this bill as far as the training and education generally of the public and of State and local public health services in stimulating their interest in the subject. I was glad to hear you envisage that sort of an accomplishment as a result of the legislation. I have felt from the very beginning in my own study of this subject that one of the things that stood in the way was the fact that the public generally is a little hard to arouse over a matter that they cannot see so well, such as mental illness. I think, however, that the public has been advancing rather rapidly, and I share your thought on this subject. Dr. STRECKER. There are two little points I might mention, in possible anticipation of things that may come up later on. For one thing, I see nothing in the bill, Mr. Chairman, that would even make it likely that the Federal Government would, as it were, endow beds in State mental hospitals. Personally I don't believe that would be a very good application of the funds, and I don't think that is anticipated, or would be particularly desirable. The other point is, and I think the bill provides for it, that the fellows, men who have had the benefit of being educated in psychiatry as a result of the funds derived from the bill, it would be only fair to say they would owe a certain amount of service to psychiatry, and perhaps to the Government and to the States, in return for the education they have received. At least, that would be the way I would interpret it, and the way I believe it would be interpreted. Mr. BROWN. Doctor, in drawing legislation, I think it is necessary to write into the law the safeguards that we desire, rather than to go on the assumption that it is not likely that something undesirable will be done. It is the duty and the responsibility of Congress as the legislative body of the Nation to fix policy, and there seems to be a general consensus among the persons who have testified here that it is not the thought or intention of the proponents of this bill to have the Federal Government pay for the routine bed care of mental patients, or to subsidize state and local educational institutions, but instead only to conduct research, furnish expert advice and assistance and, perhaps, aid in the education of postgraduate students. Dr. STRECKER. Yes, sir. Mr. BROWN. With that thought in mind, perhaps we will have to consider later on some slight amendments to this bill which will guarantee we go that far and no further, and to make sure there cannot be any possible change in policy in the future. I have, and I am very sure every member of this committee, and every member of Congress has, the highest respect and regard for Dr. Parran and those who assist him in administering the public-health laws of the United States. But Dr. Parran is not going to be here forever. am not even sure that I am going to be here. There might be some question about that. Dr. STRECKER. I know I won't be. I Mr. BROWN. And, therefore, I think we want to now make this law just exactly what we think it ought to be. I don't think we are very far apart, any of us. I agree with everything that has been said as to the necessity for research and study of this problem, but it seems to me that we must always draw the line somewhere, or build a fence, to define the field of activity in which the Federal Government can participate, and the field in which the responsibility rests with the 78160-45-6 local and State governments and with the individual citizens themselves. I believe the Federal Government should lead the way in research, in furnishing information and advice to the people of the States and their local subdivisions, but I don't think the Federal Government should take the responsibility of administering aid to the individual all the way through. I think this act should be on the general broad idea you talk about. I am glad to hear such remarks being made. I think it is exactly in line with my thoughts and ideas. Dr. STRECKER. Sir, if I may say so, I think you yourself have drawn the distinction very nicely. It would be a useless thing to pour out sums of money into beds for patients who cannot recover. I would make a distinction between subsidizing that thing, which should not be done, and the subsidizing of beds for patients whose study would make a great contribution to the study of psychiatry, beds occupied by patients, the study of whom by graduate students and fellows and residents would be necessary in their training so as to make up the sad dearth in the number of psychiatrists. I think we see exactly eye to eye about this. Mr. BROWN. I would go, perhaps, a little further. I think the Federal Government under this act could not only do the research, and perhaps furnish the State and local communities, for temporary duty-not for permanent duty-experts who could go in and aid the States and local communities in solving those problems. I think, certainly, we should engage in the designing of hospitals. I think we should make tests, give aid, and furnish information as to the different kinds of equipment and methods of treatment. There is a broad field in which we could operate, and yet there is another field in which I think the Federal Government should take no part. Dr. STRECKER. I think we see that in the same way. Mr. PRIEST. Doctor, we certainly appreciate your presence here this morning. Dr. STRECKER. Thank you for your courtesy. STATEMENT OF MICHAEL J. SHORTLEY, DIRECTOR, UNITED STATES OFFICE OF VOCATIONAL REHABILITATION Mr. PRIEST. Will you give the reporter your full name and title? Mr. SHORTLEY. Michael J. Shortley, Director, United States Office of Vocational Rehabilitation. Mr. PRIEST. You may proceed with your statement. Mr. SHORTLEY. Mr. Chairman, the passage of the Barden-La Follette amendments to the Federal Rehabilitation Act of 1943 imposed important responsibilities on the Federal-State rehabilitation program, which are very difficult to fulfill. I refer to the authorization contained in that legislation for the rehabilitation of civilians. with psychiatric disabilities. Recognition of the economy of investing money for psychiatric treatment of selected cases of emotional and mental disorder is a forward step, but the extreme shortage of psychiatrists and psychiatric clinics has made it very difficult for many States to obtain psychiatric service for the examination and treatment which is often necessary in addition to the usual vocational counseling, training, and placement of our rehabilitation clients. Entire States, including Idaho, Montana, Wyoming, and Utah, are without the services of a single qualified specialist practicing psychiatry. Where there are practicing psychiatrists and mental hygiene clinics available, they are so overburdened that they are frequently unable to take more than occasional cases referred by our rehabilitation agency. Consequently, we are to a large extent another voice crying in the wilderness for psychiatry, which does not exist. We have the organization in our State agencies to locate and select cases of psychiatric disability who might be rehabilitated by psychiatric treatment and the other rehabilitation services necessary, but there are too few cases where this can be purchased. Our work leads us to agree with the previous statement made here that there is no single place in these Ünited States where adequate psychiatric service is available to a community. Mr. Marcantonio asked a question earlier in the hearings concerning the adequacy of mental hygiene clinics in New York City. That city has disproportionate share of psychiatrists but their total services are far from adequate, as indicated by a recent study by a committee of the New York City Committee on Mental Hygiene. It was found that of 314 men rejected by selective service on account of neuropsychiatric disability, 82 percent needed psychiatric treatment. Of this 82 percent which needed psychiatric treatment, only 26 percent wanted psychiatric treatment, and of those who wanted psychiatric treatment 19 percent were receiving the treatment they needed. If that is the situation existing in New York, which is relatively rich in psychiatric facilities, you can understand that it is much worse in many other communities. It is a sad commentary on our present civilization that most cases who are committed to State mental hospitals have reached the point where commitment was necessary without having received the benefit of office or out-patient psychiatric treatment. In the treatment of other types of diseases hospitalization is reserved as a measure of last resort after extensive office or out-patient medical or surgical treatment has not sufficed, but the mentally ill have long been discriminated against in this manner. Dr. Carl Binger, in his recent book, The Doctor's Job, estimates that 2 percent of the general population have important personality problems which need psychiatric attention. During the hearings on this bill this committee has heard a great many statistics outlining the tremendous extent of mental illness so I shall not quote additional figures on the national problem of the mentally ill. Tentative figures from the District of Columbia Vocational Rehabilitation Office indicate that in the past fiscal year approximately 20 percent of all new cases have sought help because of psychiatric disabilities. Of the cases reviewed by the psychiatric consultant only about 15 percent have been authorized for psychiatric treatment. This relatively small percentage of referrals for psychiatric restoration is partly due to the limited number of psychiatrists and psychiatric clinics available to furnish this service in Washington, and is partly due to present deficiencies in psychiatric knowledge of the causes and treatment of some mental disorders. This points up the need for a determined research effort to develop new techniques for psychiatric treatment. The present bill providing for assistance to States in developing additional mental hygiene or psychiatric clinics, the training of additional personnel for staffing the clinics, and further research into causes and improved treatment of mental disorders, if enacted into law, will be of inestimable specific value to the vocational rehabilita-tion program and to all other health and welfare agencies. The President's Committee on Medical Care, reporting in 1938, recommended that Congress appropriate increasing amounts, up to $10,000,000 annually, for a mental hygiene program, but the present bill, H. R. 2550, is the first serious effort to carry out that recommendation. Mr. BROWN. I wonder if you could give me any idea as to how many medical schools, colleges, or universities are teaching psychiatry. Mr. SHORTLEY. I could get that information for you. I don't have it at the moment. Mr. BROWN. I wonder if Dr. Strecker could give us some information on that. Dr. STRECKER. Sir, I think we have it. According to a survey made in 1932 of 67 medical schools-I think Dr. Felix has it exactlythere are a very small number, I think only 11, which had separate departments of psychiatry. Of course, that does not mean there was not some psychiatry taught in the other medical schools. In connection with the training of these specialists in improving the first line of defense, according to our latest information, 49 of the 70-and-odd medical schools meet the standards of the Committee on Medical Education of the American Psychiatric Association; 19 of those 49 were providing excellent, and 30 were providing good training. Training in the remainder was unsatisfactory. Medical education is now in a state of flux and curricula are being retarded. Medicalschool administrators are alert to the need for more and better psychiatric training for their students and many desire to avail themselves of resources to facilitate this. I should say that roughly the training of the medical student for psychiatry, considering the best and the worst, is less than satisfactory in more than half the medical schools of the country. Mr. BROWN. There are about 50 schools altogether? Dr. STECKER. That being true from almost any angle by which you view it, and, of course, the most telling angle is to consider the number of hours allotted to the teaching of this subject which is of the gravest importance, and which will constitute, in one form or another, the bulk of the doctor's practice. I don't mean the psychiatrist, but the ordinary doctor's practice when he begins to practice medicine. We think, on a very modest estimate of the total number of curricular hours, we feel there should be at least 160 hours of the some approximately 3,500 hours that the curriculum covers. Of course, I wouldn't want that to be regarded as anything more than expediency in view of the dearth of teaching personnel. If the subject were accorded the importance it deserves from the only practical viewpoint of what the man is going to meet in his practice, we should be working up to 25 percent of the curricula hours devoted to teaching undergraduate medical students in psychiatry. Mr. BROWN. What number of students, if you can give us an estimate, are taking psychiatric courses? I mean, not just as a part of the regular medical course, but specializing. Dr. STRECKER. In graduate work? Mr. BROWN. Yes. Dr. STRECKER. I think Dr. Feliz can answer that question betterthan I. I know the number is quite small, and I know the number does not represent the amount of desire there is. It represents, again, one of the things this bill would correct, the insufficiency of funds to provide that education. The young graduate medical student-to come back to him is eager to learn more about psychiatry. At the University of Pennsylvania, only a couple of weeks ago, where it has been traditional to have only 2 undergraduate medical societies, 1 in surgery and 1 in medicine, a few of the boys got together and thought they would like to have an undergraduate society devoted to a discussion of psychiatry, and they got permission from the dean's office to post a notice, and 120 men out of a class of 130 signed up at once, anxious to be members of this association. That, of course, is only one medical school, but it is the oldest medical school in America. Mr. BROWN. Perhaps they have looked the world over during the last year or so and decided we were going to need more psychiatrists. Dr. STRECKER. The thing we are particularly anxious about-of course, we need more psychiatrists, and are going to make more—but over and beyond and more significant, we want the man who is going to practice surgery, eye, ear, nose, and throat, gynecology, the man who is going to treat your family and mine, and the families of the citizens, we want him to have enough psychiatric knowledge so that he does understand that an important issue in every person is his emotional and mental condition, not only his physical condition, and knowing how important that is in every illness. Mr. BROWN. But could you give me an idea as to the percentage of the present group of medical students who expect to specialize in psychiatry? Dr. STRECKER. I have been a professor of psychiatry for a long time, and I have seen that number increase-I used to keep statistics on it—and it has grown in two medical schools, the University of Pennsylvania and Jefferson College, from a quarter of 1 percent now to about 4 percent. Mr. BROWN. About 1 doctor out of each 25 expects to specialize in psychiatry? Dr. STRECKER. I believe so, but that would be just an impression; it would not be based on exact statistics. Perhaps Dr. Felix could be a little more accurate than I am in that. I can say this: During this war I had the privilege of conducting a course in Philadelphia for the Surgeon General of the Navy and for Captain Braceland, for the training of Navy medical officers in short courses of psychiatry, because the Navy was in such sad and dire need of psychiatrists. Of the 300 men that have passed through that course, I had a check made of them to find out how many of them wanted to be psychiatrists, and about half of them, if they had the opportunity, would want to be psychiatrists. Mr. BROWN. About how long would the usual course run, Doctor? Dr. STRECKER. Graduate training? Mr. BROWN. From medicine, in order for them to get the educational needs. Dr. STRECKER. After graduating from medicine, about 2 years. Dr. STRECKER. About 2 years; yes, sir. Mr. PRIEST. Are there any other questions of Mr. Shortley? Is Miss Rae Levine here? She wired yesterday asking permission to be present today and give a survey of the New York mental-hygiene clinics. She may come in later. |