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carrying on a consistent research program in the field of epilepsy, and one of these two was among the more modest endeavors. These are just a few samples of what might be done under this bill. To attempt to list all of the specific projects would be an interminable job.
The status of psychiatric training: For the most part, psychiatric training has been left to chance. Periodically the National Committee for Mental Hygiene and the American Psychiatric Association have surveyed conditions and promoted improvement. Our medical schools have not begun their curriculum based upon the need as seen in the failures of medicine. If they had, psychiatry would occupy a more sizable place in the allotted time. Neither the amount nor the type of training has been adequate to prepare the average doctor to cope with the psychiatric problems that come to his everyday attention. The graduate is ill-prepared then to proceed with postgraduate training in psychiatry. He must as a rule start from scratch after his general internship by getting a residency in a mental hospital. Too often he does this not for the attractiveness of the field or of the education that will be afforded him, but because it is a job that pays fairly in money and maintenance. He is poor after 8 years of paying for tuition.
We have attempted to bring before the prospective psychiatrist a knowledge of those hospitals that will offer him real training, but the list of such is small, and our resources for visiting these hospitals and looking over their educational offerings and making contact with prospective residents is sufficient only to show what could be done with adequate resources. What I have said of psychiatrists could be paraphrased for nurses, attendants, social workers, psychologists, and other auxiliary personnel. This is crucial. It is crucial not only to get good treatment for these sick people but to our own national morality, which can be calloused by the neglect of such patients, and I feel strongly that we cannot now, of all times, stand for anything approaching even in miniature the atrocities which are high in our consciousness today.
Following a good residency, the budding psychiatrist may wish to give special attention to children, to court cases, to industry, to teaching, to one of a number of other special aspects of this field. In Philadelphia they have pitifully small provision for training in legal psychiatry for courts, penal and correctional institutions, but it is our total national resource.
The National Committee for Mental Hygiene has 10 or so fellowships for training in child or community outpatient psychiatry, when, to meet our national problem, 200 per year would be needed. We have fellowships for refresher training and the polishing up of the brilliant lights, the potential leaders in the field$10,000 per year. Its value is in showing what can be done with such help. It does not relieve us of the almost daily demand for personnel which we cannot supply.
There is one point I think I might make here in addition, and that is that the trained personnel is not centered in the State which uses the personnel. In most instances the State which employes personnel has not entered into the training. There is really a need for a national program, rather than anything limited to one State, and I think in that respect it differs from public education.
The status of the preventive services: Under the provisions of this bill it will be possible for the Federal Government to assist in the development of preventive services. In the field of psychiatry this, in essence, means out-patient clinics and services to the general medical and surgical patient group, in general hospitals, for it is in this group that the beginnings of mental illness are apt to appear. The out-patient clinic may be an all-purpose clinic or it may be specialized to serve children, or schools, or courts, or college student bodies, or other groups of the population at large.
Since 1922 the National Committee for Mental Hygiene has maintained one division of its work that is devoted to the development of such services, particularly for children. During that time the provisions throughout the country have grown from the equivalent of two clinics which employed a psychiatrist, a psychologist, and three psychiatric social workers, to the provision of such services for most of our larger cities. But it is remarkable that this has been almost exclusively for children, and services to adults lag far behind. Furthermore, the services are almost completely limited to our first 50. cities; in other words, those that were over 150,000 population in 1930. Below that level of population the service is almost negligible. The small city and rural community need a foundation and a leadership that cannot be found in the locale but must be looked for in the State as a whole.
It is for this reason that H. R. 2550 offers a great promise for working through State departments concerned with mental health. It is in a position to counteract some of the isolation of existing State services referred to earlier and to enable a State to get a service under way on a good enough foundation to insure its quality and
The assurance of its quality and success is the best insurance of its continuance. Again, as a safeguard to its investment, there is the provision for the training of personnel.
Empirically on the basis of experience already obtained we should have one clinic of the size referred to previously for approximately every 100,000 of our population, approximately 1,300 for the country as a whole. The provision of psychiastrists for such an undertaking will come slowly. In order to proceed at a maximum speed it would involve the training of 200 per year. Instead, we shall be doing well if we can train one-eighth of that number in the first year or two of this program, since adequate training requires adequate training facilities and adequately qualified trainees. In this I am speaking only of the out-patient clinic end of the work, which is a small percentage.
Mr. PRIEST. You say there should be one clinic to each 100,000 population.
Dr. STEVENSON. Yes.
In conclusion, the mental health functions as they have been conducted to date are based upon requirements and facilities conceived in the middle of the last century. Our whole concept of humane services, by States, has grown immensely since that time. Particularly in the past 20 years have communities become something more than a rugged situation in which to survive.
Many States are coming to appreciate the fact that this all requires a shifting in the way they should provide psychiatric service to their people. H. R. 2550 offers support to the States in doing this and at the same time permits them the latitude of planning that should make
all of the 48 or 50 States experimental units in which government can mean more to people.
Mr. PRIEST. Have you any questions, Mr. Chapman?
Mr. CHAPMAN. Dr. Stevenson, you have mentioned the per capita expenditures of the States for treating mental and nervous disorders. Would you give us a little further discussion of those figures relating to the expenditures of the States?
Dr. STEVENSON. They are figures that were secured by the Census Bureau and put out in its report of 1942. They have very extensive tables on it.
Mr. CHAPMAN. I wonder if you would put into the record those figures for all of the States.
Dr. STEVENSON. Yes; I would be pleased to do that. The totals. and the per capita?
Mr. CHAPMAN. Yes.
Dr. STEVENSON. That per capita means per capita patient, not per capita population.
Mr. PRIEST. We would be very glad to have that for the record. Dr. STEVENSON. I shall be glad to submit it. (The information referred to above is as follows:)
Total expenditures of State hospitals for mental disease, and per capita expenditures
for maintenance, by divisions and States, 1941
[Statistics are based on reports from 175 State hospitals]
30, 524, 822
4, 399, 025 1,892, 679 14, 333, 693 8, 946, 427
952, 998 10, 181, 794
210.01 202. 97 271. 48 495. 33 498. 40
|| 888918 || sus || Snol
2, 371, 070
411, 243 1, 443, 427 1,027, 546
214. 01 261. 69 244. 90 271.97 257. 93 280.52 197. 60
Total expenditures of State hospitals for mental disease, and per capita expenditures
for maintenance, by divisions and States, 1941–Continued
Source: Patients in Mental Institutions, 1941, U. 8. Department of Commerce.
Mr. PRIEST. We certainly thank you for your very fine statement, Doctor.
Is Dr. Winslow here?
Mr. PRIEST. Without objection we will enter Dr. Winslow's letter in the record. That is, if he desires to present his testimony in that manner.
Dr. STEVENSON. This is a letter from Dr. Winslow stating that he would be in Washington on the 29th, but could not be here today. He will be available then.
Mr. PRIEST. Very well. Is Dr. Marquis present?
Mr. PRIEST. Will you give the reporter your full name and title?
Dr. MARQUIS. Donald Marquis. I am representing the American Psychological Association, of which I am secretary.
Mr. Priest. You may be seated, Doctor, and proceed with your testimony.
Dr. MARQUIS. I had not intended to have a prepared statement, because the nature of the problem has been made perfectly clear by the statements which you have already heard. I wish only to report the support of the psychology profession for a measure such as this, and I should like to submit for the record a resolution which was adopted at the regular annual meeting of the American Psychological Association.
Mr. PRIEST. Very well; without objection, we shall be glad to receive it at this point. (The letter referred to is as follows:) THE AMERICAN PSYCHOLOGICAL ASSOCIATION,
OFFICE OF THE SECRETARY,
Washington 25, D. C. The American Psychological Association, at its regular annual meeting September 8 in Evanston, Ill., voted approval of the purposes and general provisions of a bill to establish a National Neuropsychiatric Institute (H. R. 2550, S. 1160). The problems of neuropsychiatric disorders are of vital concern to the national welfare, and their magnitude demands a coordinated attack by all of the sciences and professions devoted to the study and treatment of such disorders.
Donald G. MARQUIS,
Recording Secretary. Dr. MARQUIS. The bill was referred to a committee of the association on clinical psychology, and also to a committee on legislation. It was carefully studied by members of the committees who reported to the board of directors of the association who, in their meeting of September 8, adopted a resolution approving the objectives and general procedures of the bill under discussion. This I say only to indicate that it had very serious consideration and study over a period of 2 or 3 months.
Psychology is one of the sciences and professions which is concerned with the problem of psychiatric disorders. It works along with other sciences and professions in the study of the problem and in the devising and administration of measures for the prevention, the diagnosis, and the treatment of such disorders. It is a member of a team of scientists and professional workers. It is our belief that the problems are so great as to demand the coordinated and concerted attack of all of the sciences and professions. Our resolution was adopted with the intention of conveying to you that psychology, as one of these sciences and professions, sees in the bill. an excellent opportunity to further the study and treatment of this problem.
It so happens that in psychology there is relatively adequate provision for research and training of professional personnel in the field of experimental psychology, a type of work which has been exploited during the war by the Office of Scientific Research and Development. There is not adequate provision for research and for the training of personnel in clinical psychology, which is that part of psychology concerned with the individual problems of the mentally disordered, as well as of normal individuals who present comparable problems. For that reason it is felt that provisions of this sort for the support and stimulation of research and improved training facilities in the field of clinical psychology, as a part of a general concerted attack on the problems of psychiatric disorders, is highly desirable and very necessary
I shall be glad to answer any questions any of your committee may want to ask about this phase of the bill.