NATIONAL NEUROPSYCHIATRIC INSTITUTE TUESDAY, SEPTEMBER 19, 1945 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE OF THE COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Washington, D..C. The committee met at 10 a. m., the Honorable J. Percy Priest (chairman of the subcommittee) presiding. Mr. PRIEST. The subcommittee will come to order. We are meeting today for consideration of H. R. 2550, and without objection the bill and report by Federal Security Agency when received will be printed at this point in the record. (The bill and report are as follows:) [H. R. 2550, 79th Cong., 1st sess.] A BILL To provide for, foster, and aid in coordinating research relating to neuropsychiatric disorders; to provide for more effective methods of prevention, diagnosis, and treatment of such disorders; to establish the National Neuropsychiatric Institute; and for other purposes Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act may be cited as the "National Neuropsychiatric Institute Act." SEC. 2. For the purposes of conducting researches, investigations, experiments, and demonstrations relating to the cause, diagnosis, and treatment of neuropsychiatric disorders; assisting and fostering similar research activities by other agencies, public and private, and promoting the coordination of all such researches and activities and the useful application of their results; training personnel in matters relating to neuropsychiatric disorders; developing, and assisting States in the use of, the most effective methods of prevention diagnosis, and treatment of neuropsychiatric disorders; there is hereby established in the United States Public Health Service (hereafter in this Act referred to as the "Service") the National Neuropsychiatric Institute (hereafter in this Act referred to as the "Institute"). SEC. 3. In carrying out the purposes of this Act, the Surgeon General of the Service (hereafter in this Act referred to as the "Surgeon General") is authorized through the Institute to (a) conduct, assist, and foster researches, investigations, experiments, and demonstrations relating to the cause, prevention, and methods of diagnosis and treatment of neuropsychiatric disorders; (b) promote the coordination of researches conducted by the Institute, and similar researches conducted by other agencies, organizations, and individuals; (c) make available research facilities of the Service to appropriate publie authorities, and to health officials and scientists engaged in special studies related to the purposes of this Act; (d) make grants-in-aid to universities, hospitals, laboratories, and other public or private institutions, and to individuals for such research projects as are recommended by the National Advisory Mental Health Council; (e) for purposes of study, admit and treat at the Institute, voluntary patients, whether or not otherwise eligible for such treatment by the Service, and patients of Saint Elizabeths Hospital transferred from the hospital pursuant to arrangements made between the Surgeon General and the Superintendent of the hospital with the approval of the Federal Security Administrator; 1 (f) collect and make available through publications and other appropriate means, information as to, and the practical application of, research and other activities carried on pursuant to this Act; (g) secure from time to time, and for such periods as he deems advisable, the assistance and advice of persons from the United States or abroad, who are experts in the field of neuropsychiatric disorders; (h) establish and maintain, from funds appropriated or donated for the purpose, fellowships in the Institute with such stipends and allowances (including traveling and subsistence expenses) as he may deem necessary to procure the assistance of the most brilliant and promising research fellows from the United States and abroad; (i) (1) provide training and instruction in matters relating to the diagnosis, prevention, and treatment of neuropsychiatric disorders, (2) provide the necessary facilities where such training and instruction may be given to persons found by the Surgeon General to have proper qualifications, and designated by him therefor, and fix and pay such persons a per diem allowance during such training and instruction of not to exceed $10; and (3) provide such training and instruction through grants, upon recommendation of the National Advisory Mental Health Council, to public and other nonprofit institutions; (j) assist, through grants, demonstrations, and as otherwise provided in this Act, States, counties, health districts, and other political subdivisions of the States and nonprofit agencies in establishing and maintaining adequate measures for the prevention, treatment, and control of neuropsychiatric disorders, including training and instruction of personnel in subjects related to neuropsychiatry, and the provision of necessary facilities for such training and instruction; and (k) adopt, upon recommendation of the National Advisory Mental Health Council, such additional means as he deems necessary or appropriate to carry out the purposes of this Act. SEC. 4. (a) There is hereby created the National Advisory Mental Health Council, to consist of the Surgeon General, ex officio, who shall be chairman, and six members to be appointed without regard to the civil-service laws by the Surgeon General with the approval of the Federal Security Administrator (hereafter in this Act referred to as the "Administrator"). The six appointed members shall be selected from leading medical or scientific authorities who are outstanding in the study, diagnosis, or treatment of neuropsychiatric disorders. Each appointed member shall hold office for a term of three years, except that any member appointed to fill a vacancy occurring prior to the expiration of the term for which his predecessor was appointed shall be appointed for the remainder of such term, and except that the first terms of the original appointed members shall expire, as designated by the Surgeon General at the time of appointment, two at the end of one year, two at the end of two years, and two at the end of three years. An appointed member shall not be eligible to serve continuously for more than three years but shall be eligible for reappointment if he has not served immediately preceding his reappointment. (b) The Surgeon General is authorized to utilize the services of any member or members of the Council in connection with matters related to the work of the Service, for such periods, in addition to conference periods, as he may determine. (c) Each member of the Council, other than the ex cfficio member, while attending conferences or meetings of the Council or while otherwise serving at the request of the Surgeon General, shall be entitled to receive compensation at a rate to be fixed by the Administrator, but not exceeding $25 per diem, and shall also be entitled to receive an allowance for actual and necessary traveling and subsistence expenses while so serving away from his place of residence. SEC. 5. The National Advisory Mental Health Council is authorized (a) to review research projects or programs submitted to or initiated by it relating to the study of the cause, prevention, or methods of diagnosis and treatment of neuropsychiatric disorders, and recommend to the Surgeon General, for prosecution under section 3 of this Act, any such projects which it believes show promise of making valuable contributions to human knowledge with respect to the cause, prevention, or methods of diagnosis and treatment of neuropsychiatric disorders; (b) to collect information as to studies which are being carried on in the United States or any other country as to the cause, prevention, and methods of diagnosis and treatment of neuropsychiatric disorders, by correspondence or by personal investigation of such studies, and with the approval of the Surgeon General make available such information through the appropriate publications for the benefit of health and welfare agencies and organizations (public or private), physicians, or any other scientists, and for the information of the general public; (c) to review applications from any university, hospital, laboratory, or other institution or agency, whether public or private, or from individuals, for grants-in-aid for research and demonstration projects relating to neuropsychiatric disorders, and certify to the Surgeon General its approval of grants-in-aid in the cases of such projects which show promise of making valuable contributions to human knowledge with respect to the cause, prevention, or methods of diagnosis or treatment of neuropsychiatric disorders; (d) to review applications from any public or other nonprofit institution for grants-in-aid for training and instruction in matters relating to the diagnosis, prevention, and treatment of neuropsychiatric disorders, and certify to the Surgeon General its approval of such applications as it determines will best carry out the purposes of this Act; (e) to recommend to the Surgeon General for acceptance conditional gifts pursuant to section 501 of the Public Health Service Act for carrying out the purposes of this Act; and (f) to make recommendations to the Surgeon General with respect to carrying out the provisions of this Act. SEC. 6. The Surgeon General shall recommend to the Administrator acceptance of conditional gifts, pursuant to section 501 of the Public Health Service Act, for study, investigation, or research into the cause, prevention, and methods of diagnosis and treatment of neuropsychiatric disorders, or for the acquisition of grounds or for the erection, equipment, or maintenance of premises, buildings, or equipment of the Institute, only after consultation with the National Advisory Mental Health Council. Donations of $50,000 or over in aid of research under this Act may be acknowledged by the establishment within the Institute of suitable memorials to the donors. SEC. 7. (a) To enable the Surgeon General to carry out the purposes of this Act with the exception of section 8, there is hereby authorized to be appropriated for the fiscal year ending June 30, 1946, the sum of $10,000,000 and for each fiscal year thereafter a sum sufficient to carry out such purposes. (b) For each fiscal year, the Surgeon General, with the approval of the Administrator, shall determine the total sum from the appropriation under subsection (a) which shall be available for allotments to States. He shall, in accordance with regulations prescribed by him with the approval of the Administrator, from time to time, make allotments from such sums to those States for plans which have been approved under this section. (c) The Surgeon General shall from time to time certify to the Secretary of the Treasury the amounts to be paid to each State from the allotments to such State. Upon receipt of such certification, the Secretary of the Treasury shall, prior to audit or settlement by the General Accounting Office, pay in accordance with such certification. (d) The moneys so paid to any State shall be expended solely in carrying out the purposes for which the grant is made and in accordance with plans presented by the health authority of such State and approved by the Surgeon General. The Surgeon General shall not approve any such plan unless it provides for expenditure thereunder, from funds of the State or from funds of the State and its political subdivisions, of such amounts as may be determined in accordance with regulations prescribed by the Surgeon General with the approval of the Administrator. (e) Whenever the Surgeon General, after reasonable notice and opportunity for hearing to the health authority of the State, finds that there is a failure to comply substantially with either (1) the provisions of this section; (2) the plan submitted under subsection (d); or (3) the regulations prescribed under section 10 (c) with respect to this section; the Surgeon General shall notify such State health authority either that further payments will not be made to the State under this section (or in his discretion that further payments will not be made to the State under this section for activities in which there is such failure), until he is satisfied that there will no longer be any such failure. Until he is so satisfied the Surgeon General shall make no further certification for payment to such State under this section, or shall limit payment to activities in which there is no such failure. (f) All regulations and amendments thereto prescribed under section 10 (c) with respect to grants to States under this section shall be made after consultation with a conference of the State health authorities. Insofar as practicable, the Surgeon General shall obtain the agreement of the State health authorities prior to the issuance of any such regulations or amendments. SEC. 8. There is hereby authorized to be appropriated a sum not to exceed $4,500,000 for the erection and equipment, for the use of the Institute in carrying out the provisions of this Act, of suitable and adequate hospital buildings and facilities, and of suitable and adequate laboratory buildings and facilities. The Federal Works Administrator is authorized to acquire, by purchase, condemnation, donation, or otherwise, a suitable and adequate site or sites, selected on the advice of the Surgeon General, in or near the District of Columbia for such buildings and facilities, and to erect thereon, furnish, and equip such buildings and facilities when funds are made available. The amount authorized to be appropriated in this subsection shall include the cost of preparation of drawings and specifications, supervision of construction, and other administrative expenses incident to the work: Provided, That the Federal Works Agency shall prepare the plans and specifications, make all necessary contracts, and supervise construction. SEC. 9. (a) Sums appropriated to carry out the purposes of this Act (except section 8) may be expended in the District of Columbia for personal services, stenographic recording and translating services, by contract if deemed necessary, without regard to section 3709 of the Revised Statutes; traveling expenses (including the expenses of attendance at meetings when specifically authorized by the Surgeon General); rental, supplies and equipment, purchase and exchange of medical books, books of reference, directories, periodicals, newspapers, and press clippings; purchase, operation, and maintenance of motor-propelled passengercarrying vehicles; printing and binding (in addition to that otherwise provided by law); pay, allowances, and traveling expenses of commissioned officers and other personnel engaged in activities authorized by this Act; and for all other necessary expenses in carrying out the provisions of this Act. (b) Persons who are not citizens may be employed pursuant to subsection (g) of section 3 and may be appointed to fellowships pursuant to subsection (h) of that section. Unless otherwise specifically provided, any prohibition in any other Act against the employment of aliens, or against the payment of compensation to them, shall not be applicable in the case of persons employed or appointed pursuant to such subsections. SEC. 10. (a) There are hereby authorized to be appointed in the Public Health Service, in accordance with applicable law, such commissioned officers as may be necessary to aid in carrying out the provisions of this Act. (b) This Act shall not be construed as superseding or limiting (1) the functions of the Surgeon General or the Service under any other Act, or of any other officer or agency of the United States, relating to the study of the prevention, diagnosis, and treatment of neuropsychiatric disorders; or (2) the expenditure of money therefor. (c) This Act shall be administered by the Surgeon General under the supervision and direction of the Administrator. The Surgeon General with the approval of the Administrator is authorized to make such rules and regulations as may be necessary to carry out the provisions of this Act. (d) As used in this Act, the term "State" means a State or the District of Columbia, Hawaii, Alaska, Puerto Rico, or the Virgin Islands. Hon. CLARENCE F. LEA, FEDERAL SECURITY AGENCY, Chairman, Committee on Interstate and Foreign_Commerce, DEAR MR. CHAIRMAN: This letter is in further response to your letter of March 14, 1945, in which you requested our comment upon H. R. 2550, a bill to provide for, foster, and aid in coordinating research relating to neuropsychiatric disorders; to provide for more effective methods of prevention, diagnosis, and treatment of such disorders; to establish the National Neuropsychiatric Institute; and for other purposes. H. R. 2550 would establish in the Public Health Service a National Neuropsychiatric Institute to serve the following general purposes: (a) Research relating to the cause, diagnosis, and treatment of neuropsychiatric disorders. (b) Training of personnel in various phases of neuropsychiatry, both at the institute and elsewhere through grants-in-aid. (c) Assistance in and promotion of the establishment of clinics and treatment centers for the prevention, diagnosis, and treatment of neuropsychiatric disorders, and for demonstrations in this field. The bill would attack the problem of neuropsychiatric disorders in a comprehensive manner. In my opinion, the neuropsychiatric disorders constitute one of our most serious · health problems today, and call for prompt and energetic action if we are to avoid an even more serious situation than that in which we now find ourselves. No age group or race is exempt from their ravages. The number of young men of military age who are incapable of serving their country because of neuropsychiatric disability gives us great concern not only for the present but also for the future. According to figures prepared by the Selective Service, as of December 1, 1944, out of approximately 15,000,000 men examined for induction into the armed services, 4,458,000 were rejected for physical reasons, of whom 1,604,500 or nearly 36 percent were neuropsychiatric rejections. In other words, it was necessary to reject for neuropsychiatric reasons approximately 1 out of every 10 men examined for induction. The fate of those who pass the induction examination is even more alarming. The December issue of the bulletin of the United States Army Medical Department presents data on this subject. From July to December 1943, 39.4 percent of all medical discharges from the Army were because of neuropsychiatric unsuitability for further military service. This percentage was twice as high as that for the second most frequent cause for medical discharges. From January to June 1944 this percentage was 48.3 or five times as high as that for the second ranking cause. These percentages do not include mental defectives, nor do they include that group of individuals classed as psychopathic personalities. We know, moreover, that mental illness is not limited to men of military age, but that it strikes men and women of all ages. Who is to care for the more than one and one-half million men found psychiatrically unfitted for induction? These people must have care, but in many cases they are not in need of hospitalization. In fact, in many instances admission to an institution actually prolongs the illness. This also applies, of course, to many of the psychiatric cases being discharged from the armed services. Our problem does not stop with those who are ill, however. As in any other public health problem, it is necessary to find the cause, provide treatment for those who are ill, reduce the incidence of new cases, and show the public how they can help in combating the disease. These things the individual States cannot do without assistance. H. R. 2550 provides for a national research center where all phases of the problem can be investigated, and for grants-in-aid, for work done either at the institute or elsewhere, to individuals who show promise of contributing to our knowledge in the field. It also provides for grants for the training of personnel to work in the field, and for facilities for such training. At the present time the number of such personnel available is woefully inadequate to cope with the problem. It has been estimated that at least four times as many psychiatrists are needed as there are now in existence. In addition to psychiatrists, moreover, we also need other classes of trained personnel. The bill also provides for assistance to States in the use of the most effective methods of prevention, diagnosis, and treatment of neuropsychiatric disorders. To assure that treatment centers are established where the returning fighting man and other members of the community can receive outpatient care in this field, the States must receive assistance in the form of grantsin-aid and loan of personnel. The Federal Government now gives such assistance to the States through the Public Health Service in other fields of health, and this bill extends this well-established and satisfactory policy to the field of mental health. There are certain changes in the bill to which I should recommend that your committee give consideration: It would seem to me desirable that the bill be recast as an amendment of the Public Health Service Act (58 Stat. 682). In recommending enactment of the bill which became the Public Health Service Act, your committee stressed the desirability of establishing "a compact and logically arranged law governing the |