to المسلم because of limitation in authority and appropriation. If this legis lation is enacted the Service can take constructive action on such projects, provided they are found to have merit and appropriations are available.osge line dotbags levinilo tof baboon sanoiteq otabommo9oBod This legislation contemplates the extension of as nearly uniform mental health services throughout the Nation as it may be possible achieve. This implies an obligation on the Public Health Service to fully inform itself of the existing needs and resources. Although 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 needs. 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 peacetime 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 material gathered 5 years ago is not completely pertinent to the problem at handai bas eroicorq gutatud obem od ivim zvarione Invisaluse 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 survey of the existing and potential facilities for training all cate gories of personnel needed in the mental health field:o) The latter 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 deter mined how many additional residents in psychiatry can be trained in the existing facilities. It must be determined which facilities not now training psychiatrie residents can be utilized for this purpose. 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 social services and the vast army of attendants working in mental institutions. It T In order that the research to be undertaken at the Institute may be coordinated with existing or contemplated projects elsewhere, a 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 clinical material are available which could well be utilized in additional research. The survey would attempt to discover which of these institutions desire to undertake research through Federal aidimebs feuolenton'I 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 Dr. Stevenson stated in his testimony, these are contemplated in cities having a population of 150,000 or more in 35 States One of the first 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.. 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 follows) uzad 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 14, 200 160,950 175, 150 114, 708 114, 708 160, 442 30: 8 65: 5 $9,000 3'064, 380 73, 380 2521; 344 -30, 796 S' 132, 140 41, 240 43: 8 100:8 10,900 470, 338 481, 238 -481, 238 100.0 25, 900 559, 965 585, 865 585, 865 585, 865 59.0 100.0 31, 500 721, 498 752, 998 752, 998 752, 998 54.2 37,653 113, 488 41.8 L178,336 101,884 W41.8 20:0 V99!19,400 19, 400 BLU 21, 790 9,000 96, 570 105, 570 5,825 35, 347 41, 172 166064, 398 47, 1 39.0 0 5.5 9,000 32, 190 41, 190 28, 174 28, 174 14,7879 JOG] 20430 pasione 17, 217 257, 520 199, 172 [Hobпision presq on 1210 covania] 13, 016 23,973 199, 172 83, 348 61.9 70.5 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] New Mexico. New York. North Carolina. North Dakota. Oklahoma. Oregon Pennsylvania. South Carolina. Tennessee. Texas. Utah.. Virginia. Washington. West Virginia.. Wisconsin. Wyoming. 1 15 States now have central offices. * Includes 240 clinics now in operation and 112 new clinics to be established. 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. 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 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 trained personnel, even this modest objective may not be immediately obtainable This first emphasis on the are areas of greatest need is 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 here, 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 10 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. . 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 the "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 this. and many desire to avail themselves of resources to fac students 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, issue of the same journal, it is stated that as 1944 there of Decemb 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 |