Pueblo County, Colorado
Colorado Insane Asylum

Policy and Positions

In an address at the Association's 1898 meeting, T.E. Eskridge, M.D., a neurologist on the Board of Commissioners of the Colorado Insane Asylum, outlined mental hospital requirements and proffered staffing ratios—one assistant physician for every 50 patients, one resident physician for every 25 patients, a staff psychologist, trained nurses, and attendants.

The matter of staffing ratios for mental hospitals was to plague APA over the next 50 years. APA was importuned to set staffing standards but was well aware of the hospitals' worsening conditions, especially over-crowding and understaffing, and data were needed upon which to base standards. In 1936 a grant from the Rockefeller Foundation to the National Committee for Mental Hygiene allowed APA to conduct a hospital survey. In 1945-46, APA issued standards that included recommendations for the organization and administration of mental hospitals and staffing ratios: one psychiatrist for every 30 patients, and one graduate nurse for every four patients in acute units.

Revision of the staffing standards gave rise to disagreements among psychiatrists and other experts. By 1954 numerical ratios were no longer in the standards and never appeared again. Instead, the standards stated principles for the provision of quality care, and each hospital was left to develop its own staffing ratios. By 1974 a nonmedical administrator was permissible in psychiatric hospitals if there was a psychiatrist medical director.

In 1948 APA began to issue official policy statements called position papers. The first dealt with aggression, violence, and war. The second, approved in 1949, dealt with electroshock therapy.

to the Pueblo County Index Page.

Please e-mail comments and suggestions to Karen Mitchell.
© Karen Mitchell