From Mental Hygiene to Post WWII Psychiatry and Community Psychiatry

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From Mental Hygiene to Post WWII Psychiatry and
Community Psychiatry
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CLIFFORD BEERS
1908
National Committee for Mental Hygiene (founded
1910)
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Adolf Meyer (1866-1950) Chief of
Psychiatry Johns Hopkins University 1909-1941
Director of Henry Phipps Psychiatric Clinic 1913

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 Mary Jarrett (1876-1961) Chief of Social
Service Boston Psychopathic Hospital 1913-1919 dir
ected Smith College School for Social Work
until 1923
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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.
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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.

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Mental Hygiene Films 1945-1970
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"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.
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From Social Work Today, July 1934
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Exposés of the Cleveland State Hospital
1943 Initiated by Conscientious Objectors (COs)
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Cleveland State Hospital
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BEDLAM, 1946 Albert Q. Maisel Life
Magazine May, 1946
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BEDLAM, 1946
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Bedlam, 1946
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• Thousands spend their daysoften for weeks at
  a stretchlocked in devices euphemistically
  called 'restraints thick leather handcuffs,
  great canvas camisoles, 'muffs, 'mitts,
  wristlets, locks and straps and restraining
  sheets. Hundreds are confined in 'lodgesbare,
  bedless rooms reeking with filth and fecesby 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

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Albert Deutsch (historian of medicine, social
reformer)
(1948)
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Byberry, Philadelphia State Asylum, 1946
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Shame of States
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Scenes from Byberry, 1942-1946
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Byberry Hospital
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Manhattan Hospital
Byberry Hospital
Overcrowded day rooms enforced idleness
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Napa State Hospital, California
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Bedlam 1946
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Oscar Nominated, The Snake Pit 1948
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Publication from National Mental Health
Foundation (founded 1946)
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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

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Menninger Clinic, 1925Topeka Kansas
Drs. C.F, Karl and William Menninger
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William Menninger Brigadier General US Surgeon
Generals Office Neuropsychiatry Division
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Innovations Milieu Therapy Group Therapy And
Open Hospital
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October,1948
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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.

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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).

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Community Mental Health Centers
GOALS REALITY

• 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

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