whatever is appropriated won't be enough to fill the needs in this area. Senator PURTELL. Is it fair to assume that if we had $50 million to assign to it at the present time, that it is something that has got to be built up? Don't we have to feel our way along, to some extent? Dr. WISE. I would have this feeling. I am not a financial expert, but I would say that any process of education is a slow process, and Í think that there can be an error either way. One million dollars looks like a lot of money to me. Is this just for training, just for education? Senator PURTELL. In the rehabilitation field. Dr. WISE. When you talk about training in the rehabilitation field, it not only means vocational counselors but perhaps physicians and other people in the field who are not medical people, perhaps employment people who are vocational counselors, psychiatric counselors, and to my knowledge there is not any academically outlined courses that is standard for a vocational rehabilitation counselor. Dr. Rusk has gone further than anyone else in outlining those standards. I do not think you would go wrong by giving too much to this field. It is basic. Senator LEHMAN. I want to make one observation in reply to the statement you made today. Although you may not be aware of the fact, in the 82d Congress and previously bills were introduced to make possible the training of medical personnel, including nurses, including vocational rehabilitation people on a very broad scale. That bill was cosponsored by a number of Senators, including Senator Taft. I believe he, deep down in his heart, was in favor of it, and we were very sanguine about getting this bill through which would require an appropriation of $60 million. For some reason at the last minute Senator Taft changed his mind and would not endorse the bill. We have been trying to get adequate funds for medical training for rehabilitation for a very long time. Senator PURTELL. I think it might be correct to say that Senator Taft did not vote against the bill but against the amendment and the bill itself was never up for a vote. Senator LEHMAN. That may be. And because of the position that was taken by Senator Taft. I make that statement not in criticism of Senator Taft, for whom I had very high admiration and who was deeply interested in medical affairs. Senator PURTELL. I think the thing that is encouraging to know is that there is no disagreement. I think you will find our committee, and I am sure the Senator agrees with me, is most willing to make this start. Dr. WISE. May I get into one other aspect of this? Senator PURTELL. Yes. Dr. WISE. The exact figures are beyond me at this time, but I would like to point out 1 or 2 other problems that a physician faces with a handicapped patient. The physician is at this time confused, the practicing physician, and I have spoken to many of them and their groups. There are so many multitudes of agencies that are available for the rehabilitation of handicapped that it has been my considered opinion over the period of years that integrating these systems is extremely important from the point of view of the patient and the physician and one question in the bill is in regard to the administration under a State agency supervising the vocational education, which is section 5 of S. 2759, paragraph (a), subparagraph (1). I was a member of the task force for the War Mobilization Board in utilization of the handicapped in our defense industry about a year or two ago, and we did an exhaustive study of the rehabilitation problem in various areas of the country in relation to the manpower situation, and it was apparent to me at that time and since that this confusion between various agencies, various services, is a deterrent to medical rehabilitation because the average time before a patient sees the Office of Vocational Rehabilitation and the time the illness starts is approximately 6 years. That average of 6 years between the time the patient is injured and referred to the Office of Vocational Rehabilitation can be expressed not only by the lack of knowledge of the attending physician but because of the confusion created by so many different sources. My recommendation is the Office of Vocational Rehabilitation develop a pattern throughout the State so that, rather than go through vocational education is one State where they emphasize vocational education and through, perhaps, employment services in another State where that is the strongest attitude, these things disperse services to the people and cause disinterest to the physician. If they were integrated in each State and each State there were an office of vocational rehabilitation, an independent agency, and if at the Federal level, if it expands at the level that President Eisenhower has recommended, it seems to me the Office of Vocational Rehabilitation should be in a bureau status to set up State plans so that each State would have a single agency. Then the educational process of the physician and the patient, they will know that at the time of the injury, at the time of the disease, that that would be referred to the proper office. Senator PURTELL. This bill permits that now. You want to go further than that? You want to make it mandatory? Dr. WISE. I would like to see from the point of view of physician and the patient that one agency be responsible for this patient so that they will not, for example, be neglected on the medical side for 6 years and then go and get vocational rehabilitation and then later on get their medical needs. I think that is the direction in which we are turning. Senator PURTELL. This, of course, leaves it up to the State to determine that. Dr. WISE. Yes. Senator PURTELL. And then it would be a question of education in the States, to have the States do it on their own. But would you prefer a quicker way perhaps by having the Federal Government insist that this be tied up to the issuance of any funds? Dr. WISE. That is my personal feeling. Senator PURTELL. Thank you. Do you have any more to say, Dr. Wise? Dr. WISE. No. Senator PURTELL. It has been most interesting. I am going to go through your statement very, very carefully. Do you have anything further, Senator Lehman? Senator LEHMAN. I was going to say Dr. Wise made a very clear statement. My objection and criticism of the bill is because, in my opinion, it is completely inadequate to care for the needs of the physically handicapped. Dr. WISE. There is no question about it. Senator LEHMAN. Today we have a physically handicapped population of about 2 million. Dr. WISE. I think that is a conservative estimate. Senator LEHMAN. We are adding to that population of physically handicapped at about the rate of 250,000 a year. And here all we propose to do in a very limited field is to increase the number of rehabilitated which we now have, which is about 16,000, by a small additional number each year for the next 5 years so that, eventually, we may get up to about 150,000 a year. We are actually cutting down the appropriations, not increasing them. In 1950, I believe the appropriations were $43 million. That was gradually cut down since then so that, in the current year, I believe the appropriation was something less than that, something like $22 million, and under this bill it is estimated it will be further reduced to about $19 million. In reading your statement, I notice the particular emphasis you lay on the need for funds. Dr. WISE. I would like to expand that for a moment. Under the new formula, the high-income-per-capita States will suffer, and I even made a few calculations that, unless the newer formula is covered by sufficient appropriations, there will be a diminished activity in the high-income States and in the District of Columbia. Last night I counted the number of medical schools in the top dozen high-income States as compared to the lower-income States, and I find that there are 28 medical schools in the top high-income States and 14 in the low-income States. If it is not covered by very adequate appropriations, and I cannot go into the figures because I do not know all the details, but, if under the new formula, it is not covered by a very adequate appropriation, the medical school educational facilities will be stunted in their growth, and that is the source of the training of personnel, people in this field. Although the new formula is probably necessary for certain reasons, I think it must be absolutely covered by very appropriate and high appropriation in order not to stunt the growth of this specialty in the high income per capita States. I think that is pointed out in my paper. Senator LEHMAN. What I do not understand is the thinking of the people who are advocating this bill. We have heard testimony not by one but by a number that rehabilitating physically handicapped is not only a humanitarian but is a mighty good investment. Dr. WISE. We cannot afford not to rehabilitate. Senator LEHMAN. For every man we rehabilitate and make him a gainfully employed citizen, the revenues that flow into the Treasury of the United States considerably more than compensate for the expenditures. Under this system, we should be considering this niggardly, this thoroughly niggardly program which helps just a handful of people doesn't make sense to me. Dr. WISE. I agree. I am not an authority on how much money can be afforded to be spent but, as you say, every dollar that is spent is a saving of apparently $10, a ratio of 10 to 1. Every dollar spent will be $10 returned. We cannot afford not to train people. Senator PURTELL. Of course, this is not a question of appropriations here, but it is a question of a program. The appropriation is another matter and will be handled at another time by another committee. Evidence that we have here presented to us would indicate that this 5-year plan outlined here is about as fast, in the opinion of some people, as we can go. We have got to provide the facilities and the personnel. You have got to be able to use the money wisely and well and you could not jump into it tomorrow if you haven't got the personnel and the facilities. Dr. WISE. There are limits on both sides. I think a sufficient appropriation for facilities will attract personnel through those facilities. Thank you. Senator PURTELL. Thank you, Dr. Wise. It is most interesting to have you and very helpful, too. We are changing the schedule of witnesses here a bit. We are now asking for Mr. Kenneth Barnes, director of rehabilitation therapy of the Maryland State Department of Mental Hygiene. STATEMENT OF KENNETH BARNES, DIRECTOR OF REHABILITATION THERAPY, MARYLAND STATE DEPARTMENT OF MENTAL HYGIENE Mr. BARNES. Rehabilitation is a team effort and I have Mrs. Henrietta B. DeWitt, director of psychiatric social services of the State department of mental hygiene for the State of Maryland with me. Senator PURTELL. Do you have a prepared statement? Mr. BARNES. Yes, sir. Senator PURTELL. Do you wish to read it or summarize it? Senator PURTELL. It will become a part of the record. (Prepared statement of Kenneth Barnes is as follows:) POLICY STATEMENT SUBMITTED BY R. K. BARNES, JR., DIRECTOR OF REHABILITATION, AND HENRIETTA B. DEWITT, DIRECTOR OF PSYCHIATRIC SOCIAL WORK, MARYLAND STATE DEPARTMENT OF MENTAL HYGIENE, IN BEHALF OF MRS. MARCINE GABELL, EXECUTIVE SECRETARY, AMERICAN ASSOCIATION OF PSYCHIATRIC SOCIAL WORKERS GENERAL STATEMENT The American Association of Psychiatric Social Workers enthusiastically supports the objective of the President's program to increase the number of handicapped citizens rehabilitated in the United States each year. The association approves the approach which the above legislation would take to increase rehabilitation services for the handicapped by providing Federal assistance for the purpose of training personnel, for research, and by establishing new and expanding present existing rehabilitation facilities. PRESENT VOCATIONAL REHABILITATION FOR THE MENTALLY ILL The association would like to emphasize how little is being done to rehabilitate the emotionally ill and how much needs to be done in this area of rehabilitation. For example, last year the joint Federal-State program of vocational rehabilitation rehabilitated into employment 61,308 handicapped persons; of this number only 4,114, or about 7 percent, were mentally handicapped individuals (and this total includes mentally retarded as well as mentally ill). Since the United States Public Health Service tells us that 52 percent of the hospital beds in the country are occupied by the mentally ill, and since, at the present rate, 1 of every 12 children born each year will need to go to a mental hospital sometime during his life because of severe mental illness, it is obvious that the mentally ill citizen cannot be reached satisfactorily by existing rehabilitation programs. We realize that the undertaking of meeting the needs of this large group of mentally handicapped persons requires the combined efforts of public and private organizations including the professional groups. State rehabilitation agencies are just beginning to work with the mentally handicapped, and additional funds and personnel will enable them to do a much more complete job. In Maryland, the State with which we are most familiar, only 1 full-time vocational rehabilitation counselor serves the 10,400 mentally handicapped patients in our 5 State institutions. Each institution could more than keep one counselor busy in providing vocational training and placement opportunities for patients who have been treated but who need this type of assistance before they can be returned to the community. NEED FOR TRAINED PERSONNEL Money alone cannot provide rehabilitation services for the 9 million Americans presently suffering from a mental or emotional disorder. However, additional moneys are needed to attract more personnel to provide these rehabilitation services. In the area of psychiatric social work about 16,000 psychiatric social workers are needed nationally: This compares to 4,500 psychiatric social workers who are currently available. At present in the 52 universities offering degrees in social work there are 4,065 students in all branches of social work enrolled full time and only 627 of these are specializing in psychiatric social work. As you can see this number will not begin to meet the need. There are not more than 15 States with professionally organized psychiatric social work programs. Federal grants to encourage training in this and other areas of professional personnel shortages should stimulate the interest of potentially suitable personnel in this field. FINANCING REHABILITATION SERVICES The association believes that if Congress decides to change the method of financing rehabilitation programs care be exercised to prevent reducing funds in any State below the current level that the State presently receives. Our experience indicates that no State, at present, has a vocational rehabilitation program adequately serving the mentally ill. Accordingly, no State grants should be decreased, and increased funds would stimulate the providing of services to these disabled persons. CONCLUSIONS The American Association of Psychiatric Social Workers is interested in expanding present rehabilitation services because of both the humane and economic benefits which can be derived from these services. We are interested in being more effective in our own specialty. And psychiatric social workers can provide more complete services to their mentally handicapped patients when sufficient rehabilitation personnel and facilities are available to assist them in the social and vocational aspects of treatment. Mr. BARNES. The American Association of Psychiatric Social Workers has no bones to pick with the present program except that it is not wide enough in scope to do the job we would like to see it do. They have, at present, excellent counselors. They have good men, but there are just not enough to go around. We are particularly interested in the present bill that you are considering in that we think it does widen the scope and will give us more people to work and, therefore, we can be more effective in our work. We think that it is a joint health, education, and welfare problem and, |