y received penal but no therapeutic care (Vourlekis, Edinburg, & Knee, 1998; "Mental," Funk & Wagnalls, 1975). Over the course of the century, it became a commonplace that the proper place for confinement of the insane was a state hospital. That view was most strongly promoted by the philanthropist, educator, and reformer Dorothea Lynde Dix, who in the 1840s began advocating humane treatment of the mentally ill, specifically by not confining them to institutions not designed for that purpose but rather by creating function-specific mental-health asylums. Dix was also an advocate of almshouse and prison reform per se ("Dix," Funk & Wagnalls, 1975). Dix personally helped found some 20 asylums, but by 1880, every state in the Union had at least one operating state hospital (Vourlekis, Edinburg, & Knee, 1998).
The creation of institutions designed to provide treatment to the mentally ill must be seen as the principal achievement of care delivery systems in the U.S. in the nineteenth century. Equally, the fact that the institutions were considered subject to public policy and public funding demonstrates a view that government agencies had a stake in maintaining mental health on one hand, or on the other protecting the public at large from the mentally ill or the mentally ill from abuse by themselves or others. This owes something to the editorial position adopted by the American Journal of Insanity (later Psychiatry) at its founding in 1844 that public action (i.e., government sponsorship) was necessary for organized treatment of mental diseases.
Vourlekis, Edinburg, and Knee (1998, p. 572) explain the so-called aftercare movement, the name given to the therapeutic services undertaken by social workers to help integrate the mentally ill, many of them indigent, who were released from state hospitals, into mainstream society. Aftercare as an institutional feature of mental-health systems was partly an outgrowth of activities on the part ...