Community mental health and the State Hospital

Summary Creedmoor State Hospital is the major psychiatric facility for the borough of Queens, a community of 2. 2 million people in the City of New York. The hospital had 5 600 patients on the in-patient roles, when in 1969, it was divided into four sections, three relating to specific geographic areas of the borough and one for chronically and acutely medically ill patients who had been admitted originally for social or psychiatric reasions. Hospital personnel developed a group process approach for in-patients and to a large extent, followed their own patients after discharge. Two years later there were 3 500 patients in the hospital and 3 000 in out-patient clinics for discharged patients and their families, and for other patients in the community. The problems of the state hospital and its historical origins have been described. Emphasis was given to the theoretical approach to the solution utilizing reference group theory, and defining the resocialization of the patients by means of a small group approach was outlined. The small reference group was described as the primary unit of treatment. The geographic unitization of the hospital, its clinical programs, its method of allocating priorities for maintenance of the physical plant, and employee relations were described.Some results of the programs were noted briefly in terms of population transfer from inhospital o community clinics and to other facilities in the borough. Issues such as community education, problems of medical and surgical illness, and political problems were considered. — It appears that when considering the development of a community program for a large institution, it is essential to have component parts of the hospital relate to various segments of the community while concurrently embarking upon community educational procedures and assuring appropriate medical care from other health delivery service organizations. A sense of group identity both for patients and staff is essential to the success of the program, in addition to any basic medical and social skills which must be brought to the program or taught to staff. The group process approach becomes even all the more important in terms of the large numbers of people to be treated, as does the utilization and recognition of the role of non-degreed mental health workers in this program.This work was done when the author was Director of Creedmoor State Hospital, Queens Village, New York.