From Mental Hygiene to Post WWII Psychiatry and

Community Psychiatry

1908

CLIFFORD BEERS

National Committee for Mental Hygiene(founded 1910)

Adolf Meyer (1866-1950)

Chief of PsychiatryJohns Hopkins University

1909-1941

Director ofHenry Phipps Psychiatric Clinic

1913

 Mary Jarrett (1876-1961)

Chief of Social ServiceBoston Psychopathic

Hospital1913-1919

directed Smith College School for Social Work

until 1923

Boston Psychopathic HospitalMyrtelle Canavan, E.E. Southard

From left to right: Harry Solomon, Myrtelle Canavan, Abraham Myerson, Douglas Thom, Ernest Southard, Herbert Thompson, Lawson Lowrey, and William Rappleye.

Mental Hygiene• Prevention of mental illness through public

health education: lectures, pamphlets, courses.• Focus on emotional adjustment: helping people

to change bad habits, adjust to challenges of life.

• Concerned with child delinquency, alcoholism, immoral behavior, immigrant mental health and syphilis.

• Operated in new locales: child-guidance clinics, juvenile courts, school counseling centers.

• Assisted by emergence of new professional role of the psychiatric social worker.

• Team approach to treatment: psychiatrist, psychologist and social worker.

• Focus on maintaining mental health.

Mental Hygiene Films 1945-1970

"The burden of my theme is that to raise the level of the activity and knowledge of mental hygiene throughout the world is the soundest way of establishing permanently mutual understanding and good feeling among nations."

John R. Lord, “The Human Factor in International Relations,” Mental Hygiene, April 1934.

From: Social Work Today, July 1934

Exposés of the Cleveland State Hospital

1943

Initiated by ConscientiousObjectors (COs)

Cleveland State Hospital

“BEDLAM, 1946” Albert Q.

Maisel

Life MagazineMay, 1946

“BEDLAM, 1946”

“Bedlam, 1946”

“Thousands spend their days—often for weeks at a stretch—locked in devices euphemistically called 'restraints’: thick leather handcuffs, great canvas camisoles, 'muffs,’ 'mitts,’ wristlets, locks and straps and restraining sheets. Hundreds are confined in 'lodges’—bare, bedless rooms reeking with filth and feces—by day lit only through half-inch holes in steel-plated windows, by night merely black tombs in which the cries of the insane echo unheard from the peeling plaster of the walls.” Maisel, Life 1946

Albert Deutsch (historian of medicine, social reformer)

(1948)

Byberry, Philadelphia State Asylum, 1946

Shame of States

Scenes from Byberry, 1942-1946

Byberry Hospital

Overcrowded day rooms: enforced idleness

Manhattan HospitalByberry Hospital

Napa State Hospital, California

“Bedlam” 1946

Oscar Nominated, “The Snake Pit” 1948

Publication from National Mental Health Foundation (founded 1946)

Group for the Advancement of Psychiatry (GAP)

• Formed in 1946• 150 psychiatrists• William Menninger, Chairman• Advocated for psychiatrists to have more

time for treatment in mental hospitals• Social workers conduct more treatments• Mental hospitals to be located in cities,

with closer connections to medical schools, and training possibilities

Menninger Clinic, 1925Topeka Kansas

Drs. C.F, Karl and William Menninger

William MenningerBrigadier General

US Surgeon General’s OfficeNeuropsychiatry Division

Innovations:Milieu TherapyGroup Therapy

And Open Hospital

October,1948

Mental Health Legislation-1• 1946 –National Mental Health Act, which

called for the establishment of a National Institute of Mental Health.

• 1949 –NIMH was formally established; it was one of the first four NIH institutes. Robert Felix was first director.

• 1955 – The Mental Health Study Act called for "an objective, thorough, nationwide analysis and reevaluation of the human and economic problems of mental health." The resulting Joint Commission on Mental Illness and Health was formed.

Mental Health Legislation-2• 1961 – Action for Mental Health, a 10-volume

series, assessed mental health conditions and resources throughout the United States

• 1963 – President Kennedy submitted a special message to Congress –Congress quickly passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act beginning a new era in Federal support for mental health services. NIMH assumed responsibility for monitoring the Nation's community mental health centers (CMHC).

Community Mental Health Centers

• Improve national health• Provide emergency

services, evaluation, consultation, education of community

• Broad spectrum of services: partial hospitalization, outpatient and inpatient

• Focus on prevention; situated in communities

• Federal monies not forthcoming (cut from 657 to 284 million)

• Problems with staff training• Rejection by communities:

questioned authority of psychiatrist; lack of attention to social justice issues.

• Only 745 CMHC built; were supposed to be 2000.

• Not enough attention to seriously mentally ill

• No evaluations of centers; not accountable

GOALS REALITY