1906 After Care for the Insane

After Care for the Insane was another much needed service that was introduced, organized and came to fruition in 1906 by Miss Louisa Lee Schuyler. When inmates were discharged from the state hospitals, many had no where to go. They had no home, no job, no friends or relatives willing to help them and many had children that had been separated from them during their incarceration. Miss Schuyler and her league of volunteers of The State Charities Aid Association helped these people to re-enter society with a helping hand by working in co-operation with the superintendents of the state hospitals.


“In our last year’s report we expressed the hope that during the coming year it might ‘be found possible to carry into practical operation some plan of assistance for those among the recovered insane (recently discharged from State Hospitals), who are in need of material relief or advice and counsel.’ This hope has been realized, and it is gratifying to be able to state that this Association, during the past year, has initiated and put into operation the first organized practical work in this country for After Care of the Insane. The first steps in this movement were taken on November 19, 1906, when at a conference of the State Commission in Lunacy with the Managers and Superintendents of State Hospitals, held in New York City, Miss Louisa Lee Schuyler, of our Committee on the Insane, upon invitation of the Chairman, Dr. Mabon, addressed the conference on the subject of ‘After Care of the Insane.’ Miss Schuyler gave a brief account of the work of the English After Care Association, based upon information obtained by her during the previous summer while in England, and closed with the following statement, outlining a plan for the organization of such work in the State of New York:

‘Conditions in England differ from those we have here, but the need of a helping hand to be extended to poor and friendless convalescents, and those discharged cured, upon leaving our State Hospitals, is just as much needed here as there, and this is what we ought to do. We need no new society because we have the machinery ready at hand; nor do we need to establish a new institution, or to own buildings, or incur large expense. All that we need is earnest interest in the subject, co-operation, organization, readiness to work.

I have thought that, with the concurrence of the medical superintendents, of two or three members of the re-established boards of managers of our State Hospitals, and of some of the local visitors of the State Charities Aid Association – those living in the respective State Hospital districts – that, with this combination, a working joint committee to provide After Care might be formed for each State Hospital. The experiment might be tried at first on a small scale, with one State Hospital, to see how it would work. I should like to see it tried, and will gladly help toward it in any way I can.’

The Chairman suggested that the subject be again presented in the form of a paper at a later conference. This suggestion was promptly adopted by the Chairman of the Committee on Topics and, at the next conference of the State Commission in Lunacy with the Managers and Superintendents of State Hospitals, held at the State Capitol at Albany, January 30, 1906, a paper upon After Care of the Insane, by Dr. Adolf Meyer, was read and discussed. The conference was largely attended, by representatives of the State Commission in Lunacy, by the medical superintendents and some of the managers of the State Hospitals, and by several officers and members of the State Charities Aid Association. It was presided over by Dr. William Mabon, President of the State Commission in Lunacy. The following resolutions were adopted by unanimous vote of the conference:

‘Resolved, That in the opinion of this Conference, it is desirable that there shall be established in this State, through private philanthropy, a system for providing temporary assistance and friendly aid and counsel for needy persons discharged, recovered, from State Hospitals for the Insane, otherwise known as ‘After Care for the Insane.’

Resolved, That the State Charities Aid Association be requested, by this Conference, to organize a system of After Care for the Insane in this State, and to put it into practical operation.

Resolved, That the representatives of the State Commission in Lunacy and the managers and superintendents of the State Hospitals for the Insane, here present, hereby pledge to the State Charities Aid Association their earnest and hearty co-operation in the establishment and maintenance of a system of After Care for the Insane in this State.”

“Immediately after this Conference the Committee on the Insane of the Association appointed a Sub-committee on the After Care of the Insane (Miss Schuyler, Chairman, Miss Mary Vida Clark, Secretary), to carry into effect the resolutions adopted by the Conference as quoted above.  At a meeting of the Board of Managers of the State Charities Aid Association, held February 9, 1906, the first report of the Sub-committee was presented and approved.  The report outlines the plan of organization as follows:

‘We propose that After Care Committees for each State Hospital shall be appointed by the Association, which shall work under the immediate control and direction of the ‘Sub-committee on After Care of the Insane’ of our Standing Committee on the Insane. These Hospital District Committees shall consist of the present visitors of the Association to the State Hospitals, or such of them as may be willing to serve, with others added as the need may arise, all residents of their respective Hospital Districts; and with them, as ex-officio members of the Committee, two or more Managers to be appointed by each Hospital Board, and the Superintendent of the Hospital. The chairmen and secretaries of the Committees are to be members of the Association. The Committees are to receive the names of their respective Hospitals, viz.: ‘Manhattan After Care Committee of the State Charities Aid Association,’ ‘Willard After Care Committee,’ etc.

In regard to expenses. Fortunately there is a humane provision on the statute books of our State, which makes it mandatory for Superintendents of Hospitals to supply to each patient leaving hospital, who may require it, clothing suitable to the season, and money, not to exceed $25, for traveling and other necessary expenses until he can reach his home or find employment. That section of the Insanity Law reads as follows:

Section 75. Clothing and money to be furnished discharged patients. No patient shall be discharged from a State Hospital without suitable clothing adapted to the season in which he is discharged; and, if it cannot be otherwise obtained, the steward shall, upon the order of the Superintendent, furnish the same, and money not exceeding twenty-five dollars, to defray his necessary expenses until he can reach his relatives or friends, or find employment to earn a subsistence.

It is expected that money advanced by the Committee for the temporary assistance of needy discharged patients, as defined and limited by the above section, will be repaid by the hospitals upon the presentation of proper vouchers.

For our part, we have offered to pay the entire administrative expenses; more especially for the employment of an agent whose duties, under our direction, will be to help local Committees requiring assistance in different parts of the State. This means a salary, traveling and other After Care expenses, which we estimate to amount to about $2,500 annually. For these purposes and for the assistance, if needed, of patients beyond the $25 allowed by the State, we shall have to ask for contributions from those who may wish to help.’

At the first meeting of the Sub-committee on the After Care of the Insane, held February 15, 1906, the first Hospital District Committee was appointed, that of the ‘Manhattan After Care Committee’ (Miss Florence M. Rhett, Chairman). Shortly afterwards an agent trained and experienced in work among the poor in their homes, Miss E.H. Horton, was engaged as After Care agent by the Sub-committee, and was immediately assigned to the duty of assisting the Manhattan After Care Committee.

After Care Committees were subsequently appointed as follows: For the Willard State Hospital, April 10, 1906; for the Hudson River State Hospital, May 22, 1906; for the Binghamton State Hospital, November 8, 1906.  These Committees have done very valuable work for the patients discharged, recovered, from their respective State Hospitals and have presented interesting reports to the Sub-committee. The work of the Committees outside of New York City has been done almost exclusively by the regular and ex-officio members, but the Agent of the Sub-committee has continued to assist the Manhattan After Care Committee in the great amount of work required in connection with the large numbers of patients discharged from the hospital on Ward’s Island to their homes in the City of New York, or frequently discharged to the Committee in the absence of a home or friends to whom they can go.

The plan of co-operation between the Hospital District After Care Committees and the State Hospitals has been outlined in detail and, to give a definite idea of the actual procedure which is followed, is here presented:

1. The Hospital is to notify the Committee of cases likely to be discharged, as soon as such discharge seems reasonably certain, preferably from a week to a month before the patient is likely to leave the Hospital. The Hospital is to furnish the Committee at that time with a summary of such facts in connection with the history of such patient recommended for supervision as will be of assistance to the Committee in the investigation of the case, including the name, age, nativity, creed, occupation, civil condition, date of commitment, previous commitments, form of insanity, character, habits and tendencies and previous history and circumstances of the patient, and the names and addresses of the patient’s relatives and friends, the character and condition of the home and the number in the family so far as known.

2. The Hospital is to notify the Committee of the final discharge, or discharge on parole, of every patient within 48 hours of such discharge, and to furnish at this time particulars regarding the case, if such particulars have not been previously furnished.

3. The Hospital is to notify the Committee if it learns of a likelihood on the part of any former patient to relapse, or of the desirability of assistance or advice in preventing a relapse on the part of former patients, whether such patients are on parole or have been finally discharged.

The Hospital After Care Committees undertake to visit through their members, or the agent of the Sub-committee, the homes and friends of patients about to be discharged, and to report immediately to the hospital such facts and recommendations as may seem likely to be helpful to the hospital in making a decision as to when and to whom patients should be discharged. The Committees also undertake to visit in their homes all patients discharged on parole, who in the opinion of the hospital may need supervision, and to report to the hospital before the expiration of the period of parole such facts as may be of service to the hospital. The Committees are ready, at the request of the hospital, to investigate the circumstances of any former patients who have been discharged, recovered, who may be considered by the hospital to be in danger of a relapse, and to require assistance or advice to maintain their physical or mental health.

In carrying out this plan of co-operation the hospital physicians have shown a generous appreciation of the value of the work done for their patients, and an earnest effort to fulfill the requirements made of them, by bringing to the attention of the Committees cases requiring assistance or supervision. By making suggestions from their extensive experience of such cases, as to the kind of assistance required, the hospital physicians can be, and have already proved themselves, invaluable allies of the Committees, co-operating with them for the permanent welfare of their patients. The practical operation of this plan may be better understood by a study of individual cases. We therefore select, from among those reported by the different After Care Committees a few individual cases assisted by these Committees, to illustrate the aims and methods and results of this work.

A.B. – A middle-aged woman, discharged from hospital May 14, 1906. She was too weak to work and the After Care agent arranged to send her to board in the country on a farm. While there she has gained steadily.  Upon her return a situation will be found for her.

C.D. – While in hospital for a number of months, her husband died, and her only child, a little girl of 12, had to be cared for by strangers. Mother worried about child, and doctor asked agent to see child and report. She found the child well and happy, and the man and wife with whom it was, much attached to the little girl. Agent secured a place with this family, at low wages, for the mother upon her discharge from the hospital. Has visited C.D. several times, and finds her much improved and very happily settled with her child.

E.F. – Discharged September 8, 1906. Agent visited her relatives several times, but found them not able to assist her in any way; also made various attempts to secure work for her. Finally found a place for her as ward helper in BellevueHospital, purchasing for her the necessary clothing. When calling to see her two weeks later, learned from the nurses that her work was satisfactory and that she was doing well.

G.H. – A married man, about 40 years old, who had broken down from over-work as bookkeeper in a large firm. After a few months at the hospital, he completely recovered, and a position was found for him in a bank, where he had formerly worked and where he was given employment of a less responsible and exacting nature, but at a very good salary.

J.K. – A young woman who had been a domestic. She was without friends to assist her and was provided for by the Committee with a temporary lodging place in the city, through the courtesy of the Children’s Aid Society Emergency Shelter, and later with a good situation, as a domestic, through the Charity Organization Society’s Agency for the Handicapped.

L.M. – A young girl of 17, whose mind became unbalanced largely because of poverty, sickness and unsanitary conditions at home. The Committee, with the co-operation of the Association for Improving the Condition of the Poor, the church and a settlement in the neighborhood, established the home-life on a somewhat better basis, provided better rooms and sent the girl and her little sister to the seashore and after their return, got the girl to join a social club at the Settlement where she will have pleasant associates and more opportunities for recreation.

N.O. – A preventive case, heard of through a State Hospital physician who served at a dispensary in the city, and there met a young girl who was so run down and nervous as to be threatened with a mental breakdown. She was sent to the country for several weeks and was completely restored to health.

P.R. – Young woman from the West who had no friends or relatives in the city; an excellent worker but, when recovered and able to leave the hospital, had no place to go to. She was discharged to the Agent who placed her with a lady, with whom she is happy, and who finds her a most satisfactory servant.

S.T. – Young woman, a Hungarian, entirely recovered, whose husband was anxious to take her home. Agent called to see her home, and found that the man was boarding in very crowded quarters and not working, although a plasterer who could earn good wages. Learned from neighbors and the woman’s family that he never had worked, that his wife had supported him. Her brother was willing to pay her passage home to Germany, where her father and mother have their own home, and she was glad to go. The husband was finally persuaded to consent, and the woman sailed for Germany within a week of her discharge from the hospital.

The Committee is glad to report that the expense of the work has not been so large as was expected at the outset. It has averaged about $100 a month. The comparatively small cost of the work is due to the fact that the Committee has been able to avail itself of the many existing charities in New York City which have shown a gratifying willingness to co-operate with our After Care Agency in furnishing temporary boarding places in the country or at the seashore, in providing material assistance in the home, in helping us to secure employment for our recovered patients, and in other ways.

The Committee has not been obliged, except in a very few instances, to call upon the State hospital funds for reimbursement for expenditures, provided for under section 75 of the Insanity Law, which authorizes the expenditure of $25 for the temporary assistance of a patient discharged from a State hospital. Whenever it has been found necessary to call upon a State hospital for such assistance the bills have been immediately approved and forwarded to the office of the State Commission in Lunacy where they have been honored. While the central office is responsible for the administrative expenses, including the salary and traveling expenses of the After Care Agent, and the hospital district After Care Committees are at liberty to call upon the Sub-committee to assist them, it is hoped that each Committee will endeavor to raise a small fund of its own over and above the amount received from the public funds, to meet the expense of assisting individual patients accepted for supervision by the Committee.

The Committee is gratified to note the many evidences of a widespread interest in After Care work. An account of the work of the Association for the After Care of the Insane was presented by Dr. Adolf Meyer, Director of the New York State Pathological Institute, at the annual meeting of the American Neurological Association, and by Dr. William Mabon, Superintendent and Medical Director of the Manhattan State Hospital, at a meeting of the American Medico-Psychological Association, both held in Boston in June, 1906.

The following resolution was unanimously adopted at the annual meeting of the American Medico-Psychological Association:

‘Whereas, The State Charities Aid Association of New York has recently established a Committee on the After Care of the Insane to work in co-operation with the State Hospitals for the Insane in that State, and to provide temporary assistance, employment and friendly aid and counsel for needy persons discharged from such hospitals as recovered, and Whereas, In the opinion of the American Medico-Psychological Association, it is very desirable that there should be carried on in connection with all hospitals for the insane such a system of After Care, therefore Resolved, That the American Medico-Psychological Association expresses its gratification at the inauguration of this movement in the State of New York, and its earnest hope that similar work may be undertaken for hospitals for the insane generally.’

Editorial articles on the subject appeared in the July, 1906, numbers of the ‘American Journal of Insanity’ and the ‘Albany Medical Annals.’ The Sunday editions of the New York Tribune and the New York Sun had, during the summer months, extensive articles on the work of the Association for the After Care of the Insane. A number of letters have been received from physicians and public officials in different parts of the country, referring to articles which had appeared in papers or medical journals and asking for printed reports and further information. Several of these correspondents have written with a view to the establishment of similar work in their localities. We greatly hope that work for the After Care of the Insane, now in practical operation in the State of New York, may soon be undertaken in other States of this country.”

SOURCE: Reprinted from Fourteenth Annual Report of the State Charities Aid Association to the State Commission in Lunacy, November 1, 1906, No.93, New York City, United CharitiesBuilding, 105 East 22d Street, Pages 20-28.  http://books.google.com/