CHAPTER 3
HUMAN SERVICES IN HISTORICAL PERSPECTIVE
CHAPTER CONTENTS
Introduction
Prehistoric Civilizations
Early Civilizations
Middle Ages
Renaissance
Human Welfare Services since the Renaissance
• Industrial Revolution
• Early Reform Movements in the United States
• The Depression and World War II
• The 1960s Through the 1980s
Mental Health Services since the Renaissance
• Early Mental Asylums
• Era of Humanitarian Reform
• Freud's influence
• Trend Toward Deinstitutionalization and Decentralization
• Community Mental Health Movement
• Advent of Generalist Human Services Workers
Real Life Human Services Work
Future Trends
Additional Reading
References
INTRODUCTION
Who is responsible for helping the disadvantaged within a society? The family? Religious
organizations? The government? Should helping be viewed as a basic human right or as a
societal gift? Throughout history, societies have responded to these questions in various ways.
If a society does accept some responsibility for helping its disadvantaged, additional questions
quickly emerge: Which groups of people and types of problems should be helped, to what
extent, and how?
How a given society answers these questions is based on its dominant values, attitudes, and
beliefs. If a society believes that its poor or senior members should be helped, then it will
develop some system or method to provide the needed care for these target populations.
Another society may give priority to its physically or mentally disabled members and develop
services focused on these groups but excluding others.
The present range and diversity of human services are quite large. Throughout history, many
people and events have influenced the development and direction of the field. As societies have
changed through the ages, values and beliefs have often been replaced or at least modified by
new ones. The developing human services systems of today are, to some extent, an outgrowth
of our previously held societal values and beliefs concerning helping. It is likely that the quality,
methods, and availability of human services in the future will be greatly influenced by current
attitudes toward helping. Through knowledge of the past, we can better understand the present
and also be in a more favorable position to shape the future.
For clarity and better understanding of the historical development of the interrelated aspects of
the human services field, this chapter is divided into several sections. The first sections provide
a general overview of the historical roots of the human services field by tracing the development
of early societal beliefs and helping practices. The next section traces changing societal
attitudes and helping practices that have contributed to the development of human welfare
services. Next we examine the historical development of mental health services. The chapter
concludes with a brief discussion of future trends in the human services field.
PREHISTORIC CIVILIZATIONS
The earliest records of helpful treatments can be traced back to the Stone Age, approximately
half a million years ago. Through cave drawings and the remains of primitive skulls, scientists
know about a medical treatment called trephining. In this procedure, a small section of the skull
was bored out, probably by means of sharp stones or other such crude instruments. This hole
cut from the skull was supposed to allow a route of escape for the evil spirits believed to inhabit
the afflicted person's body, thereby curing the person. Scientists have surmised that this
treatment was administered to people who evidenced certain forms of observable deviant
behavior. It should always be remembered that what constitutes deviant behavior is a product of
what the norm for behavior is at a given point in time.
In this early era, most human problems were attributed to devils, demons, or other evil spirits.
Belief in the supernatural or demonology was the dominant belief system of the age, and
various procedures or rites were used to exorcise evil spirits. These ideas arose from early
humans' attempt to explain the universe. All natural phenomena such as earthquakes or floods
were attributed to the work of evil spirits. These ancient people also accepted the related belief,
called animism, that spirits inhabit various inanimate objects such as rocks, trees, or rivers. The
shaman, or medicine man, who performed rites of exorcism, can now be viewed as the earliest
human services worker. It was commonly believed that these individuals understood the secrets
of the supernatural and possessed certain religious or mystical qualities that enabled them to
help afflicted individuals.
Life during prehistoric times was at best a matter of pure survival against the hostile
environment. Human problems centered on gathering food and having a relatively safe place to
sleep. Poverty meant being unable to locate or secure food, and weaker individuals were
sometimes simply left to perish. In situations involving the physically disabled or infirm elderly,
the tribe or extended family unit would usually provide for these individuals. However, the
afflicted person's importance to the tribe often determined the amount of assistance given. In
some instances, tribes took in and befriended individuals separated from other tribes.
Newcomers usually had to prove their worth in some manner in order to be allowed to stay with
the tribe.
The family was the primary source of help for these ancient people, but religion would play an
increasing role in the evolution of human services.
EARLY CIVILIZATIONS
Prior to 450 B.C., the world was believed to be governed by supernatural spirits. There were no
major organized attempts to understand human problems and behavior from a scientific point of
view. However, significant changes in beliefs were about to emerge that would alter the earlier
supernatural explanations for human behavior.
During the Golden Age of Greece, a number of philosophers began to put forth new beliefs
concerning human nature. One of these was the Greek physician Hippocrates (460–377 B.C.),
who disagreed with the belief that supernatural spirits were the sole cause of human disease.
He believed, rather, that most diseases were chiefly physiological or organic in origin. He
shared the point of view earlier postulated by Pythagoras that the brain was the center of
intelligence and that mental disorders were due specifically to the malfunctioning of the brain
(Ciccarelli & White, 2013).
Another contribution made by Hippocrates was his development of a system of psychiatric
labels for patterns of deviant behavior. These labels included melancholia, mania, and epilepsy.
To appreciate more clearly the radical change in belief advocated by Hippocrates, one must
consider that the previous explanation for epilepsy was that it was a sacred or divinely ordained
disease. Hippocrates claimed this disease was caused by a blockage of air in the veins due to
secretions of the brain (Comer, 2010). The treatments advocated by Hippocrates differed
considerably from the earlier skull-cutting procedures. His treatments often involved vegetable
diets, exercise, and a tranquil lifestyle.
Whether Hippocrates had the correct physiological explanation or treatment is not of critical
historical importance here. The theory that diseases could be explained by natural—as opposed
to supernatural—causes is of major importance. This change in belief systems regarding the
origin of diseases influenced another significant change. Because deviant behavior or
psychological problems could now be viewed as diseases of organic origin, they could be
considered part of the domain of medicine (Porter, 2002). As such, these conditions could be
treated by physicians rather than priests, medicine men, or other religious healers. This
separation of treatment responsibilities was one of the first steps toward developing the system
of specialization that has continued to the present time in human services.
In the ancient Rome of 150 B.C., another physician, Asclepiades, advocated treatment
procedures for mental disorders that stressed a medical and humane approach. His
recommended treatments often involved massages and baths to soothe excited or nervous
patients, with wine to calm the nerves. He actively denounced the cruel and severely harsh
treatments that were still popular at this time, such as housing patients in totally dark cells,
beating them with chains, bloodletting, castrating, and subjecting patients to prolonged periods
of starvation.
Galen (A.D. 130–200), a Greek medical writer, was able to compile, systematize, and integrate
a considerable amount of material from many complementary fields. His topics included
medicine, anatomy, physiology, and logic. In addition, he made a major contribution to the
understanding of abnormal behavior by developing a system of classifying the causes of mental
disorders. He believed all disorders were either physical or mental. He felt these disorders could
originate from such things as injuries to the head, fear, shock, or emotional disturbances.
The early civilizations presented some striking contradictions in helping attitudes and services.
Although many advances were being made and many individuals were attempting to struggle
against fear, ignorance, and superstition, the use of cruel treatment procedures was still
prevalent. Even as many advocated more humane and philosophical beliefs concerning the
nature of people, the practice of buying and selling slaves still existed, and the poor and
disabled often begged for alms along city streets. Although physicians were available for the
sick, only those who could pay had access to them. The Romans and the Greeks viewed
physical weakness or disability with little tolerance. Often the physically ill were taken out of
towns to uninhabited areas or deserted islands where they were left to struggle by themselves
or die. Of course, these practices were applied predominantly to the poor or those without
resources or family protection. As in most societies, the rich were treated one way and the poor
another.
The period A.D. 200–475 marked a steady decline for civilization. As major plagues killed
thousands upon thousands of people between the first and fourth centuries A.D., intense fear
and anxiety spread throughout Europe and the Middle East. In this climate of fear, Christianity
emerged and developed a large and zealous following. Medicine could not stop the plagues, so
people turned to the comfort and solace offered by Christianity, which became the prime religion
of the Western world. Religious figures replaced medical figures as the saviors from illness. The
causes of disease were again explained in terms of loss of faith and the influence of demons.
Evil spirits were viewed as the cause of most human misfortunes.
MIDDLE AGES
The Middle Ages date from the fifth century with the collapse of Rome at the hands of the
barbarians advancing from the east. During this time, exorcism reemerged as the prevalent
treatment for most disorders. The medical advances achieved by Greece and Rome were
mostly forgotten (Hollingshead, 2004). Christianity became the dominant power throughout the
Middle Ages.
As the Church became steadily more powerful and organized in the early part of the Middle
Ages, it developed and provided a variety of human services. Monasteries often served as
sanctuaries, refuges, and places of treatment for the mentally ill. The Church established
institutions for the poor, provided residences for people with disabilities, sponsored orphanages,
and founded homes for the aged. Initially, these services were housed within church facilities,
but later other nonreligious sites were founded.
In its earliest stages, the Church espoused the belief that the wealthy or those with adequate
resources had a responsibility to help the less fortunate. The less fortunate, in turn, began to
expect assistance as an obligation of the wealthy. Both the rich and the poor developed social
roles and expectations for one another, and a clear distinction between the two classes was
evident. It is important, however, to note that assistance given to the poor was set at the lowest
subsistence or survival level. Much of contemporary human services philosophy can, in fact, be
traced back to these early interpretations of religious values and teachings.
During this period, there was little interest in finding out why the disadvantaged were
disadvantaged. The causes of poverty, for example, were of little interest to those providing
human services. The rights and obligations of each class of society were clearly spelled out,
and no further understanding seemed necessary.
Initially, people believed that giving to the disadvantaged was important simply because others
were deserving of and needed help. The Church gradually began to lose this emphasis on
helping out of humanitarian concerns and replaced it with the notion that helping had to be done
if one wanted to ensure salvation and a peaceful afterlife. The Church preached that giving was
a means of salvation, a means to an end. People would be rewarded in an afterlife for fulfilling
their obligations in this life. Giving was seen as a necessary duty of the wealthy that they often
fulfilled reluctantly.
As the Church developed human services, the overall climate of the Middle Ages was marked
by chaos and extreme cruelty toward unbelievers. During the period 1200–1400, the belief in
witchcraft greatly increased, and in certain regions mass outbreaks of flagellation (whipping)
rituals occurred (Porter, 2002) in attacks against accused witches.
Although the Church tried to control all opposing beliefs and alternative religious movements, it
was not completely successful. As people became disillusioned with the ability of the Church to
protect them from misfortune, a variety of fanatical sects emerged throughout medieval Europe,
and fear of witchcraft became a mass obsession. As Rimm and Somerville (1977) point out,
Witches were viewed not only as degenerate beings in league with devils, but also as causes of
sickness, disease, personal tragedies, and the stealing and killing of children. They were
perceived as vicious instigators of terror, highly dangerous to a threatened and unstable society.
(p. 16)
In the Middle Ages, the growth of fanatical sects represented a form of extremism, an impulsive
act often characteristic of youth. In fact, the Europe of the Middle Ages was a youthful society.
The death rate was extremely high, and people did not often survive past 40 years of age.
Beginning in the thirteenth century under Pope Innocent III, a religious tribunal was established.
This tribunal, referred to as the Inquisition, was given the responsibility of seeking out and
punishing any and all crimes associated with witchcraft or other forms of heresy. The methods
employed by this ecclesiastical body to obtain confessions for alleged crimes included
intimidation, burning, boiling suspects in oil, cutting their tongues out, and other forms of torture.
Although the Inquisition used cruel and inhumane measures, the Church espoused the belief
that it was providing a service to society by getting rid of the causes of disease and famine. It
also served as a means for the Church to exert its power and encourage loyalty by threatening
those who did not conform to stated policies and beliefs.
Throughout the Middle Ages, a major power struggle existed between Church and state. Each
faction wanted more power to govern without interference from the other. The Church
developed a steady source of income by demanding that its parishioners donate approximately
10% of their incomes for church-related activities. The state viewed this steady source of
income as a threat to its own base of power and sought many times to make it illegal to give
money or services to those who could work.
Gradually, the disadvantaged came to be classified according to whether they physically could
work or were unfit for work, such as the disabled, senior citizens, and children. Those
individuals deemed legitimately unfit for work came to be known as the “worthy poor,” whereas
the others were looked upon as lazy and unworthy of assistance. Even in the face of this steady
clash over power, however, the Church was successful through most of the Middle Ages at
preserving its domain, especially in the realm of providing human services to “worthy”
individuals.
RENAISSANCE
As Europe emerged from the Middle Ages, it entered a period of rapid and turbulent change
marked by the end of the feudal system, the birth of industrialization, and a decline in the power
of the Church. As the government became more powerful and influential, individual states,
cities, and towns developed more power. The middle class, composed mainly of tradespeople,
grew, prospered, and became a more visible and distinct part of society.
By the sixteenth century, the previously established religious, social, and economic order had
changed considerably. The government, the Church, and newly emerging business leaders
shaped the nature and direction of societal change. Unfortunately, the rationale for change is
often based on the priorities and complex concerns of those in power and does not necessarily
benefit all in society. These changing societal forces had a tremendous influence on the
direction and quality of human services. It is important to realize that the current system,
providing an enormous range of services for the welfare of human beings from birth until death,
originally started out simply providing food or shelter as a form of social welfare.
Having now provided a general overview of the early development of human services
philosophy and practice, we will examine the subsequent growth of human welfare services and
then that of mental health services.
HUMAN WELFARE SERVICES SINCE THE RENAISSANCE
During the sixteenth century, the Protestant Reformation escalated the many struggles for
power between Church and state. By the end of that century, the state had finally established
authority over the Church. As a result of diminished Church power, it became incumbent upon
the state to take over many services formerly provided by the Church, including the provision of
human services.
Under Henry VIII of England, the government formally took over the human services functions of
the Church to provide for people who were not self-sufficient, establishing a system of income
maintenance and public welfare. The official policy mandating this transition of power was
outlined in the statutes of 1536 and 1572. In 1601, the Elizabethan Poor Law established a
system that provided shelter and care for the poor. This law also specified local responsibility for
the poor and disadvantaged. It was first the responsibility of the family to provide for all human
services. If the family could not provide such services, it then became the state's responsibility
to provide for disadvantaged individuals within their communities.
Although the Poor Laws involved some people with good intentions, these laws were not initially
created as a generous humanitarian gift from the state to aid its disadvantaged citizens; rather,
they were a means of social control following an era of mass frenzy, disease, famine, and
economic instability that threatened to break apart the existing social structure.
As a result of the Poor Laws in England, a system for classifying the disadvantaged into three
categories was established: (a) the poor who were capable of work; (b) the poor who were
incapable of work because of age, physical disability, or motherhood responsibilities; and (c)
orphaned or abandoned children who became wards of the state. The poor who could work
were forced to work in state-operated workhouses. Massive overcrowding, filth, and inadequate
food made these workhouses barely tolerable. If the individual was incapable of work and in
need of food or shelter, he or she could be sent to an almshouse (poorhouse). The living
conditions there were similar to those in the state workhouses.
By comparison to the almshouse or workhouse, a more tolerable alternative was available for
the more “fortunate” among the disadvantaged. In certain communities it was possible for
individuals or families to remain in their own dwelling and receive contributions of food and other
resources from their community. This circumstance was far less common than the other
methods of providing services. Money was never given directly to the poor family, and any other
essential services, such as medical care, were not generally available.
As this early, often crude human services system evolved, procedures and rules were more
clearly established and defined. Policies were established to determine who would be eligible
for available services and who would have the authority to decide who got what and who went
where. As the programs became more complicated, the government created a subsystem with
sole responsibility for overseeing its public welfare system. Each community had its specified
government welfare administrator, who made the local decisions regarding a person's eligibility
for services. As the number of individuals needing assistance increased, the local community
bureaucracy became more impersonal. Indeed, this is still a problem with modern welfare
systems. The form of welfare bureaucracy created in England during this period became the
early forerunner of our modern welfare system in the United States.
INDUSTRIAL REVOLUTION
By the 1800s, the Industrial Revolution was developing momentum. The Industrial Revolution
began with the invention of a few basic machines and the development of new sources of
power. The advent of industrialization created the mechanization of manufacturing and
agriculture, changed the speed and methods of communication and transportation, and began
the development of factory systems of labor. These events, in turn, caused dramatic changes in
economic systems (Perry & Perry, 1988).
Large populations of unemployed individuals moved from rural areas to urban centers in search
of work. Although new forms of labor were needed and work was available for some, the great
majority of people still found themselves in poverty. As a result of the swelling disadvantaged
population within urban areas, many public institutions were created. The majority of the urban
poor found themselves facing worse conditions than those they had left behind. Adequate living
space was scarce, producing overcrowded and unhealthy conditions. Food was in short supply,
and the urban environment provided little room to grow crops. Families often found themselves
separated as members left in search of work.
Workers were generally seen by businessmen as commodities, to be used only when needed
and disregarded when work was not immediately available. It was during this time that workers
started banding together to share and provide what they could for one another. This banding
together for the collective benefit of all resulted in the development of the early guilds and
unions. In an effort to deal with the perceived threat to the social order brought on by large
numbers of disadvantaged people in urban areas, the government created more workhouses,
debtors' prisons, houses for delinquents and orphans, and mental institutions.
The Industrial Revolution brought about a new social philosophy that had a strong influence
upon society's attitude toward the poor and disadvantaged. This new social philosophy, known
as the Protestant work ethic, reinforced a set of values supporting the virtues of industrialization
and condemned idleness as almost sinful.
Hard work, and thus the accumulation of wealth, was interpreted as God's reward for leading a
virtuous life. As a corollary of this philosophy, poverty was often viewed as a form of punishment
from God. This philosophy, as most notably preached by John Calvin, supported the notion that
poverty-ridden individuals should remain in their disadvantaged conditions because God had
divinely ordained this condition for them.
It was during the 1830s in England that the concept of less eligibility was established, under
which any assistance given to the disadvantaged must be lower than the lowest wage paid to
any working person. Work was seen as an ultimate good, and its absence, for any reason, was
to be looked down upon. In theory, this would provide an incentive for all to work.
Another corresponding influence on society's attitude toward the disadvantaged was the
concept of the laissez-faire economy, introduced by the Englishman Adam Smith in 1776. His
book The Wealth of Nations argued for an economy in which government had virtually no
influence and placed no restrictions on the free marketplace. According to Smith, without
government control, society would grow and prosper by itself based on people's individual merit
and hard work. Supporters of this concept saw human services not as a right but as a
misguided societal gift—a gift that they believed would actually hinder overall economic
production.
Immigrants within a large city during the 1800s.
[image]
As previously described, many of these events and philosophies developing in England and
Europe had a strong influence on societal attitudes toward helping in the United States. The
economic value system emerging from England was again reinforced in the United States by
the writing of another Englishman, Herbert Spencer. Spencer interpreted Charles Darwin's
writings on evolution in a provocative manner. His ideas, which came to be known as social
Darwinism, applied theories of animal behavior to human behavior. Using Darwin's biological
premise in regard to natural selection and coupling it with an economic argument, Spencer
espoused the idea that those disadvantaged people who were unfit for society should not be
helped; it was the natural order of things for them to help themselves or perish, as in nature.
This, it was felt, would provide another incentive for people to work. Of course, this theory did
not take into consideration those individuals who, for physical or other reasons, were unable to
work. Additionally, this theory did not consider the many individuals who wanted work but for
whom no work was available. In essence, social Darwinism only served to foster an attitude of
indifference toward the poor.
EARLY REFORM MOVEMENTS IN THE UNITED STATES
As the many institutions for the disadvantaged grew in size, workers were needed to supply the
various types of helping services, and the result was to formalize the system of “professional”
helpers. Conditions within institutions were intolerable. The large number of people housed in
small spaces created unbearable overcrowding. Lack of heat in winter, instances of brutality,
inadequate food, and many other examples of inhumane treatment generated a good deal of
concern among private citizens and led to a series of attempts at social reform.
Many of the social reformers of the mid-nineteenth century did not focus their efforts on a single
injustice but instead called for a voice of reason and humane concern in every area of human
welfare. In the late 1800s and early 1900s, the movement toward human welfare made great
advances. In this period of heavy immigration to the United States, many thousands of newly
arrived immigrants found themselves homeless and displaced in their new country. It was during
this time that settlement houses were developed to provide immigrants with the essentials of life
and to help them get a foothold in American society.
The settlement house movement was a reflection of early human services philosophy.
Settlement house workers embraced the view that it was the responsibility of society to help the
poor and disadvantaged. They also advocated a major shift in helping attitudes and human
services thinking toward the belief that many of the problems confronting individuals are created
by environmental circumstances rather than by personal inadequacy. This point of view has
come to be known as the human services perspective. The founders of the movement
expressed the idea that one must work toward improving social conditions. To accomplish this
goal, a system providing for basic human services must be created to facilitate an adequate
quality of life. It was further believed that a truly successful human services system should
provide opportunities for all people to improve their lives and realize their potential.
One notable early settlement house was Hull House, founded in Chicago by Jane Addams. It
was here, many authorities believe, that contemporary social work was born. Using Hull House
as the primary hub of her human services activity, Addams managed to create a small but
comprehensive network of human services in her Chicago neighborhood that included basic
adult education classes, kindergartens, and an employment bureau. In the following years,
many other settlement houses were founded throughout the country. They served as a training
ground for those providing social work services.
The early 1900s in the United States marked the resurgence of another significant human
services movement. Often referred to as the progressive or social justice movement, its aim was
to bring about social change through political action and legislative reform. This movement,
which reflected liberal reform ideas, was embraced by many factions of society, including the
unions. Accepting the earlier idea that the social environment is a major factor in creating
people's problems, the reformers advocated a series of economic reforms including a minimumwage standard, a pension system for older workers, an eight-hour day and a six-day workweek,
as well as laws providing for unemployment insurance and the regulation of child labor. Many
successful changes occurred despite the prevailing conservative outlook. The government
began to assume greater responsibility for the provision of human services. During this period, a
growing number of Americans became aware that a system of human services is integrally
connected to the economic system and the role of the government. A comprehensive system
providing for human services requires the support and interconnectedness of all institutions
within society.
THE DEPRESSION AND WORLD WAR II
The stock market crash of 1929 and the Great Depression dramatically changed the lives of
many Americans. With huge numbers of unemployed workers and a depressed economy, the
need for expansion of human services was evident. With millions of people unemployed, the
relationship between environmental circumstances and human problems could not have been
more clear.
The federal government under the direction of President Franklin Delano Roosevelt established
a series of government aid programs called the New Deal. These programs attempted to make
work available where possible and to provide direct assistance to those people incapable of
work. Examples of such programs were the Works Progress Administration, which provided
jobs; the Civilian Conservation Corps, which provided training; and Aid to Dependent Children,
which provided direct government aid.
In 1935 a major government response to the existing social conditions was embodied in the
Social Security Act. This legislation established a form of social insurance and protection for
individuals against an unpredictable economy. It not only helped alleviate the current social
conditions but was also calculated to aid and protect future generations. Social security
subsequently provided for a wide array of health and social welfare services.
It has happened throughout history that people's attitudes change but are sometimes difficult to
completely erase. There are always those who cling to previous ideas and attitudes for both
good and bad motives, as well as those who advocate change for similarly varied reasons. The
1940s in the United States witnessed a reemergence of the trend toward conservatism. Public
criticism was again heard denouncing the government system of providing for human services
as helping create a form of “welfare state.” Conservatives felt that too much aid would rob
people of the incentive to help themselves. However, as conservatives and liberals debated how
much assistance was beneficial, returning World War II veterans created a further need for a
variety of human services. As indicated in Chapter 1, this clash between conservative and
liberal thinking is still very evident today.
THE 1960S THROUGH THE 1980S
The 1960s were characterized by social unrest in the United States. The Vietnam War was
being waged overseas, and many Americans at home participated in marches and
demonstrations to protest the ills they felt existed within the system. This was a turbulent,
sometimes violent period marked by protests at many college campuses across the country.
Widespread and organized efforts of this kind resulted in an eventual end to the war and
advanced the civil rights movement and the War on Poverty. These latter movements were
successful in bringing national attention to the plight of minorities and the poor. New legislation
was enacted that resulted in the establishment of many programs and services. Although the
civil rights movement and the War on Poverty did create increased economic and educational
opportunities for the disadvantaged, they did not eliminate poverty and discrimination in the
United States.
In the 1970s and 1980s, human welfare services in the United States grew considerably. A
massive number of programs were developed to provide for human services throughout the life
cycle. The need for services of these types still remains great, but debates continue to rage over
which programs are truly helpful and worthy of funding and which should be trimmed from our
federal or state budgets. This controversy over social policy is discussed in more detail in
Chapter 7.
MENTAL HEALTH SERVICES SINCE THE RENAISSANCE
In certain instances, the historical development of our system of mental health services
paralleled the development of our system of human welfare services, as previously described. It
is now apparent that having an adequate food supply, shelter, income, and other necessities of
life has a direct bearing on one's mental health. Of course, contemporary knowledge and
understanding of how environmental factors influence human problems are much better than
they were in the past. Previously, individuals deemed mentally ill faced a grim future with no
meaningful alternatives. The following sections examine the people and events that have helped
shape societal attitudes and treatment of the mentally ill.
EARLY MENTAL ASYLUMS
Early institutions created to house the behaviorally deviant were commonly referred to as
asylums. The word asylum, when used in this context, refers to a place of refuge that provides
protection, shelter, and security. Although many mental patients did view the asylum as a place
of refuge or safety, a good number probably did not. It was society that viewed the asylum as a
form of protection and shelter from those labeled as deviants.
The early public mental institutions in Europe and the United States were located within
communities, and each community was primarily responsible for the governance and
maintenance of its institution. As communities tend to be different from one another, so too did
these institutions differ from one another. No universal guidelines for patient care or procedures
were established among this broad network of community mental institutions, and mistreatment
and abuse frequently occurred.
One noteworthy exception, among others, to the generalized inhumane treatment and lack of
concern toward the mentally ill was the mental hospital established in 1409 in Valencia, Spain.
This is probably the oldest mental hospital still functioning today (Andriola & Cata, 1969). As a
rule, patients were readily discharged after they were deemed able to return to society. Patients
were treated with relative dignity, and a system of voluntary admissions was established. The
example set by this hospital is even more striking when one considers that the Inquisition and
witch-hunting mania were also prevalent during this era.
One of the earliest public asylums and the one most typical in terms of the overall character of
these institutions was St. Mary's of Bethlehem (Bedlam), created in 1547 in England. Although
originally intended to be humanitarian in nature, this institution, as well as others to follow, was
little more than a dungeon in which the behaviorally deviant were locked up and subjected to
cruel, often ghoulish, treatment. Inadequate food, insufficient clothing, filth, infectious disease,
and overcrowding were commonplace. The more difficult patients were subjected to treatments
that consisted of days, weeks, or months spent in mechanical restraints or chained to the walls
and denied food or water. The majority of patients were either intellectually and/or
developmentally disabled, aged, physically ill, or accused or convicted of crimes. Little attention
was given to individual cases, and the patients could just as easily have been sent to a prison or
poorhouse as to a mental institution.
Early mental asylum.
[image]
ERA OF HUMANITARIAN REFORM
Over the next 200 years, similar conditions existed in institutions for the insane in this country,
such as Pennsylvania Hospital founded in 1752 and Williamsburg Hospital founded in 1773
(Bloom, 1977). During the late 1770s and early 1780s, a reform movement began that would
alter significantly, although briefly, the existing conditions in mental institutions. This movement
toward humane treatment of the insane has been referred to as the era of humanitarian reform
and the moral treatment movement. This movement, which had its earliest beginnings in
Europe, had great influence on institutions in the United States in the late eighteenth and early
nineteenth centuries.
Following the French Revolution in 1792, physician Phillipe Pinel became the director of La
Bicêtre, a mental institution in Paris. It was here that Pinel, inspired by the idea that the insane
might be curable, unchained some prisoners and provided adequate food, clothing, and other
necessities of life. Although reform was clearly evident, Pinel and other early reformers still
advocated the use of harsh measures as sometimes-useful tools of treatment. However, the
reforms of Pinel are considered by many to be the first major revolution in mental health care
(Torrey & Miller, 2002).
This reform movement begun in France spread to England. In 1813 the British physician
Samuel Tuke, the director of the York Retreat, initiated a similar series of reforms. In the United
States, other physicians also advocated similar improvements. It was during these early years
of reform that physicians gained most in prestige and prominence in their evolving interest and
later specialization in treating the behaviorally deviant.
Though the early reforms advocated by Pinel, Tuke, and others had an impact on the
institutions of the day, by the middle 1800s in the United States, public awareness and interest
in the plight of the mentally ill had waned. Without such interest, the institutions once again fell
into a period characterized by neglect and widespread mistreatment.
It was in the mid-nineteenth century that Dorothea Dix became a prominent figure in the
evolution of human services. Through her efforts, the earlier reform movement that began in
Europe and temporarily lost impetus in the United States was again revived and gained its
greatest foothold in the United States. Dorothea Dix was instrumental in gathering enough
public support to make greatly needed changes in the inhumane conditions of the asylums, as
well as in prisons and many poverty-related shelters. Following a personal investigation of
asylums and prisons throughout the country, Dix wrote many newspaper articles outlining the
plight of the disadvantaged. She contacted legislators and began a successful lobbying effort to
inform and educate the public concerning conditions within the institutions. As Bloom (1977)
notes,
Before [Dix's] career came to an end, 32 state mental hospitals had been built in the United
States, care of the mentally ill had been removed from the local community, and the
professional orientation toward the insane had been changed from seeing them as no different
from paupers or criminals, to seeing them as sick people in need of hospital care. (p. 11)
The creation of a system of large state psychiatric hospitals to replace predominantly poorly run
smaller community institutions was seen as an improvement in care for the mentally ill.
However, this progress was followed by new problems. Believing the large psychiatric hospital
to be the answer, the public seemed to lose concern for this population. In the following years, a
gradual and steady rise in new admissions to these hospitals once again resulted in
overcrowding, mismanagement, and mistreatment.
During the early 1900s, advocates of the social justice movement, who had been active earlier
in other areas of human welfare, turned their attention to abuses within mental institutions.
Having no desire to dismantle these institutions, they sought rather to change the system of
patient treatment and procedures.
New policies creating individual treatment plans were established. Such individualized plans,
taking into account each patient's personal history, appeared to be a more humane and
responsible way to administer treatment. This policy seemed a step in the right direction, but it
unfortunately created other abuses within the system. Too much arbitrary power and authority
were given over to the professionals and bureaucrats overseeing these systems. Of course,
some patients benefited from more individualized consideration, but generally the large and
unchecked state system often ignored individuals' rights and denied the possibility that the state
could be wrong in certain instances.
FREUD'S INFLUENCE
By the 1920s and 1930s, Sigmund Freud's classic theories concerning human behavior were
well established and widely accepted. Though he endured considerable criticism in the earlier
years of his developing work in response to his emphasis on human sexuality, his later, refined
theories had a major impact on most facets of society. Although Freud did not work directly in
institutions, he had a strong influence on the prevailing treatment approach. His theories were
so widely accepted by the public that the mental institutions of the 1930s adopted his approach
to treatment and became psychoanalytically oriented. His contributions were so influential that
many consider the second mental health revolution to have begun with public acceptance of his
work.
As discussed in Chapter 4, many criticisms of certain aspects of Freud's theories continue
today. One such criticism by those who employ a human services perspective is that Freud's
psychoanalytic theories focus too narrowly on the inner person, excluding the environmental
factors that influence human behavior. Freud's impact, though considerable, did not lead to
significant changes in the institutional system of care for the mentally ill. Steady deterioration in
this system continued. Although there were exceptions, most hospital staffs were generally
overworked, understaffed, and poorly trained. Patients were often neglected, and many
remained in hospitals for years.
TREND TOWARD DEINSTITUTIONALIZATION AND DECENTRALIZATION
In the early 1950s, certain changes began to develop in a number of hospitals as the result of
growth in the field of psychopharmacology. It was now possible through the use of drugs to
effectively reduce a patient's bizarre behavior, thereby affording other opportunities for
treatment. Many patients previously viewed as untreatable were now able to return to the
community while continuing with drug treatments at home. Many controversies surfaced
regarding the alleged widespread misuse or abuse of such drugs. Critics claimed that patients
were controlled by routinely giving them unneeded drugs. Others pointed out that drugs may
cause side effects as bad as the illness being treated.
Deinstitutionalization became a major policy during this time. There was a growing belief that
people could be treated more successfully in familiar community settings. Some felt that
deinstitutionalization was implemented more because of financial concerns than for treatment
reasons. It was felt that it was just too expensive to keep people institutionalized on a round-theclock basis, and treatment was initially thought to be less expensive in community settings.
Another change appearing at this time in the large state hospitals was geographic
decentralization. Initially begun as a change focused on administrative admissions procedures,
this trend was eventually to have a significant effect on the role of mental patients and their
communities. Patients were placed in hospital wards based on their place of residence prior to
admission. They were housed and treated with other patients from their own community rather
than being dispersed throughout the hospital system. Prior to this change, state hospitals
generally remained isolated and removed from the communities they served. Through
geographic decentralization, communities became more aware of the patients residing therein.
Many problems have resurfaced around this issue, as many communities have openly voiced
fear and dissatisfaction at having mental health facilities or programs located within their
borders.
COMMUNITY MENTAL HEALTH MOVEMENT
The 1960s were an important era for the field of mental health. Many professionals have, in fact,
referred to this decade as the third mental health revolution. The changes occurring in this
period marked another significant shift in human services philosophy as characterized primarily
by the community mental health movement.
To appreciate more fully the sweeping changes advocated by the community mental health
movement of the 1960s, one must look at the various issues that prompted this movement. A
growing disenchantment with the traditional large state psychiatric hospital system of the 1950s
was based on the following problems with that system:
The traditional system focused exclusively on the treatment and rehabilitation of existing mental
illness rather than on its prevention.
Many of the state psychiatric hospitals were too far away from the communities in which their
patients resided.
Services were fragmented, with poor coordination between hospital and community agencies.
The traditional system emphasized long-term individual therapy to the exclusion of innovative
clinical strategies, such as outreach programs, crisis hotlines, and family therapies, which might
have helped a greater number of individuals.
Nontraditional sources of personnel, such as generalist human services workers, were not being
used despite a growing worker shortage.
The Joint Commission on Mental Illness and Health (1961, p. 2) evidenced the thrust of the
community mental health movement as it recommended that the objective of modern treatment
should be the following:
To save patients from the debilitating effects of institutionalization as much as possible
If patients require hospitalization, to return them to home and community life as soon as
possible
Thereafter, to maintain them in the community as long as possible
In 1963 the Community Mental Health Act was signed into law. This legislation reflected a
growing philosophy that mental health services should be located in the community, with the
government allocating funds for the creation of these comprehensive community mental health
centers. Chapter 2 examines the specific services offered by these centers.
Deinstitutionalization was encouraged, resulting in a major shift of mental patients away from
the large mental hospitals to these community mental health centers.
The community mental health movement has its advocates and its opponents. Some assert that
although the number of patients in the large institutions has decreased and the average length
of stay has been reduced considerably, the tendency to readmit patients to the institutions over
and over has correspondingly grown (Wahler, 1971). Other watchful observers of the movement
have pointed to instances in which patients have been placed in community settings without
adequate supervision. Opponents of the movement indicate that the initial community centers
often resembled the traditional hospital organization. The difficulty of developing new mental
health services grew out of a situation in which the workers were already socialized and
accustomed to the old hospital system (Feldman, 2003).
Advocates of the movement point to the healing power of the community and the need to
normalize the method of treatment as much as possible. If the goal of treatment is eventually to
return the patient to a functioning life in the community, the community must be an integral part
of the treatment.
ADVENT OF GENERALIST HUMAN SERVICES WORKERS
Another important development in the 1960s was the formal recognition of the role of generalist
human services workers as reflected in the new careers movement. The title of generalist
human services worker, most recognized and used today, was originally the paraprofessional
worker in the 1960s. In addition, several other titles were popular during this period, including
lay therapist and new professional. The 1964 Economic Opportunity Act and the Schneuer
Subprofessional Career Act of 1966 provided the impetus and the government funds to recruit
and train entrylevel workers for a range of positions within the human services field. These
related pieces of legislation, coupled with other antipoverty amendments, created approximately
150,000 jobs for generalist human services workers (Reissman, 1967).
The rapid growth of the paraprofessional movement arose from a perceived worker shortage as
the new community health centers sought initially to use personnel in more innovative ways.
Albee (1960) pointed out the critical shortage of trained mental health professionals. He
predicted an even greater shortage in the future and advocated the creation of a new kind of
generalist mental health worker who could be educationally prepared in a shorter period of time.
Through the creation of two- and four-year training programs based in colleges, it was believed
that aspiring workers could receive enough broad-based education and general human services
skills to function on a generalist level alongside the more highly trained professionals.
| REAL LIFE HUMAN SERVICES WORK
The colorful history of the human services agency I've worked with for over ten years is attached
to a famous event in America's history. There was a festival in 1969, and this festival was called
“Woodstock” although the site was more than an hour west of the sleepy little town with the
actual name. Regardless, the town became instantly famous, and with this fame came buses
and carloads of America's youth, searching for a utopian existence and escaping the confines of
the world they were living in. Unfortunately, the once quiet little town of Woodstock was
becoming overwhelmed with young people sleeping on benches in the town's well known
“green,” people hitchhiking in and out of the town, camping in parking lots, and seeking out food
and clothing. One member of the town—Gail Varsi—recognized that there was a problem. Ms.
Varsi opened her home and her phone line to these people; the famous Family of Woodstock
Hotline still maintains the same number that was Ms. Varsi's home telephone number in 1969.
With the help of local businesses, clergy and residents, she organized food drives, clothing
exchanges, and often transportation back to where many of these young people came from.
These are the roots of Family of Woodstock, Incorporated. Today, the agency services all of
Ulster County, running programs such as the only domestic violence shelter in the county, a
teen runaway shelter, several homeless shelters, several walk-in centers (still maintaining a
“free store” and a food pantry) and case management services for adults and adolescents.
Family of Woodstock, Inc., was born when a community need was recognized and addressed;
continuing in this line of thinking was the reasoning for the MidWay Program.
There is a clear age of adulthood, and many of the young people the agency was working with,
although adults at the age of 18, were unable to live independently and did not possess the
skills necessary to maintain a manageable lifestyle. The agency was confronted with young
people who were not technically “runaways” in the classic sense, but were homeless due to
many circumstances; some were victims of domestic violence and sexual assault in their
homes, some had parents who were unable to care for them because of financial restraints,
substance abuse issues, [or] incarceration, and some just wound up with nowhere to go. Many
fell through cracks that were not as prevalent before the early 90's when divorce became
common place, opening the door for this new concept of the “blended family” and many of these
kids became unwanted as younger children took their place in the new family structure. These
kids were the basis for MidWay.
I am the director of “the Midway Program.” I oversee two houses, one in Ellenville, New York,
and one 28 miles away in Kingston, New York. The Kingston House was the site for the original
MidWay. Family of Woodstock, Inc. owns the house where the program stands in a small
residential neighborhood, close to the center of the small city. The Ellenville site exists in the
small, rural village of Ellenville, also in a quiet residential neighborhood. Both sites are home to
6 adolescents, ranging in age from 16–20. The program is co-ed, and can manage 3 parenting
teens in each program. The length of stay in the program is 18 months, or up to 24 months if the
participant enters the program at age 16 in order to allow them to complete high school while in
the program. Participants in the program are offered their own room, furnished and complete
with cable television; they share a kitchen, two bathrooms, and a common area with one
another. There is a staff member in the program 24 hours a day. From 9 to 5 there is a case
manager, available for consultation, transportation, assistance with appointments and referrals.
There is a Life Skills Manager from 4:30 to 9:30, available for assistance with imperative daily
living skills, like budgeting, laundry, grocery shopping, and other skills such as communication
and relationship building. There is also an overnight shift, [starting at] 9:00 in the evening, [and]
ending the following morning. Although there is only one staff member on at a time, there is
what is referred to as a “cross over,” where the staff leaving the program provide the staff
coming on shift with a summary of the events taking place on the previous shift.
As the director of the program, I conduct interviews with the referrals the program received from
sources including probation, hospital social workers, school guidance counselors and social
workers, and other shelters in the area such as domestic violence shelters. The clients I
interview for the program are frequently dealing with issues such as substance abuse or mental
illness, and often a combination of the two. The clients accepted into the program are referred to
local service providers for mental health and substance abuse counseling. Although the clients
the program serves are high need and may not be able to live independently, the MidWay
Program can maintain these clients with the appropriate support and care from other service
providers.
On a daily basis, I communicate primarily with the case managers of the two programs,
receiving updates on the status of the resident[s]. There is a behavioral modification system
used in the program; the residents are on different levels based on their accomplishments and
behavior. The residents sign and receive a contract when they enter the program. Their status is
tracked and discussed in a bi-weekly case conference where all of the staff of the program, the
program director, and a mental health consultant meet to communicate the events of the
program from the previous week. When a resident of the program is doing poorly, [he or she]
schedule[s] a meeting with the program director to decide whether or not [he or she] will remain
in the program.
The residents are expected to maintain their house; they have evening chores, checked nightly
by the two residential counselors of the program. In addition, they are responsible for the
condition of their rooms. They are assisted in grocery shopping, but cook their own meals, often
together because [of] the “home-like” environment the program strives to create.
The residents also create schedule[s], crafted for every individual with [his or her] specific needs
in mind with the help of the case manager. We develop schedules to occupy approximately forty
hours a week of the residents' time; the schedule contains work, school (sometimes college,
high school, or a GED course), substance abuse and mental health treatment, or any
combination of these. As the director of the program I oversee and approve these schedules. I
also meet with the kids regularly to discuss their experiences and feelings about the program; I
have a background in direct care, so this is one of the most rewarding parts of my job. I discuss
their status in the program and if a resident is not doing well in the program, I discuss the
potential of [his or her] being asked to leave the program; [he or she] may be asked to write
what is referred to as an appeal letter to explain why there should be another chance for [him or
her] to remain in the program. We like to run the program with the assumption that the staff and
the program [are] performing the roles that parents would take in a healthy family atmosphere;
we think of the program as an opportunity for the residents to experience a healthy and
supportive family environment.
Kimmer Gifford, MSW
Many of the basic tasks previously performed by psychologists, psychiatrists, or social
workers—such as intake interviewing and setting fee schedules—could be delegated to the
generalist human services worker, thus freeing the professional to focus selectively on more
advanced clinical aspects of treatment and diagnosis that often required more extensive
graduate preparation.
Although no single description would adequately encompass the diversity of roles among
generalist human services workers, there is agreement on the following important common
characteristics of the generalist:
Working directly with clients or families (in consultation with other professionals) to provide a
variety of services
Ability to work in a variety of settings that provide human services
Ability to work with all of the various professions in the field, rather than affiliating with any one
of the professions
Familiarity with a variety of therapeutic services and techniques, rather than specializing in one
Some of the more common work activities of generalist human services workers include, but
certainly are not limited to, the following:
Helping clients in their own environments with various services
Helping people get to existing services (as in simplifying bureaucratic regulations and acting as
client advocate)
Acting as assistants to various specialists (e.g., psychiatrists, psychologists, nurses)
Carrying out activities for agencies and programs, such as budgeting, purchasing, and
personnel matters
Gathering information and organizing and analyzing data
Providing direct care for clients who need ongoing services
Working with various community groups to create needed programs and develop resources
Since the 1960s, new and expanded roles have been created for generalist human services
workers. The role of the generalist human services worker, once narrowly defined as merely
custodial in nature, had grown by the 1970s to include a wide range of therapeutic activities. As
Minuchin (1969) noted, the paraprofessional movement initiated a reexamination of professional
roles and tasks, which resulted in a renewed interest in environmental factors as opposed to the
intrapsychic view of maladaptive behavior. As a result, the human services field of the 1970s
through today emphasizes the use of generalist human services workers in roles reflecting the
importance of a patient's social and environmental needs.
Chapter 6 provides a closer examination of the diverse functions and roles of generalist human
services workers. Table 3.1 lists changes in the mental health movement through history.
FUTURE TRENDS
The many tasks and problems facing our human services system today are similar to those
faced previously. Poverty, unemployment, and mental illness, among other problems, still exist.
What is different, however, is that new methods and approaches are needed to deal with them
in our highly complex and technological society. The rate of change is so rapid and the changes
so complex today that new levels of stress, anxiety, and insecurity have been created for many.
TABLE 3.1 | HIGHLIGHTS AND LEGISLATION IN THE MENTAL HEALTH MOVEMENT
800–1300s
Church becomes major provider of services to the mentally ill.
1409 Oldestmental hospital still functioning today is established in Valencia, Spain.
1752 Pennsylvania Hospital for the Mentally Ill is founded.
1792 Phillipe Pinel, director of a French mental institution, believes the insane might be
curable and initiates reforms.
1800s Dorothea Dix and other social reformers help to establish the state psychiatric hospital
system in the United States. National Society for Mental Illness (Hygiene) is established to study
the care of the insane.
1920–1930s Freud's theories concerning human behavior gain widespread acceptance.
1935 Aid to Families with Dependent Children and Social Security Act.
1937 First International Committee for Mental Hygiene is formed. Hill-Burton Act provides
funds for building psychiatric hospital units.
1946 National Mental Health Act establishes federal funds to develop training programs for
mental health professionals.
1948 World Federation for Mental Health is formed.
1950s Major advances are made in the field of psychopharmacology.
1955 Congress creates Joint Commission on Mental Illness and Health. This committee
evaluates the needs of the mentally ill and seeks to make resources available.
1961 World Psychiatric Association is formed.
1963 Mental Retardation Facilities and Community Mental Health Centers Construction Act is
passed. Trend begins toward community care for the mentally ill and decentralization of the
mental health system.
1964 Economic Opportunity Act is passed. Passage of Schneuer Subprofessional Career Act
gives impetus and funds to recruit generalists for training in human services and mental health
field.
1967 Federal government provides money for the staffing of mental health centers.
1968 Community Mental Health Centers Act provides for comprehensive services for the
mentally ill.
1970 Comprehensive Alcohol Abuse and Alcohol Prevention, Treatment, and Rehabilitation
Act is passed.
1973 Rehabilitation Act provides access to vocational rehabilitation services for adults.
1974 Juvenile Justice and Delinquency Prevention Act is passed.
1975 Education for All Handicapped Children Act and Individuals with Disabilities Education
Act ensure right to education in least restrictive environment.
1979 Mental Health Systems Act establishes bill of rights for the mentally ill and the right to
refuse medication.
1984 Office of Prevention is established within the National Institute of Mental Health.
1986 Protection and Advocacy for Mentally Ill Individuals Act is passed.
1987 McKinney Act is created for job training, child care, and literacy programs for poor and
homeless.
1990 Americans with Disabilities Act is signed into law. It prohibits discrimination against
people with disabilities.
1996 The Personal Responsibility and Work Opportunity Reconciliation Act replaces Aid to
Families with Dependent Children.
2005 The Deficit Reduction Act requires states to engage more TANF cases in productive
work activities leading to self-sufficiency.
2009 American Recovery and Reinvestment Act provides increased funds for Medicaid, food
stamps, health care, and increased unemployment benefits and TANF (public assistance)
funding.
© Cengage Learning
Along with the trend toward increasing specialization, more and more people find that their
previously acquired skills are rapidly becoming obsolete. Although scientific achievements have
increased our life span, war, terrorism, economic upheavals, the AIDS epidemic, the massive
drug problem, and other troubles have given rise to widespread concerns about what type of
future awaits us and our children.
In an effort to keep pace with a changing society, the human services system must also change
and grow. For example, agencies must develop new sources of funding, such as grants from
government, foundations, and other private groups. In addition, more agencies are reaching out
to attract volunteers to help maintain various programs and services. As indicated in Chapter 7,
the shortage of funds has become an increasingly significant issue in the early 2000s and will
continue to be an issue in the future. And as our earlier discussion in Chapter 1 indicated, the
movement toward privatization of service agencies is yet another continuing trend.
Over the past 50 years, with the change from hospital care to community care for the mentally
ill, there has been a dramatic increase in the use of paraprofessionals or generalist workers in
the human services field. At present, they are the single largest group delivering direct care to
the mentally ill. One of the more recent trends, likely to continue for quite some time, is the
establishment of bachelor's degree, master's degree, and doctoral degree programs in human
services. Many programs formerly titled “mental health technology” or “mental health assistant”
have been changing to adopt the more generic title of “human services.”
New trends in the licensing of human services professionals are appearing throughout this
country. A number of state governments have passed legislation (and some are currently in the
process of doing so) that benefits individuals whose education and/or professional training did
not meet that state's requirements for licensure in any of the mental health fields discussed
earlier in this chapter. This new legislation expands the number of professional titles under
which mental health workers may work. In New York State, for example, the title of “mental
health professional” was created. Individuals who met the specific requirements for any of the
four areas within this title (i.e., Creative Arts Therapy, Marriage and Family Therapy, Mental
Health Counseling, and Psychoanalysis) began their professional careers as licensed
practitioners in 2005. To obtain one of these licenses, the applicant must possess a minimum of
a 45-credit master's degree and between 1,500 and 3,000 hours of supervised counseling
experience, depending on the specific license (New York State Education Department, 2005a–
d). In the first year of their existence, Mental Health Professional licenses were granted to 462
individuals in New York State (New York State Education Department, 2006).
Current population trends indicate an increase in immigration into the United States. U.S.
Census figures predict that sometime between the years 2030 and 2050, racial and ethnic
minorities will become the majority population (Sue, 1996). Our human services system will be
hard-pressed to meet the needs of this culturally diverse population, many of whom will possess
little or no formal education and will find no immediate job opportunities. The great diversity in
cultural backgrounds has already initiated many changes in the provisions of services and has
caused a reexamination of the role of Western and non-Western helping strategies. Multicultural
programs and ethnic sensitivity training are already a part of our current training system, and
they are likely to continue on a larger, more formalized scale in the future. It will be increasingly
important to have (a) knowledge of other cultures, (b) the skills necessary to work with diverse
populations, and (c) the proper attitudes when working with individuals of varying cultural
backgrounds (Neukrug, 2008). Chapter 5 examines the various issues of multicultural
awareness in further detail.
Another important demographic trend is what many gerontologists refer to as “the graying of
America.” This refers to the growing number of people 65 years of age and older. More than
15% of the population is currently over 65 years of age and estimates indicate that by the year
2040, more than 25% of the population will be in that category (Landau, 2010). To understand
this trend more clearly, consider that there are currently more people living in the United States
over the age of 65 than the total population of Canada. The growth of the aged population
indicates an increasing need to provide specialized services to meet the physical and emotional
needs of later life. Programs for senior citizens can include day treatment programs within
community mental health centers, programs housed in senior care retirement settings, longterm care facilities such as nursing homes, or a variety of other services offered through senior
centers throughout the country.
It is clear that as people live longer, quality of life issues will receive more attention. Thus, the
growing emphasis on community-based services will continue. Moreover, an increased focus on
prevention and wellness, rather than on illness and treatment, will occur. The rise in the senior
citizen population will create an increased need for more people trained to provide service to
them. An increasing number of undergraduate and graduate programs are offering specialized
gerontological coursework and internship training opportunities working with the senior citizen
population.
Advances in computer technology have changed our society. Such technology has affected the
delivery of human services as well. Human services agencies are turning to technology to help
them provide better quality care in a more cost-effective manner. These new technologies have
altered the very nature of communication within the field. There is an increasing reliance on
electronic mail (e-mail) for immediate discussions and consultations with colleagues in other
work-related activities. The Internet serves as an invaluable resource to quickly obtain
information or conduct research to aid in planning and implementing programs to help those in
need. For example, we are witnessing the growth of online counseling, in which people can
receive immediate assistance within the privacy of their home.
Computer technology continues to transform information management as all intake interviews,
billing, assessment results, treatment, planning, and other client record keeping can be
coordinated, stored, and transmitted almost instantaneously.
Software programs are now being used for the training of human services professionals.
Interactive videos, CD-ROMs, and other interactive multimedia tools can provide specific
training in a variety of topics. In addition, software programs are emerging for use with clients.
These tools are designed to help clients gain knowledge and skills in areas such as parenting,
adult daily living skills, vocational skills, or substance awareness and prevention strategies. Very
clearly, the need for trained human services personnel with computer technology skills is
growing.
Another very important trend within the field is an increasing emphasis on advocacy and on the
need for human services workers to develop competency in the use of advocacy. Advocacy, as
we know, occurs on many levels. One can represent a client within an agency in an attempt to
gain additional services for the client; represent an agency within the political system to fight for
increased funding of social service programs; or lobby for new state or national legislation to
benefit an underserved population or group, such as the poor or homeless. As Chapter 5
examines more closely, advocacy work is becoming increasingly vital to this field.
As the human services profession continues to evolve and expand, the need to ensure minimal
levels of competency will increase. The National Organization for Human Services and the
Council for Standards in Human Service Education are two organizations, among others,
working toward this and other goals. Competency guidelines now exist, as do ethical standards
of practice, skills standards, and training-program standards.
Historically, human services have been focused on client populations in need of basic services
such as food, shelter, or financial support. As discussed earlier, the scope of human services
has in recent decades expanded beyond the goal of providing basic services. Another trend
likely to continue well into the future finds human services programs expanding into corporate
America. Employers have recognized that workers who have fewer psychological problems are
more likely to be effective and productive workers. Industry has encouraged its workers to seek
help, and many large corporations have responded by creating employee assistance programs.
A variety of services are available to employees, including drug and alcohol abuse counseling,
marital counseling, stress management, and many other types of personal intervention
strategies requiring trained human services personnel. Human services workers will find
increased employment opportunities within this sector.
As the managed-care approach continues to dominate the delivery of human services in
America, the already expanded role of case management will likely increase. More and more
human services workers will find themselves functioning as case managers within this diverse
service system. The devastating aftermath of natural disasters over the past several years,
along with the omnipresent threat of terrorism, have heightened the need for greater
preparedness. The federal government, as well as many local governments and relief
organizations, has created larger, more comprehensive disaster response services. These
services focus on both the physical needs of those most affected and the emotional side effects.
As a result, there will likely be an expanded role and need for specially trained human services
personnel to function as members of these response teams throughout the country.
ADDITIONAL READING
Gerson, K. (2010). The unfinished revolution: Coming of age in an era of gender, work, and
family. New York: Oxford Press.
Harris, H. S., & Maloney, D. C. (Eds.). (1996). Human services: Contemporary issues and
trends. Boston: Allyn & Bacon.
Iglehart, A. P., & Becerra, R. M. (1995). Social services and the ethnic community. Boston: Allyn
& Bacon.
Mandell, B. R., & Schram, B. (2012). An introduction to human services: Policy and practice (8th
ed.). Boston: Pearson.
Neukrug, E. (2004). Theory, practice and trends in human services: An introduction. Pacific
Grove, CA: Thomson Brooks/Cole.
New York State Education Department, Office of the Professions. (2005a). Creative arts therapy
license requirements. Retrieved February 12, 2006, from
h-t-t-p-:-/-/-w-w-w-.-o-p-.-n-y-s-e-d-.-g-o-v-/-c-a-t-l-i-c-.-h-t-m-.
New York State Education Department, Office of the Professions. (2005b). Marriage and family
therapy license requirements. Retrieved February 12, 2006, from
h-t-t-p-:-/-/-w-w-w-.-o-p-.-n-y-s-e-d-.-g-o-v-/-m-f-t-l-i-c-.-h-t-m-.
New York State Education Department, Office of the Professions. (2005c). Mental health
counseling license requirements. Retrieved February 12, 2006, from
h-t-t-p-:-/-/-w-w-w-.-o-p-.-n-y-s-e-d-.-g-o-v-/-m-h-c-l-i-c-.-h-t-m-.
New York State Education Department, Office of the Professions. (2005d). Psychoanalysis
license requirements. Retrieved February 12, 2006, from
h-t-t-p-:-/-/-w-w-w-.-o-p-.-n-y-s-e-d-.-g-o-v-/-p-s-y-a-n-l-l-i-c-.-h-t-m-.
New York State Education Department, Office of the Professions. (2006). License statistics.
Retrieved February 12, 2006, from
h-t-t-p-:-/-/-w-w-w-.-o-p-.-n-y-s-e-d-.-g-o-v-/-m-h-p-c-o-u-n-t-s-.-h-t-m-.
Sheehy, G. (1995). New passages: Mapping your life across time. New York: Ballantine.
Ward, M. J. (1946). The snake pit. New York: Random House.
Woodside, M., & McClam, T. (2011). An introduction to human services (7th ed.). Pacific Grove,
CA: Brooks/Cole.
REFERENCES
Albee, G. W. (1960). The manpower crisis in mental health. American Journal of Public Health,
50, 1895–1900.
Andriola, J., & Cata, G. (1969). The oldest mental health hospital in the world. Hospital and
Community Psychiatry, 20, 42–43.
Bloom, B. L. (1977). Community mental health: A general introduction. Pacific Grove, CA:
Brooks/Cole.
Ciccarelli, S. K., & White, J. N. (2013). Psychology: An exploration (2nd ed.). Boston: Pearson.
Comer, R. J. (2010). Abnormal psychology (7th ed.). New York: Worth Publishers.
Feldman, S. (2003). Reflections on the 40th anniversary of the U.S. Community Mental Health
Centers Act. Australian and New Zealand Journal of Psychiatry, 3, 662–667.
Grob, G. (1994). The mad among us: A history of the care of America's mentally ill. New York:
Free Press.
Hollingshead, G. (2004). Bedlam. New York: HarperCollins.
Joint Commission on Mental Illness and Health. (1961). Action for mental health. New York:
Basic Books.
Landau, M. D. (2010, October). Baby boomers' next Act. U.S. News and World Report, 147(9),
12.
Minuchin, S. (1969). The paraprofessional and the use of confrontation in the mental health
field. American Journal of Orthopsychiatry, 34, 722–729.
Neukrug, E. (2008). Theory, practice, and trends in human services (4th ed). Pacific Grove, CA:
Thomson Brooks/Cole.
Perry, J. A., & Perry, E. K. (1988). The social web (5th ed.). New York: Harper & Row.
Porter, R. (2002). Madness: A brief history. New York: Oxford University Press.
Reissman, F. (1967). Strategies and suggestions for training paraprofessionals. Community
Mental Health Journal, 3, 103–110.
Rimm, D. C., & Somerville, J. W. (1977). Abnormal psychology. New York: Academic Press.
Sue, D. W. (1996). The challenge of multiculturalism: The road less traveled. American
Counselor, 1(1), 6–14.
Torrey, E. F., & Miller, J. (2002). The invisible plague: The rise of Mental Illness from 1750 to
present. New Jersey: Rutgers University Press.
U.S. Department of Labor, Bureau of Labor Statistics. (1999, March 20). Occupational outlook.
Retrieved from:
h-t-t-p-:-/-/-w-w-w-.-s-t-a-t-s-.-b-l-s-.-g-o-v-/-o-c-o-/-o-c-o-s-0-.-5-9-.-h-t-m-#-o-u-t-l-o-o-k-.
Wahler, H. J. (1971). What is life all about, or who all needs paraprofessionals? Clinical
Psychologist, 24(3), 11–14.
Purchase answer to see full
attachment