Fifty years ago, when sophisticated psychiatric treatment was available largely for only the well-to-do, a small mental health facility that was the forerunner to the Community Psychiatric Clinic opened atop the Farmers Bank in Rockville to serve residents of then-rural Montgomery County.
Called the Montgomery County Mental Hygiene Clinic, it was established to serve those who could not afford to visit private doctors or whose illnesses did not require hospitalization. It opened its doors with a first-year budget of $50. The only doctor, a volunteer, saw about 30 patients a month.
In those days, mental health clinics for persons of modest means were not common, and long stays at psychiatric hospitals often were prescribed as treatment for everything from mild depression to schizophrenia.
Outpatient care, especially for children, was not to become widespread until the 1950s and 1960s, when there were breakthroughs in the development of psychiatric drugs and expanded public funding of clinics after passage of the national Community Mental Health Centers Act in 1963.
The Community Psychiatric Clinic was the first of its kind in the county. Today, thanks largely to public funding, there are nine clinics in the county offering care to patients of all incomes.
The celebration this week of the 50th anniversary of the community clinic, which now includes offices in Bethesda, Gaithersburg and Wheaton, "is a significant milestone," said Dr. Henry Harbin, director of mental hygiene for the state of Maryland.
Long after its pioneer period, the Community Psychiatric Clinic has remained "somewhat unique," said Maryland's assistant director of mental hygiene, Dr. Sanford M. Bienen, who oversees mental health agencies in several counties, including Montgomery.
"They have been willing to deal with services that some clinics have been reluctant to take on, such as dealing with the indigent population or geriatric services," Bienen said, "and always with the same focus of high-quality care. That's an outstanding accomplishment."
"We have patients who are living in their cars and people who come in from Potomac," said Margery Calhoun, a psychologist who is director of the Bethesda clinic. "There's a real mix."
Using funding from state, county and private sources, the clinics continue to offer services that cost the individual less than the average private psychiatric fee , said Jean Ratner, a psychologist and spokeswoman for the private organization. The typical price for a one-hour visit to a private psychiatrist in this area is about $100, she said, compared with about $80 at the clinics.
The clinic fee is determined according to a patient's ability to pay, and nearly two-thirds of the clinics' patients pay less than $80 an hour, she said. The clinics have a contract with the county to receive patient referrals from government agencies.
The three community clinics have combined staffs of 70 full- and part-time psychiatrists, psychologists and psychiatric social workers and nurses, who currently see about 2,000 patients on a regular basis, Ratner said.
Clinic staffers also see 1,000 additional people a year in special programs for drug abusers, the elderly and families and at a summer camp for emotionally disturbed children, she said.
This year's operating budget for the clinics is $1.5 million, Ratner said, with more than half of that coming from public funding.
Since 1960, the community clinics' main office has been in Bethesda. This year the office was relocated from Hampden Lane to a facility next to O'Donnell's Restaurant on Wisconsin Avenue. The Wheaton branch was opened in 1974, and the Gaithersburg offices in 1982.
Montgomery County in the mid-1930s was predominantly rural, with suburban development just beginning at the edges of the District line.Mentally ill persons in the county awaiting transport to the three crowded state mental hospitals in Baltimore were held not in hospitals but in the local jail. Electric shock, cold compresses and straitjackets were the main treatments in private and state mental hospitals.
Long-term hospital stays for mental illness were common, Harbin said. "If you or I were even moderately depressed, we would go to the hospital for a month and that was acceptable."
Today, however, the development of antipsychotic and antidepressant drugs has enabled people who are moderately depressed or suffering from a manic-depressive disorder, schizophrenia or other serious conditions to live relatively normal lives with families and jobs instead of being hospitalized, Ratner said.
About 50 percent of the Community Psychiatric Clinic's patients today are treated for mild to moderate depression and about 17 percent for schizophrenia, manic-depressive problems and major depression, Ratner said. The rest come to the clinics seeking help with temporary difficulties, such as adjusting to illness, grief or economic troubles.
Depression is the most common complaint and is "the most treatable," said H.R. Simpson, executive director of the Community Psychiatic Clinic. "And a good treatment of depression can last forever."
The clinics' founders, Lavinia Engel and Dr. Dexter Bullard, had long been active here in politics and medicine before opening the facility in 1935.
Engel was one of the first female members of the Maryland House of Delegates. She founded the Montgomery County Mental Hygiene Society, headed the county welfare board and was active in the women's suffrage movement and the Montgomery County League of Women Voters. She later was a field secretary with the Social Security Administration. Born into a Quaker family in the Forest Glen section of Silver Spring, she lived there and on Capitol Hill.
Psychiatrist Bullard was a member of the family that founded and whose descendants still operate Rockville's 75-year-old Chestnut Lodge, one of the earliest psychiatric hospitals in the state.
The community clinic began operating full time in the 1940s, and in 1957 it was incorporated as a private nonprofit organization and given a a new name.
Community Psychiatric Clinic board member Susan Schwelling said she has seen "a lot more targeting of special populations" at the clinics, with programs for the elderly, substance abusers, emotionally disturbed children, the physically disabled, child abuse and, for the general population, programs for family and marital problems, terminal illness or suicide. The clinics now also have therapists who speak Spanish and Vietnamese.
Schwelling said some of the newer programs are preventive rather than curative, such as the clinic's motivation and skill enhancement programs at the county shelters for the homeless. The shelters' residents "might not have severe mental health problems, but they do have concerns about things," she said.
Besides by word of mouth, patients learn of the clinics through the courts, the schools and other county social service agencies. "We have a significant part to play in the local network serving people who need services. The chronically mentally ill do need therapy, but they also need housing and sheltered work," Schwelling said.