Appropriation Bill for 1949 HEARINGS BEFORE THE u. 2.C SUBCOMMITTEE OF THE HX85 ·A5 1949 COMMITTEE ON APPROPRIATIONS JOHN TABER, New York, Chairman RICHARD B. WIGGLESWORTH, Massachusetts CLARENCE CANNON, Missouri CHARLES A. PLUMLEY, Vermont FRANCIS H. CASE, South Dakota H. CARL ANDERSEN, Minnesota LOWELL STOCKMAN, Oregon JOHN PHILLIPS, California ERRETT P. SCRIVNER, Kansas CHARLES R. ROBERTSON, North Dakota FREDERIC R. COUDERT, JR., New York CLIFF CLEVENGER, Ohio LOUIS LUDLOW, Indiana JOHN H. KERR, North Carolina W. F. NORRELL, Arkansas THE SUPPLEMENTAL FEDERAL SECURITY AGENCY APPROPRIATION BILL, 1949 HEARINGS CONDUCTED BY THE SUBCOMMITTEE OF THE COMMITTEE ON APPROPRIATIONS, HOUSE OF REPRESENTATIVES, IN CHARGE OF THE LABOR DEPARTMENT-FEDERAL SECURITY AGENCY APPROPRIATION BILL FOR THE FISCAL YEAR 1949, ON THE DAYS FOLLOWING, NAMELY: WEDNESDAY, MARCH 31, 1948. PUBLIC HEALTH SERVICE MENTAL HEALTH ACTIVITIES STATEMENTS OF DR. LEONARD SCHEELE, DIRECTOR, NATIONAL CANCER INSTITUTE; DR. JAMES A. CRABTREE, DEPUTY SURGEON GENERAL; DR. ROBERT H. FELIX, CHIEF, MENTAL HYGIENE DIVISION; AND ROY L. HARLOW, BUDGET AND FISCAL OFFICER GENERAL PURPOSE OF FURTHER HEARINGS ON MENTAL HEALTH PROGRAM Mr. KEEFE. When the regular estimates were before this committee for consideration several weeks ago, the committee was not satisfied with the presentation which was made in justification of the estimates for the mental health activities of the United States Public Health Service. No finger of accusation is pointed toward any person. I am only saying that previous hearings have not developed the basic facts necessary to permit the implementation of the will of Congress when it passed the National Mental Health Act. The committee wanted a further look into the whole program of mental health and into the present program dealing with narcotic addiction; it determined that it wanted a full and complete reappraisal of the present programs in the light of information that could be elicited from the best people in the field of psychiatry in the country. Apprehension was manifested in various places throughout the country that, as a result of that attitude on the part of the committee, the program might be curtailed or destroyed, and that progress already made in the States in the utilization of Federal aid, consultation and demonstration, would be slowed up or stopped. As chairman of the committee, I think I express the attitude of all the members when I say for the record that the sole purpose of the committee in having further hearings is to reappraise the whole program of mental health activities in the light of sound, basic facts, with a view to strengthening the program if possible and thus carry 1 out the very evident and manifest wish of the Congress when it adopted, practically unanimously, the National Mental Health Act, and authorized appropriations of money to implement it. With that in mind, I have consulted with Dr. Gelix, the head of this Bureau in the Public Health Service, with the Administrator of Veterans' Affairs, and with the Surgeon General, and requested that outstanding men in this field appear before the committee in order that we may lay the foundations for more intelligently dealing with this very important problem of mental health. I have been advised that in response to that request, we have present this morning Dr. William C. Menninger, whose qualifications in this field are well known; Dr. S. Alan Challman; Dr. George S. Stevenson; Dr. S. B. Wortis; Dr. Daniel G. Blain; and Dr. Frank FremontSmith. The qualifications of these men to speak on this subject will appear in the record when they are called as witnesses. In addition, we have present before the committee Dr. Leonard Scheele, who is shortly to be the Surgeon General of the Public Health Service; Dr. James A. Crabtree, Deputy Surgeon General; Dr. Robert H. Felix, Chief of the Mental Hygiene Division of the Public Health Service; Dr. Victor H. Vogel, medical director at the Lexington Hospital, and Hon. Harry J. Anslinger, Commissioner of the Bureau of Narcotics of the Treasury Department; and also Mr. Roy L. Harlow, the budget and fiscal officer of the Public Health Service, whose qualifications are well known to this committee and to the Congress. We also have Mr. Stephens, the budget officer of the Federal Security Agency who has rendered yoeman service to this committee and the Congress in connection with the tremendously varied activities of the entire Federal Security Agency. Now, Dr. Felix, as the Chief of the Mental Hygiene Division of the Public Health Service, will you state generally for the record the basic program that has been developed to carry out the intent of Congress as expressed in the National Mental Health Act, stipulating in your testimony, if you will, the general break-down of the estimates submitted and the purposes for which the proposed expenditures are to be made? GENERAL STATEMENT ON BASIC PROGRAM DEVELOPED TO CARRY OUT NATIONAL MENTAL HEALTH ACT Dr. FELIX. Mr. Chairman, under the provisions of the National Mental Health Act which you have mentioned in your opening remarks the Public Health Service was authorized to engage in activities designed to improve the mental health of the people of this country, as was stated in the preamble of the act. SERIOUSNESS OF PROBLEM OF MENTAL HEALTH The seriousness of the problem of mental illness is shown by what it costs the Nation in sickness, disability and economic loss. In discussing the extent of the problem, I should like to point out a fundamental consideration. For many years, the prevalence of mental illness was gaged by the number of patients in mental hospitals. Now, however, we know that while patients in mental hospitals constitute a very important and costly segment of the total problem, they are in fact only one aspect of the entire situation. For instance, though half of the hospital beds in the country-some 600,000—are occupied by mental patients, there are 8,000,000 persons, or more than 6 percent of our population, suffering from some sort of mental illness. Most of these millions have not retreated from life but are struggling to adjust to the everyday situations that arise in families, schools, labor, industry, courts, prisons, and so forth. Their success or failure in this struggle will determine whether they will remain useful citizens in our society or become public charges. Many could be helped if it were possible to give them the benefit of what scientific knowledge is available. It is the consensus of professional opinion that though our knowledge is meager, if what we do know was more widely understood and more fully utilized, a significant number of people could be saved from pension rolls and mental hospitals and a tremendous saving in public funds would be achieved. We can say with certainty that in mental diseases, as in other disorders such as cancer and tuberculosis, early diagnosis and prompt treatment conduces to cure. For a comprehensive picture of the extent of mental illness in our population, it may be helpful to review briefly some salient data that are available on this subject. Over 150,000 new cases of mental disease are admitted annually to mental hospitals and it is estimated that 10,000,000 of the current population will require hospitalization for mental illness at some time in their lives. Our medical experience in the recent war has given us a great deal of concrete information about the extent of mental illness. Fifteen million men were examined in the draft and nearly 2,000,000 were rejected for neuropsychiatric disorders. They made up 38 percent of all men rejected for all causes. . In spite of this initial screening, mental illness was the most frequent cause for medical discharge from the armed forces. Thirty-seven percent of medical discharges from the Army were for neuropsychiatric reasons. In all the total amount of military manpower lost because of neuropsychiatric disorders was 2,478,000 men. From the Veterans' Administration we get further evidence about the frequency of neuropsychiatric illness. Sixty percent of those hospitalized by the Veterans' Administration are for neuropsychiatric reasons and 50 percent of disability pensions are due to mental illness. Most of these pension cases are outside of hospitals and most of them should be getting some form of treatment. We should realize that the prevalence of mental illness is directly affected by the increasing life span of our population. In the next 40 years the number of persons aged 65 and over is expected to double, as compared with an expected over-all population increase of only about 23 percent. Since the incidence of mental disease increases with age, we can forecast an increase of mental cases out of all proportion to the increase of total population. Current dollarand-cents costs of mental illness show the economy of early diagnosis and treatment designed to keep patients from developing disabling disorders that would send them to mental hospitals. DIRECT ECONOMIC COSTS Our national bill for public mental hospitals is now $200,000,000. It will be $250,000,000 by 1956 if present trends continue. Even higher than the costs of hospitalization are the economic losses re |