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In addition, two other general provisions are contained in this bill, one of which is also authorized in the National Cancer Institute Act, namely, the training of personnel and, second, aid to the States in developing mental health service. I had expected to come to this analysis later, but now is a good time to take it up.
Mr. Brown. Is it your thought the new institute created by this bill would follow very closely the pattern set in the development and administration of the Cancer Institute?
Dr. PARRAN. It would, and do other things in addition.
Dr. PARRAN. If you will refer to section 7 of the bill, on page 8, you will probably recognize the language contained in that section as being similar to the language which this committee put into the Public Healtb Service Act of 1944, section 314, and this language, in turn, was taken from the provisions of the Social Security Act and of the National Venereal Disease Control Act. In other words, the type of cooperation and of aid to the States envisioned with reference to the problems of mental disease parallels and is almost identical with the grants-in-aid provisions under which we now aid the States in developing their public health service, and the specific programs like tuberculosis.
Mr. BROWN. Section 7 is the implementing power to section 5, is it not?
Dr. PARRAN. It is the implementing power of section 2 (j), Mr. Brown. Section 5 deals with the review and approval of research applications, particularly from universities, hospitals, and other institutions, public and private, and with grants-in-aid for training. Section 7
Mr. Brown. Just a minute, please. Section 5 goes just a little bit further than just providing for a review of research projects and programs. It also deals with the collection of information as to studies
Dr. PARRAN. That is correct.
Mr. BROWN. And goes on to deal with applications from universities and so forth, and finally with the review of applications from any public or nonprofit institution for grants-in-aid.
Dr. PARRAN. I would underscore the words “training and instruction,” in that section.
Mr. BROWN. Is it your thought that out of this fund will be contributed money by the Federal Government to State and local educational institutions, that is, medical schools, for training?
Dr. PARRAN. That is a part of the concept of this bill as I read it.
Mr. Brown. Do we do that now with the Cancer Institute program?
Dr. PARRAN. We do, as follows: We give stipends and travel expenses to trainees, for postgraduate training of persons who wish to acquire expertness in the diagnosis and treatment of cancer, and who take such training in one or another university.
Mr. Brown. But the Cancer Institute Act doesn't go as far as this does.
Dr. PARRAN. No, that doesn't go as far as this bill does, and I want to emphasize the importance of going further in reference to this problem in aiding the medical institutions, the teaching institutions of the country, both in their undergraduate and postgraduate instruction in matters of mental health.
Mr. BROWN. The only limit would be the decision of the Administrator, the Surgeon General, and the National Advisory Mental Health Counsel, plus the appropriation committees?
Dr. PARRAN. That is correct, sir; and I would underscore your last clause.
Mr. BROWN. Personally, it has been my experience that appropriations very seldom grow smaller as the years pass. They usually grow very much larger. I am also conscious of the fact that there are a great many people who are not deeply interested in seeing the Federal Government in the field of education, so far as State and local institutions are concerned. We have had before us for some time a bill for Federal aid to education. It is a very controversial subject. I don't want to see us go through the side door or the back door into any field that we have refused to enter through the front door.
I am going to ask, Mr. Chairman, and General Parran, to be excused at this time. I have another meeting I cannot very well miss.
Mr. BULWINKLE. And may I say, Doctor, and Mr. Chairman, I have to leave too.
Mr. BROWN. You have to appear before the same committee.
Mr. BULWINKLE. Yes; and I agree with you absolutely about mental health, Dr. Parran.
Mr. BROWN. I agree with all the general has said about the neces sity of mental health. I also want to see a great deal of mentality used while we are preparing this legislation, instead of wondering afterward why we did not. Mr. Chairman, I would like very much to have the opportunity to discuss the different sections of this bill with Dr. Parran later.
Dr. PARRAN. I shall be at your disposal at any time, Mr. Brown.
Mr. PRIEST. I am sure we will have ample time to discuss the various provisions. I am sorry you bave to go, but I know your meeting is very important.
Mr. BROWN. Dr. Parran, is that a prepared statement you have there?
Dr. PARRAN. Only some pencil notes I wrote out last night, sir.
Mr. BROWN. You are such an able witness that I am never sure whether you have a prepared statement or whether you are speaking extemporaneously.
Mr. Chairman, with that thought in mind, that we can come back to some of these matters more in detail later, I will ask to be excused.
Mr. PRIEST. The chair is reluctant to excuse you. You may proceed, Dr. Parran.
Dr. PARRAN. Do you wish me to discuss briefly the provisions of the bill? Or I can do that later? Whicbever you prefer.
Mr. PRIEST. We would prefer that you go right ahead.
Dr. PARRAN. May I return to the provisions of section 2, which authorize the conduct of researches, experiments and demonstrations, relating not only to the causes, but to the diagnosis and treatment of neuropsychiatric disorders? It authorizes also the aid and fostering of similar research activities at other agencies, public and private, and the coordination of those activities and the useful application of their results. This language, Mr. Chairman, I think repeats almost exactly the language of the National Cancer Institute Act.
Section 2 also provides for the training of personnel in reference to neuropsychiatric disorders, and developing and assisting States in applying effective methods of prevention, diagnosis, and treatment.
This last purpose is made effective by section 7 to which Mr. Brown already has referred.
To accomplish this whole purpose there is authorized to be established the National Neuropsychiatric Institute. In this Institute-I refer now to section 3 (f)—basic laboratory studies would be carried out, and in addition studies would be carried out on patients. For this latter purpose it is provided that patients of St. Elizabeths Hospital may be transferred from that hospital to the Institute for such purpose of study in accordance with arrangements mutually agreed upon. As an example, one particular type of mental disease might be the object of intensive study. A few patients, 25 or 50, may be transferred to the Institute and certain laboratory or psychological and other tests and examinations made upon them, or perhaps certain promising methods of treatment may be used. After such study such patients would be returned' to St. Elizabeths Hospital, if they were not cured, and perhaps other patients of a different type could be admitted and treated.
In the Institute itself, then, both basic laboratory studies and clinical studies would be carried out.
Now, to carry out the broad purposes of section 2, section 3 repeats somewhat the language of section 2, merely by way of authorizing the Surgeon General to carry out the purposes set forth in the preceding section 2.
The bill is clear in at least two places as indicating the intent to secure the assistance and advice of the best experts to be found, whether in the United States or abroad. The bill provides also for the establishment of fellowships, that is to say research fellowships, in and under the Institute. These fellows would be promising young research scientists, who would be giyen an opportunity over a short period of years to carry out investigations either in the Institute itself or in any one of the cooperating scientific institutions in the country or abroad.
And then section 3 (i) refers to the training and instruction in matters pertaining to diagnosis, prevention and treatment of neuropsychiatric disorders, and it authorizes also that necessary facilities therefor may be provided, presumably in the cooperating institutions of the country. In other words, while I recognize fully the point of view which Mr. Brown has expressed, in this field there seems to be a very crucial need for training personnel. In perhaps half of the medical schools of the country, perhaps less, there are well organized departments of neuropsychiatry. They have facilities in which students are given postgraduate instruction in which research would be done. We would solicit the cooperation of all such institutions in the country in attaining the total obiectives of the act, and cooperating more specifically through the National Institute.
Mr. PRIEST. Dr. Parran, I think that is one of the most important provisions in the bill, as it occurs to me. I have had a number of people ask me if I had, or anyone had, an estimate of the number who might possibly receive this training. Of course, it would be a very indefinite figure. I wonder if you have any estimate on how many might receive this training. Of course, that would depend on the number of institutions that entered into the cooperative program, to some extent.
Dr. PARRAN. It would be merely a guess on my part. I would say, speaking broadly, that we have much less than half the number of trained psychiatrists, psychiatric nurses, psychologists and other ancillary workers to meet the needs of the actual care of patients now in mental institutions and otherwise needing care. All of us are familiar with the great shortage of psychiatrists with which the armed forces were faced, and I hope you will have testimony on that score. The figure I have given, of course does not include the new army of research minds which must be trained to tackle this problem if we are going to make any progress.
Finally, section 3 refers to the grants which may be made to the States, which grants are described more in detail under section 7, which I shall refer to later.
Section 4 of the act creates the National Advisory Mental Health Council. Again, the language of section 4 parallels the language of the provisions of the National Cancer Institute Act, setting up the advisory council for that institution.
I should say that, generally speaking, the concept of this bill is that the establishment of major policies is done not by the Surgeon General alone, but with the advice of this Council, and moreover, the Council is given the specific administrative authority in that it must approve of any grant-in-aid for research before such grant-in-aid may be made.
In addition, as I have indicated, it advises generally concerning the policies of the Institute, and I must say that in connection with our researches in cancer that device has worked very satisfactorily. We have been enabled to get the best experts of the country to serve as members of that Council
, to carry out special missions and study, and, in general, to bring about coordination on the part of all scientific institutions, which increasingly look to the National Institute for leadership in this field.
I shall not review in detail, therefore, the provisions of section 5, which sets out specifically the method of appointment, the authority and responsibility of the National Advisory Mental Health Council.
Section 6 authorizes the acceptance of gifts, and even the acceptance of conditional gifts, provided they are approved.
Then we come to section 7, and knowing that the subcommittee is familiar with most every word in the comprehensive Public Health Service Act of 1944, I shall not go into detail in examining the provisions of section 7, except to say they parallel almost exactly the provisions of section 314 of Public Law 410, Seventy-eighth Congress.
Mr. PRIEST. May I ask one question on section 7? I have one letter. here from Mr. Sanford Bates, who is Commissioner of Institutions for the State of New Jersey, and he suggests an amendment in paragraph (b) of section 7, on page 9 of the bill, line 20, where it reads: made and in accordance with plans presented by the health authority of such State.
He suggests that that language might be changed, and it would make a more workable bill, if we used language as follows: authority having control of the administration of mental hygiene activities.
I am just wondering if that suggestion has come to you previously, or if there has been any particular study made of that.
Dr. PARRAN. There has been some study, Mr. Chairman. I assumed when you selected this language, Mr. Chairman, you were thinking of this measure as a public health measure.
Mr. PRIEST. Yės, sir, and it seems to me that it is phrased in almost the same language as used in the cancer and tuberculosis bills in that respect.
Dr. PARRAN. That is correct, Mr. Chairman. However, I think the committee should be informed that in some States, New York, for example, there is a department of health, and there is also a department of mental hygiene. The same problem came up with reference to the hospital construction bill which is pending before this committee, and in the hospital construction bill it is provided that the governor shall designate a single State authority. Perhaps such language might be considered by the committee. The arrangements for mental health are very divergent in the different States. In some instances, as I have indicated, they have a special department of mental hygiene; in others such mental health work as is done is a part of a department of institutions. I wouldn't want to see the major program under this act bogged down merely in the care of patients in State mental institutions. I would hope you would have a public health approach to the problem, particularly in regard to mental health clinics. Childguidance clinics, mental health clinics, and services for veterans are tremendously important. Such clinics, I am sure, should be operated under public health auspices. However, I would suggest that the committee consider possibly alternate language in the section to which you refer, which would give to each State itself the authority to name the State agency, or even, perhaps, to divide the responsibility in certain instances.
Mr. PRIEST. Thank you, Doctor.
Dr. PARRAN. Without prolonging this phase of the discussion too much, a State university may, and very likely would be carrying out certain of the cooperative functions of the Institute.
As I have said, section 7 parallels the provisions of section 314 of Public Law 410, and unless there are questions I think we can pass now to section 8, which is specific in authorizing the erection and equipment of a National Neuropsychiatric Institute, together with hospital facilities and suitable and adequate laboratory buildings and facilities, and the Federal Works Administrator is authorized to construct such building, as he does construct other Public Health Service buildings.
The rest of the language of the act is largely administrative and designed to provide the administrative organization to carry out the bill.
Mr. Chairman, as doubtless you know, this measure has been sponsored by the leading professional societies of the country. In addition, at the last annual meeting of the State and Territorial health officers, a resolution was adopted unanimously endorsing this bill for passage. The statement in part is as follows:
We have been much concerned by the evidence that the mental health of our people is far from satisfactory and that the ravages of the war may easily augment the seriousness of the situation. We believe that the same broad principles of public health apply to the problems of mental illness as to the problems of tuberculosis, venereal disease, malaria and other diseases, where we must find the cause, develop better methods of treatment, train competent personnel, care for the ill