increase of approximately $45 million over the very restrictive budget recommended by the Administration.

At this point, I would like to highlight the major items in our proposed budget:

Regular grants

RESEARCH

The Administration proposes an increase of less than $5 million to encompass all of the far-flung research activities of the Institute.

In sending up such an inadequate recommendation, the Administration ignores a number of carefully documented reports over the past several years which indicate that the level of research support must be increased by at least 15% a year to handle both rising salary and equipment costs and to allow for a small percentage of new research projects. As last year's House Appropriations Committee report noted, the non-governmental National Academy of Sciences, after a fifteen-month study, reported to a House Committee that a 15% annual increase was the minimum needed for any forward momentum. Furthermore, a Task Force of the President's own Science Advisory Committee corroborated the conclusion reached by the National Academy of Sciences.

A careful analysis of the budget indicates that the President's so-called “increase" will allow for only 14 entirely new research projects in fiscal 1968. As one who is now serving a second term as a member of the National Advisory Mental Health Council, I very frankly dread the consequences if this budget is sustained. We will have to go through the painful motions of approving scores of applications on scientific merit, and then informing the respective investigators that although we all make speeches about the need for more psychiatric research, we must turn down their projects because we lack the funds.

This tight research budget is all the more puzzling since, with the achievement of Bureau status by the National Institute of Mental Health, it has been asked to either initiate or expand a number of specialized mental health endeavors. For example, the Institute is now exorted to develop comprehensive programs in the fields of alcoholism, narcotics and drug abuse, suicide prevention, childhood mental illness, crime and delinquency, metropolitan mental health problems, and so on.

Mr. Chairman, these are all important areas, but how can we take any meaningful steps with the Administration budget restricting us to 14 new projects for the coming year? Let me illustrate by citing just a couple of specialized areas where we should, but will not be able to, make any major advances: Alcoholism

The Administration budget proposes $4.5 million in research and demonstration projects in the field of alcoholism for the coming year. This is $212,000 over this year's budget-hardly enough to finance even one of the many regional alcohol research centers which the Institute has been urged to activate in fiscal 1968.

There are many who contend-and I find it difficult to disagree with them-that alcoholism is the biggest public health problem in this country today. It is estimated that there are between five and six million alcoholics in the United States: if one includes their families, more than twenty million people are caught up in the web of this malady. It is almost impossible to give a full rendering of of the human suffering, the families broken up and the fantastic economic cost of this disease to industry.

Recent studies indicate that the life expectancy of the alcoholic is ten to twelve years less than that of the average person. W ehave figures from some states which indicate that communities spend $50,000 to $100,000 in support of an alcoholic and his family during his lifetime.

In an enlightened departure from past views, the medical profession now proclaims that alcoholism is a disease. However, we know precious little about treating this sickness. In some jurisdictions, courts now require chronic alcoholics to be treated rather than jailed, but in actual fact this treatment consists largely of drying out the alcoholic and getting him back on his feet until the next bout of alcohol and the next re-admission.

There is a consensus among leading investigators in the field that we need chemical agents effective against this addiction. Despite the cries of skeptics, research investigators have developed a number of chemical agents against the most refractive kinds of mental illness, including schizophrenia. Despite the cries of the skeptics, a new core of investigators is making initial inroads upon various forms of mental retardation.

All of these problems were previously considered hopeless. We are just beginning to lift the cloud of hopelessness surrounding alcoholism; we must therefore have funds to support widespread investigations.

At the present time, Rutgers University has the only multi-disciplinary research center for the study of alcoholism. It is my understanding that over the next year or so, the Institute will be asked to finance an additional ten to twelve regional alcoholism centers.

A careful assessment of the need, combined with a touch of realism concerning the present fiscal climate, limits us to requesting an additional $4 million over the budget for research and demonstration projects in alcoholism during fiscal 1968.

Narcotics and drug abuse

We are faced here with a problem of inadequate data on the extent of addiction to narcotics. The estimate of 60,000 users of narcotics is generally regarded as very low, since it is drawn almost exclusively from reports by law enforcement agencies. New York State, which is now developing a comprehensive program in this field, estimates that there are 40,000 narcotic addicts in that state alone.

As most of you know the Congress, upon the recommendation of the President, enacted the Narcotic Addict Rehabilitation Act of 1966. It provides for fairly liberal authorizations for various approaches to the problem of narcotic addiction, but the actual budget recommendations for both the current year and fiscal 1968 are grossly inadequate in terms of meeting the objectives of the new legislation.

At the request of the Administration, the National Institute of Mental Health set up a new Center for the Studies of Narcoic and Drug Abuse. The mandate is fine, the title of the Center is impressive, but the funds for the studies are not there. For fiscal 1968, the Administration recommends $3,900,000 for drug addiction-only $664,000 over the current year.

In combing the literature and in talking to the small band of scientists interested in this field, I find general agreement that constructing a network of facilities to get the addict off the streets is not the answer. Even if he is successfully withdrawn from the drugs while confined, there is overwhelming evidence that he soon returns to the habit when he is released. New York State is currently planning to spend approximately $250 million to construct and operate these detention camps for addicts. Years ago, New York did the same with the mentally ill, and it is today saddled with a number of monstrous human warehouses in the 5,000 to 10,000 bed range.

Buildings weren't the answer for the mentally ill then, and they are not the answer for drug addicts now.

The small amount of research conducted on drug addiction over the past few years has resulted in the development of several drugs which show promise as antagonists to the harmful and powerful narcotics-they either substitute for them or reduce the craving of the addict for them. There is considerable hope that intensification of this research can, and will, produce agents powerful enough to break the addictive process.

We therefore recommend an additional $4 million over the Administration budget to transform the Center for the Studies of Narcotic and Drug Abuse from a hollow shell into an exciting reality.

Depressions

Depression is one of the most difficult and most disabling forms of mental illness. While there are no really precise statistics on the number of people suffering from depression in this country today, there is a fairly widespread view among the professionals that depressions not only claim a vast number of our hospital beds, but are also one of the most refractory problems confronting both psychiatrists and general practitioners of medicine.

I had the privilege of attending the 4th World Congress of Psychiatry in Madrid last year; I heard papers from distinguished psychiatrists in all parts of the world emphasizing the point that depression was not only the most common form of mental lilness, but also one of the most costly health problems in terms of reduction of human productivity.

Over the past year, in an effort to mobilize a research offensive against this illness, the National Institute of Mental Health called in experts in this field who now compose a task force charged with devising new research approaches

effective against depression. It is my understanding that the task force has recommended the sum of $4 million as an initial step in achieving its objective; we therefore recommend that this amount be added to the research budget of the National Institute of Mental Health to get on with this very imporant work. The problem of suicide prevention is closely related to the aforementioned endeavor in the field of depression. On the basis of incomplete reporting, it is estimated that there are 20,000 suicides each year-the tenth leading cause of death in our country. In recognition of this fact, the National Institute of Mental Health last year set up a Center for Studies of Suicide Prevention. Its budget during the current year is $2,335,000; the Administration proposes an increase of only $265,000 for the coming year.

The new Center hopes in the next several years to develop a number of regional centers, connected with universities, to serve as both research and training facilities. With the money currently available to it, the Institute has been able to plan for only one additional center in the coming year. We therefore recommend an additional $1 million so that more of these desperately needed centers can be started.

In summary, Mr. Chairman, we recommend an additional $13 million over the Administration budget to finance manifest research needs in the fields of alcoholism, narcotics and drug abuse, depression and suicide prevention.

HOSPITAL IMPROVEMENT GRANTS

As originally envisioned in 1963, this program was designed to lift the quality of care for the forgotten patients in every one of our state mental institutions. Under the original Kennedy program, we were to reach a level of $36 million in the third year of this program. However, the Administration recommendation for the coming year is only half of this sum, of which $10,610,000 is allocated to the National Institute of Mental Health and the remainder to the Division of Mental Retardation.

Under present fiscal limitations, we are only able to reach about half of all state hospitals. Those hospitals which cannot be reached are being deprived of an enormous set of resources. For example, figures on the first three years of the program indicate that those hospitals which have received awards have increased their discharge rates significantly and have added thousands of additional personnel who are doing a magnificent job with elderly patients, children and adolescents, alcoholics and many other groups previously neglected because of shortages of staff and funds.

If the Administration recommendation is sustained, we will not be able to add a single hospital to this exciting program in fiscal 1968. We therefore recommend $6 million over the budget figure so that this highly successful program can reach thousands of additional mental patients.

TRAINING

This committee has been constantly concerned with critical shortages of mental health manpower. Over a period of years, it has appropriated monies over and above Administration budgets to see to it that the mental health field would be in a position to recruit and train the enormous numbers of people needed for service activities in hospitals, clinics, and the community at large.

Last year, emulating the discouraging pattern of the two previous years, the National Institute of Mental Health was unable to finance the training of close to 2,000 willing recruits in the mental health disciplines, even though their qualifications had been screened and scientifically approved by technical study sections.

On the basis on this evidence, this committee ordered the National Institute of Mental Health to present to it this year a realistic assessment of mental health personnel needs over the ensuing five years. May I quote the committee language in this matter?

"A major problem confronting mental health programs all across the country is the critical shortage of trained manpower in the mental health fields. In 1963, the Committee was told that the Nation would require 87,000 mental health professionals by 1970, and that annual increases of $15,000,000 for training activities would be required if this goal was to be attained. Not once in the ensuing three years has such an increase been requested, although no one has seriously questioned the wisdom of investing such sums in training. There also seems to have

been no serious question about the availability of persons to be trained. The Committee feels that it is now a matter of some urgency that those concerned with developing estimate for the training programs should concern themselves with the possible consequences for future victims of mental illness and for the community at large if sufficient numbers of trained professionals are not available to meet the expected needs. At next year's hearings, the Committee will expect a fresh assessment of the requirements for mental health personnel, by professional and sub-professional categories, five years hence and a realistic plan, including estimates of the funds required, for meeting these requirements."

After a thorough, year-long study in which it gathered statistics from the major professional groups and from every mental health facility in the 50 states, the NIMH developed a factual answer to the committee directive. It reported that there were approximately 67,000 people working in the four core mental health disciplines-psychiatry, clinical psychology, psychiatric nursing and social workat the present time; it projected the need for 100,000 of these workers by fiscal 1972. In order to achieve this increase in manpower, it estimated that $114,150,000 would be needed in fiscal 1968 and that, in the fifth year of the program, approximately $187 milion would be required.

The Administration seems to have paid little attention to this Congressionally directed report. It recommends only $100,762,000 for all of the training activities of the NIMH-a claimed increase of $8 million over this year. However, mandatory increases in the costs of training projects begun in previous years are $11 million higher than a year ago so that, in actual fact, the NIMH will be able to award 110 less new training grants for the coming year than in the current year. But statistics hardly tell the story. Just a few weeks before his untimely death, Congressman John E. Fogarty, who had done more than any member of the House to increase funds for mental health manpower, received a letter from Mr. William Forrester, Director of Personnel for "The Pittsburgh Press". Congressman Fogarty shared this letter with me, and I would like to quote a few comments from a dedicated person who sees the stifling effect of manpower shortages at the grass roots level:

"This struggle against mental illness has been my major avocation in recent years, and indeed I suspect there have been times when I have been more concerned with it than the problems I face in handling labor relations and personnel problems for my fortunately understanding employer.

"I have served Mayview State Hospital as a volunteer for the past 12 years, have been a member of its Board since 1961 and chairman since 1963. I am a member of the Boards of the county and state mental health associations, and of the newly-appointed Allegheny County Mental Health Mental Retardation Board. I served the state as a regional chairman of the Comprehensive Planning Program for a 10-county area.

"These things are cited as background to emphasize one fact which has dominated all of the activities in which I have engaged: to do even a reasonably adequate job the supply of professional manpower just has to be expanded far beyond the present potential.

"There is no more frustrating problem for our Board at Mayview. Some of the members are well informed on the mental health field, others are relatively new. All are shocked at the paucity of manpower, and we keep writing letters to our Commissioner of Mental Health and our Governor and our legislators. The theme is always the same: 'We believe our hospital is doing a reasonably good job under present conditions of inadequate staffs and budgets. How much better a job these dedicated people could do if you gave them the tools!'

"As our County Mental Health Board begins it work of planning mental health centers, the enthusiasm of the members is certainly tempered by the knowledge that all of the fine plans in the world will collapse if we can't get the staff. And this won't be easy.

"I can't think of any more glaring example than Western State School and Hospital near Pittsburgh. It was built for 500 retarded children and 200 emotionally disturbed ones. It is the only facility in Western Pennsylvania which could accept deeply disturbed children. The beds for retarded children were filled quickly (the waiting list for them is another dismal chapter in our state), but Western has accepted only 30 or so disturbed children, some of them also retarded. Why? It has been unable to get staff.

"This could go on and on, but I'm sure I've made my point.

"That's why those of us in the hinterlands, facing these problems constantly, are indeed grateful that there are men in powerful positions in our government

who do understand and support these measures which are so vitally needed to provide some day, somehow, the manpower necessary to give at least adequate care to the mentally ill.

"My earnest thanks to you for all that you are doing."

In the field of psychiatry alone every issue of "Psychiatric News", the official publication of the organization, is filled with hundreds of job listings, some of which have gone begging for a year or more.

In the field of psychology, the situation is even more critical. In a recent letter to Secretary Gardner, Dr. Arthur Brayfield, Executive Director of the American Psychological Association, estimated that the NIMH training support program in psychology would have to be increased at least five-fold to fill existing demands for services.

It is obvious from the foregoing that we cannot meet demands for mental health professionals in the traditional areas of work, much less provide the added manpower to staff the new community mental health centers, furnish psychiatric services under Medicare, supply mental health workers for Head Start, and so on. We therefore recommend $114,150,000 for the training programs of the National Institute of Mental Health during fiscal 1968. This is the exact sum recommended in the five-year study ordered by this committee, and is only a modest beginning toward recruiting and training an additional 33,000 mental health workers in the next five years.

RESEARCH FELLOWSHIPS

The Administration recommends $9,859,000 for research fellowships in the coming year, an increase of only $726,000 over the present level of support. Under this restrictive budget proposal, we will be able to support ten less fellowships than we did last year.

We are constantly reminded of the shortage of research investigators in the field of mental health, and we are chastised for not coming up with basic solutions to such simple problems as schizophrenia and alcoholism. We cannot move forward unless we have a large cadre of research investigators.

We therefore recommend an additional $2 million over the Administration budget for the research fellowship program of the NIMH.

DIRECT OPERATIONS

A year ago, I pointed out to this committee that the very restrictive Administration recommendations for the many intramural activities encompassed in this item seriously hampered the National Institute of Mental Health in its efforts to meet the fantastically increased requests for technical help from states and localities. For example, the initiation of the community mental health center program has resulted in staggering demands upon the under-staffed regional field offices of the NIMH. An individual application from a locality for a center frequently necessitates hundreds of hours of staff time in the initial development and subsequent revision of the proposal.

We therefore recommend an additional $4 million for NIMH regional and field activities to provide increased technical assistance to states and localities and also to state hospitals requiring consultation in the development of patient care improvement programs.

As the Institute moves into a number of specialized mental health programs outlined in previous portions of this testimony, it obviously must have a larger number of planning and development personnel in the central office. The Administration recommendation for fiscal 1968 provides only two additional positions for this central planning, development and administration. We therefore recommend an additional $2 million so that the Institute can provide effective technical leadership in the fields of alcoholism, drug addiction, suicide prevention, and so

on.

On an over-all basis-in order to expand many other necessary activities in the central office we recommend a total appropriation of $61,764,000 for NIMH Direct Operations during fiscal 1968.

COMMUNITY MENTAL HEALTH

I am happy to report to this committee that enormous progress has been achieved in a very short span of time in launching the new era of community mental health centers.