HOW I GOT INTO PUBLIC HEALTH PSYCHIATRY
From
The
Maryland Psychiatrist:, December 2004:
By Gerald D. Klee, MD
Matthew,
“Matt” Tayback, Sc.D. was a major Public Health figure in
I
had recently become Director of Psychiatric Outpatient Services. Not
all patients could use the insight oriented therapy we liked to teach at our
clinics. I observed that inner city patients from our neighborhood
differed from better educated suburban patients in having multiple problems,
belonging to multi-problem families and living in multi-problem neighborhoods. A
mix of physical, mental, economic and social problems often coexisted. With so
many problems in living, insight therapy was seldom sufficient or even very
useful for such patients. I had been interested in public health and
epidemiology since working one summer with the
The
psychiatric department was (and still is) located in the Western Health District
(WHD) of the Baltimore City Health Department. The WHD headquarters was just
behind our building at the corner of Penn and
The next step was to obtain the permission of Baltimore Health Commissioner Dr. Huntington Williams, before proceeding. At my meeting with the Commissioner, Matt Tayback was also present. Dr. Williams, a major figure in public health in Maryland , had a gruff and intimidating manner. When he heard what I wanted to do, he looked like he was ready to throw me out of the office. But Tayback intervened diplomatically and saved the day. He explained that the nurses had to visit the homes anyway and the Health Department would be getting my consultation time free.
Before long, I had obtained a demonstration grant from the National Institute of Mental Health (NIMH) that contributed funds to the Health Department. There was never a word of complaint from the Commissioner after that, and he had no objections when we continued the project after spending the grant money.
In brief, we partially integrated the activities of the psychiatric OPD and the Western Health District. It turned out that there was already considerable overlap because many of the families the PHNs worked with were known to the clinic and vice versa. It was illuminating for me and for psychiatric residents, as well as social work students, to obtain a comprehensive view of individuals and families in their homes. The public health nurses, who had often known and worked with the families for a long time, were a great asset. As time went on, we expanded our activities to include liaison with state hospitals and community agencies that provided service to patients in our district. I also joined PHNs in their work with expectant mothers in prenatal clinics.
Among the families we helped, we saw a wide range of health, social and economic problems. We were often impressed by their remarkable strength in dealing with problems that we didn’t think we could survive. But the problems did pile up, and even the strongest often broke down in various ways.
In 1959, when we started work in the WHD, community mental health wasn’t even on the drawing boards. The program continued until 1970. In addition to publications describing the clinical activities, the program spawned some exciting epidemiological studies which began in 1961.
With
encouragement from Matt Tayback, I formed a partnership with the NIMH Office of
Biometry and the Maryland Department of Mental Hygiene in a broad array of
biostatistical studies of mental illness in
In
this study, we examined the city by census tracts. We had created a psychiatric
case register that allowed us to obtain data for all psychiatric admissions to
inpatient and outpatient treatment in
As expected, high overall rates for diagnosed mental illness were associated with poverty, but the findings weren’t quite that simple. For example, although more affluent census tracts had lower overall rates of diagnosed mental illness, the proportion of involutional and affective disorders was significantly higher than in low income areas.
Rates
for syphilis, tuberculosis, births without prenatal care and illegitimate births
were strongly associated with psychiatric rates. Of all the variables in this
study the highest association with psychiatric rates was found for both adult
crime and juvenile delinquency rates. Residents of
The ecological findings made it seem reasonable to me, Tayback and other colleagues that a public health approach to dealing with mental illness in Baltimore made the best sense. We learned to our dismay that community mental health architects weren’t ready for it.
But
things are looking up. Since 1990, the
It
seems that at long last,
*This also had the support of Paul Lemkau, Chair of the Department of Mental Hygiene at the Johns Hopkins School of Public Health.
Klee, Gerald D. et al; pp 107-148
(In Psychiatric Epidemiology and Mental Health Planning: -APA PSYCHIATRIC RESEARCH REPORT 22, 1967) This paper was presented by the senior author (Klee) at an APA Research Conference in1966.
To reach the full text of An Ecological Analysis of Diagnosed
Mental Illness in
http://www.letreb.com/Analysis%20of%20Diagnosed%20Mental%20Illness%20in%20Balt..pdf
4/20/09 The links are no longer active. The Ecological Study can be sent and received as an attachment. GDK