Out of the Snake Pits

When John F. Kennedy sent to Congress the first presidential message ever devoted exclusively to mental illness and retardation (TIME, Feb. 15), the core of his proposal was a plan to set up mental-health centers in every major U.S. community--which might run to a total of 500 or more in the next five years. Even before Congress gets around to implementing the President's ideas, the prospect of federal money for pump priming and pilot plants has set mental-health officials and crusaders in all 50 states to taking stock of where they now stand.

A few states, mainly the more populous and wealthy, have anticipated the President's proposals--which, in fact, are based largely on their pioneering. Kansas, Massachusetts, New York and California have already done much to improve their state hospitals and to convert them into places where patients are treated instead of being simply locked away. But high on the list of mental-health pioneers there is also, surprisingly, the state of Georgia.

Rotten Underneath. As recently as 1959 a newspaper expose showed that Georgia's only mental hospital, saddled with the stigmatic name of State Hospital for the Insane at Milledgeville, was a monstrous snake pit. Behind the fac,ade of an administration building that looks like the White House, it was crowded to its rotten, rat-infested rafters with 12,000 patients. At least 3,000 were senile oldsters who did not belong there--any more than the epileptics, dope addicts or alcoholics who jammed the hospital. Comparatively few patients ever got better, and those who did succeeded mainly on their own resources, for among Milledgeville's 50 doctors, many of dubious repute, were only three psychiatrists.

Milledgeville has now been taken out of woolhat politics and reformed by a topflight psychiatrist imported from New York, Dr. Irville MacKinnon. Its budget is up from $2.49 per patient per day to $3.29 (against a national average of $5.40). It has 50 psychiatric doctors, admits 6,000 new patients a year, and sends 60% of them home within 90 days.

No Bars, No Locks. More surprising than Georgia's backlog of woes, though, is that even before the 1959 scandal it had started an earnest effort to save its citizens from Milledgeville. Psychiatric clinics were set up in general hospitals for prompt and intensive treatment of the mentally ill, and outgoing Governor Marvin Griffin put aside $300,000 in surplus funds to get the movement rolling.

In Atlanta's Grady Memorial Hospital, one of the first such clinics is now one of the most relaxed places in that vast and forbidding pile. Its windows have no bars, its doors are unlocked. Its four doctors and six nurses are more informal than their colleagues elsewhere in the hospital. Only a neat little name tag marks them as "staff.'' Patients are kept busy with psychotherapy (some of it in groups), occupational therapy and their own chores. Nearly all receive drug treatment, though few now get shock.

The Grady unit has 18 beds. Georgia also has a 20-bed unit in Augusta, and there are centers with ten to a dozen beds in Macon, Columbus and Albany. But because the facilities are still so limited, the Georgia clinics have strict eligibility rules. To get in, a patient must have the backing of a psychiatrist and another physician; he must be seeking help voluntarily; he cannot be currently addicted to drugs or alcohol; and the admitting psychiatrist must be convinced that his illness is likely to be arrested within a month.

By now, more than 2,600 patients have passed through the Georgia centers. Fewer than 300 have had to go on to Milledgeville, as against 1,700, the doctors estimate, who otherwise would have had to go there.

Line-Up of Doctors. Other widely separated states are approaching the twin goals of early detection and intensive treatment by different methods:

o NEW MEXICO is the proving ground for a plan financed by the National Institute of Mental Health. In three areas, each embracing three counties, the state has installed a "community mental-health consultant" in the office of a county health department. Their job is to serve as counselors, to spot the client who is so disturbed that he should become a patient, and to refer him elsewhere for prompt treatment. But in practice, virtually every client has been so relieved by talking things out with his consultant (and sometimes his minister as well) that an imminent crack-up has apparently been averted. For those with more severe upsets, scattered over New Mexico's sparsely settled acreage, Psychiatrist William Sears goes barnstorming in his own plane, visits each district at least once a month. In three years the three consultants have handled 1,800 cases in 2,775 interviews, referred fewer than 1% for intensive psychiatric treatment.

o ILLINOIS has 40 community clinics scattered around the state and has been supplying outpatient treatment for years. But for the more severely ill, instead of patching up the gloomy old state hospitals, Dr. Francis J. Gerty, director of the department of mental health, plans to spend $50 million on eight "hospital clinics." They will be so distributed that no one in the state will have more than a two-hour drive to reach one: two in Chicago, one each in Centralia, Peoria, Springfield, Harrisburg, Rockford and Decatur-Champaign.

o NEBRASKA has been trying possibly the most fundamental approach to prompt treatment for the mentally ill, and is now being acclaimed as the nation's second most advanced state in the promotion of mental health--after neighboring Kansas. Guided by Dr. Cecil W. Wittson, Nebraska's program aims at training the family doctor, pediatrician, internist and obstetrician-gynecologist to handle the everyday emotional problems of their patients. The Nebraska Psychiatric Institute invites family doctors to Omaha for training in consultation and observation of patients. They may even bring their own patients along for study. Back home, they are expected to set aside one half-day a week for patients with emotional problems. Twenty of them now have an average of 18 psychiatric patients each. And for a six-month course in family-practice psychiatry scheduled to begin July 1, it is the doctors, for a change, who are lined up on a waiting list and not the patients.

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