Revolt of the Aides

Only the naive believe that patients in a state mental hospital get much personal attention from psychiatrists. There are too few psychiatrists and too many patients; the ratio is about 1 to 100. Many of the doctors are administrators who never see patients, and most of them have at least some administrative duties. And after the doctor takes out time for staff meetings and professional conferences, the patient is lucky if he gets 15 minutes of a psychiatrist's time a week.

So who helps the patient? Kansas' Topeka State Hospital declares in an official pamphlet: "Patients are directly dependent on psychiatric aides, the only team members who are with them every hour of the day and night. The aides are likely to know the patient best. The aide's influence on patients and the quality of person needed in his job are often underestimated by the public. The quality of treatment in mental hospitals depends directly on them."

Work-ln. Yet one place where aides are most grossly underpaid and underrated, and where they have recently staged a dramatic revolt on behalf of themselves and their patients, is Topeka State Hospital. Kansas' state capital, with a population of only 133,000, has long proclaimed itself on roadside signs as "the Psychiatric Center of the World." That was based largely on the fame of the Menninger brothers, Karl A. and the late William C., and their private C. F. Menninger Memorial Hospital, universally miscalled "the Menninger Clinic."

In the 1950s, the Menninger brothers wrought a transformation at the nearby state hospital. Thanks to their lobbying, the old snake pit was replaced by attractive modern buildings. Topeka State abandoned its bars, chains and straitjackets and began returning "incurable" mental patients from the shadows of its back wards. (One woman was released after 53 years in confinement.) Kansas led the states in the modernity and humanity of its approach to mental illness, and its budget of $8 a day for a patient's care was about the nation's highest. But that was a dozen years ago.

That Mess. This summer the city was shocked to find that Topeka State's psychiatric aides had staged, in effect, a one-day strike. They did not call it a strike, but an "administrative takeover," and they stayed on the job for twelve hours instead of the usual eight to show that they were willing and able to give the patients more and better care than the bureaucracy would allow. Later they changed the name of their demonstration, for propaganda reasons, to a "work-in." By whatever name, it stopped Topekans from boasting about their mental-health facility and started them talking instead about "that mess out there."

At first, Dr. Alfred Bay, superintendent of Topeka State, reacted like a Mayor Daley of psychiatry. He fired the aides, had many arrested and spoke of eradicating disorder "before it spreads to the patients." Other officials called the aides' demands preposterous --a 35% pay increase, 40-hour week, revised job specifications, union representation on administrative bodies, a two-year contract, and an in-service education program to give aides a chance for advancement.

But after the Kansas civil service board held hearings and ordered nearly all of the demonstrating aides reinstated, Bay had to admit that the aides had a case. "If this were my own private business," he said, "I'd go broke in a week. This just isn't any way to run a railroad. We have moved the aide's responsibilities forward without giving him comparable recognition." The main problem, as Bay saw it, was the huge staff turnover. Except for physicians, one-third of Topeka State's employees have been there for less than a year, and one-fourth for less than six months! The reason for the turnover is simple: poor pay with no hope of betterment.

Musclemen. Emerson Stamps, 44, a Negro and president of the Topeka local of the Kansas Health Workers' Union, has been a mental-health worker for 20 years. To support his family of seven he has to work two full shifts, one at State and one at the local Veterans Administration hospital. An aide at State starting now gets $295 a month, and after six months gets a $14-a-month raise. After 15 or 20 years on the job, he might get $505 to $557 a month as a psychiatric aide Grade 3, but there are only two of these in the state of Kansas. Stamps is not one of them, though at State he draws $505 a month with two longevity raises included.

When Negroes first started taking jobs at State, says Stamps, they were regarded as mere musclemen. "The hospital wanted strong black bodies, seasoned by hard manual labor, to handle patients who hadn't been taken out of seclusion for years." Now, with no official upgrading, Stamps and the other strong men assist in electroshock treatments, guard narcotics supplies, give injections and other medications, take an active part in group-therapy sessions--and, by the doctors' insistence, must always be available to the patients. "Society is going to have to recognize that it's at least as important to help a man back to health as it is to go out to the Goodyear plant on the edge of town and make a good tire," Stamps says. "So far, it hasn't recognized that. People who work with people--the most precious product in the country--are downtrodden everywhere."

What needs to be done in Kansas can be done, as California and Colorado and, to a lesser extent, Massachusetts and Illinois have shown. In California, psychiatric aides have been upgraded to the rank of technicians, starting at $400 a month with an $80 raise at the end of a year. After in-service education, they can advance to positions of recognized responsibility, with appropriate pay raises to a top of $1,048 a month. Several of the Topeka State aides' minor grievances can be adjusted by simple administrative action, if Dr. Bay and other officials are willing. Salaries and civil service grades are rigidly controlled by the state legislature. "We expect more of our aides at Topeka State than they do in less dynamic institutions," says Bay in a sort of proud apologia. And the aides expect more of State than they have been granted. When they get it, Kansas may again lead the nation in the quality of care given its mental patients.

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