Last year, just after graduating from divinity school, I served as a chaplain intern at The Oregon State Hospital. It’s the local government-run facility for the severely mentally ill and folks who used to be called the, "criminally insane". This is also the facility where they filmed the iconic 1975 movie, "One Flew Over the Cuckoo’s Nest" based on a book by Ken Keisey. You might remember this movie, Jack Nicholson plays the role of a free spirited man who is sent to a psychiatric hospital after some legal trouble and ends up being given a prefrontal lobotomy in part because of his empowering influence on the other patients. Good film. When I took my hospital tour during new employee orientation, they mentioned the movie all the time. It seems they still take a lot of great pride in having been the setting for such great and historic film. The basketball hoop where Jack Nicholson’s character was shooting hoops with the other mentally ill patients… it is still there. The hospital lobby where he was first brought into the facility, it is still there too. This cool movie history somehow makes the place more fun…more proud…less of an embarrassing mark on our community.

I don’t know if you remember much about the movie. I haven’t seen it in years, but I remember the movie showed psychiatric wards full of patients, many wearing pajamas all day, and some walls made of a kind of chain link fence. I saw that last year too. I saw it because that is what some of the wards still look like. Old metal doors made of bars and wire mesh that clang with an eerie and foreboding sound when they close. I remember feeling for my keys, deeply thankful that I had a full set of keys in my pocket, every time I heard that sound.

People often ask me if the Mean Nurse, Nurse Ratchet, is still there. She was one of the main characters in the movie, "One Flew Over the Cuckoo’s Nest". She was a real 1970’s villain, uncaring and so manipulative in her use and misuse of power over her patients. I am pleased to say that she is not there. I have to say that I was impressed with the staff I met at the Oregon State Hospital. Doctors, Nurses, Mental Health Techs, occupational therapists, chaplains, social workers, cooks, housekeepers…There are some truly fine and generous people who work at this facility. I am proud to have worked beside many of them. These are men and women who walk across the room to put a caring hand on the shoulder of people most of us would cross the street to avoid. These are Techs who have to bathe the profoundly demented and paranoid patients who are deathly afraid of baths, do one to one observations all day with patients who are at the highest risk for harming themselves or others, techs who are spoon feed the flailing Huntington’s patients who can no longer get food into their own mouths. These are nurses who keep a watchful eye on the particularly agitated patients because some days a well timed sedative given in the afternoon can prevent throwing chairs at dinner. These are chaplains who will sit and listen to the desperately lonely patients who have not had a visitor in years and might never leave the hospital. These are caregivers from a number of disciplines who, when it is absolutely necessary, will work in concert to physically restrain a dangerous and out of control patient who is biting and spitting and kicking and punching anyone who comes near but must be temporarily restrained to keep people safe.

These are brave and caring people. They are in a dangerous line of work with very little glory. In fact when I told people I was doing my required chaplain training at the State Hospital, I would often hear, "What, couldn’t you get a placement anywhere else?" They were surprised to hear that I had actually turned down the offer of another placement to take this one. But that is how we as a society value the severely mentally ill and those who care for them. The severely mentally ill are the truly undervalued and disregarded, and so are those who serve them. I for one am proud of the work I did as a chaplain at the State Hospital. I led weekly Protestant worship services and we often sang "What A Friend We Have In Jesus". Not a typical song for a UU minister to choose, but it was very special to people I served who have no friends at all. I sat and reminisced with terminally ill patients about favorite movies or cars. I advocated for the spiritual needs of patients at ward staff meetings including several interventions when well meaning staff who were not trained chaplains would try preaching the comfort of their own faith to patients in distress. That’s what happens when you don’t have enough chaplains. Other well meaning staff try to pitch in and help. I became very attached to my patients and I still miss many of them. Even some of my patients who could be pretty dangerous when agitated were friendly and loving folks much of the time.

Now many of us have struggled with some mental illness in our lives. Perhaps you have a child with ADHD. Some classroom accommodation and medication can often make a huge difference. Perhaps you suffered some trauma. As a crime victim or military veteran you could have some post-traumatic stress. Support and therapy can help things heal over time, though some scars linger. Perhaps you or a loved one of has had some level of ongoing depression. I have a friend who calls her Prozac, Vitamin P. With the help of a daily medication she can continue her career, care for her family, and enjoy her life. I want to make it clear that this not the kind of patient I am talking about. People with this level of functioning are not in the State Hospital. I am talking about very, very sick people who really require a special kind of inpatient assistance, sometimes for many years. They need this special care in order to survive at all.

Some people are at this hospital because of severe brain disease or damage that is manifest in behaviors too difficult to be maintained in a regular psychiatric ward, group home, or nursing home. Some violently assault staff and other patients. Some act out sexually. These symptoms will get you kicked out of most programs in the community pretty quickly and make it even more difficult to live with family or friends. There is no such thing as behavior too problematic or too aggressive to be at the State Hospital. The State Hospital is the end of the road. Most people are there because they have committed a serious crime and are found incompetent to stand trial due to mental illness or not guilty by reason of insanity. These might be assaults or serious property crimes. Patients who are there after committing a crime are often sentenced to be in the hospital rather than prison. For them the hospital is often a much better choice. Others have intractable diseases and will never be well enough to live without round the clock professional caregivers. Lucky patients can eventually find the right treatment, can be stabilized, and moved out of the hospital. This is, of course, the goal. But for the most part OSH works with the sickest of the sick. Those who no one else can or will care for. Like I said, it is the mental health "end of the road".

I sure would not want to be a patient there. I would not want anyone I love to have to be a patient there. The buildings are too old and too full. The hospital was originally built in 1883 and some original building are still in use. This is not because they are cool and historic, but because they don’t have any enough space. Groups of severely agitated patients are sometimes stuck indoors in crowded rooms most of the day with no air conditioning on even the hottest days of the year. Patients assault each other much too often and keeping these attacks to a minimum is a constant challenge on every ward in the hospital. I frequently found pools of urine sitting in the plastic chairs. They can’t have a clear and uniform fire escape policy for the hospital because the hospital is made of a strange complex of mismatched buildings of different eras with different kinds of doors and different kinds of exit routes. The newest building in the complex is from the 1950’s. Few procedures are able to be consistent and uniform from department to department and that wears of staff time and resources. Due to a severe staff shortage, the number of patient care staff on each ward is minimal and many work double shifts. Line staff doing that kind of work in these conditions for 16 hours straight does not make for the best patient care let me tell you. And all this in a hospital who’s stated goal is to provide a sanctuary of safety and comfort that allows people to heal. It is so strange. In the newspaper you often read about the scandal of unclaimed cremated remains of former State Hospital patients that sit in rusty tin cans in a storage room in Salem. Believe me, it is not the dead patients at this hospital who need to be brought to our attention, it is the living ones.

The conditions I just described, this is how we treat some of the most desperately sick members of our society. These living conditions are within legal limits, regular investigations see to that. But they are not adequate. They are not good at all. Not by a long shot. I feel ashamed that we, as a society, treat sick people in this way. These people are really needy. They are severely impaired as a result of their illness. Not their choices or their motivation for change, but their illness. These are our fellow human beings. They really need help and we are falling way short of the mark in our care of them. The famous Unitarian social reformer of the 1800’s, Dorothea Dix, saw the plight of the mentally ill in America who were locked in barns and basements away from polite society. She said we should look for those "Godlike attributes in everyone". She was a brave crusader and advocated for the building of America’s first state funded mental hospitals, for the care of these very vulnerable citizens. Dorothea Dix was successful. We even build a hospital for the mentally ill in Oregon, as a frontier community in the 1800’s. But I think we can go quite a bit further today. Our Unitarian Universalist faith calls on us to do better than we are doing right now as we look to the inherent worth and dignity of every person.

There is some good news. The governor’s mental health task force has recognized that the current Oregon State Hospital needs to be replaced. At last. The state is scheduled to begin construction of a new hospital in 2009 and for it to be ready for patients in 2011. I know that is a long wait, but at least they are finally making progress. Many staff thought it would never happen. This has been a long time coming. The new hospital will be designed so patients can be observed more easily, making it a safer place for patients to live and staff to work. There will be unbreakable, double pane windows and appropriate heating and cooling systems. Building will be safer in the case of earthquake and fire. Maintaining these new building will be much cheaper than keeping up the old buildings with the constant drafts and leaking roofs. But there is going to be enormous costs up front. Not only is there the cost of a new hospital, which is very high, there is the cost of removing the old facility, with its crumbling network underground tunnels and leaking oil tanks. I read that the cost of asbestos removal alone is over 3 million dollars. And it would be nice if the new hospital were adequately staffed. With enough staff you wouldn’t have care giving staff working 16 hour shifts. But the new hospital project is out of a state budget that is never big enough. Programs that educate our children, fix the potholes in our roads, and fight forest fires all compete with the state hospital for this money. We all feel the pot holes. Few of us see the needs of the patients at the Oregon State Hospital. I’ll tell you my fear. My fear is that when the money gets tight, that these vulnerable patients with so few advocates will get the short end of the stick. I worry that someone will decide that we can just do a little more repair to the existing facility and limp along for another few years, until the next budget cycle. That would be a travesty.

I believe we in this fellowship are called to follow the example of our Unitarian ancestor, Dorothea Dix. We are called to hold up the plight of the severely mentally ill and their need for a safe and adequately staffed facility in which to live and, hopefully, get better. We can let our elected officials know that, as much as we hate the pot holes, we really want good care for our neighbors with mental illness. We can pay attention to the state plans and let elected officials know that we will notice if they don’t provide a safe mental hospital for those who need it. We can let them know that this is a priority for all of us. We, as people of faith, are not blind to the poor treatment of vulnerable members of our society. As the stewards of our money and our programs, we want our elected officials to notice as well and to advocate for those in the state care who have so little voice and so little power themselves. We can tell them that we see it as their job to do so and we will be watching.

The governor has said that building a new hospital is only part of fixing Oregon’s broken mental health system. That is so true. You see, in the 1950’s enrollment in mental hospitals was at an all time high. The deinstitutionalization movement of the 1960s worked hard to get people out of the hospital and into less restrictive levels of care whenever possible. This was a good thing. Lots of folks could do just fine with outpatient care and medication and didn’t need to live in a locked facility. Many hospitals closed or were downsized at that time. Community mental health centers and group homes were built and cared for the needs of those who didn’t really need hospital care but still needed help. But the trouble is that budget cuts of the 80’s and 90’s came along and those community resources were decimated. The result was that those who could make it outside the hospital only if they had some support did not get the necessary support to be safe and healthy. But the hospital beds were gone too. Our streets are now filled with homeless and mentally ill people who have grossly inadequate care. Too many of them die out there. Those in the state hospital who might be ready for discharge, if only there was a good community resource to support them…they have to stay in the hospital because there is no agency to help them on the outside. Locally, Children’s Farm home is laying off a large portion of it’s work force due to financial problems. This is one of the few programs that absorbed the very symptomatic children who were once served at the Oregon State Hospital children’s unit before it was closed. The human need is still there, but the resources are not there to help. So I guess we have even more vulnerable people we are call to continually hold up to our elected officials. We need to advocate for the full funding and support of community mental health facilities as well as a safe and efficient hospital. And that doesn’t need to wait until 2011. Adequate funding of community programs could happen now.

I brought this issue to you today to hold it up to the light for examination. I hope to shine the flashlight of the pulpit into dark corners of our society and show you things that most people do not see. I am not saying that if we all hit the streets with our protest signs that we can eliminate mental illness. We can’t. What we can do is acknowledge that some people need our help. As a civilized country, we have a duty to care for those who can not care for themselves. Some people need special kinds of help. Some even need to be in locked facilities for their safety or ours. But when these folks are out of our sight, they should not be out of our thought or our hearts. They should not be out of the hearts and thoughts of those who are elected to support and regulate the helping hand of our society. As I have brought this issue to your attention, pass it on. Pass on your desire to maintain safe and humane services for our most severely mentally ill. For we are all one family of humanity. We are brothers and sisters in the interdependent web of life. Unitarian Universalist minister Mark Morrison-Reed put it like this, "The central task of the religious community it to unveil the bonds that bind each to all. There is a connectedness, a relationship discovered amid the particulars of our own lives and the lives of others. Once felt, it inspires us to act for justice." So, good people of Corvallis, let us as a religious community, act for justice and look to those who need our care.

May it be so.