In two recent posts, I recounted much of my 24-year journey working as a clinical psychologist at Eastern State Hospital, a public psychiatric hospital in Lexington, Kentucky. To catch up, my early years are covered in part 1 and the development of the Recovery Mall program is detailed in part 2.
Even as our recovery-based programming garnered broad positive feedback from staff, patients and external organizations, we still dealt with the physical limitations of being in an aging 185-year old facility.
For many years, efforts had been afoot to either renovate or replace the hospital. One proposal, which was ultimately shelved, was to combine the two state psychiatric hospitals in Lexington and Louisville and build a new hospital in a location roughly midway between the two. Renovation of the old hospital was also ruled out as it was deemed too costly.
Mental health advocacy groups, including NAMI (National Alliance for Mental Illness) continued to relentlessly lobby the Kentucky legislature to provide funding for a new hospital. One of their most compelling arguments was to highlight the age of the old hospital and ask, “Where are the 185-year-old cancer centers and cardiac hospitals?” Ultimately, funding was obtained to build a $129 million replacement facility for Eastern State Hospital. This feat was even more remarkable given that it occurred during the recession of 2008-09.
As plans moved forward for the new facility, our staff were consulted by some of the architects and planners who would be designing the new hospital. We were asked for input as far as types of spaces we needed for the Recovery Mall and other treatment programs. In October 2009, plans were unveiled for the new hospital. From the architectural drawings, it looked like a beautiful, modern facility.
The new facility was to be located 2.5 miles from the original hospital on land donated by the University of Kentucky. The site of the original hospital was given to Bluegrass Community and Technical College, who planned to raze most of the hospital buildings and to build new academic buildings for a branch campus of their college. When the groundbreaking ceremony for the new hospital occurred in the fall of 2010, I got to keep one of the “gold” shovels as a souvenir.
As the new hospital was nearing completion in January 2013, it was announced that the University of Kentucky’s health care division would manage the facility. This ended an 18-year period in which Eastern State had been managed by the local community mental health center, now known as New Vista. UK HealthCare managed an extensive network of hospitals and clinics both on the UK campus and in other locations around the state. Funding for the hospital continued to be provided by a contract with the Kentucky Cabinet for Health and Family Services.
On September 4, 2013, our staff joined Kentucky Governor Steve Beshear, local leaders and state officials for a ribbon-cutting at the new Eastern State Hospital facility. I had the honor of greeting the Governor as he walked through the hospital. The new hospital was a 239-bed, 300,000-square-foot facility, filled with natural light, numerous safety features and modern amenities. The spacious and welcoming appearance shattered every negative stereotype of what a psychiatric hospital “should” look like.
In addition to the hospital (pictured), the new Eastern State campus included four 11,000-square-foot personal care homes, each with 16 beds, offering a less restrictive level of care that promoted patients’ return to a community setting. These personal care homes would serve as a step down from the acute care setting. The personal care facility was named the Central Kentucky Recovery Center.
A few days after the ribbon cutting, on September 10th, we moved the patients and staff to the new hospital. This was all accomplished in a few hours, using several vans and buses. Since the hospital had all new furniture and equipment, staff primarily only had to move small personal supplies. Patients and staff alike were wowed by the fresh and uplifting environment.
Moving from an antiquated hospital to a brand new facility was surreal, to say the least. Since we had new management, I also had new supervisors. So I had a new boss, a new office, and a new building, but basically the same job. My office was on the front side of the building and one entire wall was glass, with a great 180-degree view.
Since 2008, I had also been serving as the director for the hospital’s Psychology services, in addition to my role as the Recovery Mall director. Psychologists (along with the graduate students we trained) provided psychological testing, psychotherapy, court-related evaluations, educational groups and consulted with the multidisciplinary teams on the units.
The Recovery Mall program continued in the new hospital, much the same, but with a few adjustments. The mall space was primarily on the first floor, with classrooms, library, gym, gift shop, beauty salon, and music therapy. However, there was additional program space for art therapy, pottery, a kitchen, physical therapy, and a small recreation area on the second floor. Also, each treatment unit had its own dining room and a large room for classes and groups.
A little over two years after we moved to the new hospital, I became aware of an opportunity to join the Psychology faculty at the University of Kentucky. I had held a part-time faculty position there for 20 years, serving as director of the clinical psychology program’s training clinic and as a psychotherapy supervisor for clinical graduate students. This new position would continue those roles but would also add a new responsibility as the training director for the department’s newly accredited pre-doctoral psychology internship program. I applied for this position, went through the interview process, and was selected.
January 2016 was my final month as a psychologist at Eastern State Hospital. My co-workers showered me with gifts, well wishes, and even put together a fake chart with me as the patient, which said I seemed “stable” enough to be “discharged” after 24 years! My last day was cold and snowy, as January in Kentucky can sometimes be. As I drove away from the hospital in the snowstorm, I felt sad to be leaving my work family and the place where I “grew up” as a professional.
My route home that snowy day took me by the site of the old hospital, where I spent the majority of my work years. I reflected on the history of the place and how it has evolved and changed over the past two centuries. Inpatient psychiatric care has improved dramatically since the advent of modern medications and therapies. However, psychiatric hospitals continue to carry much negative stigma and stereotypes. I visited and interacted with many of these facilities over the years and I know the quality of care they provide can range from marginal to exceptional.
Yet, I feel fortunate to have worked in a facility that always put patients first. Our staff really cared about the patients’ welfare and strived to provide effective and compassionate care. I also am grateful to have taken part in steps to advance recovery-based approaches to treatment, emphasizing personal strengths, individualized care and improved quality of life.
Is there room for improvement in our mental health system? Yes, without a doubt. As I have discussed extensively in these columns, many do not receive care who desperately need it, for a variety of reasons. Also, public mental health programs are still greatly challenged by lack of adequate funding and not having enough highly trained staff.
But I believe there are also great opportunities today and in the future to improve access to care, provide effective treatments, reach more people, and ultimately to reduce pain and suffering. This work is not easy and it requires dedicated advocates, both consumers and professionals, who will tirelessly keep striving to make a difference. Let’s keep fighting together.
Here’s a question: What further steps can be taken to improve care in inpatient psychiatric facilities? Please leave a comment. Also, please subscribe to my blog and feel free to follow me on X (formerly Twitter) or Instagram, “like” my Facebook page, or connect on LinkedIn. Finally, if you enjoyed this post, please share it with a friend. Thanks!