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because of Įimitation in authority and appropriationi, - If this legisl lation is enacted the Service can take constructive action on such projects, provided they are found to have merit and appropriations are available io9P312021. ut in hoc nejste horsiune in

This legislation contemplates the extension of as nearly uniformt mental health services throughout the Nation as it may be possible to achieve. This implies an obligation on the Public Health Service to fully inform itself of the existing needs and resources

. Althought some very excellent surveys of certain aspects of the problem have been made, there has been no single over-all evaluation of the Nation's njeeds. Furthermore, due to the war, surveys of the type presently needed to implement a program were discontinued. - The most recent data available which might be applicable to peacetimes conditions was obtained in 1940: The Nation is now in a state of flux: Significanti shifts in the population are under way. Medical facilities, both clinical and teaching, are undergoing readjustment, so that the materiál gathered 5 years ago is not completely pertinent to the problem! at handa i bu il once sm si ish i warisan luiziisis

Surveys of the States, counties, district, and other political subdivisions and nonprofit agencies in the States are necessary to determine the adequacy of the facilities, including personnel for the prevention, diagnosis, and treatment of mental illness. There must be in addition a survéy of the existing and potential facilities for training all cate gories of personnel needed in the mental health field'ioi Thiełatter! survey can be done in a relatively short period of time and should be given priority, since it is essential to accurate initial planning of thet early phases of the total program. For example, it must be determined how many additional residents in psychiatry can be trained ini thei'existing facilities, w. It must be determined which facilities not nowy training psychiatrie íresidents can be utilized for this purposes The same procedure applies to the allied fields which are concerned in the over-all program, such as, for instance, clinical psychology, psychiatric nursing, the therapeutic aids, psychiatric soeial services and the vast army of attendants working in mental institutions. It 1) v In order that the research to be undertaken at the Institute may be coordmated with texisting or contemplated projects elsewhere,rla survey of research facilities must be made to determine the nature of the problems now being investigated: Furthermore, there are a large number of institutions where vast amounts of clmical material are available which could well be utilized in additional research The survey would attempt to discever which of these institutions desire to undertake research through Federal aidin, bis icon CTI

According to the latest available information there is provided in the entire United States only approximately one-fifth of the minimum of clinic hours estimated by the National Committee for Mental Hygiene as essential to meet the needs of the country. As Dru! Stevenson stated in his testimony, these are contemplated in cities having a population of 150,000 or more in 35 States One of the firsti objectives would be to assist, through grants, the organization' and operation of treatment facilities of this nature in communities not already served by such a center.' r. At this point, Mr. Chairman, I would like to submit for the record two tables which will illustrate what I have said.

Mr. Priest. They may be made a part of the record
The tables referred to are as followsi); int

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Table 1.- Estimated initial grants to States (from an appropriation of $10,000,000) for maintenance and operation of a central mental health office and a minimum of 1 general mental hygiene out-patient clinic for each 500,000 population

(Population based on 1940 census)

der Now

Services and cost
State and local contributions

Percent of State's

contribution

Federal
State

Additional

grants-inValue of

Tota! clinics, at 1 amount services now

amount to be

Total

aid 3
; VII 2/3!G21.00 PE 6!I DIO LOZ A GOGLE} bleven boufo hygiene LA per 500,000

contributed - amount sa ICOPCOE PPE o mimi,

provided

available by States this point
570 CIUC210!! OLULITID 809 1/3 UGAIDIC? (OPG 62 80112067
Total.

$894, 150 $11, 321,085. $12, 215, 235 $8, 201, 881 $776, 457 $8.978, 338 $3, 236, 897
Alabama

16,700 193, 140 209, 840

62, 460
52, 460
157, 380
25.0

0
Arizona

19,000 132, 190
41, 190

18, 229 16, 229 24, 961

39.4 Arkansas

11, 750 128, 760 140, 510

32, 177 32, 177 108, 333 22.9

0 California.!!

41, 400 450, 660 492, 060 388, 261

388, 261 103, 799

66.0

178.9 Colorado

19,000 164, 389 73, 380 68, 108

68, 108 15, 272

44. 2

92.8 Connecticut.

10,300 219. 565 229, 865 229, 865 229, 865

68. 9

100.0 Delaware

9,000 32, 190 41, 190 28, 901

28, 901 12, 289 66.7

70. 2 District of Columbia.

110, 228 110, 228 110, 228

72.6

100.0 Florida 60

11, 400 128, 760 140, 160

53, 821
53, 821
86, 339

38.4
Georgia S 1019

211, 840

5, 377 52, 879 58, 256 153, 584 27.6

2.5
Hawaií. 3

41, 190
84, 054

34, 054
17, 136

62.8

82. 7 Idaho I

9, 000 32, 190 41, 190

16, 847 16, 847 24, 343 40. 9

10 a Illinois. ACH

683, 770 683, 770 683, 770

57.6

100.0
Indiana

245, 930
92, 977
23, 840
116, 817
129, 113

47.5

37:8 Iowa

176, 150 60, 043 15, 702 75, 745 100, 405

43.0

34. 1 Kansas

10, 800 128, 760 139, 560 26, 437 30, 503 656, 940

82, 620
40.8

18. 9
Kentucky 909

17, 100
193, 140
210, 240
56, 458

56, 458 153, 782

26. 3

26.9 Louisiana 0103

175, 150 114, 708

114, 708 160, 442

30.8

65.5 Maině ULK

73, 380

1, 344 30, 796 $32, 140

41, 240

43.8

101.8 Maryland so

481, 238 481, 238 481, 238

57.1

100.0 Massachusetts.

585, 865 585, 865 585, 865

59.0

100.0 Michigan..

752, 998 752, 998 752, 998

54. 2

100.0 Minnesota.

16,800 193, 140 209, 940

172, 287

172, 287

37, 653 41.8

821
Mississippi.
128, 760 1:11:141,860

NI
128, 372 1128, 372

113, 488
Missouri

280, 220

vi 178, 336

101, 884
Montana
-219NG.
Jetste 99, 000 008-0 32, 190

41, 190

VU 19, 400 19, 400 R20 21,790

47. 1

0
Nebraska

9,000
96, 570
105, 570

5,825 35, 347

41, 172 24064, 398

39.0

5.5
Nevada

9,000
32, 190
41, 190

28, 174 28, 174

13, 016 068: 4pofiou 0 New Hampshire.

41, 190 14,787 100, 2, 330 parcour 17, 217

23, 973 1,6241.8 : acérG35.9
New Jersey

282, 520
199, 172

199, 172

83, 348 61.9

70.5 See footnotes at end of table, p. 88.

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Out-patient D83 01 GJIDỊC 26111062 ID 7]82T LEGIÇO FIGO x State division

39,000 101, 228

18,700 193, 140

19,000 132, 190

47, 900 635, 870

20, 600 225, 330

15, 200 160, 950

14, 200 160, 950

9,000 3064, 380

10, 900 470, 338

25, 900 559, 965

31, 500 721, 498

9,000 JOLAIGG2 32, 390

25,000 257, 520

p2 13, 100
OL11122,700

G257, 520

178, 336

v1!41.8

110-63.6

TABLE 1.-Estimated initial grants to States (from an appropriation of $10,000,000) for maintenance and operation of a central mental health office and a minimum of 1 general mental hygiene out-patient clinic for each 500,000 population-Continued

(Population based on 1940 census)

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1 15 States now have central offices. : Includes 240 clinics now in operation and 112 new clinics to be established. 3 All States would be eligible for Federal grants if personnel were available to establish the optimum of one clinic for each 100,000 population. • The amount to be contributed by States is directly proportional to the 1938-43 average per capita income with minimum contribution of 20 percent of the cost of services. • Data on clinic services in Alaska, Puerto Rico, and the Virgin Islands not available.

TABLE 2.-Number of general mental hygiene clinic hours necessary for adequate

service, the number of clinic hours now available and estimated funds without regard to source required to support these services

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1 Clinic hours required and available are from data furnished by Dr. George S. Stevenson.

2 Personal services for each clinic for each 100,000 population consist of psychiatrist, at $6,500; psychologist, at $4,050; chief psychiatric social worker, at $3,500; assistant psychiatric social worker, at $2,700; record analyst, at $2,700; clerk-stenographer, at $2,300; clerk-typist, at $2,100; and file clerk, at $1,900.

3 Nonlabor expense calculated at 20 percent of total cost. Total with personnel, $32,190. 4 Data on clinic services in Alaska, Puerto Rico, and the Virgin Islands not available.

Dr. FELIX. It is possible that sufficient trained personnel will be available to assist the States, through grants-in-aid, in establishing 100 additional clinics. The proper distribution of these would level up the mental health services to the point where every State in the Union would have at least 1 clinic for each 500,000 population. It is realized that this is far below the ultimate goal of 1 clinic for each 50,000 to 100,000. However, pending the result of the survey of

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trained personnel, even this modest objective may not be immediately obtainable. This first bemphasis on the areas of greatest need believed to be a reasonable method of approach, because it will provide psychiatric

services in those areas which, either through the lack of sufficient funds or the lack of trained personnel, have been unable to initiate them in the past.

I might add hero, Mr. Chairman, it would be extremely difficult to estimate the value of a man. Certain scientists, thinking of the materials that make up the body, have valued us at less than a dollar apiece; others, in- estimating the value of a man at various ages, have given us values of from $20,000 to $25,000, but to those parents, brothers, sisters, and children I believe the value of a man is literally unestimatable: We have roughly calculated, however, that if TO percent of the cases now going to mental hospitals could be prevented from going, considerably more money would be saved than would be expended in this program. more money

The realization of the ultimate goal can be attained only through increasing training facilities which would result in increased numbers of trained personnel and through an awareness and cooperation on the part of the public. Grants-in-aid would also be made to the States for their use in training personnel to operate clinical facilities within their own jurisdiction. Upon approval of an application grants-in-aid would be made to the various medical schools for their use in increasing and improving their psychiatric teaching facilities. It is necessary to point out that there are two broad aspects of training which must be considered. One is the training of medical students so that they will gain understanding of the psychiatric implications in the general practice of medicine. This will help the schools to strengthen thé first line of defense”--the general practitioner, the need for which was so ably pointed out by Captain Braceland

A second aspect of psychiatric education is the development of specialists in the field of psychiatry. The services of such specialists are needed in public out-patient clinics, medical schools, and mental hospitals. There is an estimated deficiency of 3,500 psychiatrists to meet-urgent public needs. In connection with the training of these specialists and improving the first line of defense,” according to our latest information, 49 of the seventy-odd medical schools meet the standards of the committee on medical education of the American Psychiatric Association. Nineteen of these 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 now being revised. - Medical school 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

According to the September 1, 1945, issue of the Journal of the American Medical Association, a total of 742 residencies in psychiatry are offered in the United States. However, in the March 31, 1945,

,

of December 1944 there were only 237 residents in training. This emphasizes that there are a large number of vacant residencies which can be utilized for training, To bring some of these up to the American Psychiatric Association standards, the addition of some personnel and funds will be necessary.

At least a proportion of the urgently needed psychiatrists can be supplied by offering short courses of instruction for those physicians

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