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United Neighborhood Houses of N. Y., Inc.
114 East 32nd Street New York 16, N. Y.
THE PLACE OF MENTAL HEALTH CLINICS IN SETTLEMENTS AND NEIGHBORHOOD HOUSES
The development of psychiatric services in the settlement houses is a natural outgrowth of the settlements’ work and position in the neighborhood. It grew out of the need to bring mental health services directly and quickly to the people where they live and where they most easily gather.
The settlement psychiatric clinic is significantly different from that in any other setting. It not only offers a more broadly based service in prevention and treatment, but it is the one place where the clinic has the opportunity to work with the total individual in his total situation – a basic treatment principle.
Also, the services are less costly. There is practical economy in energy, time and money in being able to effect such a highly coordinated on-the-spot service within the physical setup of an established agency, already known, accepted and appreciated for the constructive services it gives.
At critical times in the neighbor’s life the settlement clinic is there. Fully staffed with the usual team of psychiatrist, psychologist and psychiatric social worker, it is on the spot, ready to go into action quickly. No stigma is attached to clinic visits in a settlement where leisure time activities go on all the time. The clinic offers services within a familiar setting free from fear. The mental health clinic works as a team with the other departments in the agency. Its staff helps the other workers to understand the behavior of the people with whom they deal. Consultation on problem situations is readily available to the group leader.
Early Detection: Nowhere is there a wider opportunity for preventive psychiatry. Loss of time is at a minimum. Children are observed in the settlement program, on the playground, in the neighborhood. The group leader is in a particularly strategic position to spot those who need help. Children can be brought into treatment without a lot of complicated referral procedures. Preventive services, often on a short term basis, can be initiated quickly.
The parents bring their problems at an early stage, before great anxiety or agony leads them to the decision of applying to far away hospitals with long waiting lists.
There are additional unique advantages. In this setting children often make their own needs known to the clinic because they hear from their friends about the service. The children in turn can be instrumental in bringing their parents in contact with needed mental health services.
The juvenile delinquent and the narcotics user, many of whom do not want or feel the need for this type of help, are more accessible here than anywhere else. Through the group work staff whom he knows and trusts, and through parents and friends, contact can be made with this hard to reach youth. In a threatening situation, he, himself, may come to the clinic with specific requests. Unthreatening relations established at such a time sometimes have been the first step toward getting treatment.
Treatment: The basic treatment principle of working with the total person in his total situation can be carried out more successfully and with more consistent follow-up than in any other clinic setting.
The mental health clinic in the settlement allows for observation of the patient’s behavior in a natural environment. Particularly with children, this brings clarity and understanding of the problems to the clinic personnel much sooner than the child can bring out directly.
The availability of means to change a patient’s environment at the onset of treatment with the help of a wide variety of settlement resources is unique. These are used as an adjunct to, never as a substitute for treatment. The clinic calls to its aid the group worker, recreation worker, the musician, potter, dramatics director, painter, shop worker; the club rooms, the gymnasiums, the nursery and a variety of other available educational and recreational personnel and facilities. From stage to stage in the treatment process, the interplay of supporting activities can change emphasis as needed.
More flexibility in treatment plans is possible. At times, the length of treatment may be terminated or temporarily suspended at an earlier stage because there is a continuing contact through the regular house program and the re-opening of a case is relatively simple.
The Clinic as part of the Neighborhood: Relationship to the Community: The settlement clinic functions within a fairly well defined geographical boundary. This makes possible for its staff a deeper understanding of the significant sociological problems peculiar to the neighborhood.
The staff’s understanding and influence are extended through cooperative relationships and referrals within the community (schools, hospitals, welfare center, out-patient clinics, park department supervisors, etc.).
The clinic plays an important role through meetings with teachers of the neighborhood schools. These meetings lead to a wider and more comprehensive use of mental hygiene concepts in dealing with the children of the neighborhood.
Public and private agencies, in suitable cases, use settlement facilities as a rehabilitation service for clients discharged from Hospitals, Courts, Probation and Parole, Reformatories, Youth House and the like. The Welfare Department, private agencies, physicians, clergymen and others refer for the same purposes. The psychiatric service in a settlement strengthens these efforts through direct and indirect clinic contacts with these individuals.
The clinics already are being sued by some professional schools for the training of psychologists and psychiatric case workers through field work placements and internships. It provides opportunities for these specialists to experience and understand the impact of social, cultural and economic elements in action. It offers great potential for comprehensive research.
Existing mental health clinics in settlements have already been approved and licensed as psychiatric clinics by the New York State Department of Mental Hygiene and grants have been given under contracts with this Department. The services of the clinics have seen investigated and evaluated at regular intervals, their records have been reviewed and conferences with clinic staffs have been held periodically by representatives of the State Department of Mental Hygiene.
The New York State Mental Health Commission, in its last report, says of these clinics:*
“A multiple approach to personal and family problems is possible in this setting… In addition to direct help to children and adults with emotional disturbance, the clinical staff provides consultation and in-service training for the group leaders, nursery school and day care center teachers and all the other workers connected with the centers.”
*Fourth Annual Report of the New York State Commission of Mental Health for the fiscal year ended March 31, 1953, Department of Mental Hygiene, New York State, pg. 15-16. Published by the State Mental Health Press, Utica, New York, 1954.
Prepared by the Mental Health Committee of United Neighborhood Houses
February 15, 1955
Source: University of Minnesota, Twin Cities, Social Welfare History Archives. Minneapolis, MN: https://www.lib.umn.edu/swha