Alabama History of Mental Health Services
Introduction
The state of Alabama has witnessed the inhumane and ridiculous treatment of individuals suffering from psychological distress since the beginning of time (Flynt, 2004). Through the past decades, mentally challenged patients in Alabama have been a subject to torture. The various forms of torture experienced by these patients included subjection to chaining to walls of prison and immersion into tanks of ice-cold water. Most recent treatments have involved forced medications, and labor, frequently referred to as industrial therapy. In general, the history of mental health services in Alabama seems to have encountered various ups and down (Davis, 2003). This research paper attempts to review this history from the time documented by scholarly sources.
The history of mental health services Alabama, largely, has some connections with the establishment of Alabama Insane Hospital (AIH), currently known as Bryce hospital (Flynt, 2004). The Alabama Insane Hospital, established in 1859, is among the oldest mental facilities in the state. Under Peter Bryce, the superintendent at that time, AIH managed to be at the forefront of provision of mental health services for many years. However, the reputation of Alabama Insane Hospital a major blow during the late twentieth century. This was because of the questionable treatment of mental patients, which resulted in a lawsuit, Wyatt v. Stickney (Goldman & Buck, 2009). The court case also resulted in a Supreme Court decision that led to reforms in mental health providers throughout the entire country, including Alabama.
In the 1840s Dorothea Dix, a well-recognized crusader for specialized care for mental patients, toured the state of Alabama (Sayce, 2000). Dorothea cooperated with various parties such as the Alabama Medical Society, Alabama state legislature and Governor Henry Collier, of that time, to urge the enactment of the law that recognized the Alabama Insane Hospital. This legalized AIH as a mental health care provider. In addition, the law addressed six primary areas concerning the establishment of not only AIH but also other mental hospitals. The areas include financial support from the state, site selection, asylum governance, facility construction, patient admission and the selection of the superintendent (Sayce, 2000). The enacted legislation demanded the state to contribute 5 per cent of its yearly revenue for the forthcoming four years. However, the funding of the Alabama Insane Hospital in the fifth and beyond year later emerged as a serious mistake (Goldman & Buck, 2009). As much as the support from the state catered for the needy patients, part of it was used to pay patients as well.
Board of trustees managed the newly established Alabama Insane Hospital as stipulated by the law (Goldman & Buck, 2009). Resident trustees had the highest influential power in the decision making process concerning the management of the hospital. With regard to the management of AIH, the resident trustees were residents either of the county of Tuscaloosa or of the adjacent county. This ensured that the residents not only in Tuscaloosa but also in other counties within Alabama State had the easiest accessibility to the superintendent (Goldman & Buck, 2009). For many years, the superintendents of mental hospitals have been frequently calling trustees to assist in persuading the legislature to upsurge funding or, in various instances, not to stop the funding.
In 1852, a remarkable step in mental health care services took place. The board of trustees allowed the buying of 326 acres of land in the county of Tuscaloosa for hospital construction as designed by Philadelphian Hospital superintendent and Thomas Kirkbride, a physician (Sayce, 2000). The construction, typified with wings on all sides of the center building, was a considerable development in the mental health facilities. The current Bryce mental health facility has been referred to as the existing examples of designs of Kirkbride. The design had attracted the reputation of the state, with regard to the mental hospital field. The construction began in 1853. However, financial shortages led to poor funding resulting in the late completion in 1859. According to historians, the construction was the first building in the state of Alabama having a central heat and gas lighting, which were extremely beneficial to the mental patients.
During the same year, the board of trustees of the Alabama Insane Hospital commenced the search for a hospital superintendent. With the assistance of Dorothea Dix, the trustees endorsed Peter Bryce who was a native of South Carolina (Goldman & Buck, 2009). Peter Bryce was the most suitable person for the position of hospital superintendent, having studied mental health care and gained experience by working in various psychiatric hospitals in both South Carolina and New Jersey. The hospital officially commenced operation in 1861 with Bryce as the superintendent. Peter moved into the new apartments on the Alabama Insane Hospital. In addition, Peter’s case as a superintendent was a rare scenario since very few superintendents in the United States, during that time, were physicians (Flynt, 2004).
As the new superintendent of the hospital, Bryce invented the moral treatment plan. This was a new methodology to the upcoming mental health services in the state of Alabama. The plan focused on viewing the various mental illnesses in terms of predisposing the causes that were majorly psychological defects. In addition, the plan also considered the causes of mental illness to be precipitating from the environmental conditions at home and the society. According Peter’s plan, the treatment of mental illness, resulting from the abovementioned causes, involved removing mental patients from the probable precipitating causes (Flynt, 2004). The primary reason for removing the patients from such environment was to establish a normal environment for them while allowing time for the causes to heal. Mental patients, who were able, were therefore engaged to work that they were most familiar. As such, the work diverted the patients’ attention from their mental condition.
As much as the work-centered treatment plan was satisfactory from a medical point of view, it eventually turned out to be a stipulation when the state funding for various hospitals dropped considerably (Goldman & Buck, 2009). As a result, the hospitals had to manufacture various items for their own use and for commercial purposes to survive. Moreover, for the first three decades of AIH’s existence, the hospital complemented scanty state appropriations with revenue from the sale of goods produced by patients. The success of AIH at increasing the revenue seemed to encourage the legislature of the state to further cut down the funding. The work-centered approach to the hospital was established and continued throughout the management and beyond (Goldman & Buck, 2009). Peter Bryce died in 1892. Eight years after Peter’s death, the state of Alabama renamed Alabama Insane Hospital as Bryce hospital in his honor.
Dr. James Thomas Searcy became the new superintendent by succeeding Dr. Peter Bryce. James served as a superintendent from 1892 to 1919. Remarkably, Dr. James also established new reforms in treatment of mental illness and maintenance of medical records. He also initiated a new hospital in Mt. Vernon, Alabama that was renamed after him after his death (Goldman & Buck, 2009). The Alabama legislature established the Searcy hospital as mental health facility to reduce the overcrowding at the Bryce Hospital in the county of Tuscaloosa. The newly established facility commenced its operation in 1902. The mental hospital exclusively served the African-Americans in the state of Alabama until 1969, when the hospital underwent desegregation due to the Civil Rights Act of 1964. The Searcy Hospital is still operational and, in 2010, the hospital had about 400 extended-care beds. In addition, the Searcy hospital presently has approximately 124-bed intermediate care unit for patients suffering from severe mental disorders (Goldman & Buck, 2009). The hospital sheltered patients in modern buildings. According to scholarly sources, the hospital was a beneficial facility to the female forensic in-patient psychiatric center for the southern Alabama. Until recently in 2012, the Alabama Department of Mental Health announced that it would close Searcy hospital in a move to change its geriatric and forensic patients to community-based mental treatment.
Dr. W. D. Partlow succeeded James Searcy and served as a superintendent from 1919 to 1950. Dr. Partlow opened a new residential facility in 1923 for patients suffering from intellectual disabilities (ID). Later, the Alabama legislature acknowledged the naming of the newly developed facility by Dr. Partlow by passing an act (Davis, 2003). The W.D Partlow Developmental center is the only existing residential facility in the state of Alabama providing health care services to patients suffering from intellectual disabilities. The facility serves more than 99 per cent of patients suffering from ID in the community.
Dr. J.S. Tarwater succeeded Dr. Partlow in 1950 and became the superintendent. During the tenure of Tarwater, the state under-funded the mental health care system (Flynt, 2004). As a result, Bryce hospital had to supplement the undersupplied budget provisions from the state legislature with the sale of farm products. Importantly, Dr. Tarwater’s management established new psychological and social service departments that helped in provision of mental health care services and discharge of patients into a gradually evolving care framework. In 1965, the Alabama state legislature ratified Act No. 881 leading to the creation of the aforementioned Alabama Department of Mental Health. Later, the name of the department changed to Alabama Department of Mental Health and Mental Retardation. Prior to the establishment of the Alabama Department of Mental Health and Mental Retardation, psychiatrists offered mental health services under the authority of the Alabama Department of Public Health (Sayce, 2000). Within the first six years after the establishment of the department, the state showed an impressive improvement due to the development of various community-based mental health care programs. However, the improvement seemed insufficient to meet the ever-growing demand of mental health care services.
In 1971, the increasing demand for mental health care services, in addition to the absence of minimal standards of care hit the crisis point. During this time, mental patients overcrowded both residential facilities and mental hospitals (Flynt, 2004). Moreover, the management of the various mental hospitals experienced understaffing. The state was also cutting its financial support to mental health care institutions. For instance, Bryce Hospital, the largest provider of mental health services at that time, had approximately over 5000 mental patients. There were only three psychiatrists at that time. The psychiatrists could not effectively provide services to the large number of patients. The Wyatt v. Stickney court case prompted change across the nation (Flynt, 2004). The rulings of Judge Myron Thompson Jr. led to establishment of minimum standards of care and encouraged the development community-based mental health system. These decisions aimed at averting overcrowding at health institutions.
The treatment approach at the Bryce hospital that was initially known as Alabama Insane Hospital embraced the concept of engaging mental patients to work as a significant component of mental health care (Davis, 2003). From 1892, the time when Bryce died to 1970, the approach significantly contributed funds at the Bryce hospital through the commercialized sale of patient-manufactured goods and services. However, in 1970, the idea of patients staying long periods in the hospital as they engage in productive work emerged as subject of public concern. Many residents of the Alabama state felt that the hospital retained mental patients as a source of free labor. This resulted in a class-action court case in the federal court, referred to as Wyatt Versus Stickney. Frank Johnson Jr., the U.S District Court Judge ruled that all mental patients had the right to occasional psychiatric assessments and the right to live in unrestricted environment (Flynt, 2004). The ruling had diverse effects such as the release of many mental patients from mental hospitals to homes that provided them with independence.
Despite Bryce hospital not being intentionally at the forefront of provision of psychiatric care, its coiled history indicates the changes in attitudes among psychiatric professionals (Flynt, 2004). Many people have also changed their thinking about mental illness and mental health care. The hospital has gained popularity by providing important facilities for mental health treatment in Alabama and adjacent states. However, the fate of Bryce hospital appears uncertain. The University of Alabama had an interest in purchasing the mental health facility in 2008, but the sale appears to have trouble. Additionally the sale has generated some concerns among preservationists about the destiny of the famous Bryce campus (Goldman & Buck, 2009). John Houston, the commissioner for the Alabama mental health, established the Bryce Hospital Historic Preservation Committee. The Chairman of the committee, Thomas Hobbs, charged the committee with commending on the ways to historically preserve and manage the significant structures and artifacts of the Hospital.
Another mental health care provider in Alabama is the Mental Health Center of North Central Alabama. The health facility is a non-profit and public organization that provides psychiatric and mental health services to the counties of Limestone, Morgan and Lawrence. The facility has been operating since 1967 (Goldman & Buck, 2009). The various services offered by the institution include counseling for adults, families and children; psychiatric evaluation, monitoring and medication; treatment of substance abuse; employee assistance programs and case management services. The Alabama state legislature established the health institution under the Federal Community Mental Health Center Act of 1967and Act of 310. There are various entities referred to as 310 boards under Act 310 (Goldman & Buck, 2009). The establishment of 310 boards in 1967 was intentionally to reduce the number of patients in hospitals and providing community-based mental health care. Act 310 specified that local government authorities were to be engaged in operations of the institution. In addition, the act also stipulated that local government bodies were to share the financial burdens of the 310 boards. According Act 310, the local government bodies should construct, maintain, equip and operate mental facilities.
In conclusion, the provision of mental health care services has a rich history that integrates the evolution mental facilities in Alabama. The history also involves the emergence of civil rights movements for patients suffering from mental illnesses. The most prominent individuals enriching the history of mental health care in Alabama include Dorothea Dix, Peter Bryce, James Searcy, William Partlow and Tarwater. Dorothea Dix was a well-recognized crusader for specialized care for mental patients. Dorothea cooperated with various parties to urge the enactment of the law that recognized the Alabama Insane Hospital. Peter Bryce was the superintendent of the Alabama Insane Hospital. Peter initiated the work-centered approach in the treatment of mental illness. Dr. James Searcy established new reforms in treatment of mental illness and maintenance of medical records. William Partlow opened a new residential facility in 1923 for patients suffering from intellectual disabilities (ID). Tarwater’s management established new psychological and social service departments. However, throughout the years of service to the community, mental health facilities have been experiencing difficulties resulting from the increasing number of patients.
References
Davis, R. (2003). Tracing Your Alabama Past. Mississippi: Univ. Press of Mississippi.
Flynt, W. (2004). Alabama in the Twentieth Century. Alabama: University of Alabama Press.
Goldman, H., & Buck, J. (2009). Transforming Mental Health Services: Implementing the Federal Agenda for Change. New York: American Psychiatric Pub.
Sayce, L. (2000). From Psychiatric Patient To Citizen: Overcoming Discrimination and Social Exclusion. New York: Palgrave Macmillan.
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