At the ripe old age of 66, the Menninger Clinic continues to thrive as an international facility for treatment, education, research, and prevention. Dr. C. F. Menninger would hardly recognize the multifaceted organization that the Clinic has become today. From its origins in a small farmhouse on the outskirts of Topeka, the institution has now become an organization with over 1200 employees on two campuses in Topeka and in satellite clinics in San Francisco, Phoenix, and Kansas City.
The backbone of the Clinic remains its inpatient diagnostic and treatment services specializing in patients with difficult-to-treat illnesses. The C. F. Menninger Memorial Hospital, a 155-bed facility for adults, is complemented by a children's and adolescent hospital with a capacity of 69 beds. As a tertiary-care referral center, we receive referrals from all over the United States and throughout the world. The average patient has had three or four previous hospitalizations and has been refractory to pharmacotherapy, outpatient psychotherapy, and short-term inpatient approaches. In addition, our short-term hospital units and our outpatient diagnostic service perform comprehensive evaluations on patients who present complex diagnostic and treatment problems.
The majority of the patients referred to Menninger inpatient services suffer from severe personality disorders, often associated with serious self-destructive behavior. Patients with affective disorders that are complicated by characterological features and therefore do not respond to medication alone, refractory cases of schizophrenia and schizo-affective disorder, and persons with eating disorders who do not respond to brief inpatient programs account for much of the rest of the patient population. While psychoanalytic thinking remains at the core of the diagnostic and treatment approaches, the psychiatric staff is well trained and experienced in somatic treatment, and we use an integrated treatment approach that addresses both mind and brain.
The psychoanalytically informed hospital treatment provided at the Menninger Hospital is based on the premise that patients reenact their internal world in the milieu. In staff meetings and in individual and group meetings with patients, careful attention is paid to the developing transference and countertransference themes. In addition, an assessment of both conflict and deficit is made from an ego-psychological perspective. This assessment of ego functioning and object relations is translated into a comprehensive treatment plan. Central to the treatment of all our long-term patients is psychoanalytic psychotherapy provided through the psychotherapy service of our Adult Outpatient Department. A smaller number of patients are referred for psychoanalysis.
Inpatient treatment at the Menninger Clinic has not escaped the impact of sweeping changes in the national mental health care delivery scene. With 70% of the nation's employees in some form of managed-care program, aggressive utilization review by insurance companies has made it increasingly difficult to keep patients in the hospital as long as is clinically indicated. Like other institutions devoted to extended hospitalization, we have noted a decline in our average length of stay. In 1979 the average patient on an extended-treatment unit of the adult hospital stayed for ten months; by 1989 that figure had fallen to eight months. At the same time, our admissions have increased, and we have managed to maintain an 80% occupancy rate in an era in which hospitals and units all over the country are being forced to close because of low census.
A key component of our educational programs at Menninger is the Topeka Institute for Psychoanalysis. Founded in 1942, it has always helped us recruit first-rate professionals to staff the inpatient and outpatient services of the Menninger Clinic. Despite being a relatively small institute, we have more than 40 candidates in training. In addition to the eight training and supervising analysts in Topeka, the Institute also has three in Kansas City. Cross-fertilization between the inpatient services and the Institute creates an atmosphere of intellectual excitement that has been the hallmark of Menninger since its inception.
Somewhat paradoxically, the Karl Menninger School of Psychiatry (KMSP) residency program appears to have benefited from the increasing emphasis on biological psychiatry in most training programs. Medical students who are interested in learning dynamic psychiatry and psychotherapy have fewer and fewer residencies from which to choose. The KMSP has been blessed with large numbers of qualified applicants in recent years and has managed to match all of its residency slots while many prestigious academic institutions have been unable to do so. Other educational programs under the umbrella of the Karl Menninger School of Psychiatry and Mental Health Sciences include a postdoctoral fellowship in clinical psychology, a postmaster's fellowship in social work, commuter courses for practicing professionals, a medical student program, and postgraduate education for nurses.
Research also commands a high priority at the Menninger Clinic. Current projects include treatment evaluation studies in the inpatient services, a study of the impact of therapeutic interventions in the psychotherapy of borderline patients, a collaborative study with Harding Hospital on the prediction of optimal length of psychiatric hospitalization, research on the effects of antipsychotic medication, animal studies in the area of behavioral genetics, investigations of the impact of inpatient group therapy, a study of nonpharmacological treatment of hypertension, and an outcome study of refractory patients with eating disorders.
Menninger staff members continue to be prolificscientific writers as well. Other Menninger programs include the Menninger Management Institute, which provides consultation and training for executives; Menninger Video Productions, which produces educational audio and videotapes; an extensive outpatient service that provides a wide variety of psychiatric treatments; and a national youth homes project that provides troubled and orphaned children with families.
Within the next year or so, ground will be broken for a new children's and adolescent facility on the West Campus out-side Topeka—a move that will consolidate the children's and adult departments of Menninger on one campus. Menninger will continue to occupy its unique niche in American mental health care well into the 21st century. After 66 years, the vision of C.F. Menninger and his sons remains intact. As we grieve Dr. Karl's passing, we also carry on his tradition of humane treatment to the most challenging subgroups of psychiatric patients.