Research: Topics: Health Care: Mental Health in New York State
Mental Health in New York State, 1945-1998
Endnotes
Mental Health Besieged, 1965-77
[76] Grob, The Mad Among Us, 197-98; Grob, From Asylum to Community, 241-44, 281.
[77] Grob, From Asylum to Community, 280.
[78] Grob, The Mad Among Us, 281-83.
[79] Grob, From Asylum to Community, 281.
[80] Rael Jean Issac and Virginia C. Armat, Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill (New York: Macmillan, Free Press, 1990), 27-32, furnish a summary of Laing’s ideas. However, their work must be read with a certain degree of caution. They make no pretense of hiding their intense anger at deinstitutionalization, which they see as the end product of a determined legal and psychiatric assault upon social order, family rights, and human decency. Their sympathies clearly rest with the families of the seriously mentally ill, whom they see as burdened and abused by unresponsive courts and mental health professionals.
[81] Thomas Szasz, The Myth of Mental Illness: Foundations of a Theory of Personal Conduct (New York: Harper & Bros., Hoeber, 1961).
[82] Michel Foucault, Madness and Civilization: A History of Insanity in the Age of Reason, trans. Richard Howard (New York: Pantheon, 1965).
[83] See Michel Foucault, Discipline and Punish: The Birth of the Prison, trans. Alan Sheridan (New York: Random House, Vintage Books, 1979.
[84] Earving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (Garden City, NY: , 1961), 364, quoted in Grob, From Asylum to Community, 284.
[85] Thomas J, Scheff, "Schizophrenia as Ideology," Schizophrenia Bulletin no. 2 (Fall 1970): 15-20. Interestingly, the Schizophrenia Bulletin was published by the NIMH.
[86] Grob, From Asylum to Community, 292; Grob, The Mad Among Us, 275.
[87] One person who was not captivated by Szasz’s work was DMH Commissioner Paul Hoch, who tried to have Szasz fired from the Upstate Medical Center and apparently succeeded in insuring that he had no allies on the faculty; see Issac and Armat, Madness in the Streets, 40.
[88] See Ted Clark and Dennis T. Jaffe, Toward a Radical Therapy: Alternate Services for Personal and Social Change, Social Change Series, ed. Victor Gioscia (New York: Gordon & Breach, Interface, 1973), for discussion of the goals of and problems faced by the founders of a New Haven, CT alternative service.
[89] The extent to which the alternative mental health service movement existed in New York State is unclear. The movement was by its very nature community-based and separate from existing channels of care and funding, and may be hard to document. However, examination of community mental-health and social-service organizations may provide clues to their existence; for example, the Equinox program located in the city of Albany is apparently an outgrowth of efforts to provide alternative counseling and welfare services to troubled young people.
[90] Betty Friedan, The Feminine Mystique (New York: Norton, 1963; reprint, New York: Bantam Doubleday Dell, Dell 1983).
[91] Phyllis Chesler, Women and Madness (Garden City, NY: Doubleday, 1972); Naomi Weisstein, "'Kinder, Küche, Kirche' as Scientific Law: Psychology Constructs the Female," in Sisterhood is Powerful: An Anthology of Writings from the Women's Liberation Movement, ed Robin Morgan (New York: Random House, Vintage Books, 1970), 205-19. This interpretation of the work of the mental health professions remains powerful: see Hannah Lerman, Pigeonholing Women's Misery: A History and Critical Analysis of the Psychodiagnosis of Women in the Twentieth Century (New York: Harper Collins, Basic Books, 1996).
[92] Not all segments of the psychiatric profession supported efforts to have homosexuality removed from its comprehensive listing of mental illnesses, the Diagnostic and Statistical Manual of Psychiatric Disorders; to this day, some members of the profession regard homosexuality as a mental disorder. However, the APA asserted after a 1973 referendum vote that homosexuality was not a mental illness and that it would no longer be classed as such. For an analysis of the bitter conflict that the issue, which gay and feminist activists forced the APA to address, produced, see Ronald Bayer, Homosexuality and American Psychiatry: The Politics of Diagnosis, 2d. ed. (Princeton: Princeton University Press, 1987), 101-55.
[93] The Fountain House program was started in the 1940's by a group of former patients of the Rockland State Hospital who felt that they had been cut adrift after discharge. The program was initially an informal support group, but in 1948 it purchased a Midtown brownstone and created a halfway house. In 1955, it hired professional staffers to oversee the program. Fountain House has always emphasized the importance of work in restoring clients' self-confidence. Staffers and clients work side by side at the same tasks, and in 1960 Fountain House started a job-placement program notable for its policy of insuring that mental illness-related absenteeism will not affect employers: if a Fountain House resident cannot go to work on any given day, one of the program's staffers will substitute for him or her. Fountain House also has a striking open-door policy: any person who has been part of the program is welcome to return at any time if he or she feels the need to do so. See Issac and Armat, Madness in the Streets, 289-90.
[94] Issac and Armat, Madness in the Streets, 58-60, 163-74. The ex-patient movement continues to exist; see Support Coalition International, Support Coalition International, available [online]: <http://www.efn.org/˜dendron/home/home/home_main.html> [1 June 1998], for information about the movement as it currently exists.
[95] Grob, From Asylum to Community, 289-90, 370. Earvin may have had another reason for focusing on the issue: his late brother-in-law had for a time served as president of the APA.
[96] Act of 22 April 1964, Laws of New York, § 3, § 18. The Mental Health Information Service, which still exists, is an arm of the Appellate Division of the New York State Supreme Court. It has from the outset been completely independent of the DMH.
[97] Issac and Armat, Madness in the Streets, 121-24. The idealists and budget-cutters who championed this law were dismayed to find that it did not lead to a dramatic decrease in the number of patients involuntarily placed in state institutions for lengthy periods of time; the law's provision for involuntary commitment of the gravely ill was used to keep many patients in state hospitals.
[98] Grob, From Asylum to Community, 291; Grob, The Mad Among Us, 274-75; Ann Braden Johnson, "Unravelling of a Social Policy: The History of the Deinstitutionalization of the Mentally Ill in New York State" (Ph.D. dissertation, New York University, 1986), 282..
[99] Whitree v. State of New York, 56 Misc 2d 693 (Court of Claims, 1968), 711.
[100] Johnson, "Unravelling of a Social Policy," 280-81.
[101] Johnson, "Unravelling of a Social Policy," 285. The other cases establishing this right were Wyatt v. Stickney, a landmark 1972 federal case that also affirmed the right to treatment, and Winters v. Miller, which afforded institutionalized Christian Scientists the right to refuse psychotropic drugs.
[102] Johnson, "Unravelling of a Social Policy," 273-76.
[103] Johnson, "Unravelling of a Social Policy," 274, 284. Other legal cases also affected the operation of state hospitals. Public interest lawyers filed a number of federal suits that succeeded in barring the use of patient labor that was not compensated at prevailing wage levels. These suits were laudable in that they sought to force hospitals to honor labor laws and to prevent them from retaining patients who were well enough to be discharged but capable of performing important tasks. However, these suits also increased the patient inactivity that hospital critics deplored. For a discussion of these suits, see Issac and Armat, Madness in the Streets, 137-39.
[104] See, e.g., New York State Department of Mental Hygiene, Task Force Report: The Department of Mental Hygiene's Inability to Access Community Skilled Nursing and Health Related Facilities (Albany: New York State Department of Mental Hygiene, 1974), [6].
[105] New York State Assembly Legislative Committee, Mental Health Subcommittee on Community Aftercare, From the Back Wards to the Back Alleys (Albany: New York State Assembly, Mental Health Subcommittee on Aftercare, 1978), 5. It is unclear as to whether the existence of these quotas, which were alleged to have been in force from 1968 onward, can be documented: the subcommittee's report claims only that it received "many reports" about their existence.
[106] Johnson, "Unravelling of a Social Policy," 414-15.
[107] Johnson, "Unravelling of a Social Policy," 416-19.
[108] Johnson, "Unravelling of a Social Policy," 386-95, 482-84, 487-89.
[109] New York State Department of Mental Hygiene, 1974 Annual Report (Albany: New York State Department of Mental Hygiene, 1974), 5.
[110] New York State Department of Mental Hygiene, 1975 Annual Report (Albany: New York State Department of Mental Hygiene, 1975), 5.
[111] Unified Services Act (1973), § 11.12, § 11.13; § 11.13, subd. 4 quoted.
[112] Unified Services Act (1973), § 11.17.
[113] Unified Services Act (1973), § 11.23.
[114] Department of Mental Hygiene, 1974 Annual Report, 4. The eight regions were: Western New York (Chautauqua, Cattaraugus, Allegany, Erie, and Niagara counties); Finger Lakes (Steuben, Chemeung, Schuyler, Seneca, Yates, Livingston, Wyoming, Genesee, Orleans, Monroe, Ontario, and Wayne counties); Central New York (Tioga, Broome, Delaware, Otsego, Chenango, Cortland, Cayuga, Onondaga, and Madison counties), North Country (Lewis, Hamilton, Warren, Jefferson, St. Lawrence, Franklin, Clinton, and Essex counties); Northeast New York (Greene, Columbia, Schoharie, Albany, Rensselaer, Washington, Saratoga, Schenectady, Montgomery, Herkimer, and Oneida counties); Mid Hudson (Rockland, Westchester, Putnam, Orange, Sullivan, Ulster, and Duchess counties); Nassau-Suffolk, and New York City.
[115] New York State Department of Mental Hygiene, 1975 Annual Report, 5.
[116] New York State Department of Mental Hygiene, Task Force on Mental Hygiene Service Delivery, Toward a New System of Service Delivery of Mental Hygiene Services for the State of New York (Albany: New York State Department of Mental Hygiene, Task Force on Mental Hygiene Service Delivery, [1976]), 25.
[117] Department of Mental Hygiene, 1975 Annual Report, 16, 22.
[118] Task Force on Mental Hygiene Service Delivery, Toward a New System of Service Delivery, 26-27.
[119] Task Force on Mental Hygiene Service Delivery, Toward a New System of Service Delivery, 42.
[120] Act of 29 July 1975, Laws of New York, ch. 515, § 1, § 2.
[121] Act of 23 June 1976, Laws of New York, ch. 437, § 1, § 2.
[122] Act of 30 May 1974, Laws of New York, ch. 620, §1, § 2.
[123] Act of 30 May 1974, Laws of New York, ch. 621, §1, § 3. Laws making the state responsible for one hundred percent of the costs associated with the outpatient care of the most acutely mentally ill further retarded the development of unified services plans. They led localities to believe that a dual system of care would continue to exist and tempted them to inflate the number of cases eligible for one hundred percent reimbursement; see Task Force on Mental Hygiene Services Delivery, Toward a New System of Service Delivery, 26-27.
[124] Department of Mental Hygiene, 1975 Annual Report, 10-11.
[125] New York State Department of Mental Hygiene, Proposals for Consolidation--Realignment of DMH Facilities (Albany: New York State Department of Mental Hygiene, 1977), 4.
[126] Johnson, "Unravelling of a Social Policy," 352, 549; The Coalition of Voluntary Mental Health Agencies, Inc., The Coalition of Voluntary Mental Health Agencies at 25: A Casual History of the First Quarter Century, available [online]: [www.cvmha.org/histoire.pdf] [29 May 1998]. The coalition is somewhat vague about the circumstances that led to its creation, asserting that it took shape because the New York City Department of Mental Health did not appreciate member agencies' commitment to "caring and nurturing of clients" and tried to limit their ability to determine how their clients' needs would best be met. The issue of being forced to care for an undesirable client population is never explicitly mentioned, but it is quite possible that the agencies that formed the coalition objected to being forced to assume responsibility for care of the seriously mentally ill.
[127] Grob, The Mad Among Us, 283.
[128] Civil Service Employees Association, Task Force on Mental Hygiene, Deinstitutionalization: State and County Policies and CSEA Response (New York: Civil Service Employee Association, 1977).
[129] Accountants for the Public Interest, The Transfer of People Versus Dollars: Intergovernmental Financing for Mental Health Services in the State of New York (New York: Accountants for the Public Interest, 1983), 38-41. Part of the apparent rise in patient-staff ratio was due to the increase in outpatient and alcoholism services. Although those who conducted the study excluded hospital staffers who furnished outpatient care, they made no effort to disaggregate administrative and support staffers employed at state hospitals; some of these workers were responsible solely for outpatient programs. In addition, staffers responsible for inpatient treatment of alcoholism, a problem that was of increasing concern to policymakers, were included in calculation of staff-patient ratios. The figures put forth by Accountants for the Public Interest differ from those put forth by the Office of Mental Health, which stated in 1982 that its staff-patient ratio was .72; see New York State Department of Mental Hygiene, Office of Mental Health, Annual Report 1982 (Albany: New York State Department of Mental Hygiene, Office of Mental Health, 1982), 2.
[130] See, e.g., Task Force on Service Delivery, Toward a New System of Service Delivery, 5, and New York State Assembly, Assembly Joint Committee to Study the Department of Mental Hygiene, Mental Health in New York State (Albany, New York State Assembly, Assembly Joint Committee to Study the Department of Mental Hygiene, 1976), 191-204.
[131] Joint Committee to Study the Department of Mental Hygiene, Mental Health in New York, 195-96.
