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Appropriations for the State Hospital Department . 335

Office of the Commission 335

For State Hospitals. 335

General Appropriation Bill 336

Deficiency Appropriations for 1916-17 337

Appropriations for State Hospital Department for use in 1916-17 337

General Statistical Information 339

Census of April 1, 1917 339

Summary of Operations of Bureau of Deportation 340

Movement of Patients in the State Hospitals During the Three Months Ending March 31, 1917 341 WHAT THE STATE IS DOING FOR THE INSANE*

By Maurice C. Ashley, M. D.,

Superintendent. Middletown State Homeopathic Hospital.

Public thought is so crowded with momentous events at this time that one needs a stout wedge and a heavy sledge if he would succeed in forcing an opening and focusing attention to still another matter of great public importance. Mental hygiene is as essential as any other form of hygiene. Every man, woman and child should know how to live mentally, morally and physically so as to conserve his natural powers of resistance to mental disease, to overcome handicaps which inheritance, environment, or habits may have placed upon him, and to avoid doing those things which are likely to reduce his powers of resistance. It is the aim of the present State and nation-wide movement to attempt to disseminate such facts and information as will be likely to stimulate active, intelligent, and helpful interest in the subject, with the object of making for a healthier, stronger, sounder and saner people. To this end, public lectures are being given and public clinics are being held throughout this and many other States. The subject is being attacked in many ways and from various angles. * * *

We may profitably consider a few of the more common causes of mental disease.

First. It is generally conceded that alcohol in excess, in its various forms as a beverage, does more to create the need of additional accommodations for the insane than any other one thing. Do not understand me to say that our State hospitals are filled with alcoholics as such, for this is not the case. The drug works in devious and insidious ways.

The improper and excessive use of other drugs is a potent factor. Other vices and virtues carried to excess, predispose to and cause various psychoses. Excessive work, too frequent childbearing, syphilis, and other forms of disease, traumatism, senility, unrestrained religious devotion, insuf

* Extracts from a paper read at a public meeting In Kingston, New York, February 9,1917

ficient food, insufficient play, and insufficient relaxation may all serve as predisposing causes of insanity, as may also faulty thinking. We see, then, that excessive or unrestrained virtues, as well as vices, are dangerous. It is safer to keep in the middle of the road. It is wiser if one does not strive to become more successful in business, law, literature, etc., than the average individual, unless he is certain that his capacity and his resistance are sufficient to enable him to carry an unusually heavy mental load, just as it is wiser to realize that it is dangerous to try to see how devilish one can be as both are liable to lead, sooner or later, to an institution for the insane. Judgment, rather than ambition, should be the controlling factor.

The alleged causes of insanity are manifold, the real, or exciting, causes are few. Probably in the vast majority of cases of mental failure there exists as a predisposing cause a constitutional defect, an inherent weakness. The embers of a fire which burned in an ancestor one or more generations back and which have lain dormant, covered with the ashes of the past, need but the winds of excess in some form of work, indulgence, or stress and strain of study, competition, financial loss, or emotional shock, to blow away the ashes and cause the glowing coals of a mental disease to burst into flame. If one would but learn early in life what is a safe load to attempt to carry. In other words, if one could measure, or have some one measure for him, his mental capacity, or point out just where the danger zone lies, and he would govern himself accordingly, and therein remain content, there would, in all probability, be many less mental shipwrecks along the coast of ambition. I have always had a great respect for the camel. When he is loaded too heavily, he will refuse to budge, and will lie down until the burden is reduced to his strength to carry it. Oh, that men were as wise or possessed that instinct! * * *

Care Of Patients In State Hospitals

Any person needing care and treatment for mental disease may be received at a State hospital on a certificate made by two physicians who are examiners in lunacy and whose certificate is approved by a judge of a court of record. Forms for this purpose are prescribed and furnished by the State Hospital Commission, and may be obtained from the Commission or from any of the hospitals.

In extraordinary emergencies, patients are received at a State hospital on the application of health officers on a form prescribed by the State Hospital Commission; but an order of commitment, or voluntary application, must be obtained within ten days of the date of admission.

Patients may also be admitted in an emergency for ten days upon the regular form of petition and certificate of two examining physicians, a copy of which should be at once sent to a judge of a court of record for his approval, and must thereafter be received at the hospital within ten days from the date of the admission of the patient.

Any person suitable for care and treatment who voluntarily makes written application therefor, and whose mental condition is such as to render him competent to make such application, may be admitted to a State hospital, but can not be detained under such agreement more than ten days after having given notice in writing of his desire to leave the institution.

Private patients are admitted to the hospital upon the consent of the superintendent. The rates for private patients are from $6.00 a week upward. A surety company's bond, guaranteeing payments, must be provided.

When the papers for the commitment of a patient are completed they are sent to the hospital, which dispatches a trained attendant or nurse to accompany the patient to the hospital. A woman must always accompany a woman patient.

When a patient reaches the hospital he is received by a physician and carefully examined to ascertain his immediate needs. He is usually placed in bed under the immediate care of trained nurses and there cared for until he has been thoroughly examined, or so long as his condition may demand. He is examined within the first five days after his admission by the superintendent. His case history is carefully and fully written up and presented by the physician at a staff meeting, when the question of diagnosis, prognosis and treatment is considered and determined. He is visited twice daily by a physician. If able, an effort is made to induce him to engage in some useful and suitable occupation. Various forms of diversion, recreation, and amusement are furnished. He may write to and receive letters from friends and relatives, and also correspond without restriction with the county judge and district attorney of the county from which he was committed.

The State has wisely endeavored to place every legal safeguard about the insane. There are just two reasons to justify the depriving an individual alleged to be insaue of his liberty. The first, because you may render him a service which he otherwise could not obtain; and the second, because society would be endangered by permitting him to remain at large. The two reasons are these then—to protect the individual and to protect society. The State strives to furnish skillful and humane care to each one of the 36,000 men and women in its hospitals. It does not tolerate politics in any department. Graft is unknown.

All patients who are in condition to leave the institution and who have relatives or friends who are able and willing to receive them into their homes and care for them are paroled; and if their condition warrants, they are discharged at the expiration of the parole period.

Social Service Conducted By The State Hospitals

A social worker renders every possible assistance to former patients; she visits them at their homes and assists them in securing suitable environment and employment. Whenever she sees conditions in the home, at business, or in recreation tending to endanger the patient's mental health, she works in unison with the family to alter this state of affairs. In addition to the oversight of the patient's mental and physical health, the social worker obtains further information concerning the history of the case to assist in a medical diagnosis, and cooperates with other social agencies.

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