Research: Topics: Health Care: Mental Health in New York State
Mental Health in New York State, 1945-1998
Endnotes
The Policy Revolution, 1945-65
[3] The NCMH was founded in 1909 by psychiatrist Adolf Meyer and Clifford Beers, a Yale University graduate who had been institutionalized for a short period of time. At first, it devoted most of its energies to improving conditions in state hospitals, but within ten years of its foundation focused chiefly upon preventative programs and comprehensive studies of mental illness and treatment; see Gerald N. Grob, Mental Illness and American Society, 1875-1940 (Princeton: Princeton University Press, 1983), 147-66. In 1950, the NCMH merged with the Psychiatric Association, the fundraising division of the American Psychiatric Association (APA), and the National Mental Health Foundation, an outgrowth of the federal government's wartime Mental Hygiene Program of the Civilian Public Service, and became the National Association for Mental Health. The association was supported largely through grants from the Rockefeller Foundation; see Theresa R. Richardson, The Century of the Child: The Mental Hygiene Movement and Social Policy in the United States and Canada (Albany: State University of New York Press, 1989), 155-57.
[4] Grob, Mental Illness and American Society, 144-45, 166-71. Grob notes that the emphasis that psychiatrists within the mental hygiene movement placed upon the preventability of mental illness kept most of them from embracing the less savory aims of some of the movement's other adherents: compulsory sterilization of the mentally ill and developmentally disabled and harsh immigration restrictions designed to keep southern and eastern Europeans out of the country.
[5] Grob, Mental Illness and American Society, 243-65, details the emergence of psychiatric social work, psychology, and occupational therapy and the increasing tension that characterized their relations with the psychiatric profession.
[6] Grob, The Mad Among Us, 156. For an example of the kind of social research undertaken by those active in the mental hygiene movement, see Elizabeth Greene, George K. Pratt, Stanley P. Davies, and V.C. Branham, Report of a Survey of Mental Hygiene Facilities and Resources in New York City (New York: National Committee for Mental Hygiene and New York City Committee on Mental Hygiene, State Charities Aid Association, 1929).
[7] Sol Cohen, "The Mental Hygiene Movement, the Development of Personality and the School: The Medicalization of American Education," History of Education Quarterly 23 (Summer 1983): 124-25, 128-39. By the 1950’s, pedagogical theorists had embraced mental-hygienist ideas so fervently that the movement itself no longer existed within educational circles; the movement was a victim of its own success.
[8] Community Chest organizations were peacetime outgrowths of the War Chest charity federations that were formed in order to relieve domestic hardship during the First World War. Like their parent bodies, they were federations that solicited corporate as well as individual contributions. After the Second World War, many Community Chest federations joined forces with the Red Cross and other organizations that were not chiefly concerned with assisting the needy and became United Funds. The federations' adoption of their current name, the United Way, came sometime afterward. For a brief history of the origins of Community Chests, see Community Surveys, Inc., of Indianapolis, Community Chest: A Case Study in Philanthropy (Toronto: University of Toronto Press, 1957), 20, 266-67. For information about the philanthropic foundations that supported mental-hygiene programs, see Richardson, The Century of the Child, 40-41. The New York State Charities Aid Association, which had since its formation in 1872 worked to improve state asylum conditions, created a New York City Committee on Mental Hygiene in 1927. The association, now known as the State Communities Association, still exists and still takes an active interest in state mental health policy; see, e.g., New York State Communities Aid Association, Mental Health at the Crossroads: The Case for Psychiatric Rehabilitation (Albany: New York State Communities Aid Association, 1991). For the development of Charities Aid Associations across the nation, see Grob, The Mad Among Us, 131-32. For information about the New York City Committee on Mental Hygiene, see Greene, Pratt, Davies, and Branham, Report of a Survey of Mental Hygiene Facilities and Resources in New York City.
[9] Between 1945-59, the Community Chest of Albany and city social welfare organizations sponsored a program for children with emotional problems; see Stanley P[owell] Davies, Toward Community Mental Health: A Review of the First Five Years of Operations under the Community Mental Health Services Act of the State of New York (New York: New York Association for Mental Health, 1960), 63-64. As of 1939, the New York City's school system had a Bureau of Child Guidance that served children living in four of the city's boroughs; see Central Hanover Bank and Trust Company, Department of Philanthropic Information, The Mental Hygiene Movement: From the Philanthropic Standpoint (New York: Central Hartford Bank & Trust Co., 1939), 52.
[10] The DMH was created as a result of the constitutional reorganization of New York State government approved by the electorate in November 1925; see New York State Constitution (1925), art. 5, § 2, § 11. The DMH's inspection duties had formerly been assigned to the State Mental Hospital Commission and the State Commission for Mental Defectives, which ceased to exist in the wake of the government's reorganization.
[11]Mental Hygiene Law, Laws of New York (1927), Ch. 426, § 4.
[12] Grob, Mental Illness and American Society, 296-306.
[13] Gerald N. Grob, From Asylum to Community: Mental Health Policy in Modern America (Princeton: Princeton University Press, 1991), 161-65.
[14] Albert Deutsch, The Shame of the States (New York: Harcourt, Brace, [1948]).
[15] Grob, From Asylum to Community, 8-23, 71-77.
[16] Grob, From Asylum to Community, 146-50.
[17] Grob, From Asylum to Community, 24-43, 124-46. As Grob points out, the psychiatric profession was syncretistic, and few of its practitioners denied that both somatic and environmental factors contributed to mental illness; psychiatrists differed as to which set of factors was most important.
[18] Grob, From Asylum to Community, 44-53.
[19] Grob, From Asylum to Community, 53-56. The status and responsibilities of the NIMH have changed substantially. In 1953, the Public Health Service, of which the NIH and the NIMH were part, was made part of the newly created Department of Health, Education, and Welfare (HEW; renamed the Department of Health and Human Services after the creation of the Department of Education in 1979). The NIMH was severed from the National Institute of Health (NIH) and given bureau status in 1967, but in 1973 it was again made part of the NIH. At the same time, it was made part of HEW's newly-created Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). Following the ADAMHA Reorganization Act of 1992, which abolished the ADAMHA and replaced it with the Substance Abuse and Mental Health Services Administration (SAMHSA), the NIMH became part of SAMHSA and its research activities were transferred to the NIH. See National Institute of Mental Health, NIMH Legislative Chronology, available [online]: <http://www.nimh.nih.gov/about/legichro.htm> [ 23 April 1998].
[20] Grob, From Asylum to Community, 166.
[21] Grob, From Asylum to Community, 59.
[22] Act of April 7, 1949, Laws of New York, ch. 733, § 1-2, § 6. As it existed in the wake of the 1949 legislative changes, the SMHC was chaired by Dr. Newton Bigelow (later director of the Marcy State Hospital) and consisted of the state commissioners of health, education, social welfare, and correction; Dr. Ernest M. Gruenberg served as its executive director, Hyman C. Forstenzer as assistant director, and Luther E. Woodward as coordinator of community mental health services in the New York City metropolitan area; see Davies, Toward Community Mental Health, 2. The SMHC apparently enjoyed a de facto existence before it received its legal recognition and mandate: in 1947, it began receiving federal funds allocated in accordance with the 1946 Mental Health Act; see Davies, Toward Community Mental Health, 2-3.
[23] Grob, The Mad Among Us, 234; Grob, Mental Illness and American Society, 317.
[24] Grob, From Asylum to Community, 171-72.
[25] Community Mental Health Services Act, Laws of New York (1954), ch. 10, § 190-a, subd. 1-2.
[26] Community Mental Health Services Act, Laws of New York (1954), ch. 10, § 190-b subd. 1 and subd. 3
[27] Community Mental Health Services Act, Laws of New York (1954), ch, 10, § 190-c and § 191-a, subd. 1.
[28] Community Mental Health Services Act, Laws of New York (1954), ch. 10, § 191-a. On the goal of doubling care levels, see Davies, Toward Community Health, 8.
[29] Mental Health Construction Bond Act, Laws of New York (1954), ch. 8, § 2. Act of 5 February 1954, Laws of New York, ch. 9, § 1, § 3, created the War Bonus and Mental Health Bond Account, which was financed through a combination of income tax revenue and a one-half cent per pack tax on cigarettes.
[30] Grob, From Asylum to Community, 140-41, 144-46.
[31] See, e.g., Robert G. Hunt, "Ingredients of a Rehabilitation Program," in Milbank Memorial Fund, An Approach to the Prevention of Disability from Chronic Psychoses: The Open Mental Hospital within the Community (New York: Milbank Memorial Fund, 1958), 9-27.
[32] Grob, From Asylum to Community, 145.
[33] The six administrators sent to Britain were: Dr. Nathan Beckenstein, head of Brooklyn State Hospital; Dr. Robert C. Hunt, head of Hudson River State Hospital; Dr. Francis J. O'Neill, head of Central Islip State Hospital; Dr. Hyman Pleasure, head of Middletown Hospital; Dr. Herman B. Snow, head of St. Lawrence State Hospital; Dr. C.F. Terrence, head of Rochester State Hospital. It is unclear as to just how many patients at the St. Lawrence and Rochester State Hospitals were in open wards; however, Dr. Pleasure reported that sixty-five percent of those at St. Lawrence were in such wards even before he went to Britain and that even more patients were placed in open wards after he returned. For the views of the six psychiatrists who went to Britain and their subsequent efforts to emulate their British counterparts, see "Reports of Group Visits to Great Britain's Community-Based, Open Mental Hospitals," in Milbank Memorial Fund, Steps in the Development of Integrated Psychiatric Services: Report of the Third Meeting of the Advisory Council on Mental Health Demonstrations (New York: Milbank Memorial Fund, 1960), 14-36.
[34] Information about the Milbank Memorial Fund and its activities can be found in Ernest M. Gruenberg and Frank G. Boudreau, "Preface," in An Approach to the Prevention of Disability from Chronic Psychoses, 5, and Grob, From Asylum to Community, 89, 169. Grob asserts that the fund began supporting mental health projects in the 1940's, but a 1939 overview of the mental hygiene movement indicates that the organization's concern with mental health developed at least a decade earlier; see Central Hartford Bank & Trust Co, The Mental Hygiene Movement, 57.
[35] Hunt, "Ingredients of a Rehabilitation Program," 16.
[36] In 1959, Dr. William Carson, the chair of the St. Lawrence County CMHB, asserted that he was "constantly amazed" that many of his colleagues seemed to regard "elected officials, particularly boards of supervisors [,]. . . as backwoodsmen without any thought except guarding the county treasury" and stressed that officials generally wanted what was best for their communities; see New York State Department of Mental Hygiene, Association of Community Mental Health Boards, Fourth Annual Conference of Community Mental Health Boards ([Albany, NY: Department of Mental Hygiene, 1959]), 69-70.
[37] New York State Planning Committee on Mental Disorders, A Plan for a Comprehensive Mental Health and Mental Retardation Program for New York State, vol 1., Report of the Mental Health and Mental Retardation Sections of the State Planning Committee (Albany, NY: , 1965), 8.
[38] New York State Assembly, Assembly Joint Committee to Study the Department of Mental Hygiene, Mental Health in New York: A Report To Speaker Stanley Steingut from the Assembly Joint Committee to Study the Department of Mental Hygiene (Albany: New York State Assembly, 1976). It is important to note that local officials in certain areas may have had another reason for relying upon state facilities: fear that the hospitals would be shut down. Rural state hospitals brought money and jobs into the villages and small towns adjacent to them, and local officials might have feared that community mental health programs would ultimately lead to hospital closure.
[39] [New York State Department of Mental Hygiene, Association of Community Mental Health Boards], Second Annual Conference of New York State Community Mental Health Boards. [Albany: Department of Mental Hygiene, 1957], 11.
[40] Davies was Director of Special Studies for the New York State Association for Mental Health at the time he carried out the study. At various times, he had been associate director of the New York State Charities Aid Association, executive secretary of the New York State Committee on Mental Hygiene, general director of the Community Service Society of New York City, president of the New York State Association for Mental Health, a board member of the National Association for Mental Health, president of the Family Service Association of America, and president of the Mental Health Materials Center; see New York State Department of Mental Hygiene, New York State Association of Community Mental Health Boards, Sixth Annual Conference of New York State Community Mental Health Boards ([Albany: Department of Mental Hygiene, 1961]), 53.
[41] Davies, Toward Community Mental Health, 9-10. The Chemung County CMHB refused to allow Davies to assess its activities. CMHB's existed in Albany, Broome, Cayuga, Chemung, Dutchess, Erie, Greene, Jefferson, Monroe, Nassau, Niagara, Oneida, Onondaga, Ontario, Orange, Putnam, Rockland, St. Lawrence, Saratoga, Schenectady, Suffolk, Ulster, Warren, Washington, Wayne and Westchester counties and in the New York City.
[42] Davies, Toward Community Mental Health, 11-13.
[43] Davies, Toward Community Mental Health, 32.
[44] Davies, Toward Community Mental Health, 14-15, 22.
[45] Davies, Toward Community Mental Health, 204-05.
[46] Davies, Toward Community Mental Health, 24.
[47] The RMHAC's, which consisted of CMHB and state hospital administrators, were: New York City Region (Bronx, Kings, New York, Queens, and Richmond counties); Albany Region (Albany, Rensselaer, Saratoga, Schenectady, Warren, and Washington counties); Binghamton Region (Broome, Chemung, Chenango, Cortland, Delaware, Otsego, Schoharie, and Tioga counties); Buffalo Region (Allegany, Cattaraugus, Chautauqua, Erie, and Niagara counties); Catskill Region (Orange, Rockland, Sullivan, and Ulster counties); Hudson River Region (Columbia, Dutchess, Greene, Putnam, and Westchester counties); Long Island Region (Nassau and Suffolk counties); Rochester region (Cayuga, Genesee, Livingston, Monroe, Ontario, Orleans, Schuyler, Seneca, Steuben, Tompkins, Wayne, Wyoming, and Yates counties); St. Lawrence Region (Clinton, Essex, Franklin, Jefferson, Lewis, and St. Lawrence counties); and Syracuse Region (Fulton, Hamilton, Herkimer, Madison, Montgomery, Oneida, Onondaga, and Oswego counties).
[48] New York State Department of Mental Hygiene, Summary Statement of Reorganization of Department of Mental Hygiene, October 1, 1962 (Albany: Department of Mental Hygiene, 1961), [4]. The actual implementation of the reorganization plan seems to have occurred somewhat later. Dr. Leonard Lang served as Associate Commissioner for Community Services for a short time; he was subsequently made Commissioner for Mental Hospitals. Lang was replaced by Dr. Alan D. Miller, who also vacated the office shortly after being appointed: he was made Commissioner for Mental Hygiene in February 1966 and remained in that post until his retirement in 1974.
[49] New York State Department of Mental Hygiene, 1965 Annual Report (Albany, NY: Department of Mental Hygiene, 1965), 7.
[50] Lawrence R. Kolb, "Problems of Integration . . . in New York City: The Voluntary Hospitals and Psychiatric Care in the Metropolitan Area," in Milbank Memorial Fund, Decentralization of Psychiatric Services and Continuity of Care: Proceedings of the Thirty-Eighth Annual Conference of the Milbank Memorial Fund (New York: Milbank Memorial Fund, 1962), 67-68, 70.
[51] Dr. Marvin E. Perkins, "Problems of Integration . . . in New York City," in Milbank Memorial Fund, Decentralization of Psychiatric Services, 76-77; Dr. Harold C. Miles, "Problems of Integration . . . in Monroe County," in Milbank Memorial Fund, Decentralization of Psychiatric Services, 81-84; Dr. C.F. Terrence, "Problems of Integration . . . in Monroe County," in Milbank Memorial Fund, Decentralization of Psychiatric Services, 85-88.
[52] Grob, From Asylum to Community, 173-75.
[53] Grob, From Asylum to Community, 187-214. Grob notes that one of the most vocal critics of the JCMIH's recommendations was New York State DMH official and Psychiatric Quarterly editor Newton Bigelow, who argued that doing as JCMIH advocated and turning large state mental hospitals into chronic care facilities was in effect defining certain patients as hopeless cases and simply warehousing them.
[54] Grob, From Asylum to Community, 233-34, 248.
[55] Grob, From Asylum to Community, 235-238.
[56] New York State Planning Committee on Mental Disorders, A Plan for a Comprehensive Mental Health and Mental Retardation Program for New York State: Report to the Governor. vol. 1, Report of the Mental Health and Mental Retardation Sections of the State Planning Committee, (Albany: 1965), vii. A complete listing of all of the members of the PCMD, which was originally named the State Mental Health Planning Committee, can be found on p. 3-4. Lists of members of various task forces and regional committees can be found in subsequent volumes of the report.
[57] Planning Committee on Mental Disorders, A Plan for a Comprehensive Mental Health and Mental Retardation Program, vol. 1, Report of the Mental Health and Mental Retardation Sections of the State Planning Committee, viii.
[58] New York State Department of Mental Hygiene, Control of Mental Disorders in New York State, (Albany: Department of Mental Hygiene, 1966), 9; New York State Department of Mental Hygiene, 1967 Annual Report (Albany, NY, 1967) [8].
[59] Act of 30 April 1963, Laws of New York, ch. 932, § 1-2.
[60] Act of 30 April 1963, Laws of New York, ch, 932, § 2. Section 2 created Article 2-B of the Mental Hygiene Law. § 29-a of Article 2-B established the MHIC. § 29-c charged it with planning, constructing, and improving facilities or contracting with third parties to perform these functions and empowered it to purchase all materials and supplies needed to run facilities; § 29-c also prohibited localities from altering building plans that the MHFIC approved. § 29-g gave the MHIC sole responsibility for facility construction funds.
[61] Act of 30 April 1963, Laws of New York, ch. 932, § 18; New York State Housing Finance Authority, A Report to Governor Nelson A. Rockefeller (Albany: Housing Finance Authority, 1966, [5].
[62] Act of 30 April 1963, Laws of New York, ch, 932, § 23.
[63] New York State Department of Mental Hygiene, Control of Mental Disorders in New York State, 4, 12.
[64] Act of 28 June 1965, Laws of New York, ch. 647, § 1-2, § 5.
[65] New York State Health and Mental Health Facilities Improvement Corporation, Improved Health Facilities for Your Community: How the State Can Assist in Construction (Albany, New York State Health and Mental Health Facilities Improvement Corporation, n,d).
[66] New York State Department of Mental Hygiene, Catalog of Selected Federal Programs for Financial Assistance and Grants, (Albany,: New York State Department of Mental Hygiene, 1966).
[67] On the provisions of Medicare and Medicaid and their effects on treatment of the mentally ill elderly, see Grob, From Asylum to Community, 267-70. Grob notes that the transfer of the aged mentally ill to nursing homes freed up resources that were then used to improve care for the patients who remained. However, those sent to nursing homes encountered widely varying levels of care and a dearth of psychiatric services. The mortality rate of mentally ill senior citizens increased among those transferred, suggesting that nursing home care was often inadequate; see Grob, The Mad Among Us, 266, 289-90.
[68] New York State Department of 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 Hygiene, 1974), [1]-[2], [4]-[5].
[69] Grob, From Asylum to Community, 249-50.
[70] Grob, From Asylum to Community, 251-52.
[71] Grob, From Asylum to Community, 285-86; Grob, The Mad Among Us, 264.
[72] Grob, From Asylum to Community, 252-53.
[73] Grob, From Asylum to Community, 262-63,
[74] Grob, The Mad Among Us, 264.
[75] Grob, From Asylum to Community, 254-55.
