In the 1950s, Camarillo State Hospital, like most mental institutions of the day, was a massive warehouse for the mentally ill, its drab wards bulging with more than 7,000 patients, most of them committed for years or for life.
Crowding was so severe that many patients were forced to sleep on mattresses in hallways and to wait in line to use bathrooms or exercise areas, veteran employees said. Little effort was spent on treatment.
Then as now, the huge hospital had the deceptive appearance of a college campus. The Mediterranean-style facility, with more than 40 buildings, sprawls over manicured grounds and is surrounded by lush farm fields four miles south of the Ventura Freeway. The facility has never been completely fenced.
But behind the unchanged facade, a radical transformation has occurred in the past quarter-century.
Turning to Short-Term Care
Legal reforms, medical advances and a nationwide trend away from large mental hospitals have combined to turn the Camarillo facility into a short-term care facility.
The large hospitals were once dubbed "snake pits"--a term borrowed from the 1948 film "The Snake Pit," which painted a bleak picture of life in the nation's mental hospitals. Now, instead of being confined for years or for life, patients at Camarillo are hospitalized for an average of only three weeks, then discharged or transferred to local mental health centers or board-and-care facilities.
As a result, the hospital's count of mentally ill patients has dwindled to 644, less than a tenth of its peak volume, said a hospital spokesman. Also housed there are 580 of the developmentally disabled, bringing the hospital's total patient population to about 1,200.
Charles Kidd, the hospital's executive assistant, said even the three-week average stay for mentally ill patients is "misleading on the high side" because the vast majority stay only one or two weeks. A small percentage is hospitalized for a year or more, pushing up the average stay.
Chief among the medical advances has been the development of new drugs, chiefly antidepressants. Dr. James Lyons, a staff psychiatrist, said the drugs "quickly knock down the symptoms of mental illness," paving the way for an early discharge.
A patient, brought to the hospital shouting with terror and unable to express a coherent thought, thus can be tranquilized within a few days to the point at which he or she is able to talk calmly with staff psychiatrists, hospital officials said.
Among the legal reforms that have shortened confinements at Camarillo is a landmark 1969 state law that mandates thrice-weekly court sessions, giving patients an almost unlimited right to put their case before the court. The law also spells out the terms under which a patient can be involuntarily confined.
Under the Lanterman-Petris-Short Act, involuntary confinement is permitted only when a patient is gravely disabled or a danger to himself or others.
"There is no such thing as lock them up and forget them, like there was in the old days," Kidd said.
The prompt discharge of mental patients was significantly aided by the extension of federal Supplemental Security Income benefits to the mentally ill in 1979, he said.
Range of Benefits Told
"With an assured income," Kidd said, "there is now the reasonable expectation that a discharged patient can care for himself or herself on the outside." Benefits typically range from $500 to $600 a month.
Reflecting a nationwide trend toward community care begun in the 1960s, the law also specifies that a patient be treated in a state mental hospital only after all private and public mental health facilities in the patient's neighborhood are utilized.
As an outgrowth of the law, more than 50 facilities in Los Angeles County alone treat the mentally ill as inpatients. Many are psychiatric wards in private hospitals that operate under contract with the county and state governments.
To get more use out of the huge hospital, the state in 1967 began to treat developmentally disabled patients at Camarillo.
The developmentally disabled population (a broad category that includes the mentally retarded, autistic and victims of cerebral palsy, among others) has gradually increased, nearly equaling the mentally ill caseload at times. The developmentally disabled patients are treated separately from the mentally disabled patients.
Designated State Hospital
Camarillo remains the designated state hospital for mentally ill adults to its south from the San Fernando and San Gabriel valleys, and north from Ventura, Santa Barbara and San Luis Obispo counties.
It is the designated institution for mentally ill children from all of Southern California.
About 2,000 employees are on the staff, including 70 psychiatrists, 40 psychologists, 50 social workers and 1,000 nurses and psychiatric technicians.
Far from being warehoused, patients are immersed in activities at the hospital, including individual and group therapy, sports and music lessons. There also is training in such basic skills as making change, ordering food in a restaurant and riding a bus.
To facilitate these activities, much of the space once used to house 7,000 patients has been converted to training and recreation areas.
Retirements in recent years removed from the staff the last of a handful of employees dubbed "bug-housers"--those who believed the hospital's role was not to treat patients, but to warehouse them in a disciplined atmosphere, Kidd said.
"There were a few who held the old attitudes, but they had little or no influence on how the patients were treated," he said. "We have been committed for years to being a treatment, not a storage, facility."
William Moritz, who has been a hospital volunteer since 1978, said he occasionally hears employees talk about "warehousing" patients, "but it's always in the context of something that is to be avoided at all costs."
Far from the mistreatment of patients depicted in "The Snake Pit" and the 1975 film "One Flew Over The Cuckoo's Nest," Moritz said he has observed "nothing but the most professional and caring behavior toward the patients by the staff. I can't say enough about the professionals."
Moritz, a retired aerospace executive who spends two days a week at the hospital, is part of a movement started in the mid-1970s by Gov. Edmund G. Brown Jr.
After observing mental patients he said were being neglected at Metropolitan State Hospital in Norwalk, Brown urged volunteers throughout the state to offer their services to mental hospitals.
The volunteers could simultaneously help with patient care and keep an eye on insensitive staff members, Brown said.
Jerry Scheurn, the hospital's coordinator of volunteers, said that Brown's call resulted in a flood of applicants at Camarillo, some of whom continue to volunteer. He said that 815 persons volunteered their services at the hospital in 1985, performing such diverse tasks as talking to patients, teaching leather-working and taking groups to Disneyland.
Volunteers often "get hooked after seeing they can make a difference," Scheurn said. "I've had volunteers tell me how impressed they were that their willingness simply to talk to a patient once a week had such a positive effect on the patient's self-esteem."
A secondary benefit to the hospital is "that volunteers are our best public relations device," Scheurn said. "They come in here and see it isn't like they imagined, and they tell others. Pretty soon word filters back to the legislators that some pretty good things are going on here."
Of seven volunteers interviewed, all had unequivocal praise for the staff.
'People Who Care a Lot'
"A really professional staff," said Chris Moore, 34, a former claims adjuster who has been a volunteer teacher in a class for 12- to 18-year-olds. "I have seen nothing but people who seem to care a lot about the patients."
Tamara Gordon, an 18-year-old who has been doing volunteer clerical work in the hospital office, said she has observed that "people around here take the patients very, very seriously."
Said a 40-year-old film studio employee who occasionally talks with patients: "Given the fact that the staff has a disciplinary role, and we volunteers do not, they are remarkably caring. I'm not sure I could do it day in and day out."
One of a handful of staff members who bridges the gap between the warehouse period and today's treatment-oriented hospital is Geneva Mays, who has been a psychiatric technician at Camarillo since 1957.
Except for the crowding, she downplays the widely held assumption that staff members in the 1950s were insensitive to patients.
"I sometimes hear people call this hospital a snake pit," Mays said, "but it isn't, and I don't know if it ever was. Certainly it was not during the 29 years I've been here."
In the 1950s, she said, there was less therapy available, but fewer of the patients needed intensive therapy.
"Now, of course, we only have the seriously ill patients," Mays said, "so a lot of therapy is needed. But this has always been a fine hospital."