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History of Utah Psychiatry in the General Hospital

By A. Mason Redd, M.D

Psychiatric units in hospitals are now an integral part of medical services, but when the concept was introduced in Utah in 1954, it was met with fear and resistance. The first units were established at St. Mark’s Hospital and St. Benedict’s Hospital in 1954 and the LDS Hospital in 1959. The units were originally relegated to undesirable hospital space and watched with suspicious concern.

St. Mark’s Hospital established the first psychiatric unit

In an effort to establish a hospital psychiatric unit, Roy Darke, M.D., approached various hospital administrators. The only one receptive to the idea was Olive Wardrop at St. Mark’s hospital. The support of Wardrop, Dr. Darke and Frederich P. Champ, a member of the hospital board, enabled the first psychiatric unit to be established.

The unit was allocated the most undesirable space in the hospital, the old miners hospital sclerosis ward. It was developed into a 15-bed unit with 10 private rooms, one three-bed ward and two suites. The suites each had a private bath and a wash basin. There was one men’s bathroom and one women’s bathroom for the remaining patients. The unit had a sun porch, a dayroom, and a treatment room for electroconvulsive treatment. Doctor Darke began as the only psychiatrist on the hospital staff.

Psychiatry in the LDS Hospital began formally in 1959

Louis G. Moench, M.D., and William Pace, M.D., established psychiatric service at LDS hospital and helped design space for the unit in what is known as Three North. The original space allowed for 27 beds with several offices for attending psychiatrists, a dayroom, a treatment room, and an occupational therapy room. Three North was initially designed for treatment of severely ill patients with schizophrenia and mania. For this reason, the walls and floor of the unit were painted battleship gray, a color that was used to soothe the very ill patients. The patient population has now changed from the severely ill patients to those with depressive illnesses. The decor likewise has changed from gray to warmer, more pleasing and stimulating colors.

Psychiatry in the general hospitals has gained acceptance and there are psychiatric services in many more general hospitals in Utah today including St. Mark’s Hospital, St. Benedict’s Hospital, Holy Cross Hospital, Pioneer Valley Hospital, Utah Valley Medical Center, Lake- view Hospital, McKay-Dee Hospital, Davis North Hospital, Logan LDS Hospital, University Medical Center and Primary Children’s Medical Center. There are currently 923 general hospitals in the United States with psychiatric services.

The relationship between the general hospital and psychiatry varies from hospital to hospital. Many relationships retain vestiges of the fear that Dr. Darke encountered nearly 31 years ago. There is, unfortunately, still a fair amount of stigma associated with anything psychiatric. Many hospital administrators still do not share the vision of what is possible for psychiatry in the general hospital with their psychiatric staff. In spite of these and other problems, psychiatry and the general hospital very often have a good and vital partnership.
Psychiatry provides a variety of services that are essential to the operation of a general hospital. These services include crisis intervention in the emergency department, management of the patient who becomes acutely psychotic and evaluation and treatment for the suicidal patient. It is also important to have medical-surgical services available to psychiatry in a general hospital for patients who may need care beyond the scope of psychiatry. Some patients have concommitant medical-surgical illnesses which need specialized treatment. Hospitalization of patients with anorexia nervosa is generally better accomplished in a general hospital psychiatric unit.

Some hospitals in Utah have opted to take the role of the mental health facility which enables them to hospitalize both voluntary and involuntary patients.

The range of services provided by psychiatry in the general hospital include inpatient and outpatient evaluation and treatment, crisis intervention, consultation/liaison and day treatment. Some specialized programs include pain and behavioral management clinics, eating disorders clinics, stress management and the whole gamut of services to adolescent patients.

A  recent development by the psychiatric nursing staff of the LDS hospital is the Depression Clinic. This is currently an inpatient program designed to provide information, group discussion, aerobic exercise, crafts, and recreation therapy to groups of patients on a structured daily basis.

The program is repeated each week. It has proved to be very successful with patients, and has gained psychiatric staff acceptance. Patients need to be referred to the Depression Clinic by their psychiatrist.
Psychiatry in the general hospital has seen tremendous progress, but the forward movement is not complete. There is work to be done to enhance what psychiatry has to offer. With modern communication technology and the television, much can be done to educate patients, families and especially hospital employees to dispel the fear and stigma still associated with psychiatry. Marketing psychiatry is essential. People need to know that one does not need to be “mad” to benefit from psychiatric services. Hospital administrators, hospital boards and medical staffs could push psychiatry further by allocating personnel, space, and material necessary to bring psychiatric units up to the standard of other medical/surgical units. Finally, consultation and liaison services need to be valued and supported by general hospitals and their staffs to more fully utilize the potential for clinical good.
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