100-Year-Old Reports and the Development of Psychiatric Social Work in State Mental Hospitals

Background and Purpose:

The early 20th century was a transformative period for mental health treatment in the United States, transitioning from custodial care in asylums to therapeutic services in state mental hospitals. This period also contains the emergence of psychiatric social work as it developed a professional role within this changing institution. By using archival data with newfound digital availability, this study considers early social workers’ contributions to the development of this professional specialty. This research refines the foundational timeline of psychiatric social work, highlighting professional activity in state mental hospitals before the post-World War II period, contrary to much writing on this subject.

Methods:

This study conducts thematic analysis of annual and biennial reports from Indiana’s Madison State Hospital (1920-1929), New York’s Brooklyn State Hospital (1923-1932), and Louisiana’s Central State Hospital (1929-1938) to describe and compare early social work practices. Texts were retrieved from a digital archive that is available through HathiTrust. This data source, the annual and biennial reports of state mental hospitals, were a standard administrative record produced to provide updates, make budget requests, and describe programmatic changes.

Findings:

This comparison of state mental hospital reports reveals a range of social work activities, many persisting today and some to which the profession aspires. Core responsibilities of early social workers in state mental hospitals included visiting furloughed and discharged patients, taking histories, advising families, and offering community programs. These findings highlight early social work activities across both interpersonal and community domains of practice, which define and often silo the profession today. Findings illustrate a combination of formal and practical education that shaped the profession’s early training standards. Finally, these data highlight the participation of social workers in early 20th century social movements, such as mental hygiene and eugenics. Accounts of hospital social workers speaking publicly about mental health topics, establishing outpatient clinics, and conducting intelligence testing in schools illustrate this role.

Conclusion and Implications:

This study contributes to histories of the profession by drawing attention to state mental hospitals of the Interwar Period as a foundational context for the development of psychiatric social work. This research also showcases the comparative use of these digital archival materials and points to their potential applications across broader topics of social work scholarship, education, and training. These findings complicate static depictions of the state mental hospital era by highlighting the meaningful work of early social workers as well as their troubling service to eugenics. Descriptions of inpatient and outpatient responsibilities and of community practice demonstrate the adaptability and skill of these early workers. Their attention to aftercare and to the involvement in social supports, as represented administratively in these documents, contrasts with the fragmentation of services today, wherever workforce factors and systemic barriers limit relationship building and continuity of care.