Chapter XXI.

Connecticut has certain traditions and certain institutions which in an unusual degree favor a sound attack upon this important problem. It was in Connecticut just twenty years ago that Clifford W. Beers wrote The Mind That Found Itself, which has had so much influence in popularizing the modern viewpoint in this field, and in the same year he established the Connecticut Society for Mental Hygiene, the first organization of its kind in the world. The State Department of Health at Hartford was the first state Department in the United States to establish a division of Mental Hygiene (of which Dr. Harold A. Bancroft is now Director) in 1920. Yale University has developed a program of Mental Hygiene for its student body which is unique in scope and quality, and the Yale Psycho-Clinic under Professor A. L. Gesell has carried the study of mental defect back into the early years of childhood with a vigor and completeness nowhere else attained. With such assets, and in a small and compact state like Connecticut, we have the opportunity of building up a state program of unequalled excellence.

On the other hand, as will be indicated, there are defects in existing machinery which are as glaring on one side as are these advantages on the other. The state institutions for the care of mental disease and defect are woefully inadequate. There is not a single psychopathic ward in any public hospital of the state. Clinic service, while excellent in some communities, is wholly lacking or unsatisfactory in others; and the entire state machinery is uncentralized and sometimes duplicating or conflicting.

For the care of mental disease the State has two institutions, the Connecticut State Hospital at Middletown and the Norwich State Hospital. The former had, in 1926, a normal capacity of 2,200 and an actual population of 2,875. The latter had a normal capacity of 2,000 and an actual population of 2,030. Thus, in spite of the fact that Connecticut has more beds in proportion to population for mental disease than any other states except New York and Massachusetts, one of its institutions is full and the other is overloaded to the extent of 25 per cent of its capacity. According to the standards agreed upon by authorities in this field, there should be provided one institutional bed for mental diseases for every 250 persons in the population, which would require 2,000 more beds for Connecticut. The need seems clear for a third state institution of this class which should logically be located in the south-western portion of the state, a need in which New Haven has therefore a direct and immediate interest.

With regard to the care of mental defectiveness, the situation is even worse. Here, only the Mansfield State Training School and Hospital is available, with a population of about 700, which could be increased to 800 with an adequate water supply. Connecticut ranks twenty-third among the states in this respect, with provision for 33.9 beds per 100,000 population, as compared with 82.9 beds provided by Massachusetts, the state which ranks highest. A total of 2,000 beds of this class should be provided without delay. In addition, 600 beds are needed for the care of epileptics. The 1927 Commission therefore recommended that the capacity of the Mansfield Hospital should be increased to 1,500 and a second institution for the care of the feeble-minded and epileptic established in the south-western part of the state. At the present time, the feebleminded children of the state are in large measure being housed in the County Homes, often without recognition of their status or adequate provision for their care.

In spite of the irrefutable case presented, the Legislature of 1927 did nothing to remedy the situation except to provide for an increase of 100 beds in the capacity of the Mansfield State Training School, for the addition of a contagious disease ward and for other minor improvements.

Connecticut is on the whole fortunate in respect to such facilities. It has ten more or less adequate clinics now available as follows, (including only those which aim to give more or less general psychiatric service to patients of all ages and excluding special school and court clinics).

• Affiliated with the Connecticut Society for Mental Hygiene. Clinics at Bridgeport, New Haven and Waterbury.
• Affiliated with State Department of Health and Middletown State Hospital. Clinics at Bristol, Meriden and Middletown.
• Affiliated with Norwich Hospital. Clinic at Norwich.
• Affiliated with the Hartley Corporation. Clinic at Hartford.
• Affiliated with local hospitals. Clinics at Greenwich and Stamford.

On the other hand, it should be pointed out that while some of these clinics are of the highest calibre, others are inadequately staffed with psychiatrists or psychiatric social workers or both; and that while some of these clinics are controlled by branches of the State Society and all make reports to the State Department of Health, these reports are only made by courtesy and there is no real central authority to keep them up to standard or to prevent overlapping and duplication.

The New Haven clinic is an altogether admirable one. It is managed by the New Haven Branch of the Connecticut Society for Mental Hygiene (Mr. Lewis H. English, President), a member organization of the Community Chest. The clinic is held on two afternoons a week at the New Haven Dispensary and its medical service is provided by the Mental Hygiene Department of the University, (Dr. L. J. Thompson being at present the physician in charge). Miss Henrietta Thatcher, with one full-time assistant and several volunteers, does the follow-up. In the year 1926, 725 patients were handled at this clinic, and its work included 927 psychiatrist's interviews, 60 psychological examinations, 837 office and clinic interviews with the social service staff, and 1,818 outside social service interviews. The clinic renders a complete psychiatric, psychological and social service. Preventive work is its keynote. Among adults, neurotic cases predominate, with a few epileptic, defective and psychotic patients. Among children, behavior problems are dealt with, varying from minor bad habits and speech difficulties to serious delinquencies. The emphasis is shifting from adults to children, the older cases remaining fairly constant while juvenile patients are rapidly increasing in numberŅan excellent sign. Of 725 cases treated during 1926, 52 were discharged as "practically recovered," and 153 were sufficiently improved to be left to themselves or to their families. One hundred thirty-eight were referred to other agencies, 20 to other clinics or hospitals, 16 to private physicians, 36 to state institutions. Two hundred and seventeen remained under care at the end of the year, and 93 failed to report back, left town, or were discharged against advice. During the past four years, only one suicide has occured among all the patients under care, and there has not been a single homicidal attempt.

The grant for the work of this clinic by the Community Chest has in the past been insufficient to cover its necessary cost, and the State Society has been forced to use funds subscribed outside New Haven to subsidize this local enterprise. With recently increased appropriations, ($7,200 in 1926, $7,700 in 1927, $8,700 for 1928), New lIaven is carrying its own load and it seems possible to provide in some measure for future increases by developing an income fom patients able to pay for the service which they receive. It should be noted, however, that the demand for service is a constantly increasing one. During the last six months of 1926, the number of cases under care increased: one-third as compared with the first half of the year.

There is only one possible way to give these unfortunates the care they need, - and that is in connection with a general hospital having a well-equipped psychiatric service. It seems certain that the New Haven Hospital can not care for such cases without accommodations which it does not now possess; but it would certainly seem desirable that the Department of Charities should take the matter up with the authorities of the hospital for discussion.

New Haven is particularly fortunate in this respect in possessing Dr. A. L. Gesell's Yale Psycho-Clinic on Hillhouse Avenue. Dr. Gesell has extended the study of human behavior back into the period of early infancy with astounding success, and his clinic is internationally famous as a center of research in this field. It is open all day and every day from September 1 to July 1 and is staffed by a psychiatrist, a pediatrician, a psychologist, a statistician, a guidance worker, four graduate students and a clerk. In the university year 1926-27, 552 visits were made to this clinic by 519 individuals (including 375 new cases) of whom about one-third were under 3 years of age, one-third between 3 and 6 years, and one-third of school age and over (including two adults). These cases were referred from some twenty agencies. The value of such work at the age when the fundamental mental impressions are received and the fundamental mental habits formed is incalculable.

The City Department of Education has an excellent system of psychological examination and special class work, operated under the direction of Miss Norma Cutts (with the cooperation of the Yale Psycho-Clinic on special cases.) During the year 1926, 12,500 standard group tests and 580 individual psychological tests were made by Miss Cutts and her staff.

The State Department of Education in January of the present year opened a clinic at the Normal School for dealing with problems of school exclusion. The exact purpose of this clinic and its relation to the rest of the community machinery does not seem very clear.

The Civic Protective Association, the Children's Community Center and the New Haven Branch of the State Bureau of Child Welfare cooperate closely with the two New Haven clinics.

Locally, machinery for dealing with mental disease and defect is developing along sound lines, although we believe that the question of payment for treatment at the Neuro-Psychopathic Clinic should receive careful study. The need for a psychopathic ward in New Haven is of course scute; but this, and the general question of local clinic coordination, must await the completion of Yale's Mental Hygiene program, whose furfilment will go far to make all desirable things possible.

Dean M. C. Winternitz in his annual report to the President of Yale University for 1925-26 noted that plans were already in process of preparation for an "Institute of Human Behavior which is to be located in the vicinity of the School of Medicine and the New Haven Hospital. The building will include facilities for the Department of Psychology, the Institute of Experimental Psychology, the Department of Research in Child Hygiene, and the proposed work (including wards) in Psychiatry and Mental Hygiene. It is believed that the realization of this concept will accelerate the progress of the fundamental sciences associated with behavior, will remove the artificial barriers that exist between mental hygiene and psychiatry, as well as between psychiatry and psychology, and will stimulate the much desired cooperation which is essential between the groups engaged in the study of normal and abnormal mental reactions."

Such an institute as that here visualized would not only offer the natural coordinating center for all the mental hygiene work of New Haven, but would also go far to solve the greatest difficulty in the entire field, the crying need for soundly trained expert workers.

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