The AMA’s 1930 Survey of Mental Hospitals

The Association of Medical Superintendents of American Institutions for the Insane, established in 1844 and later renamed APA, and the AMA, organized in 1847, have maintained a close relationship through the years. A merger of the two organizations was even discussed, but the superintendents declined such a proposal in 1871.

At its annual meeting in Detroit in 1930, the AMA’s Section on Nervous and Mental Diseases made a motion that its Board of Trustees appoint a committee “to investigate problems affecting the medical profession in mental hospitals.” Among the section members were Drs. William Menninger, Leo Bartemeier, Douglas Singer, Francis Gerty (all four were elected to the APA presidency), Walter Freeman, Harry S. Sullivan, and Franklin Ebaugh. An editorial in the Journal of the American Medical Association in October 1930 emphasized the need for such an investigation.

The AMA board appropriated $20,000 for a two-year study and appointed John Grimes, M.D., to head the committee. Grimes, who was not a psychiatrist, had done previous work for the AMA. Dr. Grimes recruited three physicians and a statistician to assist in the work. A questionnaire was sent to 631 mental hospitals, and 75 percent responded. The next step was to visit 600 hospitals, and Dr. Grimes visited 40 percent of the hospitals himself. The hospital visits exposed the dire conditions in the mental hospitals, especially the public hospitals, including overcrowding, understaffing, rampant inappropriate political influence in some places, and lack of treatment for patients. Dr. Grimes described a dismal picture of patients in rockers in bare dormitories “rocking slowly hour by hour, every week, every year until death.” The private and Veterans Administration hospitals received more favorable reports.

As the two-year study drew to a close, Dr. Grimes prepared a 121-page report. The AMA did not approve his report, however, and instead sent a 10-page statistical report to some AMA delegates. Dr. Grimes was both distressed and outraged by the suppression of his report and in 1934 published, at his own expense, a book setting forth his findings and recommendations for improving conditions at the hospitals.

APA was aware of the AMA survey. At the annual meeting in 1932, the APA Board of Trustees voted to withhold official cooperation and participation in the AMA study until officially requested to do so and then only on terms that APA might set as conditions of participation.

During this period, the APA Committee on Medical Services and the Committee on Standards and Policies were attempting to gather data on the mental hospitals, but no funds were available. Finally in 1936, the Rockefeller Foundation and later the U.S. Public Health Service made grants to the National Committee for Mental Hygiene, which formed a committee that included APA, the American Neurological Association, the AMA, the U.S. Public Health Service, and the American Board of Psychiatry and Neurology.

Samuel Hamilton, M.D., later an APA president, headed the survey. His 1939 report lists 226 hospitals visited by 17 psychiatrists at the request of state governors or other officials. The report helped lead to the development of a list of hospital standards that were approved by APA in 1946. ▪