Emma Bradley was 7 when she became ill with encephalitis. She survived, but the severe swelling permanently damaged her brain, leaving her mentally impaired and suffering with cerebral palsy and epilepsy.
The Bradleys were wealthy, and they hired doctors and nurses to treat Emma, consulting with experts from Boston and New York. No one could help her.
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Emma died in 1907 at the age of 27. Yet her suffering and the generosity it inspired have made it possible for thousands of other young lives to be saved, souls to be healed and futures to be restored.
Emma’s parents, George and Helen Bradley, made the bequest that created the Emma Pendleton Bradley Hospital, the nation’s first pediatric psychiatric hospital when it opened in 1931. It remains one of the most prestigious institutions of its kind even today.
The hospital, now part of the Lifespan network, is celebrating its 75th anniversary this year, with a gala last month and a book, “Legacy of Hope,” that chronicles the East Providence facility’s history and the evolution of children’s mental health care.
Bradley is also using the occasion to begin promoting its plans for a $27 million expansion project: a three-story addition to the main building that would upgrade the inpatient facilities and create more space for day programs.
“We’re trying to plan for the future,” Daniel J. Wall, president of Bradley, said in an interview. The new wing won’t increase the number of inpatient beds – currently 60 – because the trend is to minimize hospitalization, Wall said. Instead, the extra space will allow Bradley to grow the programs that make it possible to keep children out of the hospital.
“You want as few kids in the hospital as you can – simple as that,” he said.
Like pediatric psychiatry itself, Bradley has changed dramatically in the last 75 years. When it began, its whole focus was inpatient services – not just short-term hospitalizations to deal with crises, but rather long-term therapeutic stays.
At first, Bradley specialized in four types of “nervous disorders”: birth injuries such as cerebral palsy, “sleeping sickness,” seizure or convulsive disorders, and “behavior problems.” It admitted children up to the age of 12, and they stayed for months, even years.
Even then, however, the hospital was on the cutting edge. Dr. Herbert Jasper, Bradley’s head psychologist in the 1930s, was among the first scientists in the United States to use electroencephalogram (EEG) technology to measure electrical brain impulses.
(Albert Einstein visited Bradley at one point, and is believed to have had an EEG done to learn about the technology, but the records, if they existed, long have been lost.)
The hospital’s first medical director, Dr. Charles Bradley, a grand-nephew of George Bradley, was also a pioneer, conducting early research in the uses of drug therapy in children.
But although the hospital has evolved over the years, changing its environment and its therapies with advances in the field, it is only in the last three decades that it has shifted its emphasis from inpatient services to alternative programs.
In the late 1960s – aiming to better serve the children’s educational needs, since being hospitalized could keep them out of school for long periods – then-clinical director Dr. Maurice W. Laufer established an in-house school program.
In 1969, Kevin P. Myers, a special-education expert who had been working at a school in Hartford, was hired to run the Bradley School. Myers is still the hospital’s director of education today, but he recalls things working very differently back then.
For starters, he said, only patients were enrolled, and they attended classes for only two hours per day – if they wanted to attend at all. “The hospital itself was the nursing department … and education was something nice to do on the side,” Myers recalled.
Within a few years, however, the school evolved into a full-fledged program – though still just for the patients – and it was formally approved by the state as a special-education facility.
Then, in the 1970s, in partnership with Blue Cross & Blue Shield of Rhode Island, Bradley accepted four children who lived nearby for a “day hospital” program. They attended school and received therapy during the day, then went home at night, and “it caught on fast,” Myers said. Soon enrollment grew to a few dozen children.
“That eventually evolved into the Bradley School,” Myers said. Today, the school serves almost 200 students whose behavioral or emotional problems make it impossible for them to attend regular schools, at least temporarily. In addition, a separate program serves about 20 children with serious developmental issues.
The hospital has evolved in many other ways as well.
In the mid-1980s, to better qualify for payments from health insurance companies, Bradley obtained state permission to convert all the hospital’s beds to “acute-care” status – meaning patients would receive intensive, short-term treatments, rather than staying for a long time.
In 1981, the “Legacy of Hope” book says, the hospital’s average stay was 201 days, but by 1987, it was down to 57 days. Today, in most cases, it’s two weeks.
Wall, who arrived in 1988, said that’s one of the biggest changes he has seen. Children come in amid a crisis – the standard is that they must pose a danger to themselves or others, so often the hospitalization is triggered by a violent incident or a suicide threat – and they leave as soon as they’ve been stabilized.
With shorter stays has come a larger number of patients. In 1988, Wall said, Bradley admitted fewer than 400 patients; last year, it admitted nearly 1,000. And the vast majority of children and teens served by the hospital aren’t admitted at all; each year, Bradley touches more than 3,000 young lives.
For babies and small children, Bradley now offers a pediatric “partial hospital” program that combines an intensive treatment session at Bradley, for several hours each day, with staff support to help parents at home and in the community, if they need it.
For distressed teens, the SafeQuest program offers a quiet and therapeutic place to go after school. And for children and teens who need to be away from home, but don’t need to be hospitalized, Bradley has residential facilities in East Providence and Exeter.
The hospital’s Center for Autism and Developmental Disabilities, which uses 20 of Bradley’s 60 inpatient beds, also offers a day program with special-education services, home-based services and residential facilities geared to their specific needs.
And through its outpatient treatment and counseling services, Bradley helps many young people and their families to avoid crises that would require hospitalization.
In addition, Bradley continues to have strong research and teaching programs. As part of the Lifespan health care system, it works closely with Hasbro Children’s Hospital, and it has a research and teaching relationship with Brown University’s School of Medicine.
Yet as far as Bradley has come in its 75 years, somehow the challenges keep growing, both Wall and Myers said. Many children have to be hospitalized repeatedly, Myers said – and to some extent, he blames the short stays, which lead families and insurers to expect “five-star services … at the speed of McDonald’s.”
But the demand for services also continues to grow, Myers and Wall said, and the severity of cases keeps intensifying – for reasons no one fully understands.
“It’s the big question that nobody has a clear answer on,” Wall said. “Is it society? Is it stress on the family? Is it better identification of problems? I can tell you that you’re not going to be able to get your hands on it.”
Still, Myers and the doctors and the mental-health workers – called “milieu therapists” here – see enough successes, especially in the long term, to keep them believing in Bradley’s ability to make a big difference.
“I’m proud of the place. I’ve always been proud of the place,” Myers said.
