This month, Hospital Capsules was written by Elizabeth P. Ridgeway, O.T.R., occupational therapy consultant for the Bureau of Mental Health, Department of Welfare, Harrisburg, Pennsylvania.

Pennsylvania has created 277 jobs for recreation personnel in its state mental hospitals. How did this come about? Because of:

- Fifty thousand patients in the state mental hospitals who need recreation, not only as a human right, but as a means of recovery.

- An occupational therapist, employed in the department of welfare, who was convinced of the vital necessity of such activities, who knew state hospital conditions and personnel needed it.

- A departmental committee on patient activity which studied the potential of therapeutically oriented patient activities, as well as the problems which interfere with their effective use, and made personnel recommendations.

- A citizen mental health organization which has developed public opinion to the point where it is impolite to oppose mental health appropriations.

- A secretary of welfare who is dedicated to the improvement of mental hospitals and is an effective politician; a governor with the courage to stake his political life on the necessity of adequate mental health appropriations; and a legislature with the statesmanship to place mental health above politics.

The patients are, of course, the vital reason for the program. Without the awareness that life can be a rewarding experience, no patient will make the tremendous effort necessary to recovery. The central question in developing the treatment program was: “What activity experiences does this patient need in order to grow?” And recreation always was part of the answer.

The occupational therapist acted on the principle that any activity was beneficial if in the hands of a mature person with a capacity for establishing patient relationships. Suitable staff people were selected and a program developed in accordance with their skills. The result was a program predominantly recreational, and its success proved the vital place of recreation in a psychiatric setting. As the program grew, it was decided that it could not be administered successfully without division heads—separate persons to head the recreation, occupational therapy, industry, and volunteer services. At the same time, it was essential these services be integrated.

The committee on patient activities, made up of clinical directors, nurses, and activity department heads, has been a major support and resource. The committee studied problems, collected data, considered policies, listened to reports, investigated what has been done in other states; it helped spread concepts and supported new policies.

Within the department of welfare and the bureau of mental health, the climate has been conducive to the development of patient-centered activity policies. In the process of policy development one of the most difficult decisions concerned preparation required of recreation personnel. While much can be accomplished by lay personnel (in fact their psychiatric naiveté has positive value at some points), there are important values in having psychiatrically trained recreation workers at key points. This was provided by the creation of the position of activity therapist with a specialty in recreation, music, art, and so on. A board review has been set to consider criteria and evaluate preparation of each candidate. A knowledge of psychodynamics and of the differential therapeutics of activities will be expected of persons qualifying for these positions. The recreation leader position (activity instructor), however, requires recreation skills only. There will always be a place for workers in this category; the specially qualified therapist should be reserved for special treatment situations or supervision.

The most serious compromise made in classification was in not requiring the recreation supervisor to qualify as a recreation therapist. This compromise was made realistically in order to obtain the very real values offered by experienced hospital recreation workers.

Dual preparation requirements (clinical as well as professional recreation subjects) create many problems in the educational area. An educational procedure proposed and discussed in psychiatric circles is the establishment of a core curriculum consisting of clinical subjects to be the same for all activities personnel, with specialized electives in art, music, social recreation, crafts, and so on. This would take the place of the present curriculum in occupational therapy and music therapy and would produce persons qualified for staff positions in all activity therapies. Additional preparation would be indicated for supervisory positions in any specialty or for coordinators.

You in professional recreation are now undergoing the establishment of your own standards in hospital recreation. We urge you to consider joining together with other professional disciplines in establishing such a core curriculum, for personnel so educated would better meet patients’ needs.