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There are other benefits of rehabilitation besides the economic. The value of rehabilitation to these persons in terms of personal development and personal freedom is immeasurable. No one can place a value on ability to lift a spoon to feed oneself, or to walk across a room, and these are the things that rehabilitation has meant to many disabled persons. The increased ability of handicapped individuals for self-care and employment creates a beneficial effect on the morale of the individual's entire family, his community and society as a whole.

NEEDS IN PERSONNEL

We know that the total funds which we have available are inadequate to perform the job at hand. The great need for additional trained personnel to perform these needed services has also made our task a difficult one. A survey of professional personnel employed by Easter Seal Societies made in May 1953 is illustrative of the acute personnel shortage. The survey showed that these societies employ 1,310 professional workers (including 644 full-time and 666 part-time workers). The societies have also 229 unfilled professional jobs— in other words, there are vacancies equivalent to 17.5 percent of the professional force.

The societies were asked to estimate their professional personnel needs in 5 years. They anticipate needing an additional 998 persons, a net increase over May 1953 of 93.7 percent—almost a doubling of present professional personnel.

The greatest expansion is expected to be among those professional groups who directly serve the handicapped—the physical, occupational, and speech therapists, special teachers, social workers, and psychologists. Easter Seal Societies now employ 626 of these professional workers. Within 5 years, they hope to employ a total of 1,431, an increase of 128.6 percent.

In the Nation as whole, this picture of present shortages and rapidly expanding additional needs for professional workers trained to work with the handicapped is equally true. For example, there are at present an estimated 5,000 registered physical therapists practicing, and there are 2,500 vacancies. Within 5 years, an additional 5,000 will be needed. To meet this need, a total of 8,000 must be trained (allowing for a 7 percent attrition rate). This requires an annual average of 1,600 graduates ; in 1953 there were an estimated 624 graduates in physical therapy.

In the field of occupational therapy, there are about 3,600 registered therapists practicing and vacancies for 3,000 more. The current graduation rate of a little more than 600 per year cannot begin to meet present needs, much less the expanding future requirements.” Some of the reasons for these shortages are as follows:

1. Inadequate scholarship funds.
2. Inadequate recruitment funds (and programs).
3. Inadequate funds of schools-resulting in lack of staff, space, and

equipment.

RESEARCH

Research in the general area of neurological diseases will without question have bearing on all other crippling diseases and conditions of whatever kind. Conversely, research in the preventable factors in cerebral palsy, for example, is basic and not necessarily related to cerebral palsy per se, but rather to the entire field of medicine.

Our medical counselors advise us that research in cerebral palsy extends far beyond the field of cerebral palsy per se, and involves basic and clinical research in the whole broad field of medicine. It is concernd not only with the areas of diagnosis and therapy but also with prevention and social research. The estimate has been made that more than 10 percent of the cases of cerebral palsy now occurring might possibly be prevented by application of the knowledge we now have. In addition, there are research implications in the related fields of speech pathology, psychology, psychiatry, education, social welfare, and vocational guidance, testing, and placement. In all of these fields, further research would unquestionably yield results which ultimately would mean better lives for all of the crippled, including the cerebral-palsied, and would lift at

2 Doing Something for the Disabled, Switzer and Rusk, 1953.

least part of the tremendous personal, social, and economic burdens now borne by the individuals, by their families, and by the public as a whole.

From the foregoing, it can be seen that the National Society for Crippled Children and Adults believes the problem of crippling in general, and crippling as a result of neurological diseases in particular, to be a tremendous one requiring all the energies of public and private agencies to meet. Additional funds and additional numbers of trained personnel are critically needed to provide and staff services and facilities which will bring to the crippled of our country all of the techniques of rehabilitation of which we now have knowledge. Similarly, there is an urgent need for vastly increased research efforts in fields where we already have reason to believe heartening results can be realized and in fields not yet explored.

Speaking as a voluntary agency whose strength lies in the local communities where direct services must be provided to reach the individuals in need of them, the national society pledges its financial support to research, to the limited extent to which it has funds available, while increasing its programs of care and treatment, and education to keep pace with research developments which we believe will be made possible through adequate appropriations for the National Institute of Neurological Diseases and Blindness.

(Whereupon the committee adjourned.)

HEALTH INQUIRY
(Mental Illness)

THURSDAY, OCTOBER 8, 1953

HOUSE OF REPRESENTATIVES,
COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C. The committee met, pursuant to adjournment, at 10 a. m. in the committee room of the House Committee on Interstate and Foreign Commerce, Hon. James Dolliver (acting chairman) presiding.

Mr. DOLLIVER. The hearing will come to order. As a preliminary matter, let me state that the present occupant of the chairman's seat is not the regular chairman of this committee. Mr. Wolverton was called to his home late yesterday afternoon and will be here today during the course of the hearings. He asked me to get this hearing started in his absence.

The hearings of the Committee on Interstate and Foreign Commerce on the problems of chronic illness facing our Nation will be devoted today to mental illness and tuberculosis. We will start with a discussion of mental illness.

The committee is extremely concerned about the problem, the suffering that the diseases in this category visit upon so many of our citizens and their families, and the tremendous economic factors involved in caring for and treating the mentally ill.

More than half of all the hospital beds in this country are occupied by the mentally ill. Despite this, there are not enough mental hospital beds to accommodate all of the people who are in desperate need of treatment. When you add together the cost of caring for mental patients in long-term public mental hospitals and the money spent by the Veterans' Administration in hospitals for the mentally ill, on outpatient care, and on pensions for veterans suffering from neuropsychiatric disorders, the dollar cost is staggering-probably as much as a billion dollars or more a year.

These few figures only begin to tell the story. What we are going to try to do today is to find out about the scope of the problem of mental illness, the facilities and resources that are available for dealing with the problem, and what more needs to be done to help us meet it.

The pattern that the committee has followed in conducting these hearings has been to invite a group of people who are authorities in the field under discussion to come here and testify. The witnesses have all appeared voluntarily and have conducted what, in effect, may be described as an informal symposium. The committee wishes to thank those who have come today to discuss the problem of mental ill

ness. I understand that Dr. S. Bernard Wortis has agreed to serve as discussion leader for the group.

An agenda has been prepared, and the discussion will follow the gereral outline of that agenda. However, since the purpose of this hearing is to place before the American people the maximum amount of information relating to this disease, I hope that the witnesses will bring everything they consider important to the attention of the committee, regardless of the agenda. The committee members will ask questions of the witnesses, and I hope that the witnesses, in turn, will ask questions of each other when they consider it appropriate.

I understand that a number of prepared statements have been submitted to our committee by the organizations represented here today. At this time, I would like the prepared agenda and the list of participants to be made a part of the official record of this hearing.

(The information is as follows:)

AGENDA FOR HEARING ON MENTAL ILLNESS

I. Scope of problem:
A. Disease areas to be covered :

1. Psychoses.
2. Severe emotional disturbances-psychoneuroses.
3. Personality disorders.

4. Mental subnormality.
B. Numbers affected.
C. Costs :

1. Tax money expended.
2. Loss of income.

3. Cost to family.
D. Manpower losses.
E. Effects on society :

1. Dislocation of families.
2. Juvenile delinquency.

3. Addiction to alcohol and drugs.
II. Facilities and resources for dealing with the problem:
A. Current state of knowledge in the field :

1. What is known about epidemiology, diagnosis, causes, treat

ment, and rehabilitation.
2. Research currently being conducted :

(a) Areas of research.
(b) Scientific disciplines involved.
(c) Volume of research.

(d) Organizations sponsoring research.
B. Professional manpower available for dealing with the problem.
C. Services available for diagnosis, treatment, and rehabilitation:

1. Mental hospitals.
2. Clinics and community services.
3. Private psychiatrists.
4. Institutions for mentally subnormal.
5. Rehabilitation services.
6. Dissemination of professional and scientific information.
7. Prevention services, including public education and control

work.
D. What the Federal Government is doing :

1. Research.
2. Training.

3. Technical consultation. III. Needs to help meet the problem:

A. More research :

1. Types and specific examples.

2. Manpower and facilities required.
B. More professional manpower :

1. Vumber and types needed for treatment services.
2. Methods for obtaining required personnel.

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