Ceilings are low, conversations echo and vocational space is limited at the Fulton State Hospital. Patient units lack private areas for individualized treatment, and at one structure within the oldest public mental health facility west of the Mississippi River, fire stairs are pulling away from the building.
Missouri mental health officials would like to replace antiquated space at the state hospital with a new high-security facility that has a better treatment environment and is safer for patients and employees. The cost is about $211 million.
That might be within Missouri's price range because the Republican-led Legislature and Democratic Gov. Jay Nixon have been working on a bond package to fund improvements and construction at college campuses, state facilities and state parks. Ultimately, a bonding proposal would require voter approval.
Mental health officials hope a new facility will be part of the bonding strategy.
“One of my dreams in this job would be to see the day when we actually have funding appropriated somehow or generate funding somehow to create a new high-security facility here,” said Mark Stringer, director of the behavioral health division at the Department of Mental Health.
The Fulton State Hospital is the only maximum and intermediate security psychiatric hospital in Missouri. Among its patients are those who have been committed by the courts for evaluation or treatment. It also is the statewide treatment facility for people who have been found not guilty or unable to stand trial because of mental disease.
Located about 30 miles northeast of the state Capitol, the hospital admitted its first patients in 1851. It has more than three dozen buildings, including some that are vacant. Maximum security Biggs Forensic Center has 186 beds, intermediate security Guhleman Forensic Center has 91 beds, Hearnes Forensic Center for people with developmental disabilities has 24 beds and the Sex Offender Rehabilitation and Treatment Services facility has 75 beds.
Mental health officials propose demolishing Biggs, an equally aged dietary building and some empty buildings. A new 300-bed, high-security facility would house patients from Biggs and Guhleman. In turn, it would free up beds that will be necessary for the Sex Offender Rehabilitation and Treatment Services, which then would forestall the need for a new $70 million facility.
The Department of Mental Health estimates constructing a new high-security facility would save up to $15 million in capital maintenance costs over the next decade at Fulton. It's also expected to reduce utility costs by $750,000, staffing and overtime by $1 million and workers' compensation by $1.5 million.
Costs for workers' compensation claims climbed from $800,000 in the 2005 fiscal year to nearly $3.4 million in 2012. Statistically, an employee who spends 30 years directly involved with patient care at Biggs experiences six serious injuries that require emergency room care. Some of those injuries can be life-alternating, including traumatic brain injuries and permanent physical injuries.
The oldest part of Biggs was built in 1937. Patient wards include a room with tables and seating. Extending back from that room is a long hallway with patient rooms. Officials say sightlines are poor and hallways are narrow, while echoes and an environment with significant stimulation can contribute to patients becoming agitated.
“For people with serious mental illness, that is absolutely devastating to their efforts to recover and to be calm,” Stringer said.
Proposals for bond-funded capital projects are gaining momentum this year at the Capitol. Nixon devoted part of his State of the State speech to the idea. And this past week, a House committee established to evaluate bonding proposals reviewed a measure sponsored by House Speaker Tim Jones, R-Eureka.
Money for capital improvements has been limited in recent years, and the toll has mounted. For example, state parks could use $400 million and the four-campus University of Missouri system reports a $1.3 billion backlog of renovation and repair projects.
Described as merely a conversation-starter, Jones is proposing $950 million in bonds. Of that, $250 million would go for state facilities with at least $40 million for parks. The remainder would go for higher education projects, including those at community colleges.
Nixon has not offered a specific dollar figure for a bond package but says he prefers it to be less than $1 billion with proceeds directed to K-12 school districts, higher education, state facilities and parks and the Fulton State Hospital. The governor said Missouri has a “moral responsibility” to patients and caregivers to provide an environment that is safe, secure and conducive to healing.
“It's old, and it needs to be replaced,” Nixon said.