It all started a long time ago, with a mound of dirt spewing out scalding hot water—a "Warm Springs" that the Sioux Indians considered sacred. During the 1870s, a health resort was built near the springs; the outlaw Jesse James reputedly stopped by for a visit. In 1877 a physician and his partner bought the resort and decided to care for mentally ill patients.
In 1912 Montana purchased the resort, and it became the state’s sole mental hospital, ultimately named Montana State Hospital at Warm Springs.
As the 20th century marched on, the hospital blossomed into a world all its own. There were hospital buildings connected by an underground passage—a means of getting from one to another during Montana’s brutal winters. There were poultry buildings, a dairy, gardens, a greenhouse. There were even two cemeteries since many of the patients who came to the hospital lived there until they died. By the 1950s, some 2,000 patients were being cared for at the hospital.
As the 1960s and 1970s passed, however, the hospital started reducing its patient population, just as many state psychiatric hospitals throughout the U.S. were doing. The downsizing continued into the 1980s and 1990s. By 2,000 only about 200 patients were being cared for at the hospital at any one time.
And today, near the Warm Springs, which is still disgorging scalding water, many of the former hospital buildings are empty and locked, desolate skeletons of their former selves, no longer meeting safety codes and other standards. In fact, the area of the hospital campus near the springs looks like a ghost town. But wait!
On the other side of the hospital campus, several buildings are still in use. And most astounding of all, a splendid new hospital building, with a price tag of $20 million has risen in their midst. It started operating last fall.
In brief, the 124-year-old hospital will not be closing its doors. To the contrary.
True, the decision to keep the hospital open and to endow it with a brand-new building did not come quickly or easily. It was quite contentious—hotly debated in the state legislature and opposed by some state advocacy organizations. In fact, a lawsuit was filed in federal court claiming that construction of the new building would violate the Americans With Disabilities Act, because the state would have an incentive to keep people in the hospital rather than provide them with community care. The lawsuit, however, was dismissed. Eventually money for the building was appropriated, and it was constructed.
What is the new building like? Let’s take a look on a bright summer morning, with swallows whizzing around and snowy Mount Haggin glistening in the background.
It is a large modern structure in white, aqua, and earth tones, with four pillars fronting the entrance. Once inside, one is struck by the lofty ceilings, the light and airy atmosphere, and the tastefully decorated great room, or rotunda, that forms the heart of the building. Here, a number of patients socialize or visit with family members. Behind the great room is a cafeteria, and four halls fan off from the great hall in the form of an X, leading to four separate hospital units.
One unit is devoted to older people with Alzheimer’s disease or other mental disorders. Besides having single and double bedrooms, the patients have their own television day room, and there is a bay where unit staff work. A number of patients in this unit will eventually be released to their families or to nursing homes.
A second unit, also containing single and double bedrooms, a television day room, and a bay for staff, is reserved for patients needing acute care and rapid stabilization. Some are individuals with schizophrenia who live and work successfully in the community yet need to return to the hospital three or four times a year for medication readjustments or other services. Today, a patient who has just been admitted to the unit insists that she is from the police department, that she is physically, but not mentally ill. She is obviously very distressed and in need of care.
A third unit, similar in layout to the other two, is devoted to mentally ill patients who need more long-term care than the acute unit can provide.
And the fourth unit is the forensic psychiatric unit. Here, one walks through two electronic security doors to arrive in a television day room occupied by 15 seriously mentally ill patients who have committed various felonies or have been found not guilty by reason of insanity.
They are sitting in a cluster, watching a psychotherapy video. One young patient, "Ann," gives a tour of her room to Connie Worl, the hospital’s public relations and quality improvement director, and to a visitor. The room contains a neatly made bed, bright, artwork, and a mobile that Ann has made. "Do you mind living mostly with men?," Worl asks.
"No, it doesn’t bother me," Ann replies.
"These patients are some of the most mentally stabilized in the entire hospital," psychiatric technician Marlys Hurlbert reassures Worl and her visitor. Hurlbert has worked in the unit for some 25 years, ever since she graduated from high school, and appears to feel totally at home with these patients. "A quarter century ago," she said, "patients in this unit were much more violent. I remember one patient throwing her bed against the wall."
The forensic unit also has a special admissions door where the police can bring in persons who have been indicted for crimes and need to be evaluated for mental illness.
The new building also contains an area where patients can receive dental work and other medical care.
Virginia Hill, M.D.: "Since we are now centralized, we can communicate better with each other."
What difference is the new building making in the lives of the hospital staff? "I can get to meetings on time now because we are all in the same building," said Virginia Hill, M.D., a vivacious woman with lively brown eyes and a winning smile who has served as the hospital’s forensic psychiatrist for 15 years. "And since we are now centralized," she added, "we can communicate better with each other."
"It is very helpful for all of us to be under one roof," noted Ed Amberg, a tall, amiable man who has worked in the hospital for 22 years in various capacities and who has been the hospital’s administrator since last fall.
"There are more single bedrooms than there used to be, which helps with snoring patients and other problem patients," noted Tatjana Caddell, D.O., who moved from Oklahoma to Montana three years ago and who has worked as a psychiatrist at the hospital since that time.
Another advantage of the new building, Hill pointed out, is that it exposes patients to fresh air. Before the new building, patients were in a building with recycled air, she said, and there were complaints of sick-building syndrome.
But does the new building still leave certain things to be desired? "Oh, sure," Amberg conceded. "We have an electronic door system that doesn’t work quite right, we still have problems with the nurse call system. The new building was designed for an average daily population of 135; today we have 164. That meant we had to hire additional staff that hadn’t been budgeted for."
"Although my patients like just about everything about the new building," Hill said, "the one thing they do miss is the large yard they used to have, where they could play horseshoes and run some laps. Now they have just a small yard."
Even with the new building there are still some difficulties in seeing that patients who are discharged from it continue to get the medical help that they need.
For instance, there are a number of facilities in Montana where discharged patients can get care—two 24-hour, supervised group homes on the hospital campus; private, nonprofit community mental health centers located throughout Montana; a public center for the aged, for example. "But I think we need to work better with the community, and the community with us," Caddell said. "Often it seems as if we are fighting. Say, a center doesn’t want a particular patient, says they can’t handle it, yet we don’t want the patient back either. We need some in-between service that will handle patients who don’t need a hospital or group home anymore, yet are not quite ready to return to the community. Such a service doesn’t exist at this point."
Hill, too, sees the need for greater continuity between the hospital and Montana’s community mental health centers. "One reason I think some tinkering is in order," she explained, "is that we are a state entity. The community mental health centers to whom we often refer our patients are private, nonprofit entities. When you have that kind of separate business structure, it is a little harder to move patients back and forth. So I think it would be better if someone were in charge of the whole thing, like it used to be a few years back, when the state owned the hospital and community mental health services and we all worked together."
Even with such shortcomings, of course, the new building means that the 124-year-old hospital will be able to continue to serve the seriously mentally ill in one of America’s largest states. The hospital staff, who are deeply committed to, and fiercely protective of, their patients say that they are very happy about that.
Or as Hill put it: "We are so grateful that the citizens of Montana decided to spend money for this more than $20 million project for people who need our help." ▪