American Retrospect

The After-care of the Insane.—The Committee of the American Neurological Association upon the After-care of the Insane have published their report (Journ. of Nerv. and Ment. Disease, November, 1897). Their method of inquiry was to issue a circular letter to about fifty-six leading alienists and neurologists. Fifty replies were received, the large majority of which were decidedly favourable to the principle. Only six were doubtful or positively opposed to it: and the chief objections of these were the paucity of the cases likely to be benefited by such aid; the inexpediency of the project, though admitting its possible desirability; and that, while excellent in theory, it would be impossible in practice. Eighty-eight per cent. of those who were consulted and who replied are of opinion, and some of them very strongly so, that great good would be likely to accrue from a properly organised system of after-care for convalescent or improved cases of mental disease. The majority seem to think that such a system should at first be the outcome of private organisation, and that a successful issue of such would be all the more likely to make out a good case for State aid and recognition at a later date. The number of patients, for whom such provision would be likely to be fruitful of good results, the various superintendents are as yet unable to fix with any certainty, as hitherto it has, of course, not been the custom to inquire into the circumstances. and future surroundings of each patient on his discharge from the asylum. The following is a summary of the Committee's conclusions:—“(i) It is the general and well-nigh unanimous sentiment of those who are the most conversant with the needs of the insane in this country that measures should speedily be inaugurated for the temporary relief of discharged, recovered, convalescent, and improved insane patients of the dependent class by organised outside assistance. (ii) As a preliminary step, inquiry should be made of all such patients before they leave the hospital regarding the mode of life, surroundings, and occupation to which they are returning, and appropriate advice given by a medical officer of the hospital. This precautionary measure is, we believe, too often neglected in large institutions for the insane. (iii) The legal provision whereby an allowance of money and clothing is made in some States to each patient on his discharge should be adopted by all. and (iv) that outside assistance can best be provided, we believe, through the medium of an after-care association, which, until its utility be proven, should be entirely a private undertaking, and should be organised like most existing charitable associations depending upon voluntary contributions. Obviously a large city offers the best field for starting and developing such a system.”