refresher course for people already trained, and would not try to train the postgraduate students of the country. Mr. BROWN. In other words, is it your thought you would give additional training to those specialists who desire to teach? Dr. THOMPSON. Yes, sir. It might be possible that we could get Dr. Strecker to come down for a little while and see to that particular line of work. Mr. BROWN. Is it your idea this institute would furnish facilities for teachers of psychiatric training in the medical schools, and that they could come and get special training for themselves, and obtain the latest information as to research and development in this field? Dr. THOMPSON. Isn't that your idea, Dr. Strecker? Dr. STRECKER. Yes, sir. Mr. Brown, I would sort of envisage this research institute as a great center of psychiatry, representing for psychiatry, in a way, the things that the institute of the Rockefeller Foundation does for infectious diseases. It would be, in the first place, a place for the accumulation and dissemination of scientific knowledge. Perhaps great workers in psychiatry would come there and be what is called guest workers, working on some particular project. And while you think of 200 beds, perhaps, for patients as a small number, it is really a very large number, because those beds would be absolutely controlled. At one time they might be occupied by just one kind of sick person on whom there would be a focussing of all scientific knowledge and research. So from it would emanate not only concrete results, but great scientific stimulation. Mr. BROWN. I am thinking of another agency of the Government that deals with this problem in another way-the Federal Bureau of Investigation. They have a great many problems in psychiatry, mental diseases, and criminal tendencies. Yet that Bureau is open and conducts ever so often a clinic or a school for the law-enforcement officers of the Nation, which they can attend 'under certain restrictions and conditions; and, as a result, I think our law enforcement has been greatly bettered in the United States. I am wondering if into this institute would come, perhaps, men from Ohio and Tennessee and Pennsylvania and Kentucky, and other State institutions to get a refresher course and go back to teach and demonstrate that information to the men who work under them. Is that your thought? Dr. FELIX. Yes, sir. Dr. THOMPSON. That is exactly our thought. It is not only in psychiatry, but a professor of public health administration in schools, a professor of bacteriology, a professor of chemistry, if he stays too long in the one work does not progress in his ideas out in the field, and it is the hope that the institute can be useful not only in this field but other fields of public health, to give training to people in the States already doing that actual work. Dr. STRECKER. I think, too, Mr. Brown, you can think of it as a thing that would have a very interlocking usefulness. It will not be restricted to psychiatrists or even the doctors. It may be a place where a progressive judge would want to send someone, or perhaps come himself, to find out what was the best knowledge and information about juvenile delinquency and its management. So I can see it having a great many connections, coming from, but going beyond, this central field of psychiatry. Mr. BROWN. I understood Dr. Felix to mention something which interested me very much, and that is the attendants at these State institutions. I was a State official for a number of years, and we had several thousand attendants in charge of mental, epileptic, and other cases of that sort, in our State institutions. One of the problems was that of pay. Usually these attendants were underpaid. And ever so often there was a scandal in the newspapers about some attendant who mistreated some particular patient of one of the institutions. Is it your thought, or did I glean the thought from your testimony, that there should be some attention given to these attendants, and to the method of training them, and selecting them? Dr. FELIX. Very definitely, sir. We have envisioned, for instance, that when requested, these specialists in the Public Health Service, skilled in a particular line, could go for a period of time, 6 weeks or 3 months, whatever the time might be, and conduct a course of instruction for these attendants, spending their time so that those on all shifts would obtain the instruction. It would probably mean repeating the lecture three times if they were on three shifts, using such teaching ideas as have been developed in the Army, Navy, and so forth, to train the men in their particular skills, and to demonstrate by actual doing what are good practices for attendants in hospitals. Mr. BROWN. Does the Public Health Service bave anything to do with St. Elizabeths Hospital here in Washington? Dr. FELIX. No, sir. Mr. BROWN. I recently noticed some action was taken against attendants at that institution. I am just wondering how much attention had been paid to the selection of those particular individuals who serve as attendants. I do think the selection of nurses and attendants is important. I was at a hospital 2 or 3 years ago and I had a nurse who, if she had stayed 2 or 3 more days, would have had me ready for a psychopathic ward, myself. I have another question. You said something if I got the purport of it-about uniform service throughout the Nation. I notice here on table 2, that you have the States listed, showing the hours required, or estimated, as being necessary for complete psychiatric service, the estimated annual cost thereof, and the clinical service now available. Of course, that seemingly leaves quite a lot to be accomplished, Doctor. Dr. FELIX. I stated, I believe, that taking the Nation as a whole only about one-fifth the estimated number of clinical hours are supplied. Mr. BROWN. Taking your statement about uniform service throughout the Nation-I am going back again-it isn't your thought that you should furnish that uniform service? Dr. FELIX. No, sir; but to stimulate. Mr. BROWN. To stimulate? Mr. GILLETTE. As I understand it, the doctor mentioned setting up 100 clinics in the various parts of the United States. Dr. FELIX. What I said, Mr. Gillette, was that the best we could hope for today, right now, would be to see 100 clinics set up by the States and counties. That is due to availability of personnel, and so forth. That would supply, if properly distributed by the States, one clinic for every half million people, and would allow at least one 78160-45-7 clinic in every State. By that, I don't mean that we would set them up, or that we would have anything to do with where they were set up except that grants would be given first to those communities not now having services, as indicated by the tables. But envisaging the country as a whole, the facilities are such that is the best I would want you to think could be done right now. I was trying to give you something concrete when I said that. Mr. BROWN. How long do you think it will take you to get this program under way, and to get the clinical service up to where you think it ought to be? Dr. FELIX. It would depend, Mr. Brown, on how training centers could be developed to train the deficit in personnel. Mr. BROWN. Doctors? Dr. FELIX. Not only doctors but psychologists and social workers and those adjunctive services. Mr. BROWN. I don't want to go too far now. Let us just stick to doctors. Dr. FELIX. Very well, sir. Mr. BROWN. First of all, you would have to have trained psychiatrists? Dr. FELIX. Yes, sir. Mr. BROWN. How long do you think it would take to get those trained doctors? Dr. FELIX. If all the available residencies in the United States could be utilized, which are seven hundred and some odd, that would mean, if we take Dr. Strecker's estimate, that it takes 2 years to train a man, the existing facilities could turn out three hundred-odd men a year. Mr. BROWN. About what percentage of those do you think would go into public service, at $4,050 isn't it? Dr. FELIX. It ranges from $6,500 top, to $4,050, beginning. I hesitate to make an estimate, Mr. Brown. I have nothing to go on. questionnaires have been circulated by the American Medical Association with regard to the number of physicians who wish to go into psychiatry, but I don't believe any survey has been made as to how many want to go into public service. Anything I would give you would be just a guess. Mr. BROWN. But it is your opinion it will take several years, will it not? Dr. FELIX. I would feel that the Government had done a great deal if this goal were halfway along in 10 years. It takes time to train a man, and I know of no short cut to learning. Mr. BROWN. Of course the training of doctors has been seriously interrupted by the war, and the training of scientists, and people otherwise qualified for this type of work. It will take some time to catch up with and cure that deficiency, will it not? Dr. FELIX. Yes, sir. Mr. BROWN. You are the head of this department or division of the Public Health Service, are you not? Dr. FELIX. Yes, sir. Mr. BROWN. And this calls for four and a half million dollars, doesn't it, Mr. Chairman? Mr. PRIEST. For the institute building and facilities. Mr. BROWN. And your original estimated budget is $10,000,000 a year. In your opinion, doctor, what portion of that amount will be spent at the institute? Dr. FELIX. At the institute for Mr. BROWN. Operation and maintenance. Dr. FELIX. Operation and maintenance, we have estimated with the best figures we can get that approximately $1,000,000 of that would be spent at the institute. Mr. BROWN. Would that include the payment of salaries? Dr. FELIX. It would include the salaries for the care of patients. It does not include payment of stipends for fellowships which would be at the institute. Mr. BROWN. Does it include the salaries of the specialists who would be working there, outside of the fellowship students? Dr. FELIX. The permanent staff, you mean? Mr. BROWN. Yes. Dr. FELIX. Yes, sir. Mr. BROWN. Then what would you spend on fellowships? Dr. FELIX. We had anticipated your questions, and have spent many hours trying to arrive at some estimate. Mr. BROWN. Do you have a rough estimate or a budget of how you will spend your money? I would be interested in seeing it, if you have. Dr. FELIX. We have an estimate of how much money will be spent. On research we don't know how to arrive at it. We don't know what places are conducting research, or what places would seek assistance in research. As I stated in my testimony, there has been no survey made to know what the situation is. Mr. BROWN. Doctor, what I am trying to get is an idea of your plan of projected operation, and about how much you plan to spend at the institute, in the institute, on the institute, and how much you expect to spend on postgraduate training, fellowships and so on; how much you expect to spend on field work directly under your supervision, and how much you expect to spend on contributions to State and local institutions. I understand, of course, you can't make these figures definite, or anything like that, but just a rough picture would be helpful to me. Dr. FELIX. We feel, as we have estimated on table No. 2, it will cost around 3 million dollars for grants-in-aid for encouraging the establishment of clinics and so forth. We have estimated that it will cost about $7,000 a year for the training of men. Mr. BROWN. Seven thousand dollars Dr. FELIX. Seven thousand dollars per man per year. That, I might say, includes the stipend paid to the follew by the Government I am speaking of the over-all cost-it includes quarters, subsistence and laundry cost; it includes incidentals for training materials, and it includes some figure for travel. We feel these men should, in order to have a well rounded experience, have some experience in traveling clinics, community clinics. That would be the over-all cost per man. Mr. BROWN. Two years would mean approximately $15,000. Mr. BROWN. Per man trained. Dr. FELIX. Yes, sir. That wouldn't all be borne by the Federal Government by any manner of means. Our idea on that is that grants will be made to States for them to assign men in their service, or contemplating their service, for training. Those grants would be made on a proportional basis, the same as other grants are made with which I know you are quite familiar. So the proportion of the expense borne by the Federal Government in the various States would vary between 20 and 80 percent. I have said $1,000,000 on research. I mean for the maintenance of the Institute; I can give a figure, which is a most rough sort of estimate, for the cost of research elsewhere, which I would put at about $5,000,000. That I cannot back up with specific data for the reasons stated. I believe that covers it. Mr. PRIEST. Of course, these are, as you say, rather rough estimates. Dr. FELIX. Extremely rough, Mr. Chairman. Mr. PRIEST. The grants-in-aid would depend somewhat on the number of States or local subdivisions or training organizations requesting such aid. Dr. FELIX. Yes, sir. Mr. PRIEST. That figure would have to be somewhat flexible. Mr. BROWN. Of course, I presume it is your thought that the $1,000,000 that would be spent at the institute is not the sum total that will actually be spent for research. Dr. FELIX. No, sir. Mr. BROWN. What do you place such figure at, how much of this $10,000,000 is actually going into research, and how much into aid and training? Dr. FELIX. I would estimate that from one-quarter to one-third of the total appropriation for the purposes of this act should go to research in all of its ramifications. Mr. BROWN. Let me ask you another question, doctor. I am a graduate medical student. This law is in operation. I decide I want to specialize in psychiatry. I apply for a fellowship. If I get that fellowship the Government will spend $15,000 educating me. Then, as soon as I get it I go into private practice Dr. FELIX. No. Mr. BROWN. Can't I do that? If so, is there any arrangement made, whereby a man who gets a subsidy from the Federal Government must pay back, or in some way compensate the Government, or is it your idea that this training will be only for men who will go into public service? Dr. FELIX. That is exactly what my thought is, and the selection of the men would be by the States. I would think that a reasonable requirement of these men would be that they would spend at least 1 year in public service for every year they spent in training at public or State expense. Mr. BROWN. I think that would be very reasonable. if you spend $7,000 a year on them. Offhand, I would suggest perhaps that they should be required to spend a little more time in the public service. Dr. FELIX. I think that would be reasonable. I was trying not to be fantastic in specifying a larger number of years, but I would certainly say 1 year, |