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The History of Psychiatry Social Work
Social work and psychiatry began almost simultaneously at The Johns Hopkins Hospital. The first hospital social worker was hired in 1907 and assigned to the dispensary, known today as the outpatient clinic. Two years later nurse Margaret Brogden took over and worked alone for a number of years. It soon became apparent that her services were invaluable and that the institution would benefit from having more social workers to serve patients. The Department of Social Services became a formal organization in 1912 when the hospital began hiring additional workers. Social work education was in its infancy and many of the early medical social workers had trained as nurses.
Psychiatry began at Johns Hopkins with the hiring of Adolf Meyer in 1908 as its first director. The construction of the Henry Phipps Psychiatric Clinic in 1913 revolutionized patient care and integrated psychiatry into a teaching hospital for the first time. When the Phipps Clinic opened, the expansion of the Department of Social Services in the hospital was well underway, and three social workers were assigned to the Clinic’s 60 inpatients and its many outpatients as well.
These early social workers enjoyed the strong support of Dr. Meyer who understood that social factors could weigh heavily in the genesis of psychiatric problems, and that social forces could be brought to bear to improve the chances of patients getting and staying well. His wife, Mary Brooks Meyer, worked as a psychiatric social worker before coming to Baltimore. In his previous post at the Pathological Institute of the New York State Hospitals, she had visited the homes of some of his patients and reported back to him on the conditions of family and home.
Dr. Meyer taught his psychiatry residents to look carefully at each patient’s social history when doing their initial evaluation and making their formulation of the case. He encouraged them to consider what the patient’s personal strengths and social assets were in developing a treatment plan. Meyer wanted the Clinic to serve a defined geographical district so that social workers would be able to make home visits to help with evaluations and discharge planning. These early psychiatric social workers were breaking new ground and had to rely largely on their own judgment. They looked for practical answers to the problems presented by their patients long before the conceptual framework for understanding many psychiatric illnesses was well formed and when there were few effective medications or treatments for psychiatric conditions.
While the hospital went through expansions and contractions of its social work staff over the ensuing years, the support for the social workers in the Phipps Clinic was remarkably steady. In 1975, when Dr. Paul McHugh became Chairman of the Department of Psychiatry, there were still three psychiatric social workers. Part of Dr. McHugh’s vision for the Clinic was to return to the search for practical social solutions to patient’s problems, the expertise of the original social workers in psychiatry. In 1976 Janice Hedblom joined the social work staff, and soon became Director of Social Work in Psychiatry. Hedblom oversaw the hiring of additional workers to serve in the specialty units that were being created which helped refine the role of social work. By this time training at the graduate level was a prerequisite for all clinical social workers at Johns Hopkins Hospital and was followed shortly afterward by a State of Maryland licensure requirement.
In 1982 the Department of Psychiatry moved from the Phipps Clinic building into the new Adolf Meyer building. Psychiatric care was allotted more inpatient beds, expanding to 88 beds on four inpatient floors. With the increase in patients and the push for decreased length-of-stays, the need for more social workers became apparent. A year after the move, the day hospital program opened and by 1983 there were eleven social workers serving inpatients and day hospital patients.
Social workers in psychiatry were now involved in illness education for patients and families, discharge planning, and linking patients and families with resources in the community. They were providing treatment to individual patients, families, and groups. They were helping psychiatry residents and other team members appreciate the social strengths and liabilities of their patients. While the era of home visits was past, social workers were still deeply involved in evaluating the patient’s family situation and reinforcing and strengthening the social supports that were available to the patient at discharge.
Today J. Raymond DePaulo, Jr. heads the Department of Psychiatry and Behavioral Sciences and Gretchen Withrow is Director of Social Work in Psychiatry. They have continued to expand the program. Now 18 social workers are assigned to general psychiatry as well as specialty programs in geriatrics, neuropsychiatry, chronic pain treatment, eating disorders, mood disorders, schizophrenia, and substance abuse.
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