Social Work and Aftercare of the Mentally Ill in Maryland: The Early Years
Betsy S. Vourlekis, University of Maryland School of Social Work, Baltimore Campus
“The question of affording proper care for patients discharged from hospitals for the insane is by no means a new one. The best and most satisfactory method of administering this aid has not yet been entirely decided…“ (Arthur P. Herring, Secretary of the Maryland Lunacy Commission, September 14, 1910).
Organized social welfare in Maryland had always concerned itself with the needs of those labeled “insane” (in the parlance of the late 19thcentury), since their mental and social circumstances frequently rendered them impoverished and dependent. In the early years of the 20th century notions of enlightened care for the insane came to include more systematic attention to the special needs of “recovered” persons leaving institutions. The first proposed service models for what was called “aftercare” envisioned an extension of the existing community structures of philanthropy and charity(both funds and person-power) to meet these needs as a “new branch of philanthropy.” However, as aftercare slowly developed in Maryland its functions were increasingly specialized and provided within the clinical domain of psychiatry and an emerging public mental health bureaucracy. Thus, understanding the origins of social work’s presence and melding of its practice roles and functions to psychiatric care requires looking beyond the central arena of Elfenbein’s “modern philanthropy” where social work first emerged. Aftercare became the earliest form of psychiatric social work, and the vehicle for developing the first state funded social work positions in mental health.
Early 20thCentury Psychiatric Care Reform
Proper care of the “insane” had been the focus of reform efforts throughout the 19th century. Primarily these were attempts to create and improve in various ways what came to be almost universally accepted as the most appropriate site and agent of care, the state hospital. By 1880, largely through the efforts of Dorothea Dix to remove insane individuals from local jails and almshouses, every state had at least one asylum. As emerging ideas about care emphasized disease and treatment models, state asylums came to be called hospitals.
Maryland’s specialized institutions for the care of the insane (as opposed to county and community almshouses and jails where many mentally ill continued to reside well into the 20th century) were in place by 1912. Several of them were among the earliest of their kind in the nation.
· Spring Grove (1798, second oldest in the country)
· Mount Hope Retreat (1840 – oldest listed church-owned mental institution in the nation)
· Baltimore City Hospitals, Psychopathic Unit (1865 – oldest listed city-owned mental institution)
· Sylvan Retreat, Cumberland (1888) – a specialized county mental institution
· Sheppard and Enoch Pratt Hospital (1891)
· Springfield (1896)
· Phipps Clinic (1908)
· Crownsville (1911)
· Eastern Shore State Hospital (1912)
State Care Reform. National reform efforts in the last part of the 19th and early 20th century advocated for total assumption by the state (rather than local communities) of fiscal and oversight responsibility for care of all indigent insane patients. This was a matter of increasing funding for care, but of equal importance, imposition of more uniform (and, hopefully, “enlightened”) standards of care by an empowered state administrative structure led by competent civil servants, not political hacks. New York led the way with its ground-breaking State Care Act in 1890.
In contrast, as the 20th century began over half of Maryland’s insane persons were still housed in county asylums, almshouses,jails and penitentiaries. Conditions in these facilities were generally conceded to be bad, and the Maryland Lunacy Commission (established in 1886)was an advisory body with no real authority or power.Maryland spent less per capita on care than any other state in the northeast. Conditions for African-American mentally ill persons were particularly deplorable (mostly in county almshouses; almost none received care in the existing “white” state and city hospitals), and there was an urgent need to construct a state hospital for the “colored insane.” “State Care” legislation became a priority for Maryland reformers and legislation was introduced as early as 1899. Despite the on-going efforts of the Lunacy Commission and the Maryland Medical and Chirurgical Society (MedChi, the state’s primary physician organization), re-vamping and implementation of the state’s reformed lunacy laws was not completed until 1911.
Important as these intended reforms were for the condition, care, and treatment of people with the most severe mental illnesses, they were largely devoted to the circumstances of their institutionalization, not to the circumstances of their leaving those institutions. As Jane Addams noted during the 1897 national meeting of the National Conference of Charities and Corrections (NCCC), “[T]hey have to be de-institutionalized, which is sure to be a difficult undertaking,” and further commented that nothing in Chicago was”so overlooked as this care of the convalescent insane.”
The Aftercare Movement. Interest in aftercare surfaced in the United States in the 1890s as a reform issue for the same loose coalition of social activist philanthropists, neurologists, and hospital superintendents that had been advocating a wider reform agenda for a least a decade. It received attention at the 1897 and 1898 meetings of the NCCC, an important forum for debate and education involving those who were coming to be known as social work leaders, as well as influential physicians. Both the American Medico-Psychological Association (forerunner of the American Psychiatric Association) and the American Neurological Association had formed committees on aftercare and presented models and recommendations at these NCCC meetings. However, little practical change resulted until New York State inaugurated the first formal aftercare program in 1906. A key figure in New York’s aftercare effort was psychiatrist Adolf Meyer, who was then at the New York State Psychiatric Institute. In 1908 Meyer became director of the newly established Phipps Clinic, bringing him to Baltimore. Not coincidentally his arrival marked the beginning of the active effort to bring aftercare to Maryland.
Aftercare Comes to Maryland
Also in 1908 MedChi physicians “interested in the care of the insane” formed the Maryland Psychiatric Society (MPS), resulting in increased activity and clout for issues related to psychiatric care. The same year the state’s Lunacy Commission was reorganized in an effort to create a more professional (and less political) structure in keeping with evolving ideas about civil service and public administration. The able and energetic physician Arthur P. Herring, member of the Maryland Psychiatric Society, was appointed secretary to the commission.
It was Dr.Herring who moved the appointment of an aftercare committee at the November 1909 meeting of the MPS. Serving on the initial committee were five physicians (including Herring) and Nathan Grasty, one of Baltimore’s Supervisors of City Charities. The committee was enlarged and made a standing committee, chaired by Adolf Meyer, in January 1910, and given space in the offices of the Lunacy Commission. Herring presented the committee’s report and”Plan for the Prophylaxis of Mental Disorders and the After-Care of Convalescent Patients by Organized Social Service” at MedChi’s semi-annual meeting the following September, which was attended by leaders of organized charity in the state.
The Aftercare Plan. The “tentative” plan proposed that the Aftercare Committee would serve as a medical oversight and coordinating structure, mediating between the state hospital superintendents (who would decide which patients were appropriate for parole or discharge) and the various charity organizations in the city. Agents of these organizations would do all of the practical aftercare work, namely,home investigations, finding employment, and providing tangible resources,visit regularly with the patient, and report to the after-care committee. The aftercare committee would keep patients “under observation” during a transition period, requesting them to “report at frequent intervals (at least once amonth) to a member of the committee at a central office.” While the plan was vague in its specifics, it clearly placed fiscal and practical responsibility for aftercare with existing charity and relief organizations, which traditionally had the responsibility for recovered and indigent insane persons in the community anyway. New elements were mental health expertise and consultation and a structure designed to assure continuity in care, both to be provided by the committee and its members. The committee’s services also would be funded through “private benevolence.”
In discussing the plan at the MedChi meeting, social work leaders J. W. Magruder (general secretary Federated Charities, Baltimore),Nathanial Grasty (Supervisors of City Charities), and Louis Levin (Secretary,Federated Jewish Charities of Baltimore) responded with confident enthusiasm for the extension of social work practice to this “new kind of disease” mixed with wariness about the availability of private resources to support the effort. Magruder took the opportunity to define the social worker’s role and autonomy. The social workers perhaps understood more fully than the physicians the arduous and complex work entailed in the non-medical aspects of community re-integration.
“The plan…carries with it the recognition on thepart of the hospital physician that the treatment of the patient, if it is to be adequate, must reach beyond the hospital, out into the family, the neighborhood and the workaday world – into the world in which the social worker is on his own ground, and where he is supposed to go about his business as familiarly and efficiently as does the physician in the hospital or institution for the insane. It is an extra-institutional treatment to which the social worker is called, and this is exactly what he is peculiarly equipped and qualified to do.”
And, with respect to the nature of the appropriate relationship between the physician and social worker
“…the social worker who must advise with the physician as to the patient must, in turn, be advised with by the physician as to the outside world into which the patient is to go…as the authority of the physician is necessarily supreme in the medical and institutional care of the patient, so must the authority of the social worker in the extra-institutional or social care of the patient be recognized.”
Grasty welcomed additional help and expertise, noting that his organizations have had extensive experience dealing with “these unfortunates” many of whom “tax those interested in them to the utmost to determine the wisest course to pursue.” Levin welcomed the prospect of education offered by the Aftercare committee. Without it, the ordinary friendly visitor could not be asked to take charge of a patient who had been insane, and even the professional social worker would need specialized information on the circumstances and needs of insane patients in order to recruit and supervise the visitors.
However, the fiscal practicality of the plan worried the social workers. They noted that all of their organizations were already overtaxed with demands. They feared universal public ignorance and prejudice against the insane would result in limited private benevolence, whether of money or volunteer service. And they knew it would take additional person-power.
“The one thing needful is an adequate force of social workers. The social workers have backed with might and main the successful demand of the medical fraternity for adequate institutional care of the insane by the State. May we now look to your fraternity to support the social workers in their appeal to the public for money to secure a sufficient number of workers to provide adequate after-care of the insane?”
The First Aftercare Program. As shall be seen, over the next decade concerns about both money and staffing preoccupied first the MPS aftercare committee and then the Lunacy Commission. Nor were fundamental questions of who should receive aftercare,who should do the work, and who should pay for it ultimately answered in the manner proposed originally by the Aftercare committee plan. The 1910 plan assumed the target population to be “indigent” patients whose social needs were properly the responsibility of the charity organizations, with private philanthropy the most appropriate source of funds. As these assumptions gradually changed, the central responsibility finally came to be viewed associal work’s, but as a specialized function within a separately evolving mental health arena.
In 1911 the MPS aftercare committee started fund raising to hire a physician. As committee chair, Adolf Meyer had definite views concerning the necessary therapeutic scope and functions of aftercare that were developed during his New York years. He redefined “need” from that of patient indigence on leaving the institution to the “need” for overall patient well-being, relapse prevention, closer linkage between hospital and community,and the physician’s “need” for better information about the patient’s family and environment. What was less clear in Meyer’s view was who should do the work. During the annual meeting of the MPS in 1911 Meyer asked for a resolution urging the Lunacy Commission to underwrite sending someone to the Chicago School of Civics and Philanthropy (now the Chicago School of Social Service Administration) for training. Also at the meeting he recommended that MPS 1)hire a “social service physician” to take on the “field work” of aftercare; and 2) raise the $2500 dollars needed to pay his salary. (Sixty dollars left over from the meeting’s luncheon fee was turned over to the Aftercare Committee to that end.) Meyer also believed that aftercare work should be developed under the supervision of the individual hospitals, with physicians doing as much of the work as possible with the assistance of district nurses. Clearly Meyer viewed aftercare as professional work that should be connected closely to the overall therapeutic care provided to patients. Emerging models of hospital”dispensary” or outpatient work might provide the necessary structure.
Funding remained a stumbling block for the MPS aftercare committee. With difficulty they raised sufficient funds from private contributions and a small donation from each hospital to hire physician W.B.Cornell in 1912 to do aftercare full-time. By this time the MPS committee and the Lunacy Commission shared the goal of getting a state appropriation for the work. This seemed attainable. The recent reorganization of the Maryland State Board of Aid and Charities (the ultimate state oversight authority to which the Lunacy Commission reported) led to the appointment of trained social worker and ally William Davenport as its secretary (competitively, not politically selected). In 1912, the Board cited the MPS Mental Hygiene Committee (newly renamed) as “the most important agency ever sanctioned … for preventive and after-care work among the insane” and requested an appropriation of $2500 a year to the Lunacy Commission for use by the Mental Hygiene Committee as needed. However, the committee and Dr. Cornell struggled with financing for another two years. The effort to acquire private support through subscription was”disappointing,” and the state appropriation did not materialize until 1914.
Buttressed with the state appropriation the Mental Hygiene Committee expanded its staff in 1914, hiring Anna Gorsuch as an assistant to Dr. Cornell for both office and field work. Together Cornell and Gorsuch handled over 1000 cases during the 1914-15 fiscal year, including a monthly average of 70 office visits and 180 telephone calls. The work divided between office consultations and home visits conducted on behalf of most of the city’s philanthropic organizations, and directly providing aftercare to about 120 new or continuing cases, including field visits, for those released from the state hospitals. The Lunacy Commission estimated $12,000 in savings to the state from their efforts, and advocated for wider aftercare efforts to be undertaken by each of the state hospitals directly.
The Lunacy Commission was coming to the conclusion that a formal program of aftercare should be lodged with the commission itself. The informal relationship and fiscal pass-through between the LC and the MPS’s Mental Hygiene Committee were out of step with emerging ideas about state administration. For its part, the Mental Hygiene Committee was transforming into a new entity with a mission far broader than aftercare. In keeping with its name change and identification with the mental hygiene movement nation-wide, the committee increasingly focused on concerns of prevention,public education, and advocacy. In mid-1915 the MPS “discharged” the committee, freeing it to reconstitute as the independent Maryland Mental Hygiene Society with Cornell as executive secretary. The new society agreed that the Lunacy Commission should take over the aftercare work and pledged to work cooperatively.
Aftercare at the Lunacy Commission. Whatever the good intentions, an aftercare program that relied almost exclusively on”cooperation” among different entities seemed to be problematic. Early in 1916 the LC wrestled with the need for a plan for “fuller and more satisfactory co-operation” between the Commission and the Superintendents and the Maryland Society for Mental Hygiene with respect to aftercare of discharged patients. By October of that year the LC moved to establish its own aftercare department with Anna Gorsuch as “aftercare field agent.” She was to serve as the “Social Service Agent of each of the State Hospitals,” making hers the first paid social work position within Maryland’s embryonic state mental health “central office” and dedicated exclusively to specialized work with the mentally ill. However, the legislature refused to appropriate any funds for aftercare that year, and Ms.Gorsuch’s $50 monthly salary was possible because the LC and the four state hospitals each contributed ten dollars a month.
Accounting for her first year of work, Miss Gorsuch reported a total of 124 patients under her supervision. Of these, three had died, 3 were lost to follow-up, and 23 had relapsed and returned to the hospital,leaving over three-fourths of the patients “doing well” either at home or “in situations.” She made 370 field visits on behalf of patients, 27 visits to hospitals, and conducted 187 office visits. The report further noted “great difficulty” in placing patients because of “old prejudice” and estimated savings to the state of $10,693.90 because of her efforts.
Whether because of the difficulties of the work, her low salary, its unstable funding, or beckoning other opportunities, Anna Gorsuch left her job sometime in late 1918 or early 1919. The commission unsuccessfully tried to talk her into coming back, and ultimately hired Margaret E. Dudley sometime in 1919 at a salary of 75 dollars a month. The Commission knew that its structures and personnel for aftercare were inadequate for the need and lagged behind the Commission’s own aspirations for a level of enlightened care such as achieved by more progressive states. They hoped to add “several more social service workers to take care of the ever increasing number of patients who are being paroled,” but made no progress in getting state funds for additional aftercare positions, despite requesting them each year.
The Commission’s requests for more aftercare personnel were buttressed in 1921 by the recommendations from a survey of state needs with respect to care for the mentally ill undertaken by the National Committee on Mental Hygiene at the request of the LC and the Maryland Mental Hygiene Society. The survey strategy was used at that time by reformers in a number of states to provide ammunition from credible experts for the battle with tight-fisted and largely uninformed state legislators. Prominent among the Maryland Survey conclusions was “a striking need for psychiatric social workers,” whose aftercare work would contribute to cutting down on the numbers of patients currently in the state hospitals. The aftercare services should, ideally, be provided in community-based “traveling or visiting clinics” where both the psychiatric social worker and physician could conduct preventive activities as well. Medical staffs of the hospitals should be enlarged to provide such clinics and “social workers should be employed.”
In reality, the commission itself functioned with just one social worker for the rest of the decade. At least through 1924 that was Margaret Dudley. Her line and salary (“mental hygiene clinic social worker”)were reflected in the first formal ledger of the (again) reorganized public mental health administrative structure (re-named the State Board of Mental Hygiene) at $1200 per year.
Aftercare, Social Work and the State Hospitals. Progress in implementing the survey recommendations with respect to hospital-based social work was slow. Nevertheless, by 1930 social service departments had been organized in all the state hospitals with aftercare clearly acknowledged as the key responsibility. Unfortunately, the extant record provides only a few clues concerning this development.
Lunacy Commission statistics from 1914 on supported the fact that Springfield State Hospital was making an effort to parole patients with aftercare. This may be indicative of more enlightened psychiatric leadership at that hospital, but Springfield had been designated as the “acute” facility when first constructed, with Spring Grove serving as the chronic hospital. Springfield consistently reported the most paroled patients and aftercare activities are mentioned from time to time in the annual reports of its Board of Managers. It appeared that the hospital was the primary user of the Lunacy Commission’s aftercare worker and services. While a social service department either existed or was being organized by 1930, there is no direct mention of this in the hospital’s own annual reports.
There is no mention of aftercare during 1914-20 in the annual reports of the individual hospitals, other than at Springfield. However, it is likely that different forms of informal, volunteer, or cooperative efforts were taking place. The LC meeting minutes from 1917 give a hint of this.
“Arrangements are now pending to place this patient[who was at Crownsville Hospital and deemed ready for discharge] in Baltimore city, under the [Lunacy Commission’s] After-Care Department, and to be under the supervision of Mrs. Fernandis, a colored social worker, who has agreed to co-operate with our After-Care Agent in placing patients from the Crownsville State Hospital.”
The need for care for World War I psychiatric casualties may have provided the initial inroad for hospital-based social work at Spring Grove. In 1920 the US Public Health Service negotiated with the LC concerning the provision of acute psychiatric care to “War Risk Insurance” cases at Spring Grove. One component of the agreement was the establishment, with the cooperation of the Red Cross, of a social service/aftercare department “to keep the family in touch with the patient’s condition and to hasten, whenever possible, this patient’s return to his home and to bring about at least asocial recovery.” At Spring Grove the first report from a social services department appeared in the 1928-30 Biennial report, briefly mentioning the work of an “after nurse.”
As Crownsville Hospital broke ground in 1923 for a new building to include an “outdoor clinic” (e.g., outpatient), their report noted that “a social field worker will be required.” The next year’s report listed a”social service worker” with a sum of $120/year on the hospital’s salaries and wage schedule. Presumably this was a part-time arrangement. The hospital continued to request a “social field worker” to work under the supervision of the hospital to meet the needs of patients admitted to the newly opened Hugh Young Psychopathic Building. In 1928 Crownsville hired nurse Anne Little in a part-time social work position. Miss Little’s responsibilities were to assist in paroling patients and preventing their return to the hospital by “aiding them to make adjustments in their homes.” In her first year Ms. Little made over 300 visits to 26 paroled patients in seven counties.
Thus at the end of the decade there was in place the rudimentary structure – connected to the function of aftercare – of social work within public mental health in Maryland. The presence was not robust,consisting only of a position in the “central” office and a one person (it seems) “social service department” in each of the state’s mental hospitals. But it was a start.
There were several consequences for the profession from the specific way in which aftercare developed and became identified with social work. As originally conceived by the Maryland Psychiatric Society’s Aftercare/Mental Hygiene Committee, prevention activities and aftercare were to be two sides of the same coin. With the formation of the Mental Hygiene Society and placing of aftercare under the Lunacy Commission the two functions were essentially split, leaving prevention activities and advocacy largely with the Society, which was increasingly focused on problems and issues unrelated to care of the most severely ill. Social workers came to be centrally involved in these new activities, but they were not the aftercare workers.
Unfortunately, parole and aftercare involved a small fraction of the patients committed to and housed in hospitals, in spite of the early hopes of the reformers and visionaries in the field. In terms of the absolute numbers this was primarily due to the refractory nature of mental illness without modern medications. However, official writings of the time suggested the absence of a more enlightened and assertive effort at the hospitals to help patients leave. State money and legislative support were garnered time and again for hospital construction projects, and state hospitals were important sources of employment. As a result, throughout the 1930s and1940s hospital enrollments skyrocketed, leading finally to the scandalous hospital conditions that, in 1949, came to be chronicled as “Maryland’s Shame.”
An important implication of the broadening of the social work occupational focus beyond indigence, per se, was the further diffusion of its practice into “host” settings. As with medical social work developing at the same time, this meant coming under the authority and world view of physicians, not COS executives who identified as social workers. The”institutionalization” of social work functions within these host settings, with designated staff positions funded through the host’s budget, blurred the profession’s earlier identification with private philanthropy and volunteerism. Aftercare, it turned out, was not to be achieved by”philanthropic and devoted men and women …willing to lend a helping hand to the recovering insane person” as was envisioned in the beginning.
Finally, it came to be better understood that aftercare was difficult work. It required time, effort, and expertise. Dedication to social service could be an attitude that anyone could cultivate, but social work was work, even though poorly paid. So it was that through aftercare for the mentally ill the tracks were laid down, bit by bit, of a socially recognized function to meet a begrudgingly acknowledged social need. This eventually led to the clear markings of “place” that were a condition of professional realization in an expanded field.
* I am grateful to Ellen Booker, MSW, who researched many of the state historical documents for this essay. She conducted the research for an honors project while an undergraduate social work student at UMBC, and originally presented some of her findings in a session at the 1999 NASW Meeting of the Profession in Baltimore.
 Elfenbein, J. (2001). 100 Years of Professional Social Work: History of Social Work in Maryland, Web-based essay for the National Association of Social Workers, Maryland Chapter. http://www.nasw-md.org/. Bayview City Hospital cared for mentally ill patients and held joint case conferences with COS. According to Betty Broadhurst, Mary Richmond visited both Bayview and Spring Grove to seethe mentally ill, and Amos Warner took medical students to study the insane. The working “model” was that these patients, like other deserving poor, needed a “friend” not just money and resources. Broadhurst, B. (1972).”Amos Warner and the Baltimore Community Organization Society.” Doctoral Dissertation, Microfiche#72-10 422.
 The refrain of its powerlessness echoes throughout the Lunacy Commission’s Annual Reports of this period. An example: “There is no board … whose duties are so illy defined and whose authority is so limited.” Maryland Lunacy Commission18th Report, p. 28.
 Statistics prepared by the Lunacy Commission in 1908-9 titled “Mr. Taxpayer are you proud of what Maryland is doing?” showed Maryland spending annually $28.00of state funds per state hospital patient versus, for example, $242 per patient by New Jersey, a comparable state with respect to numbers of patients and similarly without complete state care. 24th report of the Lunacy Commission, 1909, p. 34-35.
 The Lunacy Commission’s 1898 report to the Legislature gives the figures of2,382 insane in Maryland in all public and private institutions with 1,153 of these in state or city hospitals for the insane. Spring Grove had 535 patients and Mt. Hope had 632. Springfield was not quite finished. There were 400 African-American insane. Maryland Lunacy Commission 13th ,14th, and 15th Annual Reports. Baltimore: Sun Bookand Job Printing Office, 1899, 1900, 1901.
 1905 Dr. Brush, superintendent of Sheppard and Enoch Pratt and at the time president of Maryland Medical and Chirurgical Society (Med Chi) “stronglyadvocates” state care of the insane in the hospital’s annual report. MMJ,48(2),p.77. and comments on it in his annual address to the Society. The State had passed a law repealing existing lunacy laws (1904), and mandating “after 1909 all dependent insane shall be cared for in hospitals controlled and directed bythe state and at the expense of the state.” (MMJ 48(6), p. 210). The State Lunacy Commission was charged with developing the specifics of the plan. All worried that the state would try to do it on the cheap. Legislation passed in 1908 postponed the time of implementation from 1909 to 1911. 1909 and 1910 saw a concentrated push to develop a new bill with specific reform components and achieve its passage with an appropriation. “It is the sacred duty of every person in Maryland to help bring about state care in 1911.” (MMJ, v.LII, p. 302) The governor Austin L. Crothers was committed to the change.Details of the decade long effort are reported in the Lunacy Commission Annual Reports of the time as well. For an interesting recent discussion of the Lunacy Commission’s activism for state care reform and the creative use of photography to shape public opinion see Robert W. Schoeberlein’s “The Beginning of Mental Health Care Reform in Maryland, 1908-1910 in the Maryland Historical Magazine, 96, 2001, p. 439-474.
 For a complete discussion of aftercare and the political process leading to its formal adoption as a program in New York see Vourlekis, BS, Edinburg, G. and Knee, R. (1998). The rise of social work in public mental health through aftercare of people with serious mental illness. Social Work, 43,567-575.
 Meyer’s evolving thinking and views as presented here can be found in Meyer, A.(1907). The problem of “aftercare” and the organization of societies for the prophylaxis of mental disorders. In 18th annual report of the State Commission on Lunacy (pp. 160-168). Albany: New York State Commission on Lunacy and in Maryland Psychiatric Quarterly, 1(1), 1911.
 The recommendation in the Commission’s Biennial Report (1913-1915) for more attention to aftercare by each hospital seems to stem from their approval of efforts at Springfield, noted in the Commission meeting minutes of April 14,1914. While the specifics of the Springfield effort is unclear, the minutes acknowledge “…efforts made by the Board of Managers of Springfield State Hospital to extend the social service and re-educational work among the patients of this hospital.” It is likely that this is a rare glimpse in Maryland of “volunteer” efforts to deal with aftercare, similar to what had been tried in New York State for some years prior to 1906. Under the auspices of the Board of Managers,voluntary efforts to informally assist those leaving the institution would be made. Here it is instructive of the continuing ambiguity about the appropriate auspice and ownership of “social service” efforts with mentally ill patients.
 See MPQ, 5(1)(2)(3), 1915-16, for references to the creation of the Mental Hygiene Society and Biennial Report of the Luncacy Commission,Dec. 1, 1913-Nov. 30, 1915 for the Society’s first report to the Lunacy Commission.
 In a series of seven articles a Baltimore Sun reporter painted a graphic picture of the terrible living and therapeutic conditions existing in Maryland’s state hospitals. See Norton, Howard “Maryland’s Shame” Baltimore Sun, January9, 1949.
How to Cite this Article (APA Format): Vourlekis, B.S. (2011). Social work and aftercare of the mentally ill in Maryland: The early years. Retrieved [date accessed] from /programs/social-work-and-aftercare-of-the-mentally-ill-in-maryland/.