BUDGETING FOR PSYCHIATRIC RESEARCH Now let us examine New York State's expenditures for psychiatric research and training in the light of all the foregoing evidence on the enormous potential of these activities. Most of the figures will be confined to research since New York, unlike many of its sister States, makes quite a mystery of its training expenditures. Out of a total 1955 mental health budget of approximately $160 million this great State is allocating only about $2 million for research. During the past 4 years during which the National Mental Health Committee has brought out an annual fact sheet on the mental health situation in this State, the budget for the mental health department has gone up approximately $50 million. In that short span of time, the number of patients in the State system has increased by approximately 12,000-an increase of about 3,000 patients a year. This staggering rise in the patient population in a period of only 4 years has added approximately $14 million to the departmental budget. Furthermore, in the period since World II, the voters of New York State have supported more than $550 million in construction funds to build new beds to try and keep up with the ever-increasing flood of mental patients. And what about research during this same period of time? In the 4-year period from 1951 to 1955, the research budget of the State mental health department went up $800,000. In other words, $800,000 more for research as against $50 million more for custody and $550 million more for buildings. As a native of this great State, I am deeply disturbed by the imbalance represented in these figures. In a letter to the editors of the State's major newspapers which I mailed out on November 5 of this year, I said this: New York must start betting on brains rather than on bricks. It is shocking to realize that the State is spending only about $16.50 per year on research for each patient hospitalized while it is spending $1,364 a year to maintain each of these patients in a hospital. In that same letter to the editors I also pointed out that thousands upon thousands of mental patients in New York State were not receiving the newest therapies because of shortages of psychiatric personnel. Our 1955 fact sheet on the New York mental health situation documents, on the basis of the minimum personnel standards of the American Psychiatric Association, the following shortages in the New York State system: 1. Psychiatrists: The State hospital system has about 489, but it needs at least 568 more. 2. Graduate nurses: The State hospital system has about 1,450, but it needs at least 3,800 more. 3. Social workers: The State hospital system has about 155, but it needs at least 1,200 more. 4. Clinical psychologists: The State hospital system has about 13, but it needs at least 300 more. Even more personnel in all above groups are needed by the State for its preventive clinics. What can we do about this? Over the past year, the National Mental Health Committee has given this problem intensive study. For the coming fiscal year, we have recommended an additional psychiatric research and training appropriation of $10,445,000. Our proposal allocated $4,970,000 for additional research activities at 20 State mental hospitals. A minimum of $1 million of this research sum would be used for treatment and evaluation in the use of new drugs on mental patients. The training proposals in the budget would provide approximately $2 million in stipends and scholarships to recruit additional psychiatrists, psychologists, social workers, and psychiatric nurses, and approximately $2,500,000 in grants to professional schools in New York State to expand their teaching programs in the field of mental health. An additional $1 million would go to existing mental health clinics to enable them to expand their teaching programs. It is extremely gratifying to report that the mental health committee of the Governors' Conference on Problems of the Aging on October 20 passed a resolution requesting the 1956 State legislature to appropriate an additional $10,500,000 for "expanded research and training activities exclusively." Is this proposal utopian? On the contrary. New York is blessed above all other States in psychiatric resources. It has 10 medical schools-one-eighth of the national total. It has the largest concentration of psychiatrists in the world. It has a number of famous psychiatric research centers. It has all of these and yet it also has a high wall between the State mental hospital system and private psychiatry. Break down this wall and New York State will move psychiatrically into the 20th century. I make the categorical statement that New York State today is far behind many of its sister States in programs devoted to psychiatric research and training. The National Governors' Conference on Mental Health held in 1954 and regional conferences of governors held subsequently in the South, Midwest, and West have supported the view that at least 10 percent of a total State mental health budget should be set aside for research and training purposes. What are some of the other States doing? In Illinois, the mental health fund into which patient fees are paid has accumulated approximately $12 million for research and training purposes during the coming biennium. The 1955 Illinois Legislature allocated $4, million for biological and social research and an additional $2,214,620 for training programs. Over and above this, Illinois is constructing an $8 million psychiatric research institute to be administered by the five medical schools in the Chicago area. Most important, the 1955 legislature created a 10-member psychiatric research and training authority to supervise the training of psychiatric personnel and to advance knowledge through research. This new authority has been given a million dollars a year on a continuing basis for its work. In Ohio, equally gigantic strides were made. The 1955 Ohio Legislature created a special bureau of research and training with an appropriation of $10,294,720 for the coming biennium just for the purpose of training and securing new psychiatric personnel. Three new institutes for training and research were created in Cleveland, Cin cinnati, and Columbus. The Council of State Governments recently reported that the Ohio training program may be one of the largest in the world. Space does not permit giving full details of other State programs. Michigan in 1955 appropriated just under $5 million for research and training. In Indiana, a $1 million research institute is now under construction and funds for mental health clinics were tripled by the 1955 legislature. In Florida, with a population approximately one-fifth that of New York, $250,000 was appropriated for a new council on training and research. All of this omits the Kansas program, generally regarded as the most outstanding in the Nation. Over the past 4 years, despite a large increase in admissions, the Kansas mental hospitals have reduced their total patient population by about 400 patients. There are now vacant beds in the Kansas State mental health system. This has been accomplished through the expenditure of millions of dollars by successive Kansas State legislatures for the training of psychiatric personnel. In Kansas today there is 1 doctor for every 67 mental patients, as against the New York ratio of 1 doctor for every 191 patients. The daily expenditure per mental patient in Kansas is $4.66, as against $3.70 in New York State. Summarizing these recent developments, Sidney Spector, director of the Interstate Clearing House on Mental Health of the Council of State Governments, reported in November that funds for research and training appropriated by State legislatures in 1955 were about double those appropriated just 2 years ago. But this has not been so in New York State, and it is about time it became so. Senile dementia is fundamentally the end result of our failure to finance the research knowledge and the trained personnel to treat mental illness early enough to prevent it. There is only one way out for the State of New York. As I have said: The 16 million citizens of New York State now face a very simple choice. If they continue to support pennywise and pound-foolish custodial treatment of mental patients, they will be faced in a very short time with another bond issue of several hundred million dollars. However, if they choose to invest an additional $10,445,000 a year in buying new knowledge and in training the people to apply it to patients, they will reverse the trend and start reducing the patient population. о |