Now, it has basically been our experience both in getting this document together, and from the consideration of certain disease-oriented advisory groups that contain both in-house and external advisers, that this was a very good takeoff point for a somewhat different approach to program analysis than has been applied to our activities in the past. I would not propose that this activity be done annually, but in discussing this with the institutes, more particularly in relation to their getting better and sounder and broader advice from their council structure, it seems likely that having created this report to the President now, each Institute will pick out two or three important areas each year for a very definitive review and program attention.

I do not think that the biomedical sciences are moving so rapidly that this has to be an annual endeavor. I do indeed think, though, that there should be a logical, well-structured fashion which permits both the scientists themselves and those who may wish to enter an area of science to get authoritative information on what is going on.

I might say that in response to your comment about the Vice President, when he sat in your chair, sir, we in the biomedical sciences have indeed had a very effective means for information exchange that does not deal with past results, but rather with the ongoing enterprise. This was set up first as an activity of the National Institutes of Health and transferred to the National Research Council, and now has a final home in the Smithsonian Institution. It is called the Science Information Exchange.

Now, in the biomedical field, basically every activity, whether inhouse or in the grant program of each of the Federal agencies, and each of the major supporters of research-whether it be a voluntary agency or a foundation-these activities are listed in a recapturable fashion at this Science Information Exchange.

I believe that this is the only area of science which is covered in this fashion. I point out, on the output side now, that the National Library of Medicine is converting what formerly was a clinically-oriented information system, in what was then the Library of the Surgeon General of the Army, into a very broad system of scientific information. It is an output system that is a progressively broadening, computerbased operation that now is in a position to search the bulk of the biomedical literature. I talked with Dr. Cummings and, Senator Harris, if you want to make inquiry into this, I would strongly urge that Dr. Cummings be invited to testify and explain this apparatus.

Senator HARRIS. I was thinking about something that would even be broader than the medical library. For example, in the development of the artificial heart, as you know, one of the problems was to find some substance that could line the artificial heart and would be acceptable to human blood and not cause clotting, which eventually could result in the death of the patient. That problem was solved by the process of trial and error, and almost by accident, by a high school boy, I believe, who eventually found the substance.

Now, it seems to me that if there were some sort of place where these things could filter down or cut across the lines or disciplines, you might invite and induce proposals which otherwise would not come about.

We never know where an idea is going to be stimulated. I know I never do. I go to a meeting of some kind and something comes up that causes me to think of something I would not have thought of at all. It may not be directly related to what is going on. It seems to me this might result from a central filing by agencies of this year's needs in a way in which they could be indexed and retrieved by people who are interested.

Dr. SHANNON. Well, sir, to do it in precisely that way-to be so meaningful that it can be demonstrated by a specific example, quite frankly, sir, is going to be rough. But I think an effort to satisfy a large part of that need is in progress.

Decisions in the executive branch have been made that under the auspices of the Office of Science and Techonolgy, agencies will indeed develop information systems that, while they may address themselves to their individual problems, would be compatible one with the other. In other words, this is a past decision. Now comes the problem of implementing it.

The President directed the Secretary of HEW, to take a broad look at the area of toxicological information as was defined by the Panel on the Handling of Toxicological Information of the President's Science Advisory Committee. This panel defined toxicological information as information which related to the understanding of an interaction of chemicals and biological systems. Thus it is substantially wider than toxicology in the conventional sense. In discussions we felt this assignment would be a normal extension of the computerized operations of information storage and retrieval within a library system to satisfy modern needs, going beyond the simple filing of books. The National Library of Medicine has been assigned this responsibility. But the systems that they come up with will relate to the filing and retrieval of information across the whole range of scientific interests. One of the factors in this information system would be a citation index of those things that relate to the compatibility of chemical substitutes and living systems, mechanisms of clot formation and the like. But this will have to be done in such a way as will be compatible with other material and research, whether done in NASA, in Defense, in the Atomic Energy Commission, in the Department of Commerce.

I would say, Senator Harris, one is going to have to be patient. This is a rough thing to do. But I think the proper decisions to bring this information system into being have been made, and I think we need both to support the people asked to do it and to exercise some restraint in getting results.

Senator HARRIS. We have to break off now because of a vote in the Senate.

Thank you very much, Dr. Shannon. You have ben very helpful. Dr. SHANNON. Thank you.

Senator HARRIS. We shall recess now for about 10 minutes. (Brief recess.)

Senator HARRIS. The subcommittee will be in order.

We are pleased to hear now from Mike Gorman.

Mike, I apologize to you. There were three roll calls in rapid succession rather than just one, so it took a little longer than I anticipated. Mike Gorman of Washington is the Executive Director of the National Committee against Mental Illness.

Without objection we shall place in the record a biographical sketch-rather an impressive one to me-at this point.

Biographical Sketch: Mike Gorman

Director, National Committee Against Mental Illness, Washington, D.C. Member: National Advisory Mental Health Council, appointed to a four-year term in 1961 by President Kennedy.

Helped draft Community Mental Health Centers Act of 1963. Instrumental in the Congressional action which led to the formation of the Joint Commission on Mental Illness and Health and served as a member from 1955 to 1961. Appointed by President Truman as director and chief writer of the President's Commission on the Health Needs of the Nation.

Author: "The Doctors' Dilemmas", "Oklahoma Attacks Its Snake Pits", "Every Other Bed."

Awards: Edward A. Strecker Memorial Medal, U.S. Junior Chamber of Commerce outstanding young men award along with 9 others.

TESTIMONY OF MIKE GORMAN, EXECUTIVE DIRECTOR, NATIONAL COMMITTEE AGAINST MENTAL ILLNESS, WASHINGTON, D.C.

Senator HARRIS. You may proceed as you wish.

Mr. GORMAN. Mr. Chairman and members of the committee, in the previous hearings and seminars of this committee, I have noted a deep concern with the necessity for long-range planning efforts and mechanisms in the field of medicine, as well as in all other scientific areas. I should like to address myself to this problem because, in the 22 years I have been active in the mental health field, I have discovered that the resistances to long-term planning have been a major obstacle-if not the major obstacle-to progress against mental illness, whose victims still fill more than 50 percent of our hospital beds.

Starting with my first tour of State mental hospitals in Oklahoma in 1945, I soon learned that any attempts to discuss a 5- or 10-year blueprint for planned mental health efforts invited the accusation that the proponent was either naive or unrealistic, or both. Since the establishment of the first public mental hospital in Williamsburg, Va. in 1773, State mental health commissioners and State hospital superintendents have ben engaged until quite recently in a frenetic race to build additional beds to accommodate the ever-increasing floodtide of mental patients.

For example, in the immediate period after World War II, many of us in the journalistic field pointed out the gross deficiencies of a mental hospital system which provided only the most limited form of custodial care for those afflicted with mental illness. When we suggested that there were alternatives to this traditional, massive warehousing of the mentally ill, we were answered in scornful terms. As a result, in the period from 1945 through 1955, 130,000 additional beds were added by the States to the existing custodial real estate. This was a costly endeavor the States poured $100 million a year into this building program-but it is their time-honored reflex response to public concern and public indignation.

I became convinced that we were merely doing some patching and filling on a tattered, old custodial garment. I was impressed with the observation of the anthropologist, Margaret Mead, that significant revolutionary change comes about only through a dramatic, incisive break with the past. In other words, we had to create a climate in which

Government officials and the public generally would view the glaring shortcomings of the existing system in the perspective of the goal we all sought the return to the community of thousands upon thousands of patients needlessly hospitalized.

I had some illusions at that time that the National Institute of Mental Health, created by the Congress in 1946 to pull together our national resources against mental illness, might be the catalytic agent. However, its view of its mission was a most circumscribed one. Under restricted annual budgets, it concentrated upon project grants to individual research investigators along with a quite modest training program for psychiatric personnel. It venerated basic research, and it was convinced that it would eventually come up with the answer to schizophrenia.

We therefore turned to the Congress. We asked it to appropriate moneys for the support of a nongovernmental joint commission on mental illness and health which would take a hard, sociological look at why we were failing to make any progress against mental illness and what measures should be instituted to reverse the trend. We requested and received authorization over a 5-year period for this most difficult task, and we were asked to make our findings available to the Members of the Congress and to the Governors of the several States. The joint commission report was completed in 1961. It called for an unprecedented break with past patterns of confining the mentally ill, characterizing the then custodial State mental hospital system as therapeutically bankrupt. It recommended a network of community mental health centers which would involve all levels of government and many voluntary agencies in an intensive attack upon the early and treatable manifestations of mental illness.

The impact of that report was tremendous. President Kennedy incorporated its major recommendations in his historic 1963 mental health and mental retardation message to the Congress; the Congress followed through by passing enabling legislation providing Federal matching moneys to States and localities for the construction of mental health centers.

As a consequence of this report, long-range planning suddenly became fashionable. Even before the 1963 Kennedy mental health message, the Congress had authorized Federal matching moneys to enable the States and localities to draw up detailed plans for the advent of community psychiatry. Citizen participation in these planning efforts exceeded all predictions; by the time the last plan had been filed in 1965, 30,000 people in all walks of life had taken an active part in charting a new day for the mentally ill.

It is difficult to summarize in a few sentences the totality of the revolution which has taken place. In addition to the commission report and the broad-scale planning efforts, the introduction of new drugs brought about a tremendous change in the locus of treatment of most mental patients. For example, over the past decade there has been an historic, unprecedented drop of more than 100,000 patients. resident in State facilities. In 1965, just over 4 million Americans were treated for mental illness; of this number, only one in five was treated in a State institution. Compare this with the situation just two decades

ago, when these same institutions handled three out of every four mental patients.

The general hospitals of this Nation, once almost totally off limits to the mentally afflicted, treated and discharged almost 600,000 psychiatric patients in 1965-far more than the number handled by State hospitals.

Barriers to health insurance coverage of mental illness, once fierce and formidable, came tumbling down. Commercial and nonprofit health insurance companies gradually drew the mentally ill within the spectrum of their coverage, and important sections of the 1965 medicare legislation extended psychiatric coverage to the elderly mentally ill.

Local government, which for almost 200 years dumped its unwanted mentally ill upon the doorsteps of State institutions, is now assuming a growing proportion of the burden of their care. Twenty-eight States have now formalized this shared responsibility in community mental health laws which provide State and local matching moneys in support of augmented hometown psychiatric services.

I have included the aforementioned data because I believe that a discussion of the Federal role in long-range planning would be meaningless without a thorough understanding of the broad-gaged effort to make planning "respectable." I submit that abstract, germ-free planning at the Federal level is doomed to ineffectuality unless it seeks nourishment and ideas from the professional and lay community. National planning is not only more effective, but more acceptable, when it draws upon the hard-earned experiences and insights of people at the local level.

When I was appointed in 1961 to a 4-year term on the National Mental Health Advisory Council-which passes upon all applications to the National Institute of Mental Health and then transmits these recommendations to the Surgeon General of the U.S. Public Health Service I was shocked at the absence of a mechanism through which the Council could assess the existing state of the psychiatric art and then formulate plans to rectify any deficiencies which were uncovered. We were snowed under with bales of individual research and training project applications; our 3-day "deliberations" were in actuality a frenetic race against the clock to finish the last lingering application by 6 p.m. of the last day.

After several meetings of this kind, a number of us revolted. We voted for a planning subcommittee which was instructed to analyze existing procedures and devise some way in which a considerable portion of each meeting could be devoted to the broad issues in the mental health field. Early in 1962, the subcommittee transmitted a report which recommended spending less time on routine project applications and devoting at least a day of each Council meeting to uninhibited discussion of any one of a number of major problems which had been singled out either by Council members or NIMH staff for exploration in depth.

I want to emphasize that this approach did not relieve us of the necessity of reviewing those applications which were either large enough, or controversial enough, to merit careful debate. However, we leaned more heavily-and properly so-upon the recommendations of the various study sections of the NIMH which had done the first de