The purpose of this research is to examine how social workers fit in to the U.S. mental-health system. The plan of the research will be to set forth the historical context in which U.S. community mental-health systems can be analyzed, with reference to key early figures in the whole process of shaping mental-health delivery and caregiving practices, and then to discuss the current status, including cost-related factors, of American inpatient and outpatient community mental-health systems, as well as the role of the social worker in such systems.
To understand modern American mental-health systems, it is necessary to realize how relatively young the very concept of organized and humane mental-health treatment is in Western civilization. Dr. Benjamin Rush, one of the signers of the Declaration of Independence, is credited with being the father of American psychiatry, partly on account of his advocacy of humane and systematic treatment of the mentally ill. Rush's Medical Inquiries and Observations upon the Diseases of the Mind was published in 1812, the first American work on psychiatry ("Rush," Funk & Wagnalls, 1975). Rush appears to have taken a practical, clinical approach to treatment, as evident in his encouraging patients to keep a journal of their symptoms (Riordan, 1996); in the modern period, so-called scriptotherapy is suggested as an adjunct to counseling. The specifics of some of Rush's views have been interrogated by subsequent research. For example, Rush viewed alcoholism in moral and physical terms and published anti-bingeing tracts as head of Philadelphia's Pennsylvania Hospital (Burke & Clapp, 1997; Katchner, 1993). However, on the whole Rush's work, which specialized in the treatment of mental disorders, can be associated with a tendency in the earliest decades of the U.S. republic toward social and personal improvement for which public and private institutions were well suited. As Wiltse comments:
There were few s...