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Dr. FELIX. I am Robert H. Felix, director of the National Institute of Mental Health, Public Health Service, United States Department of Health, Education, and Welfare.
In addition to this I am clinical professor of psychiatry at Georgetown University and am on the faculty of the department of public health at George Washington University. I think that will be enough
My colleague on my left is Dr. George S. Stevenson.
Dr. STEVENSON. I am George S. Stevenson, associated with the National Association for Mental Health. My chief responsibilities over a period of about 20 years have been as medical director.
I have been president of the American Psychiatric Association and consultant to a number of Government agencies: Selective Service, the State Department, Labor Department, Public Health Service, Chil. dren's Bureau, and Vocational Rehabilitation. I was on the original National Advisory Mental Health Council.
I am a resident of New Jersey.
Dr. SANFORD. I am Fillmore H. Sanford, a psychologist. I have spent most of my life in teaching and research at Harvard University and the University of Maryland; and, most recently, at Haverford College. I am currently executive secretary of the American Psychological Association.
Dr. KETY. I am Seymour S. Kety, associate director in charge of research of the National Institutes of Mental Health and Neurological Diseases and Blindness, which explains why it was my honor to be present at the meeting yesterday when discussions centered around neurologic diseases.
I am also professor of clinical physiology at the University of Pennsylvania. I am a physician who has specialized in full-time research in physiology.
My colleague on my left is Mr. Charles Schlaifer.
Mr. SCHLAIFER. My name is Charles Schlaifer. I am one of the reasons we are here. I am one of the laymen, patients, that all the doctors are here to talk about.
I am cochairman of the National Mental Health Committee. I have just completed a term as a member of the National Advisory Mental Health Council to the Surgeon General, United States Public Health Service.
I am on the board of governors of the Menninger Association and am on the board of directors of the National Association of Mental Health.
I am president of an advertising agency.
Dr. BLAIN. I am Daniel Blain, the medical director of the American Psychiatric Association. At the present time I am clinical professor at Georgetown University School of Medicine. Formerly I was director of the Psychiatric and Neurology Services of the Veterans' Administration, for 21,2 years immediately following the war. At present I am on the expert committee on mental health of the World Health Organization and am consultant to the Public Health Service and the Veterans Administration.
Mr. DOLLIVER. You may proceed, Dr. Wortis.
STATEMENT OF DR. S. BERNARD WORTIS, PROFESSOR OF PSYCHI.
ATRY AND NEUROLOGY, NEW YORK UNIVERSITY COLLEGE OF MEDICINE
Dr. WORTIS. Mr. Chairman, may I say for this group, and certainly for myself, that it is a pleasure to have the opportunity to come before this Interstate and Foreign Commerce Committee of the House of Representatives.
I should like to start this symposium, if you like, by stressing a few facts concerning the backgrounds for the problems of mental health, but before outlining our problems and needs in this field more definitely may I state that the complexion of medical care and medical practice has been undergoing considerable change in the past 25 years.
American society was first rural, then urban, and now is rapidly becoming suburban in its structure. It has only been a few years since physicians came out from behind their beards and their barbers' aprons, and not so many years since they laid aside their frock coats,
, their bedside manners, their toppers, and their special odoriferous wake of disinfectant. Now we move about among our fellow men unmarked and unscented.
Even though most of us look quite ordinary, certain aims have always been foremost in the minds of physicians, and these have been human conservation and the alleviation of pain and anxiety. We possess certain expert knowledge and skills that society needs; and happily in recent years our citizens and our Congress have joined medicine in these practical and unselfish aims toward human conservation and alleviation of pain and anxiety.
When we look at the task that modern society has placed in the hands of its physicians, we soon find that the scope of medicine has broadened tremendously. For thousands of years the treatment of the sick was considered the primary task of medicine, while today the scope is infinitely broader.
In addition to the general promotion of health and restoration of health, medicine now visualizes its function to include prevention and rehabilitation.
The health record shows that in 1900 the average life expectancy of the average citizen in the United States was 47 years. Today our life expectancy at birth is close to 67 years, an increased expectancy of 20 years in the past half century; whereas in the previous half century, from 1850 to 1900, there was added only 7 years to the life span.
Moreover, preventive health measures--the use of antibiotics and improvement in surgical techniques, including advances in the science of anesthesiology–have radically changed the health picture. In 50 years medicine has made conspicuous progress in dealing with a variety of diseases-bacterial, protozoal, parasitic, and toxicdiseases due to dietary deficiencies and to disturbances of glandular secretions and metabolic disorders. We have yet to attain successs with many virus diseases, new growths, chronic diseases and that most important No. 1 health problem, mental and nervous illness.
During the same 50-year period—that is, the last half centurycertain things have been happening to the doctor. The vast expansion of medical science meant that no one physician could any longer encompass all we knew and medicine entered the “looseleaf age” where knowledge is vast and changing and could no longer be bound into a single static volume. This was one of the factors that started the era of specialization in medicine.
You will remember that at the turn of the century there were individual migrations to Paris, Vienna, and Berlin, which bred our first crop of medical specialists, who returned home with broadened medical skills and a taste for better coffee and better beer. Now physicians from all over the world come here for the best medical training in all fields. The tide has turned considerably.
Medical education has taken large steps forward. The investigative attitudes and methods entered our clinical hospital services, and soon we found that the old traditional academic borders of medicine were breaking down. Today, in the modern hospital care of patients, no one can tell where the basic sciences end and where the clinical services begin. They are both essential parts of a comprehensive health program and, happily, the social scientist has joined the team as well.
Our present concern is with health and illness in their broadest dimensions. From diagnosis to cure we have come to rehabilitation, education, and prevention. Whereas the physician started as a single, self-sufficient unit, he now has changed and metamorphosed into a very complicated set of relationships. To be effective he must use the team of other physicians and the ancillary medical schools in clinical care, research, and teaching.
Now, what has all this to do with our problem of mental health today? May I give you some statistical orientation proving that mental ill health is the Nation's No. 1 health problem.
First, as has been said by our chairman, the number of mentally ill patients in the United States exceeds the number of patients suffering from any other type of illness.
Second, approximately 50 percent of all hospital beds in the United States are needed and used for this group of illnesses, and I cite the figure of 662,500 out of a total of 1,425,000 beds. The need for treatment facilities, including both hospitals and clinics, is more acute than in any other field of medicine because of this large, continuing, and enlarging patient load.
The personnel shortage of physicians in this field of medicine is acute, and greater, I believe than in any other field of medicine. We have about 8,000 qualified practicing psychiatrists and we need about 20,000. Our national average ratio of psychiatrists to patients in our State hospitals is about 1 to usually 250 patients.
The fourth point I would like to make is that the amount invested in research in mental health from all sources-Federal, State, local, and private-amounts to less than 2 cents of every dollar spent for medical research. Our Nation spends approximately $6 million a year on research in the field of mental diseases, of which the Federal Government spends approximately $1 million. Approximately a half million dollars comes from private sources and private foundations; and approximately $11,2 million comes from State sources.
Fifth, mental illness is only in part related to acute social stress; and a good portion is acute illness as opposed to chronic illness.
The sixth point I would like to make is that mental ill health represents our greatest health problem in cost. As has been pointed out by our chairman today, approximately 40 percent of the total Federal budget for health care is for mental health; and approximately from one-sixth to one-third of State budgets in our larger States is for the care of the mentally ill. My own State of New York spends approximately $120 million out of a total budget of $380 million. Massachusetts spends $16 million out of a total budget of $58 million.
Seventh, in addition to the problems of mentally ill patients in mental hospitals, conservative estimates based on incidence studies have shown that approximately 50 percent, 40 to 50 percent, of patients who are treated in general practice have psychiatric complications.
My eighth point is that we do not know the basic causes of much mental illness, even though we can recognize mental disease today and the coloring that social or cultural factors may give such mental illness.
Ninth, during the past 25 years psychiatry has concerned itself with more than the problems of the insanities. It not only concerns itself with grossly diseased conduct as seen in the psychoses or the insanities, as commonly known-but also with the study, treatment, prevention and rehabilitation of personality maladjustments, delinquency and criminal behavior, instabilities, mental deficiencies, anxiety states and psychosomatic medical disorders. All these illnesses result from varying degrees of disturbance in either bodily structure or function, in psychological or social adjustment, or in the interpersonal relationships of human beings.
The psychiatrist, gentlemen, is a physician who studies and treats behavior disturbances which may express themselves either as physical symptoms or mental illness or both, and which range from simple maladjustments to insanity.
The 10th point I would like to make is that personality disorders were the cause of 18 percent of the draft rejections in World War II. This meant that 1 out of every 5 men examined was rejected for reasons of mental ill health.
Eleventh, our tested knowledge in psychiatry as regards prevention is very inadequate and in many spots nonexistent.
Twelfth, our programs for the evaluation of special treatment procedures are only just beyond their inception stage, and have just been developed in recent years.
The 13th item I have is that the incidence of mental ill health in our population is a matter that needs much study. Morbidity studies are not available in most of medicine. The statistics many of you hear are mortality statistics. As to morbidity statistics, gentlemen, there are not very good studies so far available to us.
The 14th point is that our knowledge of the specific causes of most very common types of mental illness that overcrowd our hospitals, such as schizophrenia, is meager and still speculative. Schizophrenia, sometimes called dementia praecox, constitutes the largest group of those patients hospitalized, and we are only beginning to learn how to get some of them well by newer methods of treatment.
Fifteen, people are living longer because of general medical skills, but we have not learned how to slow down or prevent hardening of the arteries of the brain; and, therefore, more and more of the older people are being sent to mental hospitals. The number of persons 60 years and older has increased 25 percent since 1939, but the number of patients in this age group in mental hospitals has increased 58 percent. Nearly 34 percent of all first admissions to State mental hospitals are persons 60 years of age or over.
Sixteen, about 1 to 2 percent of our population is mentally subnormal.
The 17th point I would like to make is that our Nation's population has increased 14 percent since 1939, but there have been 17 percent more persons in mental hospitals during this period.
The 18th point is that this picture is not entirely gray or blackand I want to stress that–because today approximately 40 to 60 percent of persons suffering with schizophrenia can be helped by modern treatment methods. A generation ago a mental disease called involutional melancholia was hopeless in two-thirds of these patients, or in most instances. Today about two-thirds of these patients are discharged within a year of hospital admission.
Recent studies in a State hospital in Stockton, Calif., showed that with the use of intensive treatment of chronically ill mental patients physicians could triple the sick person's chances of recovery and discharge to useful work.
The 19th point is that the draft and Armed Forces statistics show that more than 21/2 million men were lost to the Nation's Armed Forces through mental and emotional illness and defect; enough men to constitute about 177 Army Infantry divisions.
We have learned a good deal since World War II in this field, and a very great amount since World War I. For example, in Korea, where each Army had a psychiatrist, assisted by battalion surgeons, twothirds of the breakdowns were rehabilitated and returned to duty without leaving the division. Only 4 percent needed to be returned to this country for treatment. This is a most dramatic improvement over World War II, when 8 percent were evacuated to the zone of interior; and that record was an improvement over World War I. when 15 percent were in this seriously disturbed category.
These statistics, gentlemen, are mirrored in the problems one sees in community and private practice. I am director of the Bellevue Psychiatric Division in New York City, which admits about 25,000 mentally ill people a year and is probably the most acute psychiatric service in the world. With acute active treatment there we are able to return approximately two-thirds of the patients who come to us.
The 20th point I have is that the costs of mental illness to our Nation are colossal. It is a reasonable estimate that this will run as high as several billions of dollars each year. Let us consider some of the facts. Patients in public mental hospitals cost $467 million in 1951. This increased to $568 million in 1952, an increase of over $100 million. The cost of mentally ill in veterans' hospitals was $12612 million in 1951. This increased to $1461, million in 1952. If we add to this the costs of treatment of veterans in psychiatric out-patient departments, the compensation for these service-connected disabilities, and pensions for non-service-connected disabilities of a neuropsychiatric nature, all these items I have listed above cost the American people close to $1 billion in 1951-$959 million and this increased to $1,041,000,000 in 1952.
Might I point out to you that these staggering figures do not include the costs for psychopathic hospitals, the cost for private mental hospitals, treatment in mental hygiene clinics that are not part of the Veterans' Administration system, nor do they include the larger