Treatment
Then:
Early treatment methods for the mentally ill included medications such as
calomel and whiskey(1)
and restraints such as a leather muff(2),
hand mitt(3),
straight jacket(4),
restraining chair(5), and
seclusion(6).
These were followed in later years by
hydrobaths(7),
wet packs(8),
electro shock(9) and
insulin shock(10).
Now:
Modern treatment methods include
psychological testing, observation, and diagnosis(1)
followed by individual counseling sessions, group therapy(2),
occupational/vocational therapy(4),
ecreational therapy(5),
pastoral counseling(6)
and the use of new psychotropic medications(3).
Families of patients receive social service counseling(7).
Treatment methods for mental patients in South Carolina have reflected international psychiatric procedures and theories. Restraining devices used at S.C. State Hospital in the 1800's and early 1900's included the padded helmet which was attached to the patient's head to keep him from banging it against sharp or hard objects, the hand mitten which looked like a boxing glove and prevented patients from gouging and scratching, the straight jacket which restrained the patient's arms, and cold wet packs which were used by wrapping the patient in ice cold, wet sheets. In addition, patients having seizures were given hydrotherapy, in which they were restrained in bath tubs, covered up to their necks with canvas and bathed with warm water. Electroshock, insulin shock and lobotomies were used only in rare uncontrollable cases.
Antiquated restraining devices such as the mitten, helmet and straight jacket were discontinued by the S.C. Department of Mental Health in the early 1960's. Insulin shock and hydrotherapy were passing trends. Lobotomies were prohibited and have not been performed by the Department since 1953. And shock treatment is now used only in cases of extreme depression and then upon the consent of the patient or his guardian.
Today much emphasis is on treatment therapies -- occupational therapy to teach the patient a skill, recreational therapy to keep the patient in good physical condition, and the activity therapies of drama, music, arts and crafts to help the patient acquire a creative outlet.
Patient Life
Babcock ward early 1900's
Then:
- * Lived under rigid hospital conditions
- * told when to get up and when to sleep
- * ate meals planned and prepared by others
- * had no responsibilities and stopped making decisions for themselves
Now:
- *Live in supported living situations
- * with help of a case manager, live as independently as they are capable
- * live alone, with families or roommates, or in Homeshare situations
- * work full or part-time or as volunteers
- * take active part in treatment decisions
In the past, after commitment to a mental hospital, the patient was often neglected. With no public interest and little financial support and an increasing population, public mental institutions were often without adequate means to provide proper care and treatment. With greater public awareness toward individual rights in addition to recent court cases, today there is growing concern for the in-hospital life of patients. At the same time commitment statutes were revised, most state legislatures including S. C. General Assembly also added laws guaranteeing certain patient rights and privileges.
The South Carolina law now requires that all treatment and medication be authorized by the attending physician. Any restraints or seclusion may only be used as required for medical needs and such use may not exceed a forty-eight hour period and must be approved by the physician.
And, unless the medical needs of a patient dictate otherwise, a patient my communicate in any manner with anyone, receive visitors, wear his own clothes, keep and use personal possessions, and have his own storage space. Any time these privileges are limited by medical needs, the limitations but be explained in the patient's medical record.
However, no one for any reason my deny a patient the right to communicate with the State Mental Health Commission, with the committing court, legal counsel, personal physician or clergyman.
Patients may refuse any treatment not recognized as standard psychiatric treatment. They may also refuse non-therapeutic employment. And the hospitalized patient has the right to periodically petition the court for a re-examination.
Nurses:
Then:
- * Training -- S.C. State Hospital Nursing School
- * environment -- overcrowded wards
- * "Keeper of the Keys"
- * followed doctor's orders
- * administered medication
- * assisted with client grooming/appearance
- * client and family non-involvementn
Now:
- * Training -- R.N., B.S.N., degree from colleges and
universities
- * environment -- mental health centers and patient's
homes
- * case manager
- * develops treatment plan
- * develops and monitors medicine plan
- * encourages client independence
- * encourages client and family involvement
In the beginning nurses wore long-sleeved, high-necked grey dresses, starched white bib and apron with a white cap perched on top of their heads. They carried a long chain of keys about their waist. Their days amounted to what was essentially considered custodial care. They took temperatures, dressing patients, bathing them, combing their hair, and getting them to and from meals.
The days of strictly custodial nursing care largely went out with the advent of the wonder drugs. With their illness under control and their sense of awareness increased, most patients are able to take care of their personal hygiene needs and many of them can be responsible for doing their own laundry. As a result of these changes and a few others, nurses are now able to work as treatment specialists and supervisors as opposed to their earlier role as custodians or keepers of the keys.
* (This information came from the South Carolina Department of Mental Health Digest 1977-1978, pg. 8-26 and the South Carolina Department of Mental Health FOCUS May 1996)