Gateways, then, grew from frustration with the shortcomings of the state mental healthcare system in California, particularly the long-term detention of patients in state facilities. Louis Ziskind saw that people with serious mental illness were well served by neither the public safety net nor the private charities he worked for. In 1941, he began floating the idea of a facility that would treat mental health crises with a short in-patient stay, and then coordinate with local agencies and patients’ families to get them back into the community as fast as possible. “We could see the patients instead of at General Hospital or in addition to General Hospital or before General Hospital saw them and determine if they are suitable for rapid treatment,” he said. “Then we wouldn’t send them over to the state hospital. We have a way station that would give the rapid treatment.”
This approach meant ongoing mental health support, with help from faith institutions, assistance with job-seeking, and so on. For several years, the Jewish philanthropic leadership in L.A. was initially skeptical. “I had colleagues come to me when I dreamt up the thing about Gateways, [and say] you’ll never make it,” Louis remembered in 1993. “Why even try it, the [Jewish] Federation doesn’t want you to, they don’t need another area of service to raise money for.”
But, working with his wife Edith, along with Eugene, Esther, and David, Louis was able to marshal the necessary resources to found Gateways in 1953. It moved to its current Effie Street location in Echo Park in 1961, where, on a sweaty afternoon, hundreds gathered to see Eleanor Roosevelt bless the groundbreaking. The new facility was sustained from its inception by support from innumerable individuals and groups in L.A.’s Jewish community.
Of course, the Ziskinds were not the only ones to see the problem. As historian Gerald Grob has shown, many experts grew increasingly worried about the state of public mental healthcare in the 1940s and 1950s. State hospitals were often underfunded, overcrowded, and prone to coercive tactics for difficult patients, holding seemingly little hope that people could be successfully treated, only contained. Louis Ziskind mapped out what a new approach might look like, but he was not alone in contemplating change.
Gateways was among the first institutions that promoted deinstitutionalization: the idea that ill people should be treated, as much as possible, outside long-term care in large institutions. One could call it a nimbler approach to care, but also a more optimistic one. People might suffer from episodes of serious mental illness, but they could have their most acute symptoms addressed and remain part of their communities. Gateways called their approach, “Recovery first, then a ‘cure’.”