Mayfield FarmPetersburg Virginia

1870

Archival [19th & 20th century] documents on African American admissions, treatment, and outcomes in segregated state mental institutions is at risk of deterioration, destruction, and loss. This project seeks to (1) develop a prototype of a comprehensive digital library; (2) preserve documents; (3) allow public access to high resolution historical documents; but (4) restrict access to patient level data to hospital staff consistent with HIPAA and other state regulations;

(5) use longitudinal research data from historical documents to identify implications for resolving extant disparities by race, ethnicity, & language.

1. A disproportionately large number of public consumers are people of color

2. Disparities in mental health care are long term 3. There are minimal differences in the frequency of

mental illness by race, ethnicity or culture 4. Key differences in access, availability, and use of

mental health services by race, ethnicity, and culture 5. Race, ethnicity, and cultural factors have a long &

distorted history in the mental health field

Measurable, not assumed, differences between two or more objects, groups, people, or an absence of parity or equality between them. Unlike health disparities, mental health disparities are mainly in service patterns [access, diagnosis]rather than rates of morbidity.

Disparities tend to follow a complex train of events

King Davis, 2009

Family/CommunityHelp Seeking

StigmaReligious BasedFamily Burden(?)Vol. Participation

Myth & FearCultural BeliefsDiscriminationMH Literacy

History/Memory

Provider SystemWorkforce Diversity

FragmentationEthics/IRB Issues

CommitmentResources/Costs

Availability/AccessLocation/HoursService Design

EBPs/PBEsCourts/Police

Knowledge BaseConceptualization

Problem FormulationTheory/HypothesesResearch Methods

Sampling BiasCommunity Involvement

Public Policy ImpactUniversity Education

Media Portrayals/StigmaCultural Competence

Comparative Outcomes

Davis 2009; IOM 2005; HHS 2001

Access to Service Disproportionate Admissions Disproportionate Diagnosis of SMI Disproportionate Involuntary Commitments Longer Length of Stay Higher Recidivism Rates Higher Rate of Homelessness Excess Mortality Rates -

King Davis, 2009

Summary of Findings of Admissions to the Public Mental Hospitals in Virginia 1990-1999

Group Group’s Percent of Total Virginia

Pop.

Hospital Admissions

Percentage of Total

AdmissionsSelected Findings Selected Findings Selected Findings Selected Findings

European Americans

American Indians

Asian Americans

African Americans

Latino Americans

76.19

.24

2.53

18.49

2.55

68,653

135

579

37,872

811

63.54*

.12*

.54*

35.05*

.75*

2010 - 2012

I. Indexing & Assessment of the Collection II. Digitization of the Collection III. Create Digital Library – Two Types of Access IV. Ethnographic Study of Families - Cases V. Compare and contrast archival data with

current systems data VI. Publications VI. Explore Interest in Other States VIII. End of Project Symposium

Collaborators Petersburg Public Library State Library of Virginia Dinwiddie County Historical Society Central State Hospital Virginia State University University of Virginia Virginia Commonwealth University North Carolina Central University The Cameron Foundation National Endowment for the Humanities NASMHPD – SAMHSA The Crawley Company – Fredericksburg Maryland Howard University Boston University University of Kansas Medical School

Staffing King Davis, Ph.D., - UT Pat Galloway, Ph.D., Archivist - UT Gary Geisler, Ph.D., Digital Library Design - UT Celeste Henery, Ph.D., Anthropologist - UT Lorraine Dong, ABD, Archivist - UT Unmil Karadkar, Ph.D., Digital Design - UT Allen Lewis, Ph.D., Data Analysis - VCU Ning Zhang, MD, Ph.D., Statistical Analysis -UCF

Virginia House of Burgesses

How can we manage the mentally ill?

1760

ViolenceCrimeHomelessnessIncreased CostPublic Fear & OutrageRace, Gender, ClassSubstance UseFamily ResponsibilityCommunity ResponsibilityEconomic ImpactIdleness_______________InstitutionalizationSegregation Policy

Public InstitutionalizationSegregated by Gender – Male Only

Segregated by Income/Class – Wealthy OnlySegregated by Race and Slave Status – Free Whites

OnlyAsylum as Treatment

Control of Dangerousness

Immunity Hypothesis 1763-1864 Exaggerated Risk Hypothesis -1865-1965 No-difference Hypothesis 1966-2000 _____________________

Public policy is driven by the prevailing hypotheses that link risk of mental illness to perceptions of race, ethnicity, language, and culture.

New mental illnesses were coined that applied only to African Americans in southern states who sought to escape slavery, segregation, and Jim Crow.

Drapetomania – runaway syndrome Dysaesthesia Aethiopica –rascality/irresponsibility

Cartwright, 1851

Historical Research Hypotheses byAuthor and Chronological Period

ImmunityHypothesis1765- 1864

Exaggerated RiskHypothesis1865 – 1968

Null Hypothesis1969 - 2010

Future

Cartwright (1851)Galt (1840)Jarvis (1842)Jarvis (1844)Smith (1851)Va. Assembly1846Va. Assembly (1848) Va. Assembly (1853)Va. Assembly(1870)Va. Assembly(1882)

Andrews (1887); Babcock (1895); Bean (1906); Bevis (1921) Brody (1966); Carothers (1947)Conrad (1871); Crawford (1960)Denton (1960); Deutsch (1944Drewry (1916); Evarts (1914)Faris (1939); Fischer (1943)Focault (1965); Goffman (1961)Green(1914); Greenblatt (1955)Grossack (1963); Hansen (1959)Hollingshead(1958); Hurd (1916)Ivins(1950); Jaco (1960)Kardineer (1962); Keeler (1963)Kleiner (1959); Lewis (1931)Malzberg (1953); McClean (1914)(1944O’Malley); Pasamanick (1959)Parker (1966); Postell (1951)Reissman (1964); Ripley (1947)Schermerhorn(1956); Srole (1962)St. Clair (1951); US Census (1888)Williams (1949); Witner (1891)

Adebimpe (1981); Allen (1982)Alvarez (1976); Autunes (1974)Baker (1999); Bell (1980)Broman (1987) Brown (1990)Carter Com (1978); Collins (1980)Fabrega (1988); Fischer (1969)Flaskerud (1992); Gary (1978)Grob (1994); Gould (1981)Gullattee (1972); Jackson (1976)Jackson (1992); Jones (1982)Kessler (1994); Kramer (1980)Lawson (1994); Lindsey (1989)Manderscheid(1985); McCandless (1996); McCulloch (1995)Milstein (1995); Mollica (1980)Neighbors (1987); Poussaint (1998)Rack (1982); Ramm (1989)Regier (1993); Robins (1991)Rothman(1970); Ruiz (1990)Simon (1973); Snowden (1990)Thomas (1972); Warheit (1998)Wexberg (1998); Williams (1986)Willie (1973)

Bernal (2007)Brown (2007)Davis (20007)IOM(2007)Jackson (2007)Kessler (2007)Lawson (2007)Lopez (2007)Lu (2007)Miranda (2007)Neighbors (2007)Snowden (2007)Wang (2007)Whaley (2007)WHO (2007)Williams (2007)Zane (2007)

When the civil war was near its end, the Freedman’s Bureau required that Virginia develop a mental institution that would offer segregated services to former slaves. This hospital operated in Petersburg Virginia from 1868 to 1968 as the first such institution in the U.S. exclusively for Africans in America.

Vintage Psychiatry Books – 222 [85,912 pp] Bound Annual Reports 1870 – 1970 [5,000 pp] Patient Registers 35 [8,000 pp] Photographs [36,000] Board Minutes 1870 – 1970 Legislative Acts 1763 – 1968 Virginia State University CSH Archives– Gilfield Baptist Church Records–Patient Treatment Records –Commitment Papers – State Library of Virginia Correspondence -

Images: 1890s-1980s Official photographs by staff photographers

Includes wide photos Snapshots

Includes Polaroids Negatives Contact sheets Displays

Includes posters & mounted photos

Manuscripts (1880s-1960s) Admission registry books Board minutes

And another type

Medical/Patient- Admission registries- Applications registries- Ward books- Death records- Micro-film [254]

• Different admission registries have different categories

One type of registry

• LOTS of patient information• Handwritten materials – future transcription project?

Monographs (1890s-1950s) Some annual reports

Pamphlets

Need to humidify and flatten some photos before scanning; also, mold cleanup – UVA?

Institutional Board of directors

meeting minutes Deeds Annual reports Newspaper clippings Promotional:

newsletters, photos

1. Digital library accessible via internet 2. Ongoing server housed at Library of Virginia 3. Permanent repository for the original documents 4. Archival model for state hospital documents 5. Research findings comparing segregated vs.

integrated care 6. Symposium that focuses on software, digital library

construction, cross tabulations, classification 7. Publications 8. Number of doctoral graduates with archival interest

and experience

450,000 Admissions Integrated Era 1968-2008

150,000 AdmissionsSegregated Era 1863-1968

Comparative Data 1868 - 20081. Longitudinal Study of Admissions- (Comprehensive) Descriptive/frequency distribution2. Differences in Admissions by Race, Involuntary Status & Diagnosis3. Re-admissions by Race, Gender & Diagnosis4. Re-admissions by county and city characteristics5. Admissions by family structure and marital status6. Admissions by income7. Admissions by gender8. Re-admissions by gender9. Re-admissions by medications10. Re-admissions by Medicaid receip11. Admissions by SA and changes over time12. Differences in re-admissions by race & diagnosis13. Admissions by county and city14. Re-admission rates generally by hospital15. Geriatric admissions16. Admissions of children by race, county, family etc.17. Death rates -18. Forensic admissions by race, county, etc19.Admissions by family characteristics20. Community Impact -21. Diagnoses

Cumulative Percentages# years after disorder onset

1 2 5 10 15 20 30

Major DepressionAfrican American 27.2 31.7 39.0 46.4 57.4 64.3 77.6

White American 39.5 44.4 51.1 58.2 64.7 70.3 78.0

Bipolar Disorder

African American 17.3 19.5 24.5 33.0 38.1 38.1 43.9

White American 40.5 44.3 49.8 58.2 70.5 71.3 79.4

Black-White Comparison of Cumulative Proportions of Cases making Treatment Contact

by Selected Years After Disorder Onset

Preliminary Implications

Excess Preventable Deaths Untreated Illness & Lower Achievement Excess Hospital Admissions & Readmissions Excess court and judicial costs Misdiagnosis & Poor Application of EBPs Community Suspicion and Mistrust Staff Division and Conflict Absence of Scientific Knowledge & Theory Ethical Conflict: Professional & Personal Loss of Input from Special Markets: Volunteers/Policy Clinical Dropouts Cultural Malpractice Loss productivity & absenteeism Public Customers are Disproportionately Persons of Color!

King Davis, 2008

Family decision making studies Help-seeking behavior by families and individuals Use of Integrated health care EBPs and populations of color Civil commitments and populations of color Accuracy of diagnoses and populations of color Treatment outcomes and populations of color Value of practice based evidence approaches Workforce issues – distribution etc. More refined differences in data post NCS/ECA Sources of mental health information for people of color Network and referral possibilities between church and specialty mh

sector Deinstitutionalization Mortality rates and race