Settle is the psychiatric facility Thomas Birdsey repeatedly returns to after episodes, and the place Dominick Birdsey sees as the most suitable alternative to Hatch. Familiar to Thomas and connected to his working life, it stands in the novel for a form of care that seems more compatible with his ordinary routines than maximum-security confinement. Yet Settle is not a lasting refuge: as its closure approaches, the institution that Dominick keeps proposing as a destination can no longer accept him, turning the question of treatment into a question of where he can safely go at all.

Identity and Role

Settle is described as a mental-health facility with which Thomas has a long-standing connection. Dominick calls it Thomas’s old stomping ground and explains that Thomas is practically a fixture there after an episode; Thomas also has a part-time job at the facility. These details make Settle more than a name in a sequence of institutions. It belongs to the pattern of Thomas’s life before his transfer to Hatch, combining treatment with an established routine and a degree of participation in daily work.

The novel distinguishes Settle from Hatch, where Thomas is held under legal and security restrictions after his hospitalization. Dominick regards Settle as the place Thomas should have gone instead. His preference rests on their prior familiarity with the facility, while the later discussion of possible placements also makes clear that Settle’s future is uncertain. Its value to the family is therefore inseparable from its fragility as an institution.

Thomas’s Connection to the Facility

Dominick recalls that Thomas generally goes to Settle after an episode. The pattern explains his immediate objection when Thomas is sent elsewhere: in Dominick’s view, this transfer is not simply a change of address but a departure from an established course of care. Thomas’s part-time job there further complicates the contrast between patient and institution. Settle is both a place he attends for treatment and a place where he works, giving his connection to it a practical dimension beyond hospitalization alone.

Other details reinforce Settle’s place in the family’s experience of Thomas’s care. Leo Blood visits Thomas at Settle from time to time. After Thomas’s accident, Leo also went to Shanley Memorial Hospital, though he could not visit because Dominick had not included him on the visitors list. The contrast shows how access to Thomas depends on hospital procedures and on the choices of those managing his care, while Leo’s periodic visits at Settle mark a continuing connection to Thomas across his institutional stays.

From Hatch to the Question of Placement

After Thomas is admitted to Hatch under a Physician’s Emergency Certificate initiated by a surgeon at Shanley Memorial Hospital, the hospital has fifteen court-ordered days to observe whether he is dangerous to himself or others. Dominick initially argues that the transfer is a mistake and invokes Thomas’s history at Settle as part of his case. But the immediate legal framework limits what he can achieve: Thomas must remain at Hatch for at least the observation period.

As the case proceeds to the Psychiatric Security Review Board, Dominick becomes Thomas’s principal advocate. Lisa Sheffer helps him prepare arguments and says his presence will demonstrate that Thomas has family support. She also suggests that Ray attend without speaking, leaving Dominick to act as spokesperson. The board nevertheless votes unanimously to retain Thomas at Hatch for a year, finding him potentially dangerous to himself and others, with a further review scheduled for October 1991. Settle remains Dominick’s preferred destination, but his preference cannot override the board’s decision or resolve the question of whether the facility can take Thomas.

That question grows sharper when Settle’s closure is rumored. Dominick proposes sending Thomas there temporarily, hoping several months would give him time to get back on track. Sheffer explains that the state may close Settle as early as March and is phasing out its population rather than accepting new patients. A supervised group home also seems possible to Dominick because Thomas has lived in one before. Sheffer counters that Thomas was living at Horizon House when he stopped taking his medication and went to the library, and that group homes are facing further cuts and operating with much smaller staffs than before. In his present condition, she says, Thomas is not sufficiently self-sufficient for that level of supervision. The alternatives narrow to an unstable Settle, a secure Hatch, or release to his family’s custody.

Closure and the Loss of an Option

By the time Thomas’s release from Hatch is arranged, Settle is no longer merely at risk of closing. Sheffer says it is definitely closing later that year; it is transferring current residents and will make no exceptions for new admissions. Although Settle had been her first choice for Thomas, it cannot receive him. Middletown remains a possibility while she awaits an answer from admissions, but Sheffer, Dr. Chase, Dr. Patel, and the nurses advise against Thomas staying with Dominick, whom they do not consider a safe placement for him.

The closure thus changes the meaning of Settle in Thomas’s story. It had offered Dominick a concrete alternative to the more restrictive Hatch, grounded in Thomas’s previous treatment and work there. Once it stops accepting patients, that familiar route is closed not by a new judgment about Thomas but by the loss of institutional capacity. Settle’s disappearance leaves the family negotiating between a secure institution, a weakened network of community placements, and a family placement that clinicians oppose.

Institutional and Regional Context

Settle’s decline is part of a wider contraction in mental-health services. Sheffer links the shrinking number of placement options to downsizing and describes group homes as increasingly understaffed. Settle itself is being emptied rather than opened to new admissions. The novel presents this institutional change through practical consequences—where Thomas can live, who can supervise him, and whether Dominick can safely take responsibility—rather than treating closure as distant administrative background.

The Settle building also becomes a marker of change in Three Rivers. At a gathering after Thomas’s death, Sam Jacobs reflects that he and his colleagues might have stayed at work a few more years for pension reasons, but that working there had become like working in a ghost town; once the Settle building closes, he says, that will be the end of it. The remark connects the facility’s decline to the experiences of its workers as well as its patients. Elsewhere, the novel describes a regional economy reshaped by defense-industry layoffs and the expansion of the Wequonnoc Moon Casino and Resort, while negotiations consider returning former hospital grounds to the Wequonnoc Nation. Settle’s closure belongs to this broader landscape of institutional and economic change, but its most immediate consequence remains intimate: the loss of a place Dominick believes his brother already knows how to inhabit.