the country. In addition, it has helped to support a few additional centers. But the fact remains that there are only 15 suicide prevention centers concentrated in 8 States. I am informed that there are at least 3 dozen cities which would like to set up these centers, but there is no money in the title V program to help them.

The NIMH is now reviewing a plan-developed by the Los Angeles center for a nationwide chain of suicide prevention centers. The plan-all 36 pages of it-is an exciting proposal, but where is the money to implement it?

To move into these three areas alone in a meaningful way-alcoholism, drug addiction, and suicide prevention-we are requesting an additional $2 million for the title V program in the coming year.

This program was initiated 3 years ago as a part of the Kennedy program to transform our dreary State custodial institutions for the mentally ill and the mentally retarded into decent and professionally acceptable treatment facilities. By the third year of the program (fiscal 1966), it was supposed to reach out to every institution in the country for the mentally ill and mentally retarded which desired to improve its services. As I have pointed out previously, inadequate funds for this program have prevented us from even coming close to this goal.

The hospital improvement grant program has been received with unprecedented enthusiasm throughout the country. Of the 430 public institutions for the mentally ill and the mentally retarded in our Nation, more than half have applied for HIP grants in the short period of its existence. But to date, because of a limitation of funds, only about one-third of the institutions (144) have received grants. Additional grants will be made in the current year, but because the administration recommendation for the coming year holds the program to the same level as in the current year, not one single new award can be made. On the basis of long-term projections, now considered quite respectable by the Bureau of the Budget, the Institute had planned to bring 70 more institutions into the program in fiscal 1967, thereby reaching about 58 percent of all eligible public institutions.

This is a very important program with a demonstrated potential for both intensifying treatment and getting patients out of the hospitals and back into the community. Eighty percent of the funds awarded up to now are being used for additional and new kinds of personnelthose who work most closely and effectively with the patients-attendants, practical nurses, aids, activity therapists, vocational counselors, and so on.

Many of the projects have concentrated on specialized problem areas which existing inadequate staffs have been unable to handle. For example, in the mental hospital field, 23 projects support additional personnel to work with chronic and elderly patients; 12 provide desperately needed personnel to staff new units for children and adolescents; and 4 projects are helping to support specialized alcoholism treatment units which provide such services as individual and group psychotherapy, counseling for the families of alcoholics, vocational guidance, and placement and work in conjunction with Alcoholics Anonymous.

In the field of mental retardation, 32 projects are concentrating on specialized services for the severely and profoundly retarded-the

most neglected of all of our people. One outstanding project conducted by a group of Southern States developed new techniques for training attendants in providing recreational activities for mentally retarded patients. The technical manual produced by this one modest project is now being used by a number of schools for the retarded in various parts of the country.

Mr. Chairman, these are the forgotten people in our State institutions to whom President Kennedy addressed the major thrust of his 1963 message. We must, in all conscience, extend this program to the hundreds of thousands of mentally ill and mentally retarded whom it is not now reaching.

We therefore recommend $6 million over the administration budget for the hospital improvement grants program to bring its demonstrated benefits to thousands of patients in 70 institutions which have applied to the National Institute of Mental Health, but will be turned down in fiscal 1967 because no a single additional dollar is proposed by the administration for this program.

In many ways, training is the most critical area in the entire NIMH budget. Although the Institute has supported the training of 30,000 professionals in the four core disciplines-psychiatry, psychology, social work, and nursing-since 1948, we have never been able to catch up with the increasing demand for these people.

For example, approximately 25 percent of budgeted positions for staff psychiatrists in both State mental hospitals and schools for the mentally retarded still remain unfilled. Many of the filled positions are held by foreign doctors-in a number of States as high as 50 percent of the total psychiatric complement is made up of foreign born physicians. According to a recent survey published by the National Institute of Mental Health, 21 State hospitals are without a single psychiatrist, and 91 State hospitals have only 1 to 4 psychiatrists.

In Phychiatric News, the monthly publication of the American Psychiatric Association, an average of 150 positions for psychiatrists are offered each month. Some of these vacancies go unfilled for a year

or more.

There is an increasing trend toward the opening of psychiatric units in general hospitals. Last year, a record number of 600,000 psychiatric patients were admitted to general hospitals. Despite this trend, a recent pilot study made by the NIMH staff disclosed that approximately half of the hospitalized patients in general hospitals have a primary or secondary diagnosis of mental illness, yet only 6 percent of all physicians and 3 percent of all nurses in these hospitals have had any psychiatric training.

The next few years will see a fantastic acceleration in the demand for psychiatric personnel.

The medicare legislation, whose major provisions go into effect on July 1 of this year, authorizes psychiatric services for people over 65 in general hospitals, State hospitals, and private institutions; it also provides, under part B of title 18 of the Social Security Act, for psychiatric outpatient services up to $250 a year for the millions of elderly people who have already elected to participate in this phase of the program.

Labor, through the bargaining process, is winning sizable psychiatric benefits for union members. For example, the contract negotiated

by the United Auto Workers, which goes into effect on September 1 of this year, covers 22 million workers and their dependents in 77 major cities for extensive inpatient care and up to $400 a year in outpatient psychiatric services.

However, the greatest demand for mental health professionals is already manifesting itself as new community mental health centers are built under the 1963 Kennedy legislation. The announced goal of that legislation is 2,000 centers by 1975; this will generate a tremendous pressure for additional trained professionals in all disciplines.

A carefully documented 1965 NIMH survey indicates that we will need between 120,000 and 125,000 professionals in the four core disciplines by 1975. We have about 65,000 of these professionals now.

If we are to reach these manpower goals, we must have a minimal increase of $15 million a year in the training budgets of the NIMH. I put this committee on notice in 1963 that this annual increment would be needed, and I am here in 1966 to reinforce that position.

I again come back to the February 1966 Bureau of the Budget directive requesting all departments in the Government to come up with 5-year projections of anticipated needs. The necessity for long-term planning is not new to those of us in the mental health field. In the training estimates which accompanied President Kennedy's 1963 community mental health center legislation, there was a 5-year estimate of manpower needs. According to that projection, the training budget of the NIMH for fiscal 1967 should reach a level of $114 million. By way of contrast, the administration recommendation is only $89.4 million.

We only achieved the Kennedy projections in the first year of the expanded manpower training program. Last year, 1,840 approved applications were turned down. These were all highly qualified students, screened by training institutions in all parts of the countryeager to pursue careers in psychiatry, psychology, social work, or nursing. During the current year, it is estimated that we will turn down another 1,500 applicants. The picture is a little better than it was in fiscal 1965 only because the Congress added $3.5 million more than the administration requested for the fiscal 1966 NIMH training program.

If the administration recommendation in the training area for fiscal 1967 is adopted-it is an increase of less than $3.5 million over the current year-we can anticipate more than 2,000 rejections of qualified applicants during the coming year.

In light of these facts, we recommend a $12 million increase over the administration budget in the graduate training program which provides stipends for the training of psychiatrists, psychologists, social workers, nurses, and other mental health personnel.

In 1958, this committee recommended the first funds for the exciting general practitioner training program comprising two major elements: The training of general practitioners and other nonpsychiatric physicians in a 3-year residency leading to certification as fulltime psychiatrists, and a program of grants to institutions qualified to offer postgraduate courses of limited duration designed to improve the psychiatric skills of the doctor while he continues in his individual practice. In the fulltime psychiatric residency phase of the program, 94 physicians were enrolled in the first year. In the current year, 676 physicians are taking this rigorous training.

Since the inception of the program, 800 fully qualified psychiatrists have been added to our manpower pool. To some this may not seem like a great number, but as I travel across the land each year I encounter visible evidence that it has been a lifesaver to many State mental health programs and, for example, to many mental health clinics which have waited for years for one fulltime psychiatrist to run their programs.

Mr. Chairman, this program has never achieved its true potential. As a member of the NIMH Advisory Council for 4 years, I had the most unhappy experience of participating in the rejection of anywhere from 60 to 100 doctors each year who were fully qualified and eager to go into psychiatry. There is no increase for this program in the administration budget before you, so the Council will be forced to turn down an estimated 100 doctors during fiscal 1967.

The second phase of the program-uplifting the psychiatric skills of nonpsychiatric physicians-has been a resounding success. Close to 10,000 physicians have been reached in these courses; the August 11, 1965, issue of the Journal of the American Medical Association noted that psychiatry now offered more postgraduate courses than any other specialty-253 in 1965 as against 114 only 3 years ago.

But, as in the residency program, we can't keep up with the demand. There are 57,000 general practitioners in this country alone; we must step up the pace to get this knowledge to all of them.

We are therefore recommending an increase of $2 million over the administration budget so that the general practitioner program can both fund the backlog of approved applications for fulltime residencies and offer more grants to reach a larger segment of the physician population who seek limited postgraduate training in psychiatry.

This is the third year of an extraordinarily successful effort in support of grants to mental hospitals and to schools for the mentally retarded to enable them to upgrade the technical skills of those closest to the patients-attendants, practical nurses, house parents, cot. tage counsellors, and so on.

Statistics for the first 2 years of the inservice training program show that it has reached 33,000 attendants, aids, and house parents in 227 institutions for the mentally ill and mentally retarded. The program now covers 59 percent of all eligible schools for the mentally retarded and 47 percent of all State mental hospitals. An additional 91 institutions have applications already on file with the NIMH for the current year.

However, since the beginning of its second year, the inservice training program has fallen behind the budgetary projections which President Kennedy submitted to the Congress in 1963. According to that timetable, the program should have reached $11 million in fiscal 1966, as against the actual level of only $6,850,000.

The administration proposes no increase for the fourth year. If its recommendation is upheld, we will be unable to fund applications from an additional 100 institutions which are eligible. Furthermore, the present ceiling of $25,000 per inservice training grant-adopted because of financial stringencies-prohibits most institutions from broadening the program to include professional and technical staff who also need additional psychiatric training.

We therefore propose a fourth year level of $9 million for the inservice training program in order to extend support to at least a sig

nificant percentage of mental hospitals and schools for the mentally retarded whose thousands of patients are now deprived of this additional treatment resource.

The administration proposes $33,907,000 for the second year of matching staffing aid to community mental health centers. The recommendation is approximately $6 million below the authorization voted unanimously by the Congress in 1965.

Although we are still in the first year of our experience with this program, there is every indication that even the authorized funds will not be equal to the demand, because all community mental health centers in the country are eligible-not just those built under the 1963 community mental health center legislation.

The timetable in the 1965 congressional authorization for staffing called for $24 million to be allocated to new applicants in fiscal 1967. This level of new starts obviously cannot be achieved under the administration recommendation.

We therefore propose the full $40 million in Federal matching money for the staffing of mental health centers as authorized by the Congress.

The administration proposes $28,876,000 for all of the ramified intramural activities of the Institute-research, collaborative studies, professional and technical assistance, review and approval of grants, program planning and direction, et cetera.

The area where the shoe pinches hardest is in the professional and technical assistance item. The administration proposes only $300,000 more for this activity in the coming year-far from enough to meet the fantastically increased calls for technical help from States and localities. The community mental health center program, the staffing amendments of 1965, the hospital improvement grant and inservice training programs, specialized projects in childhood mental illness, alcoholism, drug addiction, suicide and so on-all of these and many more generate almost insuperable demands for technical assistance. the NIMH is in desperate need of additional professional staff qualified to work with State and local governments in the launching of these new programs.

We therefore recommend an additional $1 million for the professional and technical assistance section, bringing the NIMH direct operations budget up to $29,876,000.

The administration recommends $50 million for the third year of the community mental health centers construction program-$15 million under the congressional authorization.

We respectfully submit that this is far from enough. After several years of arduous planning involving more than 30,000 citizens in every State in this Nation, 40 States have already submitted requests for matching construction moneys for statewide networks of community mental health centers. To date, 27 State plans have been approved, and many more are currently undergoing final review.

Because of the enthusiastic acceptance of the new program, combined with a widespread feeling among public officials that the unprecedented citizen demand for these centers would soon exceed available moneys, the 1965 National Governor's Conference unanimously passed a resolution requesting the Council of State Governments to convene a conference for a thorough consideration of the future role of each level of government in multiple-source financing of community mental health programs.