. Reagan's new 14-point mental
in certain hospitals where better treat-
health program marks a significant shift
ment can be obtained at less cost nearby,
in the thinking of his Administration.
should not pose any problems.
For more than a year leaders in the field
A start has already been made toward
have complained that Reagan's policies
meeting the requirement-imposed by the
have endangered sound mental health
state on private institutions - of 70-
procedures.
square-feet of space per patient bed. For
The new approach which may change all
years the mental health department's
that, has been applauded by some leading
budget has been based on a 55-foot
authorities who have been critical in the
standard.
past.
But the element of timing arises in
There is, indeed, much to applaud in the
connection with several other items,
program. Yet much will depend on how-
notably improvement of obsolete staffing
and when-it is implemented.
standards. This step, which the governor
has embraced "in principle," would require
The governor is now preparing a special
$39 million if carried out immediately.
appropriation bill to fund two mental
Since such a sum is not available,
retardation regional centers at an estimat-
achievement of the new standards will be
ed first year cost of $500,000. Although he
"in phases consistent with sound hospital
favored the plan last year, he was forced to
and management practices."
veto it due to lack of funds. Early
Although that sounds logical, it suggests
legislative approval is expected.
the possibility of long delays. Perhaps the
Several other items may also be
improvement may not proceed as rapidly
expedited: Streamlining of administrative
as some experts in the field insist is
functions to improve efficiency; inspec-
desirable.
tions to insure proper maintenance of
That is why skepticism has been voiced
facilities; a study to determine why there
in some quarters, which indicate a "wait-
are major variances in the quality of care
and-see" attitude, remaining on the alert
at institutions.
for any foot-dragging or deviation from
Gradual elimination of outdated func-
the high-sounding goals.
tions, such as agriculture at some institu-
It is to be hoped their fears are
tions, and phasing out of surgical facilities
groundless.
San Bernardino Telegram
Feb. 26, 1968
Wise Move on Mental Health
The status of California's men-
of the new standards "a forward
tal hospitals, an up and down af-
step."
fair in the last year, resumed the
Just how quickly the new stand-
up course on Friday when Gov.
ards will become fully effective is
Reagan announced that he has ap-
not certain. The governor said he
proved "in principle" new staffing
has instructed Spencer Williams,
standards.
secretary of human relations, and
The standards were recommend-
Dr. James V. Lowry, director of
ed a year ago by a special com-
the Department of Mental Hy-
mission which found, after an 18-
giene, to set up a timetable. He
month study, that the overall de-
added that a start can be made
ficit of help was 32 per cent in
"partly with funds saved by econ-
hospitals for the mentally ill and
omies in the department."
38 per cent in hospitals for the
A department spokesman said
mentally retarded.
that if the new standards were put
Unlike the old standards, which
into effect today, the cost would
originated in 1952 and are based
be $39 million. Of that amount,
on a set number of employes per
$17 million would be for improving
patient, the new standards are
the staffing at hospitals for the
based on how much care is re-
mentally ill and S22 million for
quired by each patient to improve.
the retarded.
Under the old set of rules, Gov.
The implementation, however,
Reagan last year ordered mental
will be carried out in phases, in
hospital cuts in keeping with the
accordance with the governor's in-
decline in the number of patients.
structions. Admittedly, the pro-
This brought strong protests from
gram will take some time. since
mental health authorities, who
psychiatrists and psychiatric nurs-
b
pointed out that the patients
es are not easy to come by.
is
leaving hospitals were those who
For the long run, Gov. Reagan's
a
required a minimum of treatment,
decision should have a highly
I
and that the patients remaining
beneficial effect on mental health.
1
i
were those who needed the most
What it basically does is to take
]
time and attention from the staff.
patient care away from a rigid
:
The governor's shift to the new
set of numbers, and give it a flex-
standards has brought applause
ibility under medical judgment.
from former crities. The South-
Both responsibility and authority
ern California Psychiatric Society
are increased for the doctors, and
and the Mental Health Association
that is the way it should be.
of Los Angeles County commended
Mental health is not the least of
the "implementation of these more
this nation's problems, and the
realistic standards." A spokesman
governor deserves praise for the
at Patton Hospital called adoption
pioneering step he has taken.
El Cajon
Daily California
March 4, 1968
Reagan's Record May Lose Blot
Ever since he announced drastic cut-
on how much care is needed by a pa-
backs in the state's mental health pro-
tient to improve. This replaces the old
gram, Gov. Reagan has been sporting a
standard which merely allotted so many
patients per staff member-usually more
black/eye. It was believed by many, with
than he could handle.
some convincing testimony from those
directly concerned, that he was achieving
Gov. Reagan says he will not add any
a balanced budget and economy at the
money to his 1968-69 budget to imple-
ment his mental health reform program.
expense of these unfortunate people.
This might sound like he is already re-
So the announcement that the governor
neging on his promises, but those in the
has approved "in principle" new staffing
mental health field say this need not be
standards for state hospitals caring for
the case.
the mentally ill does much to remove
Since the population of state mental
the blot on Reagan's record.
hospitals is steadily decreasing, largely
It does, that is, if the governor is sin-
because of improved eatment tech-
cere in putting the program into effect
niques and the availability of local day
and does not throw overboard the new
care centers, the staffing standa can
standards the next time he makes a
be implemented merely by keeping the
check of the state's coffers.
budget allocations at somewhere near the
same level they are now.
Mental health authorities, many of
whom were critical when the original
In other words, as the hospital popula-
cuts were made, are encouraged by the
tion decreases money will still be avail-
adoption of the new staffing standards,
able to retain the needed staff to ade-
which replace those that were accepted
quately care for the mentally ill patients.
in 1952.
We hope this is the case. The progress
What the governor's program does is
that has been made in the care of the
to make it possible to meet some of the
mentally ill in this state is too important
staff deficiencies at state hospitals by
to sacrifice in the name of false and
basing the number of employes required
short-sighted economy.
PART III
Comments
by
Hospital
Trustees
and
THE PRESS
COURIER
Serving Ventura County
OXNARD, CALIFORNIA, FRIDAY, FEBRUARY 23, 1968
SINGLE COPY 10c-FOR I
Governor's Plan Benefits
Camarillo State Hospital
Camarillo State Hospital will
have become obsolete in the
some 2,800 jobs. He gave no
be able to provide better patient
light of medical progress and
figures on the new staffing
care when staffing improve-
particularly because of the in-
standards.
ments announced today by Gov.
creased emphasis on local treat-
Nash said Camarillo State
Reagan are put into effect, Dr.
ment of the mentally ill."
Reagan said last year that
Hospital had reduced its staff
Louis Nash, hospital superin-
tendent, said.
mental hospital staffs should be
"through normal attrition" SO
Nash said an increase in the
cut back because more patients
that no programs were serious-
nursing staff would provide "a
are being handled by local fa-
ly affected. The Board of Trus-
better ratio of personnel to pa-
cilities. The cutbacks triggered
tees of Camarillo Hospital met
tients. He lauded Reagan's
strong criticism from hospital
today and issued a statement of
move as a big step toward elim-
employes and other groups.
gratitude to the governor for
inating "archaic" staffing
Reagan imposed staff cut-
the move which they said will
standards.
backs in state hospitals last
greatly improve" programs at
year calling for elimination of
the hospital.
Reagan today directed the
Department of Mental Health to
implement recommendations by
the California Commission on
Staffing Standards in 1967.
Reagan said they will replace
1952 standards "because they
San Diego, Calif.
Evening Tribuce
(Cir. W. 116,303)
Ent.
1838
R.C.E.
State Mental
ACTION LAUDED
Hal Logan of El Cajon, chair-
b
man of the board of directors of
t
Patton State Hospital, lauded
Hospital
the action as "one of the most
outstanding recommendations
for change in the last decade."
He called the changes "a step
forward in the treatment of the
RulesAltered
mentally ill, long sought by
groups such as the California
Medical Association and the
California Mental Health Asso-
SACRAMENTO (UPI) - Gov.
ciation so that as many persons
Reagan said yesterday the state
as possible are returned to their
has abandoned patient-staff ra-
local communities through
tio staffings standards at men-
greater intensity of care."
tal hospitals and adopted new
The new standards, recom-
standards set by a special com-
mended in a two-volume study
mission.
by the California Commission
on Hospital Standards, will re-
The new standards are based
duce the number of patients
on how much care an individual
because they will begin receiv-
patient needs as measured by
ing treatment immediately and,
the time necessary for his care
consequently, "create a new
and treatment, a Department of
1
morale among professional peo-
Mental said. Hygiene spokesman
I
ple when they realize they can
give their best efforts and be
Reagan, whose cutbacks in
I
effective," he said.
funds for mental hygiene stirred
(
EARLY ADOPTION
a bitter controversy last year,
y
said implementation of the new
I
He said he hopes the stan-
standards would be conducted
dards will be adopted at Patton
in phases based on a timetable
this fiscal year.
to be determined by Spencer
Reagan called the current
Williams, human relations
0
standards, adopted in 1952, ob-
secretary, and the department
E
solete "in the light of medical
director, James Lowry.
F
progress and particularly be-
cause of the increased emphasis
on local treatment of the men
tally ill.'
Ventura Star
Free Press
2-25-68
CHS Trustees
Applaud Reagan's
Staffing Policy
Staff members and trustees
of Camarillo State Hospital have
expressed complete agree-
ment with the new 1967 staff-
ing standards for mental hy-
gene recently adopted by Gov.
Ronald Reagan for all state
mental hospitals.
The new staffing standards
were generated by an Aerojet
General time study in 1967 to de-
termine the kind and amount of
care needed for the various
types of patients. Standards
had not been changed since
1952, Dr. John F. Sheel of the
hospital staff said yesterday.
Sheel said, "With the new
staffing standards, we can more
adequately determine our staff
needs, and where to place
them." Sheel said there will be
an increase in the staff at Cam-
arillo State Hospital, determin-
ed by the survey, but the state
budget will govern just ho W
large an increase can be made.
The Camarillo hospital's
board of trustees met Thursday
and issued the following state-
ment:
"The board of trustees of
Camarillo State Hospital are
most gratified that Gov. Reagan
has recognized the need to im-
plement the new 1967 staffing
standards. We believe the Cali-
fornia State mental health
program will be greatly improv-
ed."
7.628. 1968
DeMeo Likes
Les Anceles
New SSH
Times
Staff Plan
3-5-68
By Staff Correspondent
ELDRIDGE-The chairman of
the board of trustees at Sonoma
State Hospital has expressed sat-
isfaction with Gov. Ronald Rea-
Staffing Program Hailed
gan's acceptance of new staff-
ing standards for state mental
Gov. Ronald Reagan announced Feb. 23
hospitals.
the Administration has adopted in principle
the staffing standards for state mental hos-
Charles DeMco of Santa Rosa
pitals set in 1967 by the California Commis-
noted that the approval of new
sion on Staffing Standards.
plan, proposed last year by the
"Implementation of the standards will be
California Commission on Staff-
carried out in phases consistent with sound
ing Standards, could mean an
increase of 500 medical services
employes at the Eldridge facil-
hospital and management practices," he said.
The governor said the 1952 standards
ity when fully implemented.
should be replaced by new standards
Timing of the new staffing
because they have become obsolete in light
proposal, part of a "comprehen-
of medical progress and particularly because
sive" new plan for the 14 hos-
of increased emphasis on local treatment for
pitals, now awaits formulation
the mentally ill.
of a schedule by Spencer Wil-
This is an excellent step in the right direc-
liams, state welfare administra-
tion; a culmination of hard work on the part
for. and Dr. James Lowry, di-
of those interested in the Department of
rector of the state Department
Mental Hygiene, and will greatly implement
of Mental Hygiene.
and increase the level of care in the state
Whether additional job posi-
hospitals throughout the state,
tions will actually be added to
This is particulaly true of the Fairview
meet the new plan remains to
State Hospital, in that it will increase the
be seen, however.
standards which at the present time are
about 60% of the staffing standards for state
Patient Load Cut?
hospitals set in 1967 by the California
An alternative viewed as like-
Commission on Staffing Standards.
ly by administrators may call
The board of trustees of Fairview State
for reduction of the hospitals'
Hospital feels that this is an excellent
mammoth patient load-1.400 -
program and when properly implemented,
will increase the care of those who are
to a size where it would fall in
unable to care for themselves.
line with new standards.
VERN O. FAHRNEY
That could also bring the hos-
Chairman, Board of Trustees
pital in line with another por-
Fairview State Hospital
tion of the Reagan plan-a rec-
Long Beach
ommendation to increase the
average space per patient from
55 to 70 sq. ft.
The staffing plan replaces one
formulated in 1952, which has
long been the target of criticism.
Mr. DeMeo said the Reagan
decision was one of the most
forward looking steps in the care
for the retarded taken by the
state during his 25 years on the
board.
PART IV
Comments
by
Psychiatric
Societies
Bay
2+ Los Inteles Times
Reagan OKs New Staff
Rules in Mental Health
SAT., FEB. 24, 1968-Part
3
Authorities Say Revised Standards Could
Improve Quality of Care in State Hospitals
BY HARRY NELSON
Times Medical Editor
Gov. Reagan announced
tion will begin putting the
Friday he has approved
new standards into effect
"in principle" new staffing
"partly with funds saved
standards which mental
by economies in the de-
health authorities say
partment."
could significantly im-
The Southern California
prove the quality of care
Psychiatric Society and
in state hospitals for the
the Mental Health Assn. of
mentally ill and mentally
Los Angeles County, both
retarded.
of whom have been criti-
The new staffing stan-
cal of many of the gover-
dards were recommended
nor's previous actions in
a year ago by a special
mental health, applauded
commission which found,
the announcement, as did
after an 18-month study,
the California Council for
that the overall deficit of
Retarded Children.
help was 32% in hospitals
for the mentally ill and
Dr. Ruth Barnard, pres-
38% in hospitals for the
ident of the psychiatric
society, said "implementa-
mentally retarded.
tion of these more realistic
Unlike the old standards,
standards is one of the
which are based on a set
employe-patient ratio, the
ways the care and treat-
new standards are based
ment of the mentally ill
on how much care is re-
and mentally retarded can
quired by each patient to
be brought up to a more
acceptable level than is
improve.
The Reagan Adminis-
currently being achieved."
tration was strongly criti-
Called Pioneering Move
cized by mental health
David C. Honey, pres-
groups for initiating a
ident of the Mental Health
personnel cutback in the
Assn., called the move a
Department of Mental Hy-
"pioneering and important
giene on the heels of the
contribution" and a "step
staffing commission's re-
forward to providing ade-
port.
quate care and treatment."
In his announcement
A department spokes-
Friday, Reagan said im-
man said that if the new
plementation of the new
standards were put into
standards would be car-
effect today, the cost
ried out "in phases consis-
would be $39 million. Of
tent with sound hospital
that amount, $17 million
and management practi-
would be for improving
ces."
the staffing at hospitals
Orders Timetable
for the mentally ill and
He said he has instruct-
$22 million for the retard-
ed Spencer Williams, se-
ed,
cretary of human rela-
Since implementation of
tions, and Dr. James V.
the staffing standards will
Lowry, director of the
be done in phases, it is
Department of Mental Hy-
expected that the cost will
giene, to set up a timetable
be less than 617 million for
for putting the standards
the mentally ill because
into effect.
the number of mentally ill
Reagan said the 1952
in state hospitals is declin-
standards which have
ing.
been in effect are "obso-
The cost for improving
lete in the light of medical
staffing for the retarded
progress and particularly
persons is expected to stay
because of the increased
the same because the hos-
emphasis on local treat-
pital population of retard-
ment of the mentally ill."
ed persons is not declin-
He said- the Administra-
ing.
Sacramento Union
2-27-68
Psychiatrists
Laud Reagan
The Central California Psy-
chiatric Society, which repre-
sents 115 Central Valley psy-
chiatrists, Monday lauded Gov-
ernor Reagan's decision to adopt
the principles of the 1967 report
of the California Commission on
Staffing Standards for state hos-
pitals.
"We are especially interested
in the governor's statement that
he intends to begin putting these
new standards into effect im-
mediately, using current sav-
ings," said Dr. George Gross,
president of the Society.
Dr. Gross said sufficient state
funds must be provided simul-
taneously to county mental
Sacramento, Calif.
health programs.
Bee
10th D. 124251)
2-25-68
Alians
P.C.S.
En: 1688
Psychiatrists' Unit Praises Program
The Central California Psy- cerning a 14-point program to
chiatric Society has praised
improve the state's mental hos-
Gov. Ronald Reagan's decision
pitals.
to adopt the principle of the
Dr. George Gross, president
staffing standards recommend-
of the society which represents
ed by the 1967 report of the
115 psychiatrists in the valley
California Commission on Staff-
area, said the decision should
ing Standards.
mean "measureable increases
The governor announced the
in staffing ratios this year and
decision Friday and affirmed it further increases in the ratio in
in today's announcement con- future years."
tal
budget
of recent information.
Fresho, Calif.
Reagan said his budget for
Fresno See
the coming fiscal year includes
D. S. 140,538)
a record increase for Short-
Also appeared in the
Doyle programs, up by $1.6 mil-
2-25-68
Sacramento Bee and Modesto Bee
lion to a total of $29.5 million.
The over-all mental Hygiene
Department budget for the year,
Est.
1388
P.C.B.
he said, is up by more than $6
million to $244 million.
Reagan Issues 14-Point Program
Psychiatric society leaders al-
ready have pointed out that
Lowry, in a letter dated last
To Improve Mental Health Care
year, said $7 million to $9 mil-
lion would be needed for Short-
By Peter Weisser
"We don't care who gets the
1 - setting up two added
Doyle. Analysis of the budget
SACRAMENTO - Gov. Ron-
medals for these things. He's
mental retardation hospitals.
shows that while the department
ald Reagan issued a 14-point
started moving in the right di-
2 - junking of the 1952 staff-
as a whole is up, the hospital
program to improve the level
rection on mental hygiene."
principle of enriched" standards
budget actually has been cut by
of care for patients in the
ing standards and adoption "in
$400,000.
Dr. Ruth Barnard, the physi-
state's hospitals for the ment-
cian who is president of the
set up last year by the Califor-
12-Renewed Instructions to
ally ill.
Psychiatric Society of Southern
nia
Commission
on
Hospitals
Lowry that "he has now as he
Many of the suggested re-
California, said Reagan's list
Standards.
has had in the past year com-
forms are apparent reversals of
"sounds like a program for peo-
3 -creation of a state board
plete discretion in maintaining
Reagan's economy-oriented cuts
ple and goals in which incon-
of medical visitors for each hos-
th estaffing requirements and
of more than $11 million from
cur."
pital.
levels for care of patients."
the hospital budgets in fiscal
Last year the governor trim-
4 - inspection of hospital
1967-68.
med $11.4 million from the De-
buildings by the State Depart-
Reagan last year, after the
Reagan specifically calls for
partment of Mental Hygiene's
ment of General Services.
initial flareup of criticism, ex-
a junking of "obsolete" stand-
5 -a determination of why
plained that if the level of care
budget request, then blue-pen-
there are "major quality vari-
for the state's estimated 36,000
ards for staffing hospitals for
cied the amount when he signed
the mentally ill although the
the budget June 30, 1967, after
ences among the mental hospi-
patients were threatened, Low-
$11.4 million in cuts made last
the legislature reinserted it. His
tals," variences which are un-
ry had authority to restore
year were done without regard
budget cuts, according to testi-
specified, "and to find out why
whatever money and jobs of the
to staffing standards.
mony before legislative bodies
some are not operated as well
3,700-positions were eliminated.
The reform list includes es-
by Dr. James V. Lowry, depart-
or as efficiently as they should
13 - Administative stream-
ishments of two additional
ment director, were carried out
be."
lining within the Department of
mental retardation centers,
along fiscal guidelines and with-
3/4-Quick action to find out
Mental Hygiene.
through Reagan vetoed propos-
out attempts to reevaluate stan-
which facilities should be phas-
als for retardation centers in
dards of care.
ed out due to greater reliance
14-Creation of an advisory
San Diego, Fresno and Sacra-
A resulting drumfire of crit-
on local programs. (Physicians
committee on mental health to
mento last year.
icism arose from critics as di-
note there is no mention of in-
consult with the governor on
In other reversals of position
verse as Jimmy Persall, former
creasing aid to local facilities
mental health issues.
the governor called for creation
Boston Red Sox baseball star,
to provide for the increase in
"We cannot be satisfied with
of a board of medical visitors,
labor union leaders and psychi-
local puyient load and expense.
out-omded programs," asserts
an idea he rebutted during a
atric societies.
The hospital close-down propos-
al year after year finds advo-
the governor. "Rather we must
highly publicized visit to Cama-
rillo State Hospital, and for a
While the administration em-
cates in the office of Legisla-
continue moving forward with
determination of why there are
phasis last year was decidedly tive Analyst A. Alan Post, chief-
a positive and progressive plant
"major quality variances among
budgetary, according to the ly on the ground of efficency.)
o--ne that expands and further
the mental hospitals."
testimony of lowry and others,
7-Elimination of outdated
implements the concept of local
Guarded Reaction
the chief concern of the new
functions such as farming op-
care for the mentally ill where-
There was guarded reaction to
Reagan program is on standards
erations. Though the governor's
ever possible.
L
the governor's reform program,
and treatment of care.
announcement did not allude to
"Many of the problems in our
along with the speculation it
"We have always known that
it, a similar proposal recently
mental hospitals permitted to
may have been triggered in part
problems in our mental hos-
was made by the California
grow in seriousness over the
by the fact leaders of the Cali-
pitals go beyond budgetary fac-
Taxpayers' Association.
years are now catching up with
fornia Medical Association this
tors," the governor stated.
8-Trimming out of surgical
us.
weekend are putting the final
"Many of the economies we
facilities from some hospitals.
touches on a study of the state's
have achieved over the past
9-Upgrading space standards
"But, as we have repeatedly
mental hospital facilities.
year - coupled with greater
per patient bed, from about 55
told the people of California, the
The study on which the
emphasis on local treatment fi-
square feet per patient to 70
time is long overdue for action
Reagan reform measures are
nanced in large measure by the
square feet.
designed to stop the warehous-
based, according to a Reagan
state - will now permit us to
10-Adoption of clear-cut and
ing of the mentally ill."
aide, "is an administration ef-
devote more of cur resources
definitive goals for the treat-
Last year opponents of the
fort" - not the CMA study by
for the more difficult cases re-
ment of mentally ill persons
governor's mental hygiene cuts
ctors in 14 survey teams.
maining in our hospitals."
which have "been acclaimed by
condemned the budget trim-
member of the CMA
Chief Points Listed
leaders in the mental health
mings as false economy, re-
study group flatly stated most
Chief points in the program
field".
peatedly warning they would
of the recommendations issued
are:
lead to the "warehousing" Rea-
by the governor are identical to
gan now deplres.
the study recommendations. But
he added:
Vallejo, Calif.
Times Horald
(Cir. D. 25,853 S. 29,845)
2-24-68
Allon's & C.B.
Est. 1888
Psychiatrist
Wants Study
SAN FRANCISCO (AP)-The
chairman of California's psychi-
atric societies urged Gov. Rea-
gan Friday to give closer atten-
tion to the needs of local pro-
grams for treatment of the
mentally ill because they are
"inadequately financed."
Dr. Irving Phillips, in a state-
ment made in behalf of the so-
cieties, praised the governor's
"adoption of new standards for
patient care in state hospitals."
He referred to reccommenda-
tions made by the California
Commission on Staffing Stand-
ards.
"We would urge the gover-
nor's close attention to the
needs of local programs which
at present are inadequately fi-
nanced. We hope that he will
request sufficient funding to al-
low for program development
to continue," said Phillips.
PART V
Comments
by
Citizen
Organizations
Sacramento, Calif,
Bes
Also appeared in the
(Cir. D. 172,254 S. 194,251)
Fresno and Modesto
2-24-68
papers
P.C.A.
Est. 1888
Foresees Progress
"The old standards were un-
Mental Health
realistic and a detriment to pro-
viding adequate treatment. We
commend Governor Reagan for
Leader Praises
adopting the new standards.
They are a pioneering contribu-
tion, and I am confident they
Reagan Action
will help California assume its
proper role as the leading state
in providing the best possible
programs for its citizens who are
Arthur Hellender, president of
hospitalized in state institutions.
the California Association for
"The association participated
Mental Health, has praised the
with the select commission of
action by Gov. Ronald Reagan
professionals in the 18-month
in adopting "in principle" pro-
study which led to the recom-
posed new staffing standards for
mendations," he added.
1
California's state hospitals.
The standards were recom-
Retarded Children's
mended a year ago after a study
Group Applauds Step
I
by the California Commission on
Staffing Standards.
The California Council for Re-
1
"The adoption by California of
tarded Children has applauded
the very sound and realistic rec-
an announcement by Gov. Ron-
ommendations of the commis-
ald Reagan his administration
sion is a critical step forward
is accepting higher staffing
to providing adequate care and
standards for the state's men-
treatment for a large segment
tal hospitals.
of those Californians who are
"This is a move in a positive
mentally ill," Hellender said,
direction of assuring a more
Concur On Importance
adequate level of care for the
"The California Association for
mentally retarded in our state
Mental Health shares with the
hospitals," commented Stanley
professional community the opin-
LeBon, council president. Coun-
ion that the new standards for
cil personnel helped prepare the
staffing state hospitals is a pio-
report on which the increased
neering and important contribu-
staffing standards is based.
tion.
"The new standards will ulti-
"We look forward to cooperat-
mately replace the out-of-date
ing with the governor, the De-
standards established in 1952,"
partment of Mental Hygiene and
said Lebon. Ultimately, he said,
the legislature in the realistic
the move will improve the level
implementation of these new
of care for the retarded.
standards.
The Sacramento Union
w
Saturday, Feb. 24, 1968
New Guidelines
Reagan Asks Hike
In Mental Staffs
An increase in the number of local treatment of the mentally
state mental hospital workers
ill."
per patient has been proposed
Reagan said, "We will begin
by Governor Reagan, who last
putting these new standards into
year slashed their staffs in a
effect partially with funds saved
controversial economy move.
by economies" in the State De-
A statement from Reagan's
partment of Mental Hygiene.
office said the administration
Last year, Reagan announced
has "adopted in principle"
state mental hospital staff cut-
guidelines set last year by the
backs calling for elimination of
California Commission on Staff-
about 2,800 jobs. He said the
ing Standards.
cuts were justified because
However, neither the number
more patients are being handled
of employes to be restored nor
by local rather than state facil-
the cost of the additions were
ities.
revealed as Reagan administra-
Word of his new proposal was
tion prepared a comprehensive
hailed by leaders of groups
program for improving mental
which bitterly attacked the 1967
hospital care.
cutbacks.
"There will be an increase in
"This is a move in a positive
the number of staff people per
direction of assuring more ade-
patient," said an aide to Spen-
quate level of care for the men-
cer Williams, secretary for hu-
tally retarded in our state hos-
man relations. The aide added
pitals," said Stanley LeBon,
that the program wouldn't go
president of the California Coun-
into effect until the fiscal year
cil for Retarded children.
starting July 1 as it will need
Terming the plan "a pioneer-
legislative approval.
ing and important contribution,"
The statement from Reagan's
the president of the California
office said the old 1952 stand-
Association for Mental Health,
ards should be replaced "be-
Arthur Hellender, said the adop-
cause they have become obso-
tion is "a critical step forward
lete in the light of medical pro-
to providing adequate care and
gress and particularly because
treatment for a large segment"
of the increased emphasis on
of the mentally ill.
Vallejo News
Chronicle
Feb. 29, 1968
MENTAL CARE
PLAN LAUDED
SACRAMENTO (AP) - One
of Gov. Reagan's leading critics
on mental health Wednesday
described as "a delightful turn
of events" Reagan's announced
plan to reform the state's men-
tal health program.
The Citizens Committee for
Improved Treatment in Our
State Hospitals pledged support
for Reagan's plan to adopt 1967
staffing standards at the state's
mental hospitals.
The state has been operating
on a 1952 staffing level plan.
Winston Wilson of Sacramen-
to, committee chairman, urged
Reagan to seek emergency
funds from the legislature to
begin putting his reform into
effect.
But Reagan said Tuesday he
does not plan to add funds to
the mental hygiene budget dur-
ing the coming year. Some of
the reforms can be accom-
plished with savings made in
the department, he said.
The entire reform program
will have to be accomplished
over "the long haul," he added.
Wilson said, "We are truly
pleased that the governor now
wants to take some positive
steps toward bringing adequate
care and treatment to those
hospitalized by mental illness."
Friday, March 1, 1968
The Sacramento Union
Our Readers Write
Mental Health Group Lauds Reagan
Editor, The Union: We have been
ment to the hundreds of Sacramentans
informed of the announcement of
who are presently hospitalized in our
Governor Reagan's acceptance in prin-
state mental hospitals.
ciple of the recommendations of the
We are in total agreement with the
California Commission on Staffing
new Staffing Standards as recommended
Standards in state mental hospitals.
by the Commission. We do hope that
The Sacramento Area Mental Health
adequate funds will be made available
Association compliments him for this
SO that these important recommenda-
important step forward and. we feel
tions can be implemented.
that it can do much to improve the
VIRGINIA L. YOUNG
quality and quantity of care and treat-
President
Many of Governor Ronald Reagan's proposals for Mental
Hygiene have long been advocated by CSEA. In what
appears to be a reversal in the administration's position,
the pressing questions are: How will the 14-point program be
implemented? When?
Thomas T. Jordan, the Association's deputy gen-
eral manager, also praised the governor's new pro-
Reagan Plan
gram.
"We are delighted," he said, "and Governor Rea-
gan may be assured that CSEA will cooperate fully
Would Enrich
in the common effort to achieve the goals at the
earliest possible time."
Jordan said the new program will cost more
Mental Hygiene
money than is provided in the governor's proposed
budget, but noted that the budget is to be re-
evaluated.
A 14-point plan aimed at improving the state's
"We hope that reevaluation will produce sub-
mental hygiene program has been announced by
stantial budget increases for staff enrichment at all
Governor Ronald Reagan.
levels, from support classes to direct treatment per-
sonnel," he stated. "We realize that we cannot
Included in the governor's list of program
achieve 100 percent of the general improvement
changes is a higher ratio of staff to patients in state
goals immediately, but a significant start should
hospitals for the mentally ill and mentally retarded,
be made now."
creation of two new mental retardation centers, an
increase in space for each hospital bed, hospital
One of the governor's new program points is a
"
maintenance inspections and a re-evaluation of the
determination at the earliest date what hospi-
1968-69 budget for the Department of Mental
tal facilities should be phased out or eliminated in
Hygiene.
the light of basic changes in the patient load
because of greater emphasis on local care and
All of these measures long have been a part of
treatment."
CSEA's mental hygiene program.
Jordan said CSEA will be interested to know how
CSEA officials agree that the key point of the gov-
any of the department's "presently overcrowded
ernor's revised program is his decision to improve
facilities" can be eliminated in the near future if
the ratio of hospital staff to patients. In junking "as
bed space is to be increased from 55 square feet
obsolete" the 1952 staffing standards under which
or less to the governor's new goal of 70 square feet.
the department has been operating, the governor
accepted "in principle" the much richer standards
Jordan also pointed out that "resident popula-
recommended by the California Commission on
tion" should be only one factor in the determination
Staffing Standards.
of staffing patterns. He said that total annual ad-
The commission's recommendations, published
missions to the hospitals are the highest in history,
and that admissions will continue to increase as the
in January 1967 after a comprehensive, 18-month
state's population rises.
study of the hospital system, called for staffing in-
creases averaging 35 percent to bring the staff-
"These people must be cared for just as long-term
patient ratio to "minimally acceptable" levels.
patients are cared for, and this care requires a lot
However, the governor two months later an-
more people," he added.
nounced his intention to cut staff by 3,700 positions
Jordan said he has some reservations about the
- a move he said was justified by the declining
ability of local jurisdictions to absorb much more of
resident patient population in the hospitals.
the state's mental patient load in the near future.
CSEA disagreed strongly with the governor's
"The department still plans to close all of its local
decision to reduce staff, arguing that the main rea-
day treatment and after-care centers," he com-
son for the decline in resident patients was the then
mented. "Are we sure that the counties will be able
gradually improving ratio of staff to patients.
to take over these patients?"
The Association joined in statewide efforts of
citizen groups to resist the cutback and was suc-
Department of Mental Hygiene officials say that
cessful in winning a legislative appropriation
despite adoption of new staffing standards, layoff
sufficient to maintain staff at the January 1967 level.
schedules for the remainder of this fiscal year have
The governor vetoed these additional funds.
not been changed. However, many hospitals al-
ready have lost so many employees that they cur-
"We are extremely pleased that Governor Rea-
rently are operating with less staff than current
gan agrees with us that the staffing recommen-
schedules provide, so there is some doubt that ad-
dations of the Staffing Standards Commission
ditional layoffs will be necessary.
should be adopted," CSEA President Frances M.
Dillon commented. "I am sure that the new staffing
A spokesman for the department said that Dr.
goals will greatly improve the morale of the dedi-
James Lowry, department director, is working on a
cated people who now are carrying the huge burden
schedule to implement the 14 points contained in
of treating and caring for the mentally ill and
the governor's program. He said the governor has
retarded."
given Dr. Lowry "complete discretion in main-
taining the staffing requirements and levels of care
THE CALIFORNIA STATE EMPLOYEE, MARCH 1, 1968
for patients."
PART VI
Comments
by
Hospital
Staff
MORE RELEASES
However, Dr. Adams be-
Wins Praise
lieves that the new standards
Stockton Record
will allow the program of re-
(Cont. From Page 1, Sec. 2)
leasing more patients into
development, and will enable
the community to continue.
us to come closer to an ac-
Feb. 24, 1968
The trend of keeping fewer
ceptable level of care," Dr.
patients in the institution,
Adams said.
developed over the past sev-
As far as possible changes
eral years, would have to end
in program emphasis are con-
soon if the 1952 standards and
cerned, the new standards
related job cuts were main-
may mean a slight shift to-
tained, Dr. Adams said.
ward more work with com-
One possible way of bring-
munity mental health pro-
ing the new standards into
grams and outpatient care, he
effect would be to refrain
said.
from elimination of jobs as
the patient load drops, thus
The new standards will be
increasing the level of care, he
implemented in phases on a
timetable to be determined by
said.
James Lowry, director of the
State Hosp.
SHARP VARIATIONS
Department of Mental Hy-
Dr. Adams said that when
giene, and Spencer Williams,
the study was completed a
human relations secretary.
(
year ago the over-all level of
Staffing Plan
staffing at the hospital was
However, there was no in-
\
only about 68 per cent of that
dication whether any effort
{
recommended under the new
would be made to change Rea-
$
standards, with sharp varia-
gan's proposed 1968-69 budget,
Wins Praise
tions from that in the dif-
which calls for further staff
ferent specific job categories.
cutbacks in state hospitals.
Adoption of the new stand-
Reagan said the 1952 stand-
Dr. Adams Hails
ards is "a most encouraging
ards "have become obsolete in
New Standards
development, and will enable
the light of medical progress
us to come closer to an ac-
and particularly because of
Adoption of new staffing
ceptable level of care," Dr.
the increased emphasis on
standards by the Reagan ad-
Adams said.
local treatment of the men-
ministration for state mental
tally ill."
As far as possible changes
hospitals was hailed today as
The commission that rec-
in program emphasis are con-
"a tremendous step forward'
ommended the new standards
cerned, the new standards
by Dr. Freeman Adams, Stock-
worked for 18 months under
may mean a slight shift to-
ton State Hospital superin-
a Senate resolution intro-
ward more work with com-
tenden
duced by Sen. Alan Short
munity mental health pro-
The new standards, based
(D-Stockton) authorizing the
grams and outpatient care, he
on recommendations made: a
study.
said.
year ago by a special study
The new standards will be
The commission used com-
commission, apparently re-
implemented in phases on a
puters and personnel of Aero-
flect an abrupt change from
jet General Corp. in tabulat-
the previous administration
timetable to be determined by
ing and evaluating material
policy of eliminating jobs at
(Continued on Page 22, Col. 3)
to help determine the nursing
state hospitals.
time actually needed for
The cutbacks, which in-
patient care.
cluded more than 200 jobs at
Stockton State Hospital last
year, touched off a bitter con-
troversy over adequacy of care
for the mentally ill.
IN FUTURE
However, the application of
the new standards may be
some time off. The Depart-
ment of Mental Hygiene
budget now under considera-
tion, for 1968-69, does not re-
flect the new standards, Dr.
Adams noted.
The old standards are based
on a 1952 formula for
employe-patient ratios. The
new standards are based on
how much care an individual
patient needs as measured by
the time necessary for his
care and treatment.
Just how this eventually
will affect the staffing at
Stockton State Hospital is not
clear.
FEB. 13 THRU FEB. 27 1968
Pomo News
Admissions
241
Indefinite Leaves
31
Discharges
235
Population
1,649
A Progressive Paper for Progessive Patients
L. XXI, No. 17
MENDOCINO STATE HOSPITAL, FRIDAY, MARCH 1, 1968
TALMAGE, CALIFORN
Klatte Lauds
Reagan's OK of
New Staffing
Governor Ronald Reagan's rec-
ognition of the need for more
staffing in the State's mental hos-
pitals has brought approving com-
ments from hospital superinten-
dents throughout the state.
Mendocino's superintendent, Dr.
E. W. Klatte, had this to say:
"We are very pleased with the
announcement that the Governor
is endorsing the new staffing
standard developed by the Cali-
fornia Commission on Staffing
Standards for Mental Hospitals.
This is the first time that staffing
standards have been based on an
CHERI SHAW shows Arthur, the parrot star of "Dr. D
intensive study."
little" to Nellie Dailey, who's a patient on RT-D. Arthur is a han
More Nursing Service
some blue, green and yellow macaw with beautiful black markin
Explaining how MSH would be
on a white face. In the movie he plays Polynesia, the parrot wi
affected, Dr. Klatte said "The hos-
taught Dr. Dolittle how to talk with birds and animals. Cheri h
pital now has 480 nursing service
been with Big John Strong's Circus for about a year.
positions for the wards. Accord-
ing to the new standards there
ould be 613 nursing service posi-
Animals Star Attractions of
ns at the ward level and, in ad-
aution, 24 positions for off-ward as-
signments. We are now at 75 per
Big John Strong's Circus
cent of the new standards."
CLOWN Eddie Spaghetti alias
By ED ANDERSEN
Dr. Klatte added that although
ace juggler Hugh Marquandt,
Big John Strong and his all-star cast captivated the patients :
the standard has been adopted, it
spins a plate high atop a pole
staff of this hospital last Wednesday afternoon. From Eddie Sp
is his understanding that final de-
cisions on some aspects have not
while Fred Strom looks on. The
hetti, The Deans, Cheri Shaw with her parrot Arthur and beaut
been made and that there will
picture was taken on RT-D where
doves, Neena, a ton or more of charming pulchritude, a varied ass
probably be a slight adjustment.
some of the circus people stop-
ment of goats, rams, llamas, shetland ponies and pedigreed car
Psychiatric Aides
performers and last but not le
ped to bring the circus to those
Last September the hospital's
C'est la Vie Club
Big John himself.
psychiatric technician training pro-
patients who could not come to
At the Wednesday afternoon I
gram received accreditation, which
the auditorium.
formance well over seven hund
means that when the PTTs com-
Enjoys Unit A Combo
patients jammed the auditori
plete their year of training, they
Sacramento Channel 10
amid bags and bags of pope
are certified by the Board of Vo-
A combo from the Med-Surgical
and fruit punch SO thoughtfully I
cational Examiners. Accreditation
Division provided the entertain-
vided by Rehab Services and 11
criterion limits the classes to 15
Visits MSH to Televise
ment at the Feb. 22 meeting of
many, many volunteers. T
students, and when 23 PTTs were
C'est La Vie, the newly organized
worked for days prior to the s)
hired in January (this was done
Channel 10, from Sacramento.
popping pounds and pounds of e
by downgrading some professional
club in town for patients and ex-
visited the hospital recently to
and incidentally popping
vacancies) only 15 were eligible
patients. Harold Erlanger played
film sequences for a series it is
lights in the Rehab building.
for the training. The other eight
the piano and Charlie Thomas the
doing on mental health. Filming
Visits Closed Units
became psychiatric aides and un-
violin; both men are from Unit A,
der this classification they have
here was done on RT-A, the al-
Big John's day began early W
and had put their talents together
a variety of duties. Of the 22 psy-
coholism and drug abuse services
nesday morning along with
chiatric aides currently employed.
only the night before.
Deans, Eddie Spaghetti, Cheri,
and the adolescent program, with
ten are assigned to nursing serv-
emphasis throughout on the role of
Two club members from the
thur, the Doves and Miss Pea
Poodle visiting many of the wa
lees; the others have assignments
the hospital as a psychiatric train-
community also entertained. Hazel
around the facility. As you are
in the beauty shop, clinical lab.
ing center.
Geraghty played "Turkey in the
aware many of our fellow pati
dental lab. physical therapy. Re-
hab, Social Services, Research,
The series of five programs cov-
Straw" and Carlos Fernandez sang
could not attend the performa
VARC and Voc Rehab. The psy-
ers a wide range of facilities. It
"Pennies from Heaven."
at the auditorium and Big J
starts on a county level, then visits
and his fellow performers brot
Matric aide program is coordinat-
Mendocino and Sonoma State Hos-
Special thanks from the club
a bit of the circus into many
ed by Harold Neville, Supervising
pitals for State hospitalization se-
went to Velma Lawton, nursing
the units. Big John in his in
PTT working in Nursing Education.
quences and ends up with a sum-
services supervisor in the Med-
table manner did an exception
mary by Dr. James V. Lowry,
Surgical Division, for the gift of
fine job in reaching the heart
NEED A JOB?
DMH director in Sacramento.
a 75-cup coffee maker.
his audience and lighting up t
See Your Counselor
Viewing time of the series is
The club meets every Thursday
eyes by calling many of them
their names. We trust that
for A Referral to
from 6-7 p.m. on Wednesdays, with
from 7-9 p.m. in the recreation
Service
the Mendocino sequence scheduled
room of Holy Trinity Episcopal
pictures capture some of this :
PORTERVILLE STATE HOSPITAL
Porterville, California
VOLUME 16
Number 3
NEWSLETTER
March, 1968
SUPERINTENDENT'S MESSAGE:
"I'm sure we were all delighted to read about our Governor's 14 point program
for the mentally ill and retarded in California which he issued February 25, 1968.
Of course, some of the items we have been working towards for the last 15 years and
some of the items have already been accomplished at Porterville. For example, we
have a most capable Board of Medical Visitors known as the Medical Advisory Committee
which, incidently, will meet here on March 8. We never developed farming operations
which are now determined to be therapeutically out-moded. We have worked toward
the 70 square feet standard per patient bed and adopted this in May of 1966 (See
HB 37-R) but because of a waiting list for admissions have never been able to reduce
our patient population to 2095 from the present 2450 plus.
"The most heart-warming development however, is the acceptance by the Governor
of the California Commission on Staffing Standards Report issued in February 1967
and consistently advocated by those of us 'inthe field' throughout the trying 'freeze'
on hiring between Jan. and Apr. of 1967 and the 'cutbacks' in fiscal 67/68.
"Next year, beginning July 1, 1968, looks quite encouraging. The Governor's
Budget proposes 356 new positions for the treatment of the mentally retarded in
California, some 312 positions in nursing service. This is a most significant in-
crease in staffing and should mean some 70 or 80 additional persons at Porterville
to upgrade our daily nursing care of the patient. We shall continue to request re-
placement of those plant maintenance personnel deleted in fiscal 67/68. We cannot
operate a sound treatment program without necessary support personnel and adequate
operating expense funds. Repairs and remodeling as well as new construction must be
programed. At this writing over one million dollars had been proposed in the Gover-
nor's budget for 1968/69 to construct the first phase of refrigerated air condition-
ing to replace the inadequate evaporative coolers on twelve of our 34 non-acute wards.
Good news, as this early Spring weather brings the temperature up, up, up!
JAMES T. SHELTON, M.D.
SUPERINTENDENT AND MEDICAL DIRECTOR
MATES NEEDED FOR MATING GAME AT ANIMAL SHELTER:
School Principal Chet Powers reports several vacancies existing among distinguished
residents of the animal shelter at our School Division. As a result of our PSH
radio appeal, a peahen has been donated by Mrs. "Doc" Spuhler of Woodville to marry
the peacock recently donated by one of our Family Caretakers, Mrs. Druie Calucag of
Earlimart. Males are still wanted in the sheep and goat divisions. If you know of
a Ram and a Billy Goat who are at loose ends, perhaps an exiciting new life of mar-
ital bliss awaits them at our shelter. Please contact Cupid Powers if you come
across any prowling prospects.
RED CROSS TIME IS HERE AGAIN:
You will be contacted soon regarding a contribution to the American Red Cross. Our
total effort last year averaged out to 20¢ per employee. How much good could you
do for someone in need on the basis of 20c to spend for an entire year? In 1965 we
reached our peak of generosity with an average 29¢ per employee. Could you spare
four bits for the volunteer solicitor when you are contacted this month?
JOINT COMMISSION ACCREDITATION INSPECTION COMING MARCH 20-21-22:
Coming to inspect us for the continuation of our accreditation by the Joint Commis-
sion will be Dr. Theodore J. Hughes, who previously inspected us in Feb. 1962. We
have enjoyed continuous accreditation since our first inspection in Jan. 1959.
(
your
Vi
IMMEDIATE RELEASE
ATTACHED ARE THREE DOCUMENTS:
1. A statement by Spencer Williams
2. A commentary by the Director of Mental Hygiene
3. The California Medical Association report on the
State mental hospitals
IMMEDIATE RELEASE
STATEMENT OF SPENCER WILLIAMS
CONCERNING THE CALIFORNIA MEDICAL ASSOCIATION REPORT
I am extremely pleased that the final conclusion of the report is
that "patient care, particularly in the area of new admissions, has
shown improvement over conditions found in our earlier survey,
reported in 1965".
It is the aim of this Administration to continue to improve patient
care in our State hospitals, and, indeed, to improve our entire
mental health system, particularly in the community where treatment
is generally most effective.
The report notes that California is already in a "very favorable
comparative position in relation to mental health programs throughout
the nation" and that the Department of Mental Hygiene has provided
a "high level of leadership".
We intend that this leadership continue.
We recognize that there are deficiencies in some elements of the
system. Some of the same defects were noted by the Governor's
Survey on Efficiency and Cost Control earlier and remedial action
has already been undertaken.
On behalf of the State, I want to express our great appreciation for
this public service to the California Medical Association; its
President, Dr. John Morrison; Dr. Stuart Knox, Chairman of its Mental
Health Committee; and to the corps of hardworking physicians who made
the inspections.
February 29, 1968
RECOMMENDATIONS OF CALIFORNIA MEDICAL ASSOCIATION
REGARDING CALIFORNIA STATE MENTAL HEALTH FACILITIES
WITH COMMENTS BY
JAMES V. LOWRY, M.D., DIRECTOR, DEPARTMENT OF MENTAL HYGIENE
The 1968 report of the California Medical Association survey of the hospitals
of the Department of Mental Hygiene, like the 1965 report of a similar survey,
will make a valuable contribution to progress in the care of patients in state
hospitals. It is a concise, sometimes laudatory, sometimes critical report.
It is presented with an objectivity that recognizes the progress that has been
made since the last survey. It identifies the problems that continue and pre-
sents constructive recommendations for their solutions. It appropriately com-
mends the staffs of the hospitals for their performance under difficult cir-
cumstances.
My reactions to the recommendations are as follows:
1. The "Staffing Standards for Public Mental Hospitals," as reported
to the State Senate by the California Commission on Staffing Standards
in February 1967, be adopted immediately and implemented as rapidly
as possible. The "Staffing the Care of Patients Effectively" (SCOPE)
surveys based upon an industrial engineering study of nursing per-
sonnel in the California State hospitals for the mentally ill and
retarded, can accura ely monitor the level of patient care on the
wards.
Comment. I agree with the recommendation and am pleased that
Governor Reagan has approved the adoption of the California Commission
on Staffing Standards for hospitals of the Department of Mental Hygiene.
A study is being made by the Department of Mental Hygiene to develop
a realistic plan for implementing the standards. There will be two
problems: money and availability of professional personnel. (The
Department has funds to employ 168 professional personnel, including
86 physicians, at this time but these personnel are not available).
2. The Department of Bio-Statistics of the State Department of Mental
Hygiene should continue studies determining length of patient stay,
why and under what conditions patients leave, how many patients re-
turn and how soon after leaving the hospital.
Comment. Now being done and will continue.
3. The Department of Mental Hygiene should be encouraged to continue its
efforts to secure more appropriate placement for patients who do not
continue to require medical and nursing services in a hospital.
Comment. Now being done, and I will ask Mr. Williams to ask the
Department of Social Welfare to strengthen the placement program.
-2-
4. Wherever possible, patients should be admitted to State mental
hospitals only by referral from local private physicians or the
local mental health program.
Comment. In process of developing systems in cooperation with
local mental health programs.
5. Provision should be made for the Department of Mental Hygiene to
establish a class of personnel which would perform nontechnical
ward duties.
Comment. Some months ago the Department initiated the establishing
of a class of personnel to be called Technician Assistants.
6. Contractual arrangements with other community resources should
be made for provision of service functions which could be more
effectively and economically provided by such resources than by
the hospitals attempting to provide these services themselves.
Comment. A study of feasibility on a hospital by hospital basis
will be initiated.
7. Provision should be made for a stepped-up program of out-of-state
recruitment to enable the filling of vacant but authorized staff
positions.
Comment. This has been and will continue to be a principal
mechanism for obtaining professional personnel.
8. Independent surveys of the state mental institutions should become
an ongoing program of the California Medical Association, perhaps
through a Board of Medical Visitors for each hospital.
Comment. I am pleased that the California Medical Association is
agreeable to continuing its survey service to the state hospitals
and welcome the Board of Medical Visitors concept.
9. Continuity of treatment supervision should be continuously re-
evaluated to be sure patients receive adequate treatment after
discharge.
Comment. Continued treatment is of vital importance to partially
recovered patients who can leave the state hospitals and can be
available throughout the state by referral to private physicians
and to local mental health programs. Only in this way can patients'
care be adequately supervised. The Department of Mental Hygiene
will strengthen and extend this system as rapidly as cooperation
from local sources can be obtained.
10. Efforts should be made to correct, at the earliest possible time,
the existing defects in physical plant and maintenance.
Comment. Adequate physical plant is essential to good patient care.
Governor Reagan has recognized this and identified the mechanism in
one of the fourteen points in his recent statement regarding the
program of the Department of Mental Hygiene.
Observation and Comments Based on a Resurvey of
CALIFORNIA STATE MENTAL FACILITIES
by the
CALIFORNIA MEDICAL ASSOCIATION
February 26, 1968
PREAMBLE
Since the early fifties, the California Medical Association, with
the full cooperation of the Department of Mental Hygiene, has
participated actively in the development of long-range policies
for effectively dealing with the problems of mental illness and
mental retardation in this state. California has pioneered inno-
vative changes in coping with these problems and has produced a
strong movement toward decentralizing care and increasing emphasis
on a local program development. The achievements and developments
thus far realized put California in a very favorable comparative
position in relation to mental health programs throughout the
nation.
Currently we are in a mid-stream position in this vast transitional
process. The numerous changes inherent in these evolutionary
developments have, of necessity, left undesirable gaps in the con-
tinuity of some treatment programs. It is our sincere wish that
the findings and recommendations of this report will open new
avenues of constructive planning and procedure which will keep
California in the forefront with improved care for patients with
mental illness and mental retardation.
We feel that the Department of Mental Hygiene has provided a high
level of leadership and guidance in meeting California's needs in
this field, and that continued study and effort will develop
greater efficiencies and economies in the management of the stagger-
ing load which confronts us.
PURPOSE
Considerable public concern and controversy were aroused in
California during 1967 about the level of care in the state
hospitals. The visit of a prominent foreign official to Sonoma
State Hospital who publicly questioned the quality of care
rendered at that institution for the mentally retarded brought
this public concern to a climax.
-2-
The California Medical Association, in line with its continuing
concern for the delivery of quality medical care to all
California citizens, again offered as it had earlier in the year,
to evaluate the quality of medical care received by the mentally
ill and/or retarded in all fourteen state hospitals. It also
offered to assess progress made by the hospitals in implementing
recommendations made by the California Medical Association in a
report submitted to the California State Department of Mental
Hygiene on January 18, 1965.
The offer was accepted by Spencer Williams, Administrator of the
State Health and Welfare Agency. A general report of the findings
was to be submitted to the Administration by mid-February, with
specific reports to follow at a later date.
METHOD
Before undertaking the survey, the California Medical Association
Committee on Mental Health carefully reviewed the 1965 report to
be sure comparisons between current and previous conditions would
be accurate and meaningful.
Inspection teams were composed of from five to seven physicians.
To obtain a more accurate appraisal of changes in levels of care,
each hospital (with one exception) was revisited by at least one
physician who had participated in the survey of that hospital for
the 1965 report. At least two psychiatrists were on each team,
with the remainder being selected from other medical disciplines.
Physicians from the local area were included on each team.
The prospective survey was announced by letter to institution
administrators. At a meeting held by each team before its site
visit, team members received assignments and instructions regarding
survey duties. Several hours were spent in these preparatory
meetings.
To be used as guides in surveying the institution, each member was
given a questionnaire with specific questions about the physical
plant, personnel, psychiatric services and medical-surgical services,
and a copy of the 1965 California Medical Association report.
A brief conference with the superintendent and other key personnel
began the inspection day. Necessary keys for access to all areas
of the hospital were given to team members at that time. From this
meeting, surveyors went independently to their individual assign-
ments.
At noon, the members met to compare findings and to plan afternoon
assignments that would assure satisfactory evaluation of the
institution.
-3-
During the survey, the team met with members of the hospital
staff at all levels and from most departments. After the site
visit, team members reconvened to report personal observations
and assessments of the hospital's functioning and the quality
of patient care. A report summarizing each team's observations
was prepared. These reports were then reviewed by the California
Medical Association Committee on Mental Health.
FINDINGS
I. PHYSICAL PLANTS
Generally, the physical facilities used for direct patient care
in the hospitals are in reasonably adequate repair, and for the
most part have improved since the 1965 report. Many of the 1965
structural recommendations have been implemented. Some of the
buildings are in excellent condition; others, however, even in the
same institution, are seriously deteriorating, and many should be
eliminated.
In most hospitals, building maintenance is on an emergency basis,
with nearly all attention being diverted to critical repairs.
Inadequate manpower is available for day-to-day upkeep to prevent
serious deterioration.
Grounds, basic equipment and many structures show evidence of
inadequate maintenance in numerous situations. For example,
peeling paint, damaged plaster, broken windows (several hundred
in one hospital) and uncared-for grounds are common. Personnel
report they are unable to keep up with requests for repairs, and
the backlog of these requests has increased substantially during
the past few months.
The level of housekeeping varies from ward to ward. In those
housing ambulatory and less disabled patients, the situation is
markedly better than in wards where the patients are less able
to perform housekeeping duties. In most instances, the poorest
housekeeping is found in the acute medical-surgical wards where
the demand for nursing care is most critical, but the general
conditions in these wards were superior to those found in the
1965 survey.
II. PERSONNEL
Uncertainty about the future is creating personnel problems
throughout the entire hospital system. Budget and policy develop-
ments will be watched closely by the personnel.
-4-
It was observed that:
(a) In many wards, the ratio of nursing personnel
to patients is deficient, as shown by the
recent SCOPE surveys. The September 1967 level
of ward personnel was 76.7% of the standard and
the January 1968 level was 79.5%. Especially
during afternoon and evening shifts, there were
wards with one or two persons caring for up to
ninety mentally ill patients. There is limited
provision for replacement of absent personnel.
(b) Female ward personnel is being used alone on some
men's wards with disturbed patients.
(c) Skilled personnel is spending too much time
performing housekeeping and clerical chores.
(d) Reassignment of some nursing personnel and changes
in the type of patient being cared for on some
wards have not been preceded by adequate retraining
or orientation of personnel for their new duties.
(e) As was true in the survey reported in 1965, a
shortage of rehabilitation, teaching and recre-
ation personnel was noted in all hospitals, especially
in adolescent and children's units, which lack male
personnel to supervise necessary activities. In
most hospitals, occupational therapy was available
to only a small percentage of the patients.
(f) Clinical laboratories are still understaffed.
(g) In most hospitals, pharmacies are adequately staffed.
(h) About 165 positions for professional personnel are
vacant, and recruitment, as in the past, continues
to be very difficult.
(i) Clerical and janitorial personnel shortage is
critical almost everywhere.
(j) Under the civil service system, often the first
persons to be discharged are those who are younger
and more able-bodied. This is conspicuous among
those doing maintenance work, as well as among
ward personnel.
-5-
(k) A shortage of cooks was noted in most hospitals.
The variety of menus was limited. Much serving
of food and feeding of patients needing
assistance is done by nursing personnel and by
other patients.
(1) Postgraduate physician education in the hospitals,
both insofar as courses offered and the number
of persons taking them, improved after the 1965
report. More physician time is being spent with
patients. This makes adequate allocation of time
for these courses difficult.
(m) Research in those hospitals which have received fede-
ral research grants is of high quality. Grants for
treatment research usually provide additional
personnel.
The temporary curtailment of inservice training programs for new
psychiatric technicians has had a detrimental effect because of
the loss of the vitalizing influence of educational programs on
personnel. The reduction of this educational function eliminated
new, younger and potentially valuable replacement from the roster
of those who deal most directly with the patients.
Transfer of more capable mental retardates to special programs
in hospitals for the mentally ill has deprived the hospitals for
the mentally retarded of valuable patient work contributions,
since only the more severely affected patients remain.
In several instances, much-needed therapy facilities, smaller wards
and classrooms are not fully utilized because of the lack of person-
nel to staff them.
III. PATIENT SERVICES
Most hospitals have had an increase in admissions. Many of these
patients are very sick and are being given immediate and intensive
care. Treatment of these acutely ill patients has resulted in a
greater proportion of personnel time being devoted to this phase
of hospital activity. This limits the medical service available
for the remaining patients, most of whom primarily are receiving
custodial care.
Individual psychotherapy is still lacking throughout the system.
Group therapy has been used more widely than four years ago.
However, recently, the size of the groups has increased, and the
frequency of treatment group meetings has decreased.
Rehabilitation and occupational therapy programs continue to be
inadequate and understaffed. While work can be therapeutic, most
of the work assignments for patients seem to be based on hospital
needs rather than patient needs.
-6-
More children are attending educational classes than four years
ago, but more teachers' assistants and special supplies are
needed in practically every institution to avoid neglect of
children who are educable.
Patients are dressed in their own individual clothing, as
recommended in the 1965 report. For the most part, laundry
services are slow and often irregular. When laundry service is
inadequate, this additional burden is assumed by ward personnel.
In most hospitals a definite improvement was noted in drug supplies
as compared with previous surveys. Pharmacies are well staffed in
most institutions and pharmaceutical records are in good order in
practically every instance. Drugs are being used more frequently
as a primary factor in patient treatment.
Recommendations made in the 1965 report in regard to shock treatment
safeguards have been carried out in all but a few instances; electro-
shock therapy is used less frequently than four years ago.
Adequacy of clinical records ranged from poor to excellent. Even
in institutions with excellent records the equipment and means for
keeping them are outmoded or inoperative and clerical help is swamped.
Frequently, record-keeping takes valuable professional time away from
patient care.
Chaplain services are available and being utilized although in some
instances, they could be expanded and improved.
The ongoing reorganization of the hospital system to provide services
to patients from the surrounding geographic area is a positive re-
flection of recent trends in psychiatric care. This regionalization
allows greater continuity of care as well as better communication
and coordination between hospital staff, community physicians and
local mental health resources.
Aftercare programs need to be better coordinated in almost every
instance. Satellite services, maintained by some hospitals in the
communities they serve, provide pre-admission screening and
aftercare. They have been rendering valuable services. Local
programs must be urged to assume these functions immediately.
IV. MEDICAL AND SURGICAL SERVICES
Medical and surgical services are adequate. Some are excellent.
Relationships with nearby community physicians have been improved
in some instances. While consultants are used upon occasion,
community resources should more often be utilized to provide many
services; i.e., laboratory, intensive care, surgery and X-ray,
more effectively and economically.
-7-
The most uniform deficiency in the medical services is the lack
of modern, functioning medical and surgical equipment and
frequent absence of disposable items which could cut housekeeping
time and expenses considerably. Contract services with community
resources could solve this problem.
Medical records, while usually adequate, are frequently located
in files away from the wards and are almost inaccessible for
routine reference. This is a difficult problem which can be solved
only by more sophisticated record-keeping systems.
Safeguards provided in radiology departments are an improvement over
four years ago.
Anesthesia is properly administered by trained personnel.
COMMENDATIONS
All teams reported they received the utmost in cooperation from both
administration and staff. Hospitals with serious administrative
problems in the 1965 report have improved considerably.
The staffs of the hospitals are to be commended for their performance
under difficult circumstances and with the continuing inadequate
numbers of personnel noted in earlier surveys. Nursing personnel
especially has shown sincere dedication and ingenuity in the care
of patients. Nurses and psychiatric technicians are working extra
hours and must later take compensatory time off with resulting
decreases in on-duty staff.
CONCLUSIONS
I. The continuing decrease in hospital population is a result of
several factors, including the following:
(a) More intensive treatment for the newly-admitted
patient has shortened individual hospitalization
periods.
(b) The greater number of voluntary admissions has made
possible the premature self-discharge by patients
before completion of treatment.
(c) Certain patients are being discharged from state
hospitals to other appropriate facilities in the
community.
(d) The Short-Doyle program has assumed responsibility
for some 42,000 of the acutely mentally ill patients.
However, the population of the state is increasing
to a degree that keeps first admission rates constant.
-8-
II. The alteration of the characteristics and care requirements
of the current inhospital population necessarily requires greater,
more flexible and more innovational use of treatment personnel.
III. These alterations of patient characteristics have left a hard
core of patients with difficult problems, who require a higher ratio
of treatment personnel per patient to provide adequate care. Daily
patient census does not fully reflect staffing needs.
IV. Reductions in the 1967-1968 Budget have been detrimental to the
maintenance of the hospitals' physical plants.
V. The problems of personnel morale and recruitment have been made
even more difficult than usual because of unfortunate controversy
and uncertainty.
VI. Patient care, particularly in the area of new admissions, has
shown improvement over conditions found in our earlier survey,
reported in 1965.
RECOMMENDATIONS
The California Medical Association Committee on Mental Health recom-
mends that:
I. The "Staffing Standards for Public Mental Hospitals," as
reported to the State Senate by the California Commission on
Staffing Standards in February 1967, be adopted immediately and
implemented as rapidly as possible. The "Staffing the Care of
Patients Effectively" (SCOPE) surveys based upon an industrial
engineering study of nursing personnel in the California State
hospitals for the mentally ill and retarded, can accurately monitor
the level of patient care on the wards.
II. The Department of Bio-Statistics of the State Department of
Mental Hygiene should continue studies determining length of patient
stay, why and under what conditions patients leave, how many patients
return and how soon after leaving the hospital.
III. The Department of Mental Hygiene should be encouraged to con-
tinue its efforts to secure more appropriate placement for patients
who do not continue to require medical and nursing services in a
hospital.
IV. Wherever possible, patients should be admitted to State mental
hospitals only by referral from local private physicians or the local
mental health program.
V. Provision should be made for the Department of Mental Hygiene
to establish a class of personnel which would perform nontechnical
ward duties.
-9-
VI. Contractual arrangements with other community resources should
be made for provision of service functions which could be more
effectively and economically provided by such resources than by the
hospitals attempting to provide these services themselves.
VII. Provision should be made for a stepped-up program of out-of-
state recruitment to enable the filling of vacant but authorized
staff positions.
VIII. Independent surveys of the state mental institutions should
become an ongoing program of the California Medical Association,
perhaps through a Board of Medical Visitors for each hospital.
IX. Continuity of treatment supervision should be continuously
reevaluated to be sure patients receive adequate treatment after
discharge.
X. Efforts should be made to correct, at the earliest possible time,
the existing defects in physical plant and maintenance.
Hental
STATE OF CALIFORNIA-HEALTH AND WELFARE AGENCY
RONALD REAGAN, Governor
DEPARTMENT OF MENTAL HYGIENE
1500 FIFTH STREET
SACRAMENTO 95814
file
July 30, 1968
Mr. Curt Taylor
Executive Assistant to the
General Manager
California State Employees' Association
1108 0 Street
Sacramento, California 95814
Dear Curt:
This is the follow-up to our telephone conversation of this morning.
Quite naturally, I am in no position to dispute the survey, but I surely can dispute
the statement, "As soon as this backward movement is stopped, we hope the Adminis-
tration will start moving forward with the 14-point program announced by the
Governor." The Governor has not only started, but you can see for yourself that
no grass has grown under his feet. Let's take them point by point:
1. Establishment of two additional Mental
Not only is the Administration supporting
Retardation Regional Centers.
this, but it is supporting the estab-
lishment of four instead of two, which
will bring the total to six Mental
Retardation Regional Centers.
2. Junking of the obsolete 1952 standards
The Governor has adopted the Commission's
for staffing hospitals for the mentally
standards and the budget for this fiscal
ill and adoption in principle of the
year has funds to achieve the first of a
standards set forth in 1967 by the
series of increases required to reach
California Commission on Hospital
full implementation of the standards
Standards. Implementation of these
within the next five years. I know you
standards will be in phases consistent
are aware that the 1952 standards had
with sound hospital and management
not been achieved by 1967.
practices.
3. Creation of a Board of Medical Visitors
With the exception of one hospital,
for each state mental hospital to
which is awaiting the nomination of a
insure on-going surveys of each
physician from a particular county,
institution.
the boards of medical visitors have
been appointed.
4. Inspection of hospital buildings by
The first inspection has been completed
the Department of General Services to
and the Department of General Services
assure their proper maintenance.
will conduct periodic, scheduled
inspections to assure that the buildings
are properly maintained.
Mr. Curt Taylor
-2-
July 30, 1968
5. Instructions to Spencer Williams,
This is still under study.
Secretary of Human Relations, to
determine why there are major quality
variances among the mental hospitals
and to find out why some are not
operated as well or as efficiently
as they should be.
6. Action aimed at determining at the
The plan has been completed, and rather
earliest date what hospital facilities
than phase-out of hospitals, beds
should be phased out or eliminated in
vacated by mentally ill patients can
the light of basic changes in the
be used for treatment units for the
patient load because of greater
mentally retarded, where there is still
emphasis on local care and treatment.
some overcrowding.
7. Implementation of a program to
Farming operations will be discontinued
eliminate gradually out-dated
within the near future except at two
functions such as farming operations
hospitals.
at some of the hospitals.
8. Phasing out of surgical facilities
Surveys and negotiations with local
at some of the hospitals, particu-
general hospitals are underway. It
larly where better treatment for
may not be possible to obtain these
patients can be obtained nearby at
services at less cost, and so the
less cost.
implementation may not be possible.
Also, the hospitals in areas where
most of the state hospitals are
located may not be able to handle
an increased surgical load.
9. Immediate establishment of standards
The 70 square feet was established.
requiring 70 square feet of space per
The Department has been trying for
patient bed. For the past three
three decades to gain this standard.
decades, the state's standard for
The number of patients in the
each patient has been less than 55
hospitals for the mentally ill is
square feet. The 70 square feet
lower than the rated bed capacity
standard is the nationally-accepted
of 70 square feet per patient.
standard.
10. Adoption of clear-cut and definitive
Adopted--copies are attached.
goals for the treatment of the mentally
ill and the mentally retarded. These
goals have been acclaimed by leaders
in the mental health field.
11. Re-evaluation of the budget for mental
The budget was re-evaluated, and the
health in the light of the most up-to-
1967-68 budget was increased by
date information available, based on
$1,800,000. The budget submitted in
need as well as resources available.
January (the 1968-69 budget) was
increased by over $6,000,000.
Mr. Curt Taylor
-3-
July 30, 1968
12. Renewed instructions to Dr. James
Still in effect. It means that the
Lowry, Director of the Department of
Department of Mental Hygiene has the
Mental. Hygiene, that he has now as he
authority to utilize funds appropriated
has had in the past year complete
for professional positions that are
discretion in maintaining the staffing
vacant for any health care personnel
requirements and levels for care of
that are available for employment.
patients.
13. Streamlining of administrative functions
The new reorganization was approved and
within the Department aimed at greater
became effective July 1. A copy of the
efficiency which can be reflected in
chart is attached.
better care for patients.
14. Creation of an advisory committee to the
The Governor's Advisory Committee on
Governor on mental health.
Mental Health has been appointed and
the first meeting should occur in the
near future.
Relative to the statement, implementation of the program will not begin until
1970", I pointed out under Number 2 above that there are funds in this year's
budget to start in the hospitals. This is a total of 487 additional positions,
and is the first increment toward meeting the staffing standards. 148 of the
positions are in hospitals for the mentally ill, 312 in hospitals for the mentally
retarded, and 27 for the mentally retarded in hospitals with both mentally ill and
mentally retarded. These positions are in addition to those required to continue
to maintain the level of care provided on July 1, 1966. As you are aware, that was
the budget in effect in the year when the Governor took office, and was the highest
staffing ratio ever achieved within the Department during the last three decades.
I have never researched beyond that.
Sincerely,
Alcan Alfred M. Calais
Public Information Officer
AMC: 1fb
CC: Dr. James V. Lowry
Mr. Robert Fugina
Mr. Paul Beck
Attachments
How Employees Rate Today's Hospital Care Compared to 1966
OCCUPATIONAL
NUMBER
OF
EMPLOYEES
100
200
250
300
400
500
600
700
750
800
900
1000
1100
GROUPS
MUCH BETTER
SOMEWHAT BETTER
ABOUT THE SAME
MUCH WORSE
SOMEWHAT WORSE
WASN'T HERE IN 1966
DMH Staff Says State Mental Care Fails
Most employees who care for patients in state
71 percent said there is less care and treatment.
professional standards, and 11 percent listed num-
mental hospitals believe that standards of care and
18 percent said the quality or quantity of food, hous-
erous other proposals.
treatment have declined since 1967 budget cuts
ing and other living conditions is worse.
were imposed.
71 percent of support services personnel (main-
o 79 percent said that staff training is either non-
tenance, food service, laundry, etc.) said their level
An even greater number of employees in main-
existent or reduced.
of service has dropped.
tenance, food service, laundry and other support
work say the level of services they provide is lower
33 percent of clerical employees in medical
because of the budget cuts.
asked to list priorities for improving patient
records sections said their services are better
care, 51 percent said more staff is needed; 10 per-
17 percent said they are about the same. This the
More than three-quarters of the nursing staff-
cent proposed better use of staff; 10 percent sug-
best showing by any hospital service. Only 37 per-
doctors, registered nurses, psychiatric technicians,
gested better facilities; 12 percent asked for higher
cent said their services are poorer.
psychologists, therapists, social workers - lay
principal blame for reduced patient care on a short-
age of staff and low employee morale.
These opinions are among dozens offered by
3,567 hospital personnel who answered
sponsored questionnaire last March and April Tab-
Survey Replies Say Short Staff, Low
ulation of the responses was completed last week
by CSEA Headquarters Office.
Morale Hinders Mental Patient Care
Information developed by the survey will be
used by CSEA to back its argument that more staff,
not less, is needed in the hospitals.
The final question on the questionnaire asked the employee
if he wished to add any comments. Many did. Here are repre-
A. Curtis Taylor, executive assistant to the CSEA
sentative samples of what they said:
general manager, said copies of the survey report
have been submitted to the governor's office and to
Department of Mental Hygiene officials.
We need more help. These patients are
getting more psychotic and we can't do any-
Much has been stressed about increase in
"We hope that this survey will prompt an im-
thing about it. It is your duty to them and
patient injury
It must be mentioned that
mediate stop to the cutback in hospital jobs,"
to the general public to do something for
personnel injuries are just as important
Taylor said. "As soon as this backward movement is
these people, SO they can once again go out
Inadequate staffing on acute wards lead to
stopped, we hope the administration will start mov-
and lead a normal, fruitful life.
patients attacking personnel
Inadequate
ing forward with the 14-point program announced
- Psychiatric Technician
staffing on geriatric wards where much lifting
by the governor."
is required, and increase in PT work loads,
leads to more back injuries and strains.
Governor Ronald Reagan announced in February
Prior to the budget cuts, it was my feeling
Psychiatric Technician
that he had adopted a 14-point program of improve-
that we at this hospital were reaching a staff-
ments in the hospitals, including the staffing recom-
patient ratio where effective work was pos-
mendations submitted by the California
sible in small group situations and one-to-one
I had five technicians on the p.m. shift; I
Commission on Staffing Standards in January 1967.
relationships with patients throughout the
now have two - usually only one working
However, implementation of the program will not
hospital. My first reaction to the cuts was
with me. This is an admission ward with
begin until 1970.
that we were being penalized for the accom-
acutely ill psychotics, etc. No time for patient
Taylor said the opinion survey was undertaken
plishments that had been made.
contact anymore.
by CSEA to find out what employees them-
Rehabilitation Therapist
Nurse, R.N.
selves think has happened to the standards of treat-
ment and services they render."
Those at the "top of the ladder" SO to speak,
Following are highlights of the statistics:
I thank you for allowing me to make my
are not looking to the future. There will
feelings and observations known. I hope
always be suffering humans with mental
67 percent of nursing staff respondents said
some good will come of it. I enjoy my work
that patient care is "somewhat worse" or "much
disorders who will require supervision and
when I feel I am accomplishing something
care. Who will do this? Your older PTs are
worse,' 19 percent said it is "about the same,"
and helping others to do this. I haven't felt
while 8 percent said it is "somewhat better" or
retiring, quitting and dying. How many young
very satisfied lately and I've become very
ones are left? Very few! The ones who are
"much better." (Among those who said that care is
tired and have seen this in my employees.
capable of doing a job are seeking employ-
the same or better are employees of hospitals for
However, I'm still hopeful for the future as
the mentally retarded, which were not affected by
ment elsewhere. They just can't stand work-
I feel things can't get much worse. And with
the budget cuts to the same extent as hospitals for
ing in a surrounding which promises no
continued investigations and re-evaluations,
the mentally ill.)
improvement in patient care, treatment or
the truth of our needs is bound to come out in
hope of advancement.
the open.
77 percent said the cause of reduced patient
Psychiatric Technician
Psychiatric Technician
care is shortage of staff and low employee morale.
THE CALIFORNIA STATE EMPLOYEE, JULY 26, 1968
TH
Mental
FOR RELEASE: 1:30 p.m.
WEDNESDAY, July 2
1969
Statement by Spencer Williams, Secretary
Human Relations Agency of the State of California
to
Senate Business and Professions Committee
State Capitol
Sacramento, California
This hearing is called to consider a report that the Human Relations Agency
originated. The Agency arranged for the study, employed the independent consultants
and provided the Committee with the report. Dr. Lowry and I wanted an objective
group to give us a responsible impartial report of the care of the retarded in
order that we might further improve that care.
We asked that the problems be exposed with a view to their correction. We
recognize, as does the Committee, that this is a controversial field in which
experts disagree and in which any finding is likely to be controversial. This
has been compounded in the matter before you because what you have had up to now
is not the total report.
Instead you have had a report on one hospital out of nine hospitals that serve the
retarded ----- and not the report of the task force, but rather a report of
consultants to the consultants. You have had a piece of an appendix to a report.
And the one that has been publicly published isn't even that. It's a draft of a
piece of an appendix to a report.
Furthermore, state hospitalization of the retarded is but one segment
and
a
small one at that --- of the total care of the retarded.
Therefore, I think that it is appropriate that we place some perspective on the
report concerning Sonoma State Hospital. This is not to say that I am unconcerned
about the report. I am quite concerned about the report and I am determined that
we shall further improve conditions there.
To provide this perspective, I want you to have the total report concerning our
State hospitals for the retarded and I want to describe the place of state
hospitalization in the total system of care for the retarded.
Governor Ronald Reagan believes, and has moved to implement, the concept that
development of the retarded to his fullest potential is best achieved by care and
treatment in the community.
-2-
We have moved in a variety of ways to implement that concept. New legislation that
went into effect July 1 offers the potential of an increase in services to the
retarded. This legislation was a part of a comprehensive revision of our mental
health system. Other legislation now under consideration (AB 225) can do even
more.
Since 1957 California has supported a jointly-financed state-county community
mental health service that in the last fiscal year embraced 47 of our 58 counties
and more than 95 percent of our state population. Funding proportions and many
other elements of the community programs are changed by the new legislation.
As it affects the retarded, the basic changes are those which increase the range
of services to include rehabilitation and partial hospitalization and which clearly
state that a physician other than a psychiatrist may be used when it is more
appropriate to the treatment needs of a retared patient.
Despite the new legislation's fiscal emphasis on treatment of the mentally ill,
plans submitted by the counties provide for a perceptible increase in services
offered to the retarded starting in July.
I anticipate that as experience with the new procedures is gained, there will be
greater increases in the services offered to the retarded through the community
mental health programs.
The new legislation now under consideration and strongly supported by the
Administration, brings all the diverse elements of the mental retardation services
together in a single coordinated system. The key to the effectiveness of this
system is the Regional Diagnostic Center. The centers provide diagnosis, counseling,
and help provide services to the retarded and their families. They also perform
the admission functions for the state hospitals and after-care placement. Three
such centers are currently in operation. Three additional centers will soon be
opened.
The centers not only increase the professional resources available to the retarded
and their families, they also facilitate the use of all existing resources.
-3-
An important feature of the community-based center is its function in setting
priorities. Within the limits of the contractual amounts, the center can deter-
mine who needs services most and what services it can support. Obvious needs and
available services can be matched in this way, structuring an array of services
to meet actual needs.
This way the concerned individuals at the local level participate in the decision-
making process. We feel this is far more desirable than establishment of
priorities in Sacramento and offering them to the community on a take-or-leave-it
basis.
It is our hope that by the use of local planning and regional centers all of the
communities in California will determine for themselves how best to care for
their retarded. The State's role will then be one of setting standards and providing
guidance and funds, not one of directing operations and exerting stringent controls.
As a result of 1967 legislation and increased state financial support, there was
substantial expansion of development centers for handicapped minors. These 29
centers provide day service for retarded and other youngsters so severely
handicapped that they cannot participate in even the special education courses in
the public schools. More than 1,000 children are cared for in these centers,
permitting their parents to work. The program also reduces the need for
institutionalization.
The public schools provide classes for both the educable retarded and more
recently the trainable. There are more than 65,000 children in these classes.
Much of the community-based effort that I have SO far discussed has been aimed at
providing prompt, flexible, close to home care to prevent needless hospitalization.
There is, however, a second thrust at the community. That is to return persons to
the community from the state hospitals. This involves both the provision of more
intensive services in the hospitals and the development of community resources.
At the present time and primarily because of fiscal advantages, the State Department
of Social Welfare operates the placement and after-care programs for the
retarded released from state hospitals. There has been a dramatic upsurge in
-4-
community placement since June, 1967. In about two years the caseload has
increased from 3,500 to 5,700. The Department basically purchases needed
community services.
The Department is also financing a special pilot program under which retarded
receiving aid as totally disabled are referred to sheltered workshops for
vocational evaluation. The program was funded at 200 and we are asking that
it be increased to 350 this year. Some do prove to have the potential for
vocational training, but the main benefit has been to improve their capacity to
manage for themselves.
I should mention, in this connection, that we have about 19,000 retarded
individuals receiving aid to the disabled under our welfare program. The retarded
represent only a minor portion of that total program which serves more than
141,000 persons currently.
While we are moving into more effective community treatment, we are at the same
time strengthening hospital services. The ratio of hospital treatment staff to
patients has been improved for the first time in years.
In 1967-68, the number of filled treatment positions in our state hospitals for
the retarded increased by more than 200. In the year just ended, the number of
filled treatment positions was further increased by an additional 300 personnel.
That is a total of 500 more staff in less than 24 months. We are currently
requesting an additional 200 positions. Most of these would be a new class we
call hospital workers. They will relieve the nursing staff of some of their
routine duties and permit them to provide more treatment time. The worker
classification has another benefit in that it provides a career opening for the
disadvantaged. The California Commission on Hospital Standards conducted a study
employing industrial engineering and aero-space techniques to determine staff
requirements in terms of patients and their varying needs. We have adopted those
standards. They replaced lower, less scientific standards, set in 1952. Those
previous standards had not been achieved 15 years later. This Administration,
however, is moving aggressively to meet the new standards and plans to achieve them
in the next five years.
-5-
We have adopted the national 70-square foot standard and achieved it at our new
units for the retarded at Agnews, Camarillo and Napa. These units have been set
up in capacity vacated by our rapidly declining mental hospital population.
Overcrowding continues at the four hospitals exclusively for the retarded although
the opening of the new units and the decline in the total have effected some
reduction.
The State Department of Rehabilitation plays an important and growing role in
all of these programs, both in the hospitals and in the community and in
cooperation with other state departments, local school districts and community
mental health programs.
Back in 1958, the predecessor of the Department rehabilitated 12 retarded persons.
In the last fiscal year the Department rehabilitated about 1300 retarded persons.
The increase was spurred by the creation of the cooperative programs, especially
those directly with the school districts. Another more basic factor was also
involved in the great increase in the number of retarded served. This was the
fact that as the Department gained experience with the retarded it became more
willing to undertake additional programs with retarded clients.
Services for the retarded have also been stimulated by the Regional and Community
Planning Project. The State contracted with the California Council for Retarded
Children to administer the Project. It in turn worked through local voluntary
agencies, providing an in-depth community involvement.
Community placements have been facilitated by a recent law providing that the
State Director of Public Health can be named guardian or conservator for a
retarded person. This gives the family the security of knowing that there will
always be someone to protect the retarded person and his interests.
As I have described our program, you may have been mentally checking off the
number and variety of organizations involved in providing service.
I have mentioned five major State departments which have direct responsibilities
to the retarded. There are other departments as well as the various community
organizations. This, obviously, creates problems of coordination.
-6-
There are studies underway seeking improved coordination. I want to avoid,
however, the creation of some monolithic organization designed solely to serve
the retarded. I would prefer to see us make the maximum use of our general
resources with each of them serving the retarded as appropriate along with
others. We need a nice balance of efficiency and variety of service. Our
current objective is to maintain our retarded fellows in the mainstream of
our society.
Our ultimate objective is reduction of mental retardation through research and
its application. We are pursuing this goal in a variety of ways.
The new research program at the Neuropsychiatric Institute in Los Angeles is
off to a running start. The Center, a cooperative venture between the Department
of Mental Hygiene and the University of California, is one of 12 such research
establishments in this country.
The four-story physical facilities have been completed. The out-patient unit
is in operation, serving over 100 patients a month. The first in-patients have
been admitted. A variety of intensive, generally short-term, treatments are
offered. The facility will demonstrate good clinical practice as part of the
residency training program.
Nine interdisciplinary research teams are already at work. There are 25 teams
planned, falling in four basic divisions: neuro-biology; neuro-chemistry;
neuro-physiology; and a social, behavioral, epidemilogical section. Researchers
from a variety of specialities will conduct the wide-ranging research.
Basic research is planned in genetics and brain structure. The way protein is
formed is to be investigated in relations to PKU. The influence of socio-economic
factors is another subject of study. Elsewhere the development of new vaccines
for prevention of diseases known to be associated with retardation also holds out
great hope that the incidence of retardation can be significantly reduced.
California is now spending about $140-million a year from its General Fund for
services to the retarded. In addition there is another $20-million or more in
federal and county funds that is expended.
In summary, there is substantial progress being made. It is a time of ferment,
of advances in research, of improved services and particularly in the development
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of comprehensive, locally-based community program through state-community
partnership.
But still there is much more to be done. Progress is never fast enough for
those who devote their professional careers to a compelling social problem or
for those who suffer the effects of the problem.
The report that this Agency had made and has placed before you raises problems
but it also points the way to additional progress.
I am really amazed that in the many decades in which the State has been involved
in the care of the retarded, there has been no master plan developed.
I have today directed
the development of a master plan to encourage
the maximum growth, development and fulfillment of each individual who is
mentally handicapped. This is the number one recommendation of the task force
and one with which I wholeheartedly subscribe.
While this plan is being formulated we shall proceed to implement the other
three major points submitted to me for action by the task force so far as the
Legislature will permit.
We shall expand the Regional Diagnostic and Counseling Center network to provide
residential and other services as close as possible to the individual's home
consistent with quality care.
We will encourage innovation in provision of residential care, but always with
the best interest of the individual uppermost.
And the centers will provide a single point of entry into the system to help each
parent learn what his child needs and to secure the necessary resources.
Other major recommendations of the study have been directed to Dr. Lowry. He
has already told me that there are some of these that he can begin to implement
at once. Others will require extensive study, both by his department and other
agencies such as the State Personnel Board. We will be pleased to report back
to the Committee when we have explored these further,
Meantime, we urge the Committee to support our efforts to provide an integrated,
modern, effective system of care for California's retarded.
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