Stan Miller Vows To Do Something
Governor Shafer took office in 1964 and appointed Stanley Miller as his Secretary of the Department of Public Welfare. Stan had served as the Governor’s campaign treasurer and would eventually serve as a Keystone Board Member for many years.
Soon after taking office, Stan went to visit the state institutions he was now responsible for and was appalled by what he saw. He returned to Harrisburg and went into the office of his Commissioner of Mental Health and Mental Retardation, Dr. Joseph Adlestein. He said, "Joe, we have to do something. This is wrong." Dr. Adlestein opened his desk drawer and pulled out a concept paper for a community mental health and mental retardation system (MH/MR). That paper was the beginning of the Community Mental Health Mental Retardation Act of 1966 - the foundation legislation of Pennsylvania's community program today.
Stan Miller's successor, Secretary of Public Welfare, Helene Wohlgemuth would pay a surprise visit to Polk State Center on a Sunday morning. Secretary Wohlgemuth found residents being caged in 4' x 4' slatted wooden boxes in a room and then was appalled at observing staff using cattle prods from the Polk cattle farm on the residents of the Center. Secretary Wohlgemuth was so outraged by what she saw that she fired the hospital superintendent on the spot and banned the use of cattle prods and cages. She brought back one of the wooden cages and placed it on display in the rotunda of the Capital prior to a Senate Committee hearing. This incident was a pivotal event in the public outcry that opened the doors for community alternatives to institutionalization.
The 1960s - A Time of Radical Change
The 1960s were a time of radical social change. The Civil Rights movement was underway and the Civil Rights Act of 1964 had passed Congress. The Vietnam War protest was raging and Pennsylvania passed one of the first Right to Education Laws in the country. President Kennedy's sister Rose had intellectual disabilities, and the Kennedy family had a strong interest in the treatment of people with intellectual disabilities.
Burton Blatt did a photographic expose on the Willowbrook State Center in New York. His undercover photographs (many of which are used in this history) were published in Life magazine and created a national outrage. One Flew Over the Cuckoo's Nest played an important role in informing the public about the realities of institutionalization. Head Start, Medicare and Medicaid were approved by Congress as part of President Lyndon Johnson's vision of building a "Great Society."
It was a time when people believed government programs had the ability to end poverty, illness, racism and oppression in our society. Prior to the availability of Federal Medicaid funding, state institutions were funded completely with state dollars at a cost of around $7.00 per day per person. When Federal Medicaid funding was made available to the states it was with the requirement that conditions would be improved within the state facilities.
Everyone was particularly appalled by the common practice of having over 100 people sharing a single bedroom, so one of the early Medicaid requirements was a 70 sq. ft. requirement per person in sleeping quarters. This 70 sq. ft. requirement, along with litigation, would drive the de-institutionalization movement across the country. The 70 sq. ft. requirement would eventually threaten a quarter billion dollar loss in Federal funding in Pennsylvania.
Community Services Were Almost Non-existent
Prior to 1968, there was little government funding for services other than state institutions. Organizations such as Easter Seals had been serving children and adults with disabilities for about 50 years and were supported almost exclusively by charitable funds. Most families were told that it would be best if they put their child away and forgot them. In Pennsylvania, there were thousands of people in private licensed facilities awaiting placement in state centers.
Families of children with mental or physical disabilities found that services were almost non-existent. Parents who kept their children at home found that their children were excluded from public education because of their disability. The Center for Human Resource Development, led by Dr. Adlestein, Stan Miller and Gary Ellis, would sponsor the New Day School, a private school for children with autism. The Center for Human Resource Development would join Keystone in 1974 after the Right to Education Act passed in Pennsylvania and the New Day School was no longer needed.
Adlestein Writes the MH/MR Act of 1966
Under Dr. Adlestein's leadership, the Community MH/MR Act of 1966 provided a vision and a legislative base for a comprehensive array of mandated community services funded by the State through county-based MH/MR programs. The intent was to have a comprehensive, seamless system of care delivered in community settings. The Pennsylvania legislation followed the 1964 Federal Community Mental Health Centers Act, which provided federal funding for the emerging community programs throughout the country.