COMMITTEE ON APPROPRIATIONS

GEORGE H. MAHON, Texas, Chairman

KENNETH SPRANKLE, Clerk and Staff Director

DEPARTMENTS OF LABOR AND HEALTH, EDUCATION, AND WELFARE APPROPRIATIONS FOR 1967

MONDAY, MARCH 21, 1966.

MENTAL HEALTH

WITNESSES

MIKE GORMAN, EXECUTIVE DIRECTOR, NATIONAL COMMITTEE AGAINST MENTAL ILLNESS

DR. FRANCIS J. BRACELAND, PSYCHIATRIST IN CHIEF, INSTITUTE
OF LIVING, HARTFORD, CONN.; CHAIRMAN, COMMISSION ON
CURRENT ISSUES IN PSYCHIATRY, AMERICAN PSYCHIATRIC
ASSOCIATION

DR. DANIEL BLAIN, PHILADELPHIA, PA.; CHAIRMAN, COMMISSION
ON MANPOWER, AMERICAN PSYCHIATRIC ASSOCIATION
REV. ROBERT TATE, D.D., AUSTIN, TEX.; REPRESENTATIVE, NA-
TIONAL ASSOCIATION FOR MENTAL HEALTH

Mr. FOGARTY. The committee will come to order. We are starting today with outside witnesses on mental health.

Mr. Mike Gorman, you have been here many times before. You may proceed.

Mr. GORMAN. Mr. Chairman and members of the committee, on February 5, 1963, President John F. Kennedy, in the first Executive message ever delivered to the Congress on mental illness and mental retardation, called for a revolutionary war upon these twin afflictions of mankind in these stirring words:

Mental illness and mental retardation are among our most critical health problems. They occur more frequently, affect more people, require more prolonged treatment, cause more suffering to the families of the afflicted, waste more of our human resources, and constitute more financial drain upon both the Public Treasury and the personal finances of the individual families than any other single conditions ***. Every year, nearly 1,500,000 people receive treatment in institutions for the mentally ill and mentally retarded. Most of them are confined and compressed within an antiquated, vastly overcrowded chain of State institutions.

Sounding a clear trumpet call for a "bold new approach" to these. diseases, he told the Congress that "if we launch a broad, new mental health program now, it will be possible within a decade or two to reduce the number of patients now under custodial care by 50 percent or more."

The trumpet sounded clearly enough in 1963, but in subsequent years its sound has been fading away.

I do not contend that we are not making progress. Over the past decade we have reduced the number of patients in State mental hospitals by 15 percent-from 558,000 in 1955 to the current low of

475,000 in 1965. This 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.

However, I must in all candor point out to this committee that we are not meeting the goals set by President Kennedy-the average annual reduction in State hospitalized patients over the past decade has been only 1.5 percent.

Why are we failing? The answer is quite simple. We are not meeting any of the long-term budgetary goals which President Kennedy submitted in connection with his historic 1963 message.

According to several recent newspaper stories, the Bureau of the Budget has asked every department and agency in the Government to submit 5-year plans for program development. Mr. Chairman, President Kennedy did this in the field of mental health in 1963. We have the carefully documented projections which would make obsolete within a decade or so the dreary human warehouses which now house hundreds of thousands of our mentally ill and mentally retarded. But we lack one thing-the money to implement these projections.

For example, psychiatric manpower is at the very core of any significant increase in the treatment potential of these institutions. Placing the greatest emphasis upon this area, President Kennedy reminded the Congress in 1963 that

we must increase our existing training programs and launch new ones; for our efforts cannot succeed unless we increase by several-fold in the next decade the number of professional and subprofessional personnel who work in these fields.

President Kennedy proposed in that year, and the Congress voted, a $17 million increase in the training programs of the National Institute of Mental Health for fiscal 1964. However, in both the fiscal 1965 and 1966 budgets, we fell considerably below this level of increase, and the fiscal 1967 recommendation of the administration really holds these training programs at a standstill level.

Pointing out that more than half of the mentally ill and mentally retarded in State and county institutions were receiving no treatment whatsoever, President Kennedy proposed a hospital improvement plan program starting at $12 million in fiscal 1964 and reaching $36 million in fiscal 1966. In the current year, we have only reached half of this target level, and the administration proposes the same inadequate sum for the coming year.

President Kennedy also placed great emphasis upon the upgrading of the skills of personnel working in public mental institutions. He submitted projections which would permit these inservice training grants to reach a level of $11 million in fiscal 1966. The hard money has never caught up with the projections; the sum the administration proposes for these vital grants in fiscal 1967 is little more than half of the amount President Kenendy envisaged for the current year.

Mr. Chairman, we therefore propose a realistic budget of $287,358,000 for the National Institute of Mental Health during the coming year-an increase of approximately $34 million over the administration recommendation. This overall figure is solidly predicated upon two sets of documentation: the detailed, 5-year budgetary projections which accompanied the 1963 Kennedy message and the current level of scientifically approved applications in all areas which cannot be

paid because of a shortage of funds. Appended to this statement is a detailed breakdown of our budgetary requests and I assure this committee, as I have over the past 16 years during which I have testified on the NIMH budget, that there is no pie in the sky in our recommendations they are the minimum amounts needed to turn the corner against mental illness.

Mr. Chairman, with your permission, I would merely like at this point to highlight the major items in our proposed budget:

The administration budget proposes a cut of $2,374,000 in the regular research grants which are awarded on a competitive basis to investigators in all parts of our land.

Mr. Chairman, we find this reduction inexplicable, especially in light of the fact that the administration has proposed an increase in the total research programs of the National Institutes of Health of $32 million for fiscal 1967.

Under the impact of this kind of cut, we will be able to award about 100 less research grants than in the current year. Our job right now is to find some research answers which will enable us to treat, on a more rational basis, many forms of mental illness. We know precious little about the basic causes of schizophrenia, the mode of action of the new drugs, the mysteries underlying the development of emotional disturbance in children, yet the Institute is now being asked to extend its research spectrum into a number of new fields-alcoholism, drug addiction, and suicide, to name but a few. If the Institute is unable to fund its present research obligations, how can it make any significant efforts in these new and challenging areas?

If the administration recommendation is not increased in the research grant area, more and more distinguished psychiatric researchers in all parts of the country will be getting the following letter of rejection which goes out to too many of them at the present time:

I regret to inform you that although your application for a research grant, MH was recommended for approval by the National Advisory Mental Health Council, we are unable to make an award because of the lack of sufficient funds. No further action, therefore, will be taken on your request. I should point out that we are able to fund only one-half of the projects which were deemed scientifically sound and worthy of support.

The demonstration projects program under title V is one of the most enthusiastically received of all NIMH activities, supports demonstrations in hospitals and in the community designed to develop more humane and economic alternatives to the costly institutionalization of mental patients.

The administration proposes an increase of only $372,000 for these project grants. Members of the Congress, a large segment of the psychiatric community, and many voluntary health organizations have been pleading with the Institute to support additional demonstration projects in many neglected areas. Let me cite but three of them:

About 5 million people in the United States are alcoholics, affecting 20 million family members. An estimated 200,000 new cases develop each year. According to a survey by the Industrial Division of the Menninger Foundation, alcoholism alone costs industry $2 billion a year. It has been estimated that alcoholism is a contributing factor in half of the auto fatalities in this country. In 1963, there were 1,500,000 arrests for drunkenness, and an additional 215,000 arrests for driving while intoxicated.

One out of every seven admissions to State and county mental hospitals is an alcoholic.

A recent study of cases of aid to families of dependent children found alcoholism as a major factor in 14 percent of the families receiving tax moneys under this program.

Last year, because of a limitation of funds, the Institute spent less than $4 million in support of all research, training, and demonstration programs in the field of alcoholism. In the title V area, it supported 19 projects at a cost of less than $1 million.

This is not to say that the NIMH is not moving in this area. Over the past 4 years it has supported the work of the Cooperative Com mission on the Study of Alcoholism, established through the joint efforts of the Institute and the North American Association of Alcoholism programs. The report of the Commission is due later this year, and we are confident that it will make landmark recommendations for improving preventive, treatment, and educational services. The Institute is also supporting the first nationwide study of patterns of drinking in the general population.

Under the title V program, the NIMH is addressing itself to the fact that 63 percent of general hospitals still do not admit alcoholics despite the clear and repeated position of the American Medical Association that alcoholism is a sickness and not a criminal offense.

At the Massachusetts General Hospital in Boston, the Institute is supporting a project which is attempting to reach out to alcoholics in the community with supportive clinical services. A somewhat similar project is being tested in a general hospital in a rural area of New Hampshire. At the Malcolm Bliss Hospital in St. Louis, it is supporting a comprehensive program including inpatient treatment in the hospital in combination with a wide range of services offered by health and welfare agencies attempting to stabilize the alcoholic in a productive way in the community.

It is conservatively estimated that there are about 60,000 drug ad dicts in the country. They are responsible for a major percentage of crime in some of our larger cities.

One of the most serious problems in this field is readdiction-as high as 90 percent of those discharged from the Public Health Service hospital in Lexington become readdicted to drugs shortly after their discharge. Title V grants in East Los Angeles and in Brooklyn are supporting halfway houses as a resource to keep the addict from returning to the hospital. Another project supported over the last 4 years in the Washington Heights area of New York City is exploring the potential of a local public health agency in providing continual support for the newly discharged addict who is trying to gain a foothold in the community.

There are an estimated 20,000 suicides in this country each year, with leading students of the problem contending that the stigma surrounding it prevents full reportage and a much higher figure. There are approximately 200,000 suicide attempts a year.

Suicide is now the 10th leading cause of death in this country, and the third leading cause of death among college students and in the peacetime armed services.

Over the past 6 years, the NIMH has supported the pioneering work of the Los Angeles Suicide Prevention Center, the finest of its kind in