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'Cbe Conservative * 3
PUBLIC POLICY IN THE CARE OF
THE INSANE.
RY L. L. UHLS.
A friend interested in The Conserva
tive asked me to write an article for
publication dealing with public policy
as exhibited in the care of the insane.
I consented , not because I thought I
could do this bettor than others , but
because of the great importance of
the subject and the hope that my ex
perience and observation might be
helpful to the readers of The Con
servative , and that in this way I
might aid in making the sad lot of
thisjielpless and dependent part of
our population more satisfactory and
possibly the expense to the state , less.
The manner in which this matter
HII lias been discussed in recent years
plainly proves that the present policy
in many instances has not proven sat
isfactory. Yet it is pleasing toj iote
the improvement that is being made.
I am sure that it is not possible to
make laws .that will nt all localities
equally well. Frank B. Sauborn says ,
' ' .customs , traditions , peculiarities of
race , of religion , of social habit , in
terfere to prevent that which seems
similar from actually resulting in
similarity. ' '
Practical Questions.
The'following are , I think , practical
questions : First. What is the prime
object to be attained by the state in
caring for the insane ? Second. Who
shall pay the bills ? Third. By what
methods shall care be administered ?
The prime object is to restore the in
sane to sanity , and send them home
competent to assume the responsibili
ties of citizenship. And yet , when
we remember that not one-third of
those afflicted with insanity ever re
cover , all must agree that a large prob
lem remains , viz : The care and main
tenance of the chronic insane. Here
let me say that the care of the insane
brings the largest item of expense to
the states. As to who shall pay the
bills : It might be done by the fam
ily , the municipality , the county or
the state , or all of these may contrib
ute to carry the bxarden. I shall take
issue with many excellent men and
say that I think the state should pay
the bills , and in all cases where the
insane person cannot be sent to a pri
vate institution , he should be sent tea
a state institution and kept at the ex
pense of the state. I believe he will
get better care in this way. The
state will provide better buildings ,
more sanitary surroundings , and prob
ably physicians with larger experi
ence in the treatment of mental and
nervous diseases than would otherwise
bo provided.
By what methods shall care bo ad
ministered ? In some way I have re
ceived the impression that this is the
question my friend wishes mo to dis
cuss in this article.
I cannot take time to discuss at
length the policies' adopted by other
countries , nor oven to refer to many
of the states of the Union. I shall
confine myself to conditions as they
have come under my own observation ,
rather than refer to the difference in
the almost exclusive state care in New
York and Ohio , and the state care and
county custody of Wisconsin and
other states.
Let us consider the insane in
dividual from the time he presents
the first symptom of insanity. What
shall be done and who shall be re
sponsible ? How can we best look
after the welfare of the insane per
son and at the same time best serve
the state ?
Insanity a Disease.
First , insanity is a'disease. Quali
fied physicians are competent to diag-
iiose and treat diseases better than
others. A person thought to be insane
should not be legally declared insane
and placed in an asylum without first
having his case passed upon by a com
mission , of which the majority of the
members shall be physicians. In ad
dition , he should not be denied the
right of a trial by jury if he , or a
responsible friend , * demands it. Nine
cases in ten a jury will not be wanted
or needed. The insane man , his fam
ily and friends , should be spared all
unnecessary inconvenience and an
noyance. The unfortunate man should
not be arrested , tried , convicted and
committed in the same way as the
man who is guilty of some great
crime. In other words , the machinery
that handles criminals should not
handle the insane. The insane man
is not a criminal. He should not be
subjected to a public trial , and he.
should not have to go to jail. He
should bo kept at home , restrained if
necessary , until time to remove him
to an a'sylmn , and' then he should be
taken by a trained attendant who is
connected with an asylum , unless the
man's family or friends can do it safe
ly. If the man is very violent it is
possible but not probable , that a sher
iff , constable or marshal ought to be
called to make the arrest , but he
should have nothing more to do with
the case. I admit that a sheriff can
handle a criminal better than can an
rtsylum attendant. But that he can
handle an insane man better than can
the attendant , I deny. However ,
from a recent personal experience , I
would suggest that it might be well
to make the office of sheriff a salaried
office before the above is attempted.
Now that we have the insane man
safely lodged in the asylum what is
the further duty of the state ? We
may here properly refer to the ap
pointive power , the board of control ,
the board of charities , the trustees , eras
as in Kansas , the state board of char
ities and corrections , and then to the
local officers , their qualifications , au
thority , etc , the employes , their
qualifications , duties , etc , and last
of all , the inmate or patient.
Who should appoint the board which
controls the state charitable institu
tions ? The erovernor.
Who should discharge them if they
prove to be incompetent or unfaithful ?
The governor.
What institutions should be under
the care of the board having charge of
the insane asylum ? One board should
have charge of all state charitable in
stitutions. This board should consist
of three members and their salaries
should be ample and they should de
vote their entire time to the work.
Their duties should be to have the gen
eral management of these institutions ,
audit the accounts , oversee the pur
chase of supplies , let contracts for
new buildings and all large improve
ments , look after needed legislation
and appropriations. They should ap
point the superintendents of all the ,
state charitable institutions , and dis
charge them if incompetent or un
faithful. They should devote much
time to studying advanced methods.
They should attend all meetings , if
possible , of state and national chari
ties , etc. , and as in Iowa , they should
be fined if they even suggest to a sup
erintendent the appointment of any
employe in a state charitable institu
tion. They should appoint and dis
charge superintendents without any
aid from a legislative committee , or
any other committee. A superintend
ent should not be appointed for politic
al reasons. Neither should he be
discharged for political reasons. Fit
ness for the place alone shoxald be the
requirement for appointment and unfitness -
fitness the occasion for discharge. In
other words , the state should employ