TABLE 10.-Disciplines of investigators supported to date by the career investigator grant and research career programs of the National Institute of Mental Health

Mental health investigators supported by the research career program are engaged in the study of a broad range of problems, both clinical and basic, for which it is essential that additional knowledge be produced in order to improve the effectiveness of the contribution of the behavioral sciences to mental health. A brief description of the work now being accomplished by these investigators will identify the nature of the contributions which may be expected.

About 30 percent of the scientists supported by the research career program are working on research directly relevant to clinical problems, including studies on schizophrenia, depressions, neuroses, psychosomatic disorders, alcoholism, mental retardation, the use of psychopharmacological agents and the effectiveness of psychotherapy.

Approximately 30 percent of the investigators are engaged in basic studies of biological and physiological processes fundamental to the understanding of behavior. They study problems in neurophysiology, neurochemistry, and basic biochemistry, in the function of the autonomic nervous system, in endocrinology, neuropharmacology and genetics. Others in this group are investigating the mechanisms of sleep and fatigue, metabolic functions of importance in the control of behavior, and factors in growth and development.

A third group, about 25 percent of the investigators presently supported, is attempting to increase our understanding of psychological capacities and proeesses, such as learning and motivation, perceptual and cognitive functions, intelligence, emotional processes, personality structure and dynamics, language and communication.

The remaining group, about 15 percent, is engaged in research on social processes and sociopsychological correlates of behavior. Among the areas of special interest are aspects of child development, family structure, small group behavior, factors in community structure and dynamics, and the nature and development of human attitudes and values.

If the kind of research which has been encouraged by the NIMH research career program is to be continued and further developed, it will be necessary to maintain salary support for most of the investigators with career development awards (group 1 and group 2), and also to attract other scientists with an outstanding potential to the pursuit of research in appropriate settings. Other

sources of funds are still quite inadequate to maintain the investigators currently employed, not to mention the need for additional research scientists in the mental health centers-notably the departments of psychiatry in medical schools, the psychiatric and general hospitals, the institutes of the behavioral sciences, and the nonaffiliated biomedical research institutes.

It is proposed, therefore, that the current program of salary support for mental health investigators be continued and expanded, with no diminution of effort to nurture the research which is presently being accomplished.

In fiscal year 1968 it is estimated that the total number of awards should be approximately 190 (including about 140 committee continuations). In each of the subsequent years it is estimated that 12 to 15 young investigators of promise may be recruited to begin careers of research in mental health with the support of career development, group 1, awards and that 20 to 25 investigators fully qualified for independent research will be recommended for career development, group 2, awards. Maintaining salary support for most of the investigators now in the NIMH research career program, and expanding the program by 32 to 40 new awards each year will require an annual increase of funds after fiscal year 1968 averaging approximately $950,000, reaching a total expenditure in fiscal year 1972 of approximately $8,000,000 for approximately 335 awards.

6. Special programs

The organization of the Behavioral Sciences Training Program represents, in part, the response of the Institute to the increasing use of the term "behavioral sciences" in the field and, more importantly, the recognition of commonalities among various disciplines and scientific areas. While there is no generally agreed upon definition as to what comprises behavioral science, it is true that the evolution of certain biological science areas, psychology and the social sciences has reached a point where the overlap and interdependence among these areas is visible. The Special Programs Section has been organized in an effort to increase the probability that the collaborative efforts among these scientific areas be provided with such appropriate training support as is necessary for their development.

In pursuing the goal of providing support for the training and advanced education of broadly based behavioral scientists and professionals, efforts have focused on the academic and research institutions of the Nation and the philosophy of the support program has been largely continuous with the existing academic purposes of research and teaching. However, the general academic purpose is changing and expanding. In part, these changes reflect the increasing recognition of the substantive interdependence of various scientific domains such as behavioral sciences and are concretely illustrated by the rapid development of centers and institutes within universities to allow the interchange of ideas and the conduct of multidisciplinary research.

To some extent, collaborative training efforts are currently being supported within the Biological Sciences Program. However, this program emphasizes training in those areas where biological constructs and the behavioral dimension come together. The potentials of training within multidisciplinary programs involving the psychological and social sciences have as yet not been realized. It would be the function of the Special Programs Section to encourage and foster the appropriate development of such programs so as to permit a broader investigative contribution of the behavioral sciences to all aspects of mental health. E. Experimental and Special Training Program

1. Program objectives

The general mission of the Experimental and Special Training Program is to plan, administer, direct, and coordinate a national program of training grants for (1) new, unique, innovative, and exploratory time-limited mental health training projects directed to personnel allied to the mental health effort and the training of inter-disciplinary groups of mental health workers; (2) programs in special areas such as community mental health, narcotic and drug abuse, alcoholism, suicide prevention, crime and delinquency, childhood mental health, and recruitment; (3) the extended support and replication of meritorious pilot and other training projects; (4) the mental health-public health training of students enrolled in the Schools of Public Health in the United States; and (5) the convening of training workshops, conferences, institutes, and surveys concerned with curriculum development, dissemination of training information, and training in special areas.

The training emphasis may be on the development of programs for mental health related personnel, research training, continuation or extension of training, training new types of mental health personnel, training techniques and methods, or preservice training.

A key factor in the Experimental and Special Training Program is the requirement that grantees evolve a model for training which they have tested out and evaluated. These models are then made known to other training institutions which might wish to adapt or adopt features of the grant program. Efforts are made to provide grant support where major diffusion of findings will result, and where grant support can provide a crucial point of intervention within an area of training, a profession, or a social system.

Support is also available to Schools of Public Health for the expansion and improvement of the mental health content of the curriculum both for the general student body and for specialty training in public health-mental health.

Special Grants are provided for various training activities such as conferences. institutes, workshops, and demonstrations.

2. Contemplated activities, trends, and needs

a. Training for comprehensive community mental health centers.—It is anticipated that the development of comprehensive community mental health centers will be accompanied by demands for new and different types of personnel to staff these institutions. Models must be formulated and tested in order to create, on a broad scale, the necessary personnel, many of whom will be of a subprofessional character. One of the missions of this program is to promote the development and testing of these models, so that knowledge may be gained about the jobs to be performed in the various services which comprise the comprehensive community mental health center. Several models have evolved for training personnel to staff inpatient, outpatient, consultation, and rehabilitation services, as well as for the training, research and evaluation, and administrative functions of centers.

b. Increased demands for training in “pressure areas.”—As programs in the so-called "pressure areas" of delinquency, narcotic and drug abuse, mental health administration, mental health communication, and community mental health are expanded within the NIMH, there will be need to meet the challenge of opening up training opportunities for personnel to work in these fields.

c. Increase in numbers and types of personnel to be trained.-The need to provide appropriate training models for the many kinds of persons having community mental health-related job responsibilities will continue to be acute. Likewise, mental health manpower, in all job categories, will be needed increasingly. Mental health training has progressed past mere desirability to a necessity for maximal functioning among such groups as school teachers, clergymen, lawyers, school administrators, correctional workers, judges, police, and welfare workers, to name just a few community agents. Under the Experimental and Special Training Program, numerous types of community agents are being trained for active participation in mental health work.

d. Increased demand for training in new and special areas.—Music therapists, occupational therapists, journalists, and recreation workers illustrate just a few of the groups which are seeking mental health training and for whom initial support via a pilot project has been provided. The mission of this program calls for developing programs in the following areas which have not received support: indigenous, subprofessional community personnel: geriatrics workers; city planners; and art therapists. In addition, it is recognized that while new areas are being explored and tested, demands will continue for the increase in training opportunities for such groups as the clergy, school personnel, and research workers.

e. Broadening of the types of training settings.-Increasingly, public, private, and nonacademic research and service agencies or organizations are seeking to utilize their facilities and staffs, independently and/or cooperatively for mental health training, both preservice and inservice. This development would appear to be a function of the growing emphasis upon the intern, journeyman. or apprentice training model as well as the increase in applied research concerns, and new patterns of care.

The proliferation of qualified training centers has increased significantly the potential number of applicants who are ready and able to undertake new, innovative patterns of training aimed specifically at the wide variety of ancillary personnel within a community who can contribute meaningfully to mental health efforts.

f. Need for a multipurpose mental health worker.-As efforts continue to develop sufficient manpower to serve specific specialized mental health functions, there appears to be need to create a multipurpose mental health worker who would be a generalist. Such a worker would have multiple skills including those needed for consultation, community organization, training, research, clinical work, and administration, or some reasonable combination of these areas.

F. Continuing Education Program

1. Program objectives and priorities

The broad objectives of the program in Continuing Education are as follows: (1) to increase the effectiveness of existing mental health manpower of all types wherever they may work; to make continuing education and staff development a built-in component of service, training and research programs in all mental health settings; (2) to meet the immediate and urgent need for successful implementation of the Community Mental Health Centers program so far as effective utilization of manpower is concerned; (3) to foster the development of continuing education as a type of education, i.e., make it a much stronger component of the mental health educational programs within universities and training centers; and (4) research in continuing professional development, learning styles and work-learning processes: evaluation of continuing education programs and methods. Initially, priority will be given to projects with one or more of the following emphases: (1) development of strong continuing education divisions within training centers for the mental health professions, increasing the amount and quality of continuing education resources available in the vicinity; (2) continuing education which is an integral component in the implementation of community and State mental health planning efforts; (3) projects with a program development emphasis, targeted to the needs of a specific group of potential trainees, as compared to offering isolated courses to whoever may be recruited; and (4) research and evaluation projects, preferably built into active continuing education and staff development programs.

2. Potential training centers

There are currently approximately 95 medical schools, 287 psychiatry training programs, 65 schools of social work, 140 major departments of psychology, 880 diploma, 188 baccalaureate, 53 masters, and 3 doctoral programs in nursing in the U.S. which are potentially eligible for grants to develop continuing education programs. It is anticipated that there will be considerable growth in the number and size of these programs in the next 5 years. In addition, there are a large number of other graduate and undergraduate training programs, including social sciences, biological sciences, public health, education, law and theology which may be eligible for support or collaboration in continuing education relevant to mental health. For example, there are approximately 125 undergraduate departments of colleges and universities offering courses with social welfare content. Possible grantees also include regional agencies, the 53 States and Territories, numerous mental health clinics and hospitals, professional societies and associations, as well as a variety of public and private social and health agencies. Special regional centers for continuing education may also need to be established. Sound program development will also require support of research and evaluation projects plus application of new technology. These should include: basic research in professional development, patterns of practice, work habits, learning processes, etc.: evaluation of individual continuing education projects and teaching-learning methods; experimentation with newer continuing education methods and communications technology; more specific analysis of the needs of the field and collaborative research projects involving several continuing education centers. Potential grantees may include any of the previously mentioned institutions and agencies, and contracts may be developed with industry and special educational foundations or institutes.

3. Program areas

a. Professional training centers.-It is estimated that during the fiscal year 1968, approximately 80 professional training programs in psychiatry, psychology, social work, nursing and social sciences, will be funded to enable them to establish or expand their continuing education programs. Based upon the funds needed to provide minimum basic support of such programs, approximately $40,000 per institution, or $3,200,000 would be required.

b. G.P. postgraduate education.-The NIMH support of postgraduate training programs for nonpsychiatric physicians has lagged far behind the current demand. In the interest of providing the best medical and mental health care, continuing education in psychiatry should be made available to all practicing physicians. To achieve the ultimate objective of providing appropriate psychiatric training for every physician, and to help meet the program needs and objectives of community mental health centers, many of which will be based in psychiatric units of general hospitals, a significant expansion in grant support is essential. In addition to the establishment and support of continuing education divisions in departments of psychiatry, it is proposed that there should be a G.P. postgraduate education programs centered in the 178 metropolitan areas of 100,000 or more population. Some of these grants will be made with national medical organizations for purposes of fostering program organization and development. It is estimated that during fiscal year 1968 it will be possible to fund 15 new projects for a total of $250,000.

c. Other training programs and resources.—In order to stimulate and involve State mental health agencies, regional organizations and national professional associations and agencies, in the development and expansion of their continuing education activities related to mental health, it is estimated that during fiscal year 1968, it will be possible to fund at least 20 programs at $30,000 each for a total of $600,000. It is anticipated that such training programs would provide direct training experiences such as institutes and seminars for employees, coordinate training efforts in the various institutions and agencies where appropriate, develop meaningful linkages with institutions of higher education in the State and regions, and provide a vehicle for the development of training aids and materials.

Regional bodies, responsible for training functions within specified areas of the country, will need to develop and carry out programs designed to meet regional needs. In addition, national professional organizations and agencies have expressed a desire to develop a variety of training approaches to meet the needs of target groups such as psychiatrists, social workers, etc.

It is also estimated that $250,000 will be awarded to fund a minimum of 10 programs of continuing education in public and private service agencies (hospitals, clinics, mental health centers, family and children's agencies, etc.) during the fiscal year.

d. Conferences.-During the fiscal year 1968, it is planned to hold 5 regional conferences for college and university faculty and service agency personnel involved in continuing education, at a cost of $30,000 each for a total of $150,000. Since the ultimate success of a continuing education program hinges so directly upon the close collaboration of institutions of higher education and individuals and agencies providing direct mental health services to people, it is essential that adequate provisions and opportunities are made for an appropriate exchange among them. The five conferences proposed would be aimed at this objective. They would be held in strategic locations in the U.S. and would involve individuals in leadership positions. Each conference would have from 75–100 participants. It is expected that these conferences, which would be multidisciplinary in nature, would determine and help initiate a general plan and approach for more effective programming and implementation of continuing education activities designed to meet the needs of mental health personnel.

IV. BUDGET NEEDS TO MEET THE MANPOWER GOALS: 1968-72

A. Training Programs

In the original long-range projections made in 1963 when the community mental health center legislation was passed, the entire mental health program budget was developed through 1973. As one part of that long-range budget plan, estimates were made as to funds needed in training programs to meet the manpower requirements for the total mental health program from 1963 through 1973. Those estimates indicated annual increases averaging approximately $15 million per year. Thus, the funds for training were to increase from a level of $50 million in 1963 to $185 million in 1972. In actual fact, with the exception of the allocation for 1964, the increases to-date have not averaged the projected levels. In 1967, the appropriation indicates a level of $94,448,000 for training. Since the original projections called for almost $114 million this means that in the four years since the initial estimates, the actual level has fallen almost $20 million below the projections. The full impact of this difference has not yet been felt, since the graduates of these programs do not get into the manpower pool until three to four years after they commence graduate training.