Mr. FOGARTY. How about the problem of facilities and personnel? Every once in a while when this bill is on the floor they say, "Where are you going to get the personnel, and why don't you do something about building facilities?"

The budget, because of Vietnam, has recommended the construction of all these research facilities be just about cut off. I don't agree with that. I think President Truman made a mistake when he cut back, during the Korean situation, on such construction. Some congressional committee made a study of it at that time and concluded that the shutdown of 1 or 2 years set the program back 8 or 10 years. Is that a fair statement?

Mr. GORMAN. I think so. We have been moving ahead in training. Since 1948, under NIMH stipends, we have trained 30,000 people in the 4 corps disciplines. This is a place where the demand far exceeds the supply.

There are 21 State hospitals without a psychiatrist: 90 State hospitals with 1 to 4 psychiatrists; many mental health clinics without a single psychiatrist, getting only 3 or 4 hours of psychiatric time a week.

We have to train these people. When people say, "Where do you get the people?" the answer is simple. You train them. During World War II you trained pilots. You didn't have any pilots.

President Roosevelt said he was going to build a hundred thousand planes and people said, "Where are you going to get pilots?"

He said, "I am going to put moneys in the budget to train them." Now, we say the same thing, that if we get the training money—we are turning down 2,000 applications a year in training alone. We have the warm bodies. We have them right there in front of us. We send them that letter, "We have no money. Glad you came in to see us, but we have no money for you."

Mr. FOGARTY. Then last Friday I had a group of parents from a State school for retarded children in to see me and they can't get a speech therapist or a physical therapist or any of these people at this time.

I think maybe if the State paid a decent salary they could get some of these people, but we are notorious for the low salaries we pay.

Mr. GORMAN. I think this is one of the real problems. You cannot compete and many States cannot compete because of the low salary level, but also, we don't have enough people. I am not discouraged about it; we just have to work harder at it.

Mr. FOGARTY. Why shouldn't a Governor recommend higher salaries to take care of some of these needs like you mention for the school for the retarded or a State hospital for the mentally ill?

Our State hospital is manned by a very high percentage of physicians who came from overseas.

Mr. GORMAN. You have one of the highest percentages in the country of foreign-born physicians.

Mr. FOGARTY. I am not saying they are not doing a good job, but the percentage is awfully high. One of the reasons is they don't pay very good salaries.

Mr. GORMAN. I think they are just not attracting the young American psychiatrist because you are not paying a big enough salary. You can't get them without paying salaries.

I think you have to train a lot more people. We have doubled the number of trained people in the State mental hospitals in the last 15 years, but we still have to move ahead. I am not pessimistic about it, but it is going to take money.

With this kind of a budget, Mr. Chairman, we can't do it.

Mr. FOGARTY. It can be done. When you compare State by State you can see how it is done. There is no comparison between the State of Kansas and the State of Rhode Island, is there?

Mr. GORMAN. That is right, or Michigan.

Mr. FOGARTY. With regard to taking care of the mentally ill.

I give Kansas because that is perhaps one of the best, isn't it?

Mr. GORMAN. That is one of the best. Nebraska is too. In terms of drop-in patient population and in terms of attracting young doctors into the institutions, that is an excellent example.

Massachusetts has an excellent mental hospital system.

Mr. FOGARTY. Why is Rhode Island so backward in this area? Mr. GORMAN. Leadership. Unless the Governor gets up in the hustings and tells the people what this is going to cost-and it is going to cost money-I don't see that anything can be done.

Until Youngdahl got up in Minnesota and said, "It will cost you an extra cent on cigarettes and an extra 2 cents somewhere else—" it was not done.

Mr. FOGARTY. They supported him, didn't they?

Mr. GORMAN. They supported him in a big way.

The first time I went to the State capital I was in a cab with a driver and I thought I'd needle him. I said, "The price of cigarettes is very high."

He said, "That extra cent on cigarettes is for mental patients. I have to pay for mental patients. Why not? They are our people, aren't they? It is very important."

That is from a cab driver who had a Governor who told him what it was going to cost.

Mr. FOGARTY. There are Governors who like to look the other way when they walk through a mental hospital.

Mr. GORMAN. When a Governor is really interested and takes a walk through these wards and sees some of the conditions, he moves to act.

I walked through the wards with Governor Youngdahl in 1949. He saw so many patients in restraint, in heavy wristlets, and he had a party on the grounds of Anoka State Hospital on Halloween and burned every piece of restraint in that hospital.

STATEMENT OF DR. FRANCIS J. BRACELAND

Mr. FOGARTY. Dr. Braceland, we will place in the record your biographical statement and you may proceed.

(The biographical statement follows:)

I am Francis J. Braceland and I have been a psychiatrist for nearly 35 years. I graduated from Jefferson Medical College in 1930 and was an intern and chief resident at Jefferson Hospital. I began my psychiatric fellowship training at the old Pennsylvania Hospital in Philadelphia in 1932. I was then a Rockefeller fellow in psychiatry in Zurich, Switzerland, and at the National Hospital, Queen Square, London. I returned to be clinical director at the Pennsylvania Hospital until 1941, when I was appointed professor of psychiatry and dean of the School of Medicine, Loyola University.

I have since occupied the following positions:

1942-46: Special assistant to the Surgeon General, U.S. Navy, and wartime chief of the psychiatric section. I am a rear admiral, Medical Corps, USNR, retired.

1946-51: Head of the section of psychiatry, Mayo Clinic, and professor of psychiatry, Graduate School, University of Minnesota.

1951-65: Psychiatrist in chief, The Institute of Living, Hartford, Conn.; since 1965 senior consultant in that institution and clinical professor of psychiatry, Yale University; since 1960, lecturer on psychiatry, Harvard Medical School.

I have been in the past: President, American Board of Psychiatry and Neurology, 1953; president, American Psychiatric Association, 1956–57; president, Association for Research in Nervous and Mental Disease, 1957; president, Board of Examiners for Certification of Mental Hospital Superintendents, 1955; chairman, American Medical Association, section on nervous and mental disease, 1956; chairman, National Health Forum, 1958; vice president, World Psychiatric Association, 1961-.

I am now editor of the Americal Journal of Psychiatry, the official organ of American psychiatry and am a psychiatric consultant to the Surgeons General of the Army, Navy, and Public Health.

Dr. BRACELAND. Mr. Chairman, this is a different climate we come into now, to ask you for funds. A different climate made very largely by you gentlemen and your counterparts in the Senate.

Mr. FOGARTY. I hope all those who are going to talk today would also keep in mind the idea that many newspapers and many Governors and the administration itself seems to think we ought to cut back on these programs in order to support a war in Vietnam.

I don't happen to think that way myself.

Dr. BRACELAND. When we started testifying before this committee 10 years ago, the situation was entirely different.

Mr. Chairman and members of the committee, I appreciate this opportunity to appear before you on behalf of the American Psychiatric Association, an organization which numbers approximately 17,000 psychiatrists on its rolls, and to express the support of that official organization for the citizens' budget for the National Institute of Mental Health as just elaborated by my colleague and friend, Mr. Mike Gorman.

I began to appear before this committee 20 years ago and with few exceptions I have had the privilege of appearing before you every year since then, so you can see that I am a hardy perennial. However, Mr. Chairman, we are appearing today in a different psychiatric world than the one in which we began our testimony 20 or even 10 years ago and I hasten to add that much of the progress which we have made over that period was aided, abetted, encouraged, and financed by the assistance given us by you gentlemen and your counterpart in the Senate, Apropos of this fact, the March issue of the American Journal of Psychiatry, which I have the honor to edit, has a special section of 10 papers on community psychiatry and an editorial by Dr. Robert H. Felix, which is entitled "Community Mental Health, a Great and Significant Movement." I quote two short statements taken from Dr. Felix's commentary, for I know that you know he played an important part in our mental health advances. He said:

(1) It is not a dream but a reality. More progress has been made in psychiatry in the last 30 years than in all the span of recorded medical history before that time.

(2) Now mental illnesses and their prevention have become in fact the community concern we have said for so long they should be. Mere words cannot express the great debt the American people and, in fact, people everywhere owe to the late President Kennedy and the Congress of the United States for translating the findings and recommendations of the Joint Commission on Mental Illness and Health into law, thus making possible action at the community level.

Here today I need not add that this committee played an important part in the formulation and financing of the Joint Commission; incidentally, this is the fifth anniversay of the publication of its report, Action for Mental Health.

Mr. FOGARTY. Really, a Senate committee established that Commission; I think at the urging of Mr. Michael Gorman. We went along with it. Isn't that right, Mr. Gorman?

Mr. GORMAN. Yes, sir; Mr. Chairman, that is quite correct, sir. Mr. FOGARTY. We will take all the credit we can, but we have to give some credit to the Senate once in a while.

Dr. BRACELAND. I managed to get them in by saying your counterparts in the Senate.

I said recently in a review of 1965 psychiatric advances in the Medical World News that psychiatry has been influenced more by happenings outside of its field than those events which took place in it. İn that you are acutely aware of and have been the obstetricians of many of those external happenings, I would ask your permission to examine for you the professional aspects and background of those urgent requests which Mr. Gorman made of you here today.

The figures which he gave you are dramatic in their impact:

The unprecedented reduction in State mental hospital populations has saved the States an estimated $2 billion in patient-care costs and $4 billion in construction costs over the 10-year period.

He then called your attention to the fact that, even with these savings, the goals of the martyred President have not been met. The average annual reduction in the State hospitalized patients has been only 1.5 percent and the President had hoped the census of these institutions would be reduced by 50 percent in one or at most two decades. He expressed the opinion that we are failing because budgetary allocations to accomplish this had not been forthcoming.

Mr. FOGARTY. May I have that statement again?

Dr. BRACELAND. It was his hope in his message to Congress that we would be able to reduce the mental population in this country by 50 percent at the end of 10 years. That was in the President's message. Either 10 years or at least within 20 years.

Mr. FOGARTY. You refer to President Kennedy's message now? Dr. BRACELAND. Yes, sir; message of 1963. Now we are not going to make it.

I have lived in mental hospitals for over 30 years, gentlemen, and I am acutely conscious of the number of sick people they house. Despite our advances, those institutions still house 475,000 souls and some of them are hardly proper places in which to expect people to get well. Even if we attain our goals and gradually reduce their populations, these institutions will be with us for a long time to come. In the past we have investigated them, exposed them, condemned them, excoriated them, and abolished them numerous times but they are still with us. Actually, the talk of abolishing them is farfetchedsheer demands of economics of space and long-term illness require them. Besides, we do not want to abolish them, we only want to abolish the old image they cast. We must improve them, however, and make them habitable, decent, and functional.

Most of these hospitals were built in the last century. They are large structures and some of them are grim. As my colleague said earlier, they simply warehoused human beings. Most of them are much better now but they need to be kept up and in good repair, for proper surroundings are an aid to convalescence, and the road back to home and loved ones is a hard one, which needs all the help and encouragement which can be given.

Therefore, the hospital improvement program is an exceedingly important one. It has to do with the surroundings and the dignity of sick people. It cannot be shortchanged, for these people have few understanding friends. It is our opinion professionally that the sum of $24 million is needed to do this job properly. Admittedly, this is $6 million more than is asked for in the President's budget but this is necessary if the 70 institutions which have asked for help will not be turned down.

In that problems do not arise singly, the mention of hospitals brings up another serious situation; namely, manpower. Without proper staffing at all levels, hospitals simply become shelters. My colleague, Dr. Daniel Blain, who is well known to you, has recently been chairman of a Commission on Manpower of the American Psychiatric Association. He was charged with thoroughly investigating this important problem and his group made a thorough examination of the situation and has recently completed a report on the subject. Fortunately, he is here today and prepared, in case you would care to ask him questions on the subject. To avoid repetition and conserve time, I for