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Dr. FELIX. Yes, sir. That wouldn't all be borne by the Federal Government by any manner of means. Our idea on that is that grants will be made to States for them to assign men in their service, or contemplating their service, for training. Those grants would be made on a proportional basis, the same as other grants are made with which I know you are quite familiar. So the proportion of the expense borne by the Federal Government in the various States would vary between 20 and 80 percent.

I have said $1,000,000 on research. I mean for the maintenance of the Institute; I can give a figure, which is a most rough sort of estimate, for the cost of research elsewhere, which I would put at about $5,000,000. That I cannot back up with specific data for the reasons stated. I believe that covers it.

Mr. PRIEST. Of course, these are, as you say, rather rough estimates. Dr. FELIX. Extremely rough, Mr. Chairman.

Mr. PRIEST. The grants-in-aid would depend somewhat on the number of States or local subdivisions or training organizations requesting such aid.

Dr. FELIX. Yes, sir.
Mr. PRIEST. That figure would have to be somewhat flexible.
Dr. FELIX. Yes, sir.

Mr. Brown. Of course, I presume it is your thought that the $1,000,000 that would be spent at the institute is not the sum total that will actually be spent for research.

Dr. FELIX. No, sir. Mr. Brown. What do you place such figure at, how much of this $10,000,000 is actually going into research, and how much into aid and training?

Dr. FELIX. I would estimate that from one-quarter to one-third of the total appropriation for the purposes of this act should go to research in all of its ramifications.

Mr. BROWN. Let me ask you another question, doctor. I am a graduate medical student. This law is in operation. I decide I want to specialize in psychiatry. I apply for a fellowship. If I get that fellowship the Government will spend $15,000 educating me. Then, as soon as I get it I go into private practice

Dr. FELIX. No.

Mr. BROWN. Can't I do that? If so, is there any arrangement made, whereby a man who gets a subsidy from the Federal Government must pay back, or in some way compensate the Government, or is it your idea that this training will be only for men who will into public service?

Dr. FELIX. That is exactly what my thought is, and the selection of the men would be by the States. I would think that a reasonable requirement of these men would be that they would spend at least 1 year in public service for every year they spent in training at public or State expense.

Mr. Brown. I think that would be very reasonable. if you spend $7,000 a year on them. Offhand, I would suggest perhaps that they should be required to spend a little more time in the public service.

Dr. FELIX. I think that would be reasonable. I was trying not to be fantastic in specifying a larger number of years, but I would certainly say 1 year,

Dr. THOMPSON. I want to point out the difference between fellowships and trainees. A fellow is a man who alrcady is trained. He has a background, but he is developing some ideas which are useful. He comes into the Institute because he can contribute. The trainee or the graduate student is a man who is interested in psychiatry. He would go to medical school and get his full training. Is that your idea, Dr. Streker?

Dr. STREKER. Yes; and as you yourself suggested, I think there would have to be a good deal of leeway as to the interpretation of public service. A man might be trained in the direction of spending the rest of his time in research, which might necessarily be in terms of public service with some particular agency. But a broad interpretation of public service, as I see it, would cover him. I think that estimate of 2 years is a little modest. In other words, their first contribution in return for what they receive should be in terms of benefitting the mental health of the country in one way or another.

Mr. Brown. Of course, the country benefits if he goes out in private practice, but I am just wondering whether or not that is a fair procedure, and I am glad the provision is here they must enter public service in one way or another. I can understand that a man conducting research is of great benefit, even if it is private research.

Dr. Felix. In answering your question, I assumed you were speaking of the latter category which Dr. Thompson mentioned. Mr. BROWN. Yes, sir. Mr. PRIEST. Doctor, we certainly thank you.

I believe Miss Rae Levine, of New York, is here now. Miss Levine, we are glad to have you here.



Mr. PRIEST. Will you give the reporter your name and official title?

Miss LEVINE. Rae A. Levine, psychiatric social worker, reporting on a study of psychiatric rehabilitation which was done by the New York City Committee on Mental Hygiene, and of which I was the chief psychiatric worker in charge.

Mr. PRIEST. All right; you may proceed.

Miss LEVINE. Best figures ayailable indicated that by June 30, 1944 approximately 110,000 men in New York City had been rejected and discharged because of neuropsychiatric handicaps. Of these approximately 78,500 were rejections, and 31,500 dischargees. Of these it was estimated that only a small proportion were so ill mentally as to require hospitalization. Of the remaining, it was not known whether the handicap which was severe enough to disqualify the men from service would also interfere with their civilian adjustment.

When it became evident that neuropsychiatric condition was the most frequent cause of rejection of men for military service and discharge from the armed forces for neuropsychiatric condition was higher than for any other single cause, a study was undertaken by the New York City committee, which was made possible by a grant of $19,000.

Mr. Priest. This grant of $19,000, was that a grant by the city?


Miss LEVINE. It was a commonwealth grant.

For the study, about 1,000 men who were rejected and discharged, were selected as a valid random sample from New York City, and these men were studied intensively. The findings that came out of this study are as follows:

Of the group studied it was found that 82 percent were in need of psychiatric help, principally intensive individual treatment by psychiatrists, which meant that the psychiatric handicap for which they were disqualified from service was severe enough to interfere with civilian adjustment.

When this percentage of 82 is projected to the neuropsychiatric rejectees and dischargees in New York City, this figure gave a presumptive estimate of 90,000 men who need intensive individual psychiatric treatment.

Mr. Priest. That is out of a total of 110,000 that were rejected?

Miss LEVINE. Yes. This is a presumptive estimate based on our findings from a simple sample.

Mr. BROWN. Would you say that would be typical of the whole Nation, on the average?

Miss LEVINE. We did not attempt to project them on to the Nation; we just tried to get the rates for New York City on the tentative assumption that perhaps the rates might be similar, somewhat the

That is, in terms of contribution of men for the armed forces and rates of rejection and discharge.

Of the 82 percent who were found in need of this kind of help, only 21 percent were sufficiently aware of the nature of the problem or had a sufficient understanding of what psychiatric help meant to be receptive of such help. Then of that group only 21 percent wanted it. Most of these men were under treatment, psychiatric treatment, by general practitioners but their problems were unalleviated.

Of the 21 percent who wanted such help, only 10 percent were receiving such help in the community Projecting these last figures to the neuropsychiatric discharges and rejections gave a presumptive estimate of 19,000 men in New York City who need, want and are ready to accept psychiatric help if it is made available to them, of whom only about 2,000 were receiving it, and this estimate is based on very minimum standards of what constitutes adequate psychiatric help.

In the sample that we studied, most of the men were the responsibility of community civilian agencies, that is, we did not study dischargees with service-connected disabilities or handicaps, because they, logically, are the responsibility of the Veterans' Administration, so that all of these needs relate to people who are a civilian community responsibility.

Of the group who need this kind of help 61 percent will require free service, and of the remaining 39 percent there are only a very few who could meet the cost of extended private psychiatric treatment, by private psychiatrists.

Mr. PRIEST. Sixty-one percent will require free service?
Miss LEVINE. Sixty-one percent.
Mr. Brown. May I interrupt to ask a question?
Miss LEVINE. Yes.
Mr. BROWN. What is your community doing about this situation?

Miss LEVINE. Well, as the recommendation will indicate, we feel that the problem is of such great magnitude that the community is not really equipped to handle it.

Mr. BROWN. You mean the city of New York is not able to take care of its own?

Miss LEVINE. The small private facilities are not able to.

Mr. Brown. I mean, what is the city of New York or the State of New York doing to meet this situation?

Miss LEVINE. So far as I know, nothing at the present time in terms of a large program.

Mr. Brown. Do you believe the Federal Government has to move into it?

Miss LEVINE. We believe public sponsorship is necessary,

Mr. BROWN. I am not talking about public sponsorship. The municipality of New York, if it should do it, would be public sponsorship, or if the State of New York should do it. I am asking you if the Federal Government should move into New York City and take over this problem, or if you are taking any action to meet it yourself.

Miss LEVINE. We feel the Federal Government should do it,
Mr. BROWN. You want the Federal Government to do it?
Miss LEVINE. Yes.

Mr. Brown. In other words, this is a perfect example or answer to the discussion we had this morning to the effect that local subdivisions; that is, cities and States, are always willing to pass the burden on to the Federal Government. Here is New York City, the richest city in the world, and New York State, the richest State in the Union, yet you are telling us you have a problem that you cannot meet locally and the Federal Government will have to handle it. I am sure you appreciate that the people of New York, both the State and the city, pay into the Federal Government far more than they get back in benefits from any program of this type. Wouldn't it be cheaper for you to handle your own problems? The State of New York pays in something like $3 in taxes for every dollar it gets back in benefits from any Federal program. I am just wondering whether it wouldn't be cheaper for you to spend your own money in your own community, rather than channel it through the Federal Government back home again and let the Federal Government take that $2 out of every three.

Miss LEVINE. I am sorry, I can't answer that question. I am not familiar with the financial aspects of it.

Mr. BROWN. But there has been no attempt made, to your knowledge, by the city of New York, to meet this situation?

Miss LEVINE. Nothing that has come to any fruition, so far as I know.

Mr. BROWN. Have you made any attempt to get the common council or the governing body of New York to take action, to make provision for such a clinic?

Miss LEVINE. We did take some action.
Mr. BROWN. Have you done that?
Miss LEVINE. Not entirely.

Mr. BROWN. Have you gone to your State legislature, or to the Governor of New York and asked for help?

Miss LEVINE. No; I don't believe so.
Mr. Brown. Then why do you come here?

Miss LEVINE. I think the reason this is being reported here is because of the findings of the particular study in connection with the needs in psychiatric rehabilitation are so large that while I can see it could be handled locally by city and State governments, I believe we assumed that perhaps we also needed Federal intervention and Federal help for such a large program, in which the city and State will also join.

Mr. BROWN. Just a minute. Don't you think that our first responsibility is to handle our own problems and solve them, if we can, and then only apply to father, or to the Federal Government, when we just actually can't meet the situation, when it is so large that we have to turn to the parent for help?

Miss LEVINE. Well, I would assume that we don't have the facilities to meet it city and State-wide.

Mr. BROWN. You said you didn't know of any attempt made to present this problem to your city council, your State legislature, your mayor, or anything like that.

Miss LEVINE. I started to say that we had exerted pressure on the State department of hospitals to set up psychiatric clinics. That program, I think, is about to start. But even that small number will not be sufficient, you see, to meet the needs of 90,000 men in New York City who need this kind of help.

Mr. BROWN. Now, my dear young lady, I come from a rural county out in Ohio, with about 30,000 population. Twenty-five years ago I served on the county health board, and the people of our county taxed themselves to furnish certain health services, and I think perhaps some of the men who are in the Public Health Service can tell you that county is one of the leaders in the United States in rural public health, in checking every child in school for ear, eye, nose, and throat conditions, giving Schick tests, stamping out diptheria and other diseases, and in other public health services. I am just wondering, if the backward people of a rural county, as we are sometimes labeled, could do that 25 years ago, why a great big city like New York can't at least try to shoulder its own load before it comes to the Congress of the United States for help. I really feel strongly that our cities and our States put too much dependence on the Federal Government and not enough in themselves. It surprises me to learn that nothing has been done, as you say, to really meet this problem in a concrete and practical way in the city of New York or in the State of New York.

Miss LEVINE. When I said nothing was being done, I assumed that what you meant was in a very effective manner. From that point of view, I still believe not very much is being done, but facilities in New York City have tried to meet the problem.

Mr. BROWN. You tell me you don't have enough facilities. Why don't you get more facilities? You have the money. You have the wealth in your city and your State. You have far more wealth than the Federal Government. Neither the city of New York nor the the State of New York are bankrupt, and we are.

Miss LEVINE. Well, I am sorry, I can't dispute that; it sounds very reasonable and plausible, very logical, but I can't discuss it.

Mr. PRIEST. Just one little observation in that respect: Is it not true, Miss Levine, that irrespective of the wealth of the city or the State that very little action has been taken in this field, and that is one of the great needs for this type of legislation, to furnish the impetus

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