We left NHH in the last article in the early years of the 20th century with a rapidly increasing population. When Dr. Charles Bancroft retired and Dr. Dolloff became the Superintendent in 1917, NHH had completed the transition to a state institution with a population of over 1200 patients. New buildings had been constructed (Thayer in 1907, Walker in 1917, Brown in 1924, Tobey in 1930) but could not keep pace with the explosion of admissions and the increasingly longer stays of the patients. Many of the indigent patients simply had no other place to live, spending decades living at 105 Pleasant Street (the NHH address in those days). In 1938 over 2000 patients lived at the New Hampshire State Hospital (The official name had now been changed from New Hampshire Asylum for the Insane). The Annual Report to the Legislature in 1939 described in large bold type "THE STATE HOSPITAL IS OVERCROWDED". As a solution the Hospital sought to expand to a second campus, a location within 10 miles of Concord, and build new buildings as well as increase the acreage of the farmland. (The Hospital remained a working farm until into the 1970's, and the opportunities for patients to work on the farm were considered an essential part of life at the Hospital – The farm also produced a substantial portion of the food consumed. In 1939 the farm produced 100% of the corn, beans, cabbage and Swiss chard consumed, and a whopping 177,000 pounds of potatoes). The legislature turned down the proposal.
The population continued to rise every year until 1955 when over 2,700 patients resided at "the State Hospital". The crowding was extreme. For some years in the 1940's and early 1950's each psychiatrist had an average of more than 250 patients to treat. While kindness was still the philosophy, providing individual care of any type had become impossible. And, for the most part, society had come to view the mentally ill, not as people who needed humane treatment but had consigned the mentally ill to a dark and humiliating corner of American life. State hospitals became the physical reflection of that attitude. Books like "The Shame of the States" and "Asylum" or movies like "The Snake Pit" drew attention to the plight of the mentally ill. The annual reports make clear that despite the best efforts of staff and administration the New Hampshire State Hospital had become quite a different place than the Asylum of the nineteenth century. In New Hampshire as well as nationally, the "problem" of mental illness had become a simmering pot, waiting to boil.
A dramatic, unforeseen and incredible change began to take place in the 1950's. Within 30 years the patient population of the State Hospital would change from 2700 to less than 500, and by 1990 the population was less than 300, a decrease of over 90%.
What happened? The changes began with new treatments. Medications, especially Thorazine and its relatives, were introduced. They were remarkably effective in reducing in many patients the worst symptoms of severe mental illness. By the 1960's these medications were in wide use, allowing patients the possibility of living outside the Hospital. In 1963 President Kennedy proposed, and the Congress promptly passed, the Community Mental Health Centers Act, a "bold new approach" to mental illness that provided a broad array of services in the community. In 1968 Federal legislation to Medicare allowed the disabled mentally ill to have an income. This made possible the ability of those with pervasive mentally illness to afford to live outside the hospital. The 1971 lawsuit of Wyatt v. Stickney was an additional force. These events paved the way for one of the great social transformations of American history – "Deinstitutionalization"
Deinstitutionalization came to be the name used to describe the movement out of the hospital and into the community of more than a half million state hospital patients nationally. Deinstitutionalization promised to give patients a new life in the community with all the freedoms and advantages of "regular" life. Deinstitutionalization has had a dark side also; the safe refuge and protected haven for vulnerable and ill mental patients was eliminated. Homelessness and incarceration of the mentally ill steadily have become commonplace for too many of those with mental illnesses.
New Hampshire became a model state for "deinstitutionalization". Not only did patients return to community living by the hundreds in New Hampshire; not only were a broad range of services developed for them across the various communities, but also the legislature and the citizens of New Hampshire supported the creation of a new hospital with an innovative treatment model. Thus was born the present day NHH building, and the acute treatment intervention model. By 1990, the new building was open and the contractual agreement with Dartmouth Medical School for its management was in place. Through the 1990's and into the beginning of the 21st century New Hampshire was a national leader in the treatment of mental illness, with NHH a top-rated public psychiatric institution.
Where are we 2012? The high ideals that inspired the beginnings of NHH in the 1840's are today still guiding the spirit of treatment at 36 Clinton Street. However, the recent hard economic times have taken a toll on the resources available for the public treatment of mental illness. Add to that the fact that public attitudes toward mental illness are in a fractured and uncertain place. Judging by descriptions in the media, to some in New Hampshire, the mentally ill seem helpless victims of illness, to others they seem a misunderstood nuisance. NHH is caught in the middle of these uncertainties. The average daily population of NHH is now approximately 145 (compared to over 2000 fifty years ago). Mentally ill patients are waiting in the Emergency Departments of community hospitals every day for a bed to become available. The mentally who are in New Hampshire jails or the state prison also face waiting lists for treatment beds.
Despite the cutbacks and the limited resources, the care of patients at NHH is still characterized by those same two basic values that brought the institution into being in 1842. These two values are a commitment to the best possible treatments to restore those with mental illness to living a full and meaningful life, and an environment of pure kindness, support and respect in which patients are reminded daily of their dignity as a particular human being with a particular and precious human life. These values are the heart of NHH, and it is still beating strong.