The third class includes patients who have been discharged from insane hospitals as cured, or as so much improved that they should be able to maintain themselves and take part in family life again.
This work of after-care is extremely important. Many cases of mental disease can be safely discharged from an insane hospital if there is assurance that they will be properly followed up in their homes. Such supervision requires the joint efforts of the physician and the social worker.
Miss C., for instance, a woman of thirty-three years, was sent to the clinic for after-care, by arrangement with the superintendent of the insane hospital to which she had twice been sent for maniac-depressive insanity. Her mother had also been a patient for years in the same hospital. During the first weeks of her treatment at the clinic, she was still nervous, complained of gnawing sensations in the back of her head, and dreaded to ride in the street cars. When sitting, she constantly pulled and twitched different parts of her clothing, beat upon the floor with one foot, and kept one hand on her head, using the other one alone. She lived with a married sister who was in comfortable circumstances, and worked for her brother in an unprofitable little plumber's shop, which he apparently kept mainly to afford employment for Miss C. and a younger brother.
With this history it was plain that careful oversight and regular clinical visits were necessary to prevent future attacks. Advice and encouragement were given with the object of stimulating Miss C.'s normal interests and of persuading her to return to wholesome companionship. During the summer of 1912 it was decided to remove Miss C. entirely from home associations, and a desirable position as housekeeper was secured in the country. There she gained in weight and spirits, and acquired valuable experience. She still comes regularly to the clinic, and the medical and social prognosis seems favorable.
The value of organized social service in connection with the clinic for mental diseases has been strikingly shown since its recent establishment at the Boston Dispensary. In the department for mental diseases in this institution, which is a large and long-established dispensary taking all classes of diseases, a trained social worker was set at work in January, 1912. At the expiration of a year an efficiency test was made, comparing the clinic during 1911, when the medical staff had no social worker to assist them, with 1912, when she was at their service. The following table summarizes this test:
| 1911 | 1912 | Increase Per Cent | |
| New Patients | 125 | 213 | 70 |
| Old Patients | no record | 100 | — |
| Visits by New Patients | 388 | 909 | 134 |
| Visits by All Patients | 516 | 1568 | 203 |
| Cured or Substantially Improved | 19% | 22% | 16 |
| Cases Pending at End of Year[8] | 2% | 22% | 1000 |
| Transferred to Other Agencies | 16% | 49% | 206 |
| Patients Lost | 27% | 5.6% | 90[9] |
| Relative Efficiency | 43% | 94% | 118 |
[8] The increase of "cases pending" is due to the organized medical and social follow-up work, whereby the patients are held at the clinic until the physician feels that they may safely be discharged. Without this service the cases do not "pend" because they are lost.
[9] Decrease.
The gist of these statistics is that, with the aid of a trained social worker, it is possible to treat certain forms of mental disease effectively in an out-patient clinic. The physician becomes able to keep a grip upon all patients that he wants to hold. There is practically a closed circle, and the results of treatment bear favorable comparison with private work. It is not too much to say that such a clinic, provided with a staff of interested mental specialists and with trained social workers, can perform an important function in treating mental disease and preventing its spread in the community.[10]
[10] The preventive work of the clinic takes place in two ways: first, by diagnosing cases of mental defect that ought to have institutional care, and in securing this care for them by placing them or inducing their families to consent to place them in the proper Institution; second, by the education of patients and their families in habits of life and principles of mental hygiene which establish a home environment favorable to the preservation of mental health.