See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/13870444

Community Care and the Origins of Psychiatric Social Work

Article  in  Social Work in Health Care · February 1997

DOI: 10.1300/J010v25n03_03 · Source: PubMed

CITATIONS READS

4 921

1 author:

Paul H Stuart
Florida International University
35 PUBLICATIONS   90 CITATIONS   

SEE PROFILE

All content following this page was uploaded by Paul H Stuart on 05 June 2014.

The user has requested enhancement of the downloaded file.

This article was downloaded by: [Florida International University]
On: 09 October 2013, At: 15:29
Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number:
1072954 Registered office: Mortimer House, 37-41 Mortimer Street,
London W1T 3JH, UK

Social Work in Health Care

Publication details, including instructions
for authors and subscription information:
http://www.tandfonline.com/loi/wshc20

Community Care and the

Origins of Psychiatric
Social Work
a
Paul H. Stuart PhD
a
School of Social Work , The University
of Alabama , Box 870314, Tuscaloosa, AL,
35487-0314, USA
Published online: 12 Oct 2008.

To cite this article: Paul H. Stuart PhD (1997) Community Care and the
Origins of Psychiatric Social Work, Social Work in Health Care, 25:3, 25-36,
DOI: 10.1300/J010v25n03_03

To link to this article: http://dx.doi.org/10.1300/J010v25n03_03

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of

all the information (the “Content”) contained in the publications
on our platform. However, Taylor & Francis, our agents, and our
licensors make no representations or warranties whatsoever as to the
accuracy, completeness, or suitability for any purpose of the Content.
Any opinions and views expressed in this publication are the opinions
and views of the authors, and are not the views of or endorsed by
Taylor & Francis. The accuracy of the Content should not be relied
upon and should be independently verified with primary sources of
information. Taylor and Francis shall not be liable for any losses,
 actions, claims, proceedings, demands, costs, expenses, damages,
and other liabilities whatsoever or howsoever caused arising directly
or indirectly in connection with, in relation to or arising out of the use
of the Content.

This article may be used for research, teaching, and private study
purposes. Any substantial or systematic reproduction, redistribution,
reselling, loan, sub-licensing, systematic supply, or distribution in any
form to anyone is expressly forbidden. Terms & Conditions of access
and use can be found at http://www.tandfonline.com/page/terms-
and-conditions
Downloaded by [Florida International University] at 15:29 09 October 2013
 Community Care and the Origins
of Psychiatric Social Work
Paul H.Stuart, PhD
Downloaded by [Florida International University] at 15:29 09 October 2013

SUMMARY. Psychiatric social work began in the early twentieth

century as a result of a movement for community care of the mental-
ly ill. Formerly preoccupied with institutional care of the mentally
ill, psychiatrists now became interested in the control and prevention
of mental illness in the community. This paper reviews the contem-
porary literature on early psychiatric social work. The paper then
discusses the mental hygiene movement and early psychiatric social
work practice. It concludes with a consideration of the changes in
psychiatric social work which accompanied World War I. [Article
copies available for a feejiom The Hawonh Documenr Delivety Service:
1-800-342-9678. E-mail address: getinfo@haworrh.comJ

Psychiatric social work began in the early Wentieth century as the

result of a movement for community care of the mentally ill. During the

Paul H. Stuan is Professor at the School of Social Work, The University of

Alabama, Box 870314, Tuscaloosa, AL 35487-0314. E-mail: PSTUART@SW.
UA.EDU
The author would like to acknowledge the assistance of Joan E. Esser-Stuart,
who read and commented on several earlier versions of this study, and of two
anonymous reviewers of this work. All provided helpful comments which re-
sulted in an improved paper.
A sabbatical leave and an Ernest G. Williams Endowed Faculty Enhancement
Award from the University of Alabama supported the research which is reported
in this paper.
This paper was presented at the First International Conference on Social Work
in Health and Mental Health Care, The Hebrew University of Jerusalem, Jerusa-
lem, Israel, January, 1995.
[Hawonh co-tndexmg entry note]. "Community Cure and the Origins of Psych~amcSoc~alWork."
Stuan. Paul H Co-oublished simullaneouslv in Social Work in Health Care (The Hawonh Press. Inc.)
Vol. 2;. No. 3. 199j, pp. 25-36; and: ~ocia1'~oWork
in Menral Health: Trends andlssues (ed: Ur'i ~ v i r a r n j
The Hawonh Press, 1";. 1997. pp. 25-36 S~ngleor mult~plecopies of thu sn~cleare available for a fee
horn The Hawonh Dccument Dellvery Service [I-800-342-9678.9.00 a.m. - 5.00 p.m. (EST). E-mad
address: getinfo@hawarth.cnrn].

O 1997 by The Haworth Press, Inc. All rights resewed. 25

 26 SOCIAL WORKIN MENTAL HEALTH: TRENDS AND ISSUES

first decades of the century, the interests of psychiatrists began to shift

from institutional management to mental hygiene. Formerly preoccupied
with institutional care of the mentally ill, psychiatrists now became inter-
ested in the control and prevention of mental illness in thc community.
This broadened the scope of their activity, and created new demands. "The
fundamental aim of the mental hygiene movement," wrote psychiatrist
William L. Russell (1916),
Downloaded by [Florida International University] at 15:29 09 October 2013

is to spread abroad the knowledge which has been gained in the

medical study of mental disorders, and to promote in every way
possible, its effective application in dealing with the problems occa-
sioned by these disorders in the individual and in the social body as
well as in hospital work (p. 268) . . . [B]y extending the activities of
the hospital itself beyond the present limits, so as to deal with mental
disorders in closer relation with the conditions in which they arise
and in which they interfere with the social welfare . . . the state
hospital . . . can contribute most to the advancement of the aims of
the mental hygiene movement. (p. 269)

Psychiatric social workers were essential to this shift in focus. Yet early
psychiatric social work has been neglected and misunderstood by contem-
porary writers. In this paper, I will review the contemporary literature on
early psychiatric social work practice, discuss the mental hygiene move-
ment and early psychiatric social work practice, and conclude with a con-
sideration of the changes in psychiatric social work which accompanied
America's entry into World War I.

WRITINGS ON EARLY PSYCHIATRIC SOCIAL WORK

Psychiatric social work began in the United States in 1907, when Mas-
sachusetts General Hospital initiated social work services in its neurological
clinic. The specialization developed rapidly and by 1920, major changes
in the specialty were well underway. Good descriptions of the activities of
practitioners during this early period are difficult to find. A possible ex-
planation for this omission is that the attention of the leading practitioners
was focussed on the future. They believed that the most interesting and
exciting developments lay ahead. Similarly, later writers have been more
concerned with the 1920s and afterwards. Most have evaluated the early
period as important mainly as preparation for the "Psychiatric deluge" of
later decades, when social caseworkers adopted an essentially psychologi-
 Paul H. Sfuarf 27

cal interpretation of human behavior (Wenocur and Reisch, 1989; Wood-

roofe, 1962).
For example, Black (1991) contrasts two methods which were devel-
oped by American social workers to respond to the crises resulting from
World War I-the Red Cross Home Service program and the expansion of
psychiatric social work. After the war, psychiatric social work flourished,
while the Home Service program languished and was ultimately aban-
Downloaded by [Florida International University] at 15:29 09 October 2013

doned. Psychiatric social workers "were clearly 'aides' to the psychiatrist,"

in Black's view; social work, subordinated to psychiatxy, "was forced into
a premature transformation with no inherent stability" @. 397). This view,
while faithhl to the attitudes of social workers of the 1930s and '40s, may
tell us more about those times than about the years before and during
World War I.
Courtney's (1992) discussion of the development of psychiatric social
work is focused more narrowly on the early discussions about private
practice among psychiatric social workers in the 1920s and '30s. He
provides little information about psychiatric social work practice before
1920. In a similar vein, Specht and Courtney (1994) attribute the decline
of social work as a positive force to its association with psychiatry begin-
ning in the 1920s. Early social workers "started out with a vision of a
profession that would help construct the city on the hill; but instead . . . we
have a ~rofessiondedicated to building- the church of individual r e ~ a i r "
(p. 85):
Gerald Grob (1983) provides the most complete description of early
psychiatric social work practice available in the secondary literature. In
Grob's view:
Before 1920 psychiatric social work was based on the assumption
that a knowledge of the social environment was vital to an under-
standing of individual behavior. The gathering of such information
by means of social casework was, in theory, the primary function of
the specialty. In practice, however, social casework was fluid rather
than fixed. The daily activities of social workers centered on provid-
ing assistance and aid to distressed individuals and to help them take
advantage of a variety of supportive services. (p. 250)
After 1920, psychiatric social workers pursued psychological understand-
ing of the patient and aspired to provide direct treatment. Ironically, ac-
cording to Grob, the blurring of the distinction between psychiatrists and
psychiatric social workers, much sought after by psychiatric social work-
ers in the 1920s and '30s, impeded their quest for professional status, since
the specialty lacked "a specific occupational focus and . . . [had rejected
 28 SOCIAL WORK IN MENTAL HEALTH: TRENDS AND ISSUES

its] service function" @. 257). As a result, psychiatric social work "re-

mained a marginal specialty before 1940" @. 256).
During the early 1900s, psychiatric social workers were excited about
the potential alliance with psychiatry. They were more interested in what
the future would hold than in the present realities of practice. "A qualitative
difference" in social casework thinking "is beginning to appear," wrote
psychiatric social work pioneer Mary C. Jarrett (1918a). Casework was
Downloaded by [Florida International University] at 15:29 09 October 2013

"about to pass into a psychological phase," in which "personality" rather

than "environment" would be "the dominant influence" (p. 288). Accord-
ing to Lois French (1940), director of a study of psychiatric social work
sponsored by the American Association of Psychiatric Social Workers,
..
osvchiatric social work oractice in the 1920s and earlier emphasized "social
manipulation-the findkg of jobs, boarding homes, schobls, recreational
facilities. and explanation or internretation to families of the psychiatrist's
recomm&dation:" These " s t e r e o h d activities" created "diHs~isfaction"
since there was a perception "that the psychiatric social worker is only an
'errand girl' attached to a clinic to cany out specific behests of the psychi-
atrists" (p. 203). Much more exciting were the newer and more flexible
roles which promised to blur the distinctions between psychiatrists and
psychiatric social workers and foster the development of psychotherapy as
a social work service.

THE MOVEMENT FOR COMMLrNITY CARE

Although social workers had long been interested in the problems of the
mentally ill, a distinctive social work contribution was not needed as long
as institutional care for the mentally ill predominated. Disenchantment
with institutional care and the publication of Clifford Beers' autobiograph-
ical A Mind that Found Itself(1909) sparked the mental hygiene move-
ment, characterized by attempts to prevent mental illness and to place
patients in community settings. Recognition on the part of psychiatrists
that social conditions contributed to disease led to increased interest in the
patient's social environment (Kline, 1916). Psychiatrists needed to find
ways to understand and influence the patient's environment and social
workers proved to be natural allies. In addition to their charity organiza-
tion and settlement activities, social workers already were providing com-
munity linkage functions in hospitals, public schools, and child care insti-
tutions.
Psychiatric social work began as a part of the movement for community
care of the mentally ill in the early twentieth century. Asylum care, which
dominated American psychiatry for most of the nineteenth century, was
 Paul H.Stuart 29

widely perceived as a failure by the century's end (Rothman, 1980). Pro-

grams of aftercare and community care, "extending the activities of the
hospital itself beyond the present limits" (Russell, 1916, p. 269), promised
to provide alternative methods of treating mental illness. However, most
psychiatrists lacked knowledge of community resources and were unable
to take the time to visit patients in their communities (Tafi, 1918b).
Precedents for work with the mentally ill in their own communities
Downloaded by [Florida International University] at 15:29 09 October 2013

existed and were known to American psychiatrists. The English Society

for the After-Care of the Insane, supplemented by the Lady Almoners,
visited discharged patients in their homes "to learn of their needs, social or
medical, and to refer them to the proper agencies," as early as 1880.
Working with a visiting nurses' service, these visitors gave the discharged
patients "friendly supervision" and publicized their problems (Kline, 1916,
p. 504). In 1904, Adolf Meyer, a Swiss-born psychiatrist who had been
inspired by these and other aftercare experiments, had his wife visit his
patients and their families. "We thus obtained help in a broader social
understanding of our problem and a reaching out to the sources of sick-
ness, the family and the community," Meyer (1922, p. 222) commented.
Two years later, the New York State Charities Aid Association, a voluntary
organization, employed an "after care agent" to develop a program for
discharged psychiatric patients. The New York state aflercare program grew
slowly during the next decades (Grob, 1983). With the goal of "keeping
patients under supervision and exercising some influence in shaping their
lives after they have left the hospital," New York developed parole, board-
ing out, and aftercare programs staffed by social workers and outpatient
clinics in which social workers played an important role (Russell, 1916,
p. 271).
The New York aftercare program was based on a view of mental illness
which emphasized its social components. "In connection with no other
disease," the New York State Charities Aid Association's Sub-committee
on Prevention and After-Care noted in 1909,
is an understanding on the part of the physician of the patient's
previous manner of lifc more essential to intelligent treatment, and in
no class of homes could a social worker undertake more preventive
and ameliorative work than in those homes where either an inherited
family tendency or an existing mode of life has already sent at least
one member of the household to an institution for the insane. (Quoted
in Grob, 1983, p. 248)
Social workers were natural allies for psychiatrists seeking to develop
an understanding of the origins of mental illness in the environment. In
 30 SOCIAL WORK IN MENTAL HEALTH: TRENDS AND ISSUES

1905, Massachusetts General Hospital established its Social Service De-

partment, initiating the new specialization of hospital social work (French,
1940). Hospital social workers investigated the home conditions of pa-
tients, provided for needed treatment, and secured resources for the pa-
tient's family during treatment (Howard, 1913). Indeed, hospital social
work was one of several applications of the new technology of social case
work to existing institutions. During the first decade of the twentieth
Downloaded by [Florida International University] at 15:29 09 October 2013

century, social workers began providing individualized services in public

schools, as well as hospitals (Stuart, 1986). In schools, as in hospitals,
social workers, as they put it, "socialized the school and individualized the
child" (Lubove, 1965, p. 37). That is, they provided much-needed knowl-
edge of the community to school and hospital authorities and explained the
demands of the institution to pupils, patients, and their families.
In 1907, Massachusetts General Hospital assigned a social worker,
Edith Burleigh, to the neurological clinic. Four years later, New York
began to pay aftercare workers using state fimds. Outpatient departments
were established at Long Island State Hospital and other New York state
hospitals (Kline, 1916). In 1912, Adolf Meyer went to Baltimore to direct
the new Psychiatric Clinic at Johns Hopkins, and a social worker was
added to the staff in 1913.
During the next decade, a new institution, the psychopathic (or reception)
hospital, was developed in hopes of providing more effective treatment for
the mentally ill (Copp, 1916; Grob, 1983; Rothman, 1980; Southard, 1913,
1917). Operating midway between such "front-line" community agencies
as the schools, courts, and dispensaries or outpatient clinics, and long-term
residential institutions like mental hospitals, reform schools, and prisons,
the psychopathic hospital was "a sorting machine for cases which cannot
be readily sorted on the social firing line, cases which may not deserve
internment forever in" institutions but which needed short-term hospital-
ization (Southard, 1917). Public education, consultation to "front-line"
caregivers, research, and prevention of mental illness were also important
functions of the psychopathic hospital (Copp, 1916). Because of the psy-
chopathic hospital's focus on short-term hospitalization and community
care, social workers were an essential part of the hospital staff.
Boston Psychopathic Hospital opened in 1912 under the direction of
Elmer E. Southard. Southard recruited Mary C. Jarrett, a social worker with
a background in Charity Organization and child welfare, to be the director
of the social service department in 1913. The activities of the psychiatric
social workers included taking a social history of the patient, working with
the patient's family, and "acting as a liaison agent between the physicians
and social workers in the community" (French, 1940, pp. 39-40).
 Paul H. Strtart 31

Although the psychopathic hospital "idea" generated a great deal of

excitement, only a handful of psychopathic hospitals were established in
the United States before the nation entered World War I. Since psycho-
pathic hospitals focussed on receiving patients from the community, they
had little impact on the treatment of the mass of the institutionalized
mentally ill (Grob, 1983; Rothman, 1980). However, the increased aware-
ness of the patients' community and the innovation of psychiatric social
Downloaded by [Florida International University] at 15:29 09 October 2013

service had a significant impact. Some state hospitals, particularly thosc in

Massachusetts and New York, added aftercare workers before 1915 (Kline,
1916; Russell, 1916). In Massachusetts, new members of the State Board
of Insanity who were appointed in 1914 moved quickly to "extend the
out-patient work of each state hospital throughout the districts which the
several hospitals covered." The Board encouraged each state hospital to
employ social workers to provide outpatient clinics, aftercare, and board-
ing out programs for discharged patients. In addition; preventive services
were to be provided to people who had never been admitted to the institu-
tion, and a prevention program was directed toward physicians and the
general public (Briggs and Steams, 19 15).

METHODS OF EARLY PSYCHIATRIC SOCIAL WORKERS

The early experiments in the aftercare of former mental patients and the
movement for community placement of the mentally ill necessitated social
work intervention to provide linkages to the patient's community and to
help the patient adjust to his or her environment. Early psychiatric social
workers prepared social histories of patients who were entering mental
hospitals, visited discharged psychiatric patients in their homes. super-
vised boarding homes for discharged patients, found jobs in the communi-
ty for patients, and secured resources from social agencies for patients and
their families (Kline, 1916; Rosanoff and Cusack, 1920; Tafi, 1918a).
The duties of Edith Burleigh, the social worker who was assigned to
Massachusetts General Hospital's neurological clinic in 1907, included
supervising "patients in their homes and communities," and arranging
"for employment, recreation, and better adjustment in family relation-
ships." She talked with patients "at the clinic and in the home, not only
giving encouragement and friendly advice, but also participating in a
definite plan on psychotherapy as prescribed by the psychiatrist." She
"also maintained a close relationship with the social agencies in the com-
munity" (French, 1940, pp. 36-37).
At Danvers State Hospital in Massachusetts, the social worker provided
the psychiatrist with "social knowledge of the patient" by compiling a
 32 SOCIAL' WORK IN MENTAL HEALTH: TRENDS AND ISSUES

social history of each patient upon admission to the institution. In addition,

the social worker at Danvers visited the homes of patients who were
released from the hospital, supervised boarding out facilities, and "con-
nected needy persons with the proper agencies" (Kline, 1916). Similarly,
social workers at the Pennsylvania's outpatient psychiatric clinics con-
ducted pre-clinical investigations and did follow-up work "to see that thc
recommendations of the psychiatrist are carried out" and "to secure em-
Downloaded by [Florida International University] at 15:29 09 October 2013

ployment for patients" (Abbot, 1920).

At the Johns Hopkins psychiatric clinic, social workers helped psychia-
trists understand the patient "in his complete human relations" (Campbell,
1917, p. 573). The aim of treatment was defined as "the readjustment of
the patient to the environment." The method was "largely re-educational."
Following a psychiatrist's diagnosis and treatment, social workers were
involved in contacts with family members and in the provision of educa-
tion to the patient @. 576). Social workers were also involved with a
variety of community agencies, which supplied "the machinery for the
readjustment of the patient" (p. 581). Social workers at the Michigan State
Psychopathic Hospital engaged in "intra-mural" work with psychiatrists
and other hospital staff members but carried particular responsibility for
"extra-mural" work, which aimed "to extend as far as possible facilities
for psychiatric and treatment of the citizens of the state," by assisting at
outpatient clinics and visiting the families of hospitalized patients (Barrett,
1921, p. 319).
In her Smith College master's thesis, Louise Silbert (1932) provided a
rcview of the evolution of record keeping in the Social Service Depart-
ment at Boston Psychopathic Hospital. From the start of Mary Jarrett's
tenure in 1913, a central activity of the social worker was the preparation
of a social history for each patient. The social history was designed to
provide the psychiatrist with social information which was needed to
make an accurate diagnosis. In addition, it provided information upon
which the social worker could base her interventions in the community.
The social history included "facts concerning family, friends and refer-
ences, work, recreation, schools, home and neighborhood," as well as the
patient's developmental history. The treatment provided by the social
worker "consisted in manipulating environmental details, either placing
the patient in a new setting or introducing new factors into his." The
interview was to be directed by the social worker and to focus on the "here
and now" (pp. 25-27). Silbert noted few changes in recording or in treat-
ment methods at Boston Psychopathic Hospital until the late 1920s, when
the influence of psychoanalysis led to "skepticism and doubt" about so-
cial service methods of the past fifteen years (p. 30).
 Paul H.Stuart 33

The methods of these early psychiatric social workers were consistent

with those used by social workers in other fields of practice. Rather than a
new method of social work, according to Mary Jarren (1921), psychiatric
social work was "the application of social case work in a new field" @. 64).
She saw psychiatric social work's contribution to the care of psychiatric
patients as the "social adjustment of individuals" (Jarrett, 1923, p. 416).
Specifically, psychiatric social workers obtained information necessary for
Downloaded by [Florida International University] at 15:29 09 October 2013

the psychiatrist's diagnosis by inquiry in the community, made "necessary

changes" in the patient's environment, and encouraged patients "to main-
tain proper mental habits" (p. 417). Thus, psychiatric social workers
shared the environmental and sociological emphases of other branches of
the profession.

WORLD WAR I: EXPANSION AND TRANSFORMATION

Psychiatric social work expanded during World War I as war-related
problems increased the demand for psychiatric services. An unexpectedly
large number of war-related psychiatric problems, popularly called "shell
shock," troubled Army psychiatrists. Jarrett (1918b) argued that many
neuroses encountered in civilian life were "shell-shock analogues." So-
cial workers could help these patients, and by extension the shell-shocked
veterans, by finding them employment, securing resources, and interpret-
ing the illness and its management to family members. In 1918, Jarrett
started a summer school program to train psychiatric social workers for the
war emergency at Smith College. This program grew into the Smith Col-
lege School for Social Work.
ARer the war, continuing psychiatric problems presented by veterans
and an increasing awareness of mental hygiene increased the demand for
psychiatric services, including services provided by social workers. Psy-
chiatrists, who had earlier guarded their prerogative to treat patients, now
began to envision a broader role for social workers. Douglas Thom (1922),
a psychiatrist at Boston Psychopathic Hospital, told the National Confer-
ence of Social Work that "the psychiatric personnel in this country . . . is
quite inadequate to meet the demands" for psychiatric services. It was
therefore necessary "to broaden the scope of the social worker's functions
and increase her responsibilities" @. 377). As director of the Massachu-
setts Habit Clinics, Thom presided over one of the settings where social
work hnctions and responsibilities were enlarged (Orme & Stuart, 1981).
Three years earlier, at the 1919 National Conference of Social Work, a
series of papers on psychiatric social work generated considerable interest.
The authors of these papers proposed new directions for psychiatric social
 34 SOCIAL WORK IN MENTAL HEALTH: TRENDS AND ISSUES

workand, by implication, for all of social work. Jarrett (1919) was most
restrained. She argued that psychiatry, along with economics and biology,
provided essential knowledge for social workers. Yet the work of the
psychiatric social worker "was essentially the same as the work of other
caseworkers" (p. 590). Others were more critical of current practice. South-
ard (1919) argued that caseworkers should focus on the individual rather
than the family. Jessie Tafi (1919) complained that much psychiatric social
Downloaded by [Florida International University] at 15:29 09 October 2013

work was "just ordinary social sewice which only happens to be directed
toward the mentally ill." In contrast, "a new way of approaching all case
work," which combined "social technique" with "an understanding of
human psychology," promised to enable "the social worker to deal with
the personality of the patient in his social setting as intelligently and
constructively as the psychiatrist deals with it in the hospital" @. 594).
These papers, and developments such as the Habit Clinics and Child
Guidance Clinics of the 1920s, began to chart a new course for social work
with individuals. The new social casework that developed would empha-
size understanding the psychology of the client as well as his or her social
setting and would be less environmental and less focussed on the "here
and now" (Robinson, 1930). In time, the changes in psychiatric social
work would transform all of American social casework-and would influ-
ence group work and community organization in the United States as well.
Yet early American psychiatric social work, like social work itself, was
based upon understanding and changing the social environment of clients.
In our own time, observers have noted a resurgence of interest in "achiev-
ing influence through and within" the social environment (Payne, 1991,
p. 250). According to Rose and Moore (1995), the use of case manage-
ment techniques in social work practice has increased dramatically as part
of a movement for community care of previously institutionalized client
groups. Case managers assess the needs of clients in the community, plan
services or treatment programs for those clients, refer clients to appropri-
ate community resources, and monitor clients to see "that services are
delivered and used" @. 336). Like the early psychiatric social workers,
today's case managers must work in communities which are characterized
by fragmented service delivery systems, "severe deficits of resources,"
and the "underdevelopment of appropriate resources to sustain people in
their transitions from institutional care to community settings" @. 336). In
this respect, psychiatric social workers of the early 1900s had much in
common with contemporary social workers involved in the provision of
case management services and community care of the mentally ill. Early
psychiatric social workers were not the prophets of a new "church of
individual repair" (Specht and Courtney, 1994, p. 85). The carly psychiat-
 Paul K. Stuart 35

ric social workers were actively involved with psychiatric patients and
their families in community settings. They provided linkages within the
patient's community and helped the patient adjust to his or her environ-
ment. In addition, they helped secure needed services and employment for
discharged psychiatric patients. Contemporary psychiatric social workers
who provide case management services are following the practice tradi-
tions of these early pioneers.
Downloaded by [Florida International University] at 15:29 09 October 2013

REFERENCES
Abbot, E.S.(1920). Out-patient or dispensary clinics for'mental cases. American
Journal of Insanity, 77.2.21 7-225.
Barren, A.M. (1921). The state psychopathic hospital. Americun Journal of Insan-
ity, 77,3,309-320.
Beers, C. (1909). A Mind That Found Ilselj: An Autobiography. New York: Long-
man, Green.
Black, W.G., Jr. (1991). Social work in World War I: A method lost. Social
Service Review, 65.3.379402.
Briggs, L.V., & Steams, A.W. (1915). Recent extension of out-patient work in
Massachusetts state hospitals for the insane and feeble-minded. American
Journal of Insanity, 72, 1.35-43.
Campbell, C. Macfie (1917). The mental health of the community and the work of
the psychiatric dispensary. Mental Hygiene, 1 . 4 , 572-584.
Copp, 0. (1916). The psychiatric needs of a large community. Proceedings of the
American Medico-Psychological Association, 72,493-502.
Courtney, M. (1992). Psychiatric social workers and the early days of private
practice. Social Service Review, 66.2, 199-214.
French, L.M. (1940). Psychiatric Social Work.New York: Commonwealth Fund.
Grob, G.N. (1983). Mental Illness and Americun Society, 1875-1940. Princeton:
Princeton University Press.
Howard, H.B. (1913). Growth and efficiency of hospitals. Journal of the Ameri-
can Medical Association, 61,22, 1965-1966.
Jarrett, M.C. (1918a). Psychiatric social work. Mental Hygiene, 2,2,283-290.
Jarrett, M.C. (1918b). Shell-shock analogues: Neuroses in civil life having a
sudden or critical origin. Medicine and Surgery, 2,266-280.
Jarrett, M.C. (1919). The psychiatric thread running through all social case work.
Proceedings of the National Conference of Social Work, 46,587-593.
Jarrett, M.C. (1921). The place of psychiatric social work. Hospiral Social Ser-
vice, 4.63-66.
Jarrett, M.C. (1923). The psychiatric social worker in relation to mental hygiene.
American Review, 1 , 4 , 4 1 3-420.
Kline, G.M. (1916). Social service in the state hospital. Proceedings of the Ameri-
can Medico-Psychological Association, 72,503-51 7.
Lubove, R. (1965). The Prqfksional Allruist: The Emergence ofSociul Work as a
Career, 1880-1930. Cambridge: Harvard University Press.
 36 SOCIAL WORK IN MENTAL HEALTH: TRENDS AND ISSUES

Meyer, A. (1922). Historical sketch and outlook of psychiatric and social work.
Hospital Social Service, 5,221-225.
Orme, J.G.,& Stuart, P. (1981). The habit clinics: Behavioral social work and
prevention in the 1920s. Social Service Review, 55,242-256.
Payne, M. (1991). Modem Social Work Theory: A Critical Introducfion.Chicago:
Lyceum.
Robinson, V.P. (1930). A Changing Psychology in Social Case Work. Chapel Hill:
University of North Carolina Press.
Downloaded by [Florida International University] at 15:29 09 October 2013

Rosanoff, A.J., & Cusack, T.S. (1920). Parole system and its relation to occupa-
tional therapy. American Journal of Insanity, 77.2, 149-163.
Rose, S.M., & Moore, V.L. (1995). Case management. Encyclopedia of Social
Work, 19,335-340.
Rothman, D.J. (1980). Conscience and Convenience: The Asylum and Its Alterna-
tives in Progressive America. Boston: Little, Brown.
Russell, W.L. (1916). What the state hospital can do in mental hygiene. Pmceed-
ings of the American Medico-Psychological Association, 72,267-274.
Silbert, L. (1932). A Proposed Case Record Form to Meet the Needs of Psychia-
trists and Social Workers of he Boston Psychopathic Hospital. Unpublished
M.S.S. thesis, Smith College School for Social Work, Northampton, Massa-
chusetts.
Southard, E.E. (1913). The psychopathic hospital idea. Journal of the American
Medical Association, 61.22, 1972-5.
Southard, E.E. (1917). Zones of community effort in mental hygiene. Proceedings
of the National Conference of Social Work, 44,405-5 13.
Southard. E.E. (1919). The individual versus the family as the unit of interest in
social work. Proceedings of the National ~onfer&e of Social Work, 46,
-582-587.
. ... .
-

Specht, H., & C o m e y , M.E. (1994). Unfaithful Angels: How Social Work Has
Abandoned Its Mission. New York: Free Press.
Stuart, P. (1986). School social work as a professional segment: Continuity in
transitional times. Social Work in Education, 8.3, 141- 153.
Taft. J. (1918a). Supervision of the feebleminded in the community. Mental Hy-
giene, 2, 3,434442.
Taft, J. (1918b). The limitations of the psychiatrist. Medicine and Surgery, 2,
365-367.
Taft, J. (1919). Qualifications of the psychiatric social worker. Proceedings of the
National Conference ofSocial Work, 46, 593-599.
Thom, D.A. (1922). Results and future opportunities in the field of clinics, social
service, and parole. Proceedings of the National Conference of Social Work,
49,375-381.
Wenocur, S., & Reisch, M. (1989). From Charily to Enterprise; The Development
of American Social Work in a Market Economy. Urbana: University of Illinois
Press.
Woodroofe, K. (1962). From Charity to Social Work in England and the United
States. Toronto: University of Toronto Press.

View publication stats