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funds that add to the general picture-has that served to discourage initiative on the part of the State and the voluntary groups?
Dr. Felix. On the contrary. Mr. Chairman, if I may, I can give you a figure on that which will illustrate it, and this is in the field of mental health services generally in the State—not the State hospital—because none of the Federal funds that go into the State hospitals are considered as being embraced in this program. In the original hearings they were considered solely a State responsibility.
The matching formula requires that there must be 50 cents of State money to every dollar of Federal money allocated to the States out of the appropriation for that purpose. Originally, in the first year, 1947, it was about 50 cents State money to $1
of Federal money, and in 1953 it was this way: For every dollar of Federal money there was $3 of State money, and in terms of gross figures, we started at 50 cents to a dollar and reversed it. The total amount appropriated by the Federal Congress and by the States is $17 million of Federal funds to match over $43 million of State, local, and private funds.
The CHAIRMAN. Are the last figures which you have for the year 1953?
Dr. FELIX. No; that is the total situation for the 6-year period 1947–53. The Mental Health Act was passed in 1946, and the first appropriation was made in 1947.
Mr. HESELTON. In connection with some of these statements which have been made as to the action on the State level, recently my attention was called to an article which had been written by a gentleman who had been on the staff and visited a number of hospitals in one of the States. It was perfectly amazing as to the report he made in terms of the absolute lack of any kind of adequate care from the standpoint of finances. I believe it was something like 50 cents a day for food, and you cannot feed anyone on 50 cents a day. I assume and I think you have already testified—that diet in many of these cases is extremely important. That leads me to think that it is not only a responsibility in regard to the diet but that there is a very definite responsibility to wake somebody up in at least some of the State governments in regard to this situation.
Mr. SCHLAIFER. You will find in some of the State hospitals that they have some of the finest facilities, but that causes them to have less in the research picture. Unless we do enough research in the field of prevention and cure, we will still have more beautiful hospitals and perhaps we will feel better as human beings since we do not have "snake pits.” But we still are not doing enough to get the people out of the hospitals and keep them out of them. Therefore, it becomes an overall problem of how much research and training can be done to effect this result.
Dr. WORTIS. Mr. Chairman, I think it would help a great deal to hear from Dr. Felix in terms of what the Federal Government funds under the Mental Health Act have done not only in this field to help the States at the level of matching grants but also what has been happening in the field of training, technical consultation, and research. I think that might be well worth being made a part of this record so that the Congress would be advised on that point.
The CHAIRMAN. Very well. We shall be pleased to hear from the doctor.
STATEMENT OF DR. ROBERT H. FELIX, DIRECTOR, NATIONAL
INSTITUTE OF MENTAL HEALTH_Resumed
Dr. Felix. Mr. Chairman and gentlemen, I would consider this in effect a report to my employer, since that is who you are. In addition to this committee here, I would like to preface my remarks by one statement. Mr. Priest mentioned the distinguished gentleman from Ohio who was so responsible for working with him in the passage of the act, and there were many others both in the Senate as well as the House. Without any attempt to single out any living person, I should like to feel that as I speak, I am speaking to one who is not here but who recognized this problem, who worked hard in the upper House, and whom I think should hear this report wherever he is, and I am sure that wherever he is is a good place. I refer to the Honorable Robert A. Taft of Ohio.
The Mental Health Act, as you gentlemen are all aware, provided for activities along certain lines. We were instructed and the money was appropriated to foster research through grants-in-aid, through investigations, and through laboratories; to promote the training of professional people in these fields and to assist the States and, through the States, the communities in the development of mental health programs. In order to advise us and to keep us aware of the professional and of the community needs and interest, the Congress very wisely directed that there be appointed as adviser to the Surgeon General and to his staff a National Advisory Mental Health Council.
All applications for research or training grants must be reviewed by the National Advisory Mental Health Council and recommended favorably to the Surgeon General before payment can be made. The Surgeon General may make no grants-in-aid for research or for training except as the applications are recommended favorably by the National Advisory Council on Mental Health, a group which is made up of not less than six professionals. It is usually broken down into 6 professionals, and 6 laymen, and I do not like to use the word “laymen” because it depends on what you are, whether you are a minister or a lawyer or something else. So let us say six people not professionally trained in the mental health area.
The Surgeon General does not necessarily have to make a grant to every applicant who is favorably recommended by the National Advisory Mental Health Council.
The applications for grants exceed in sums requested, the appropriations.
Now, I should like to tell you something about what has happened in this program since we had our first appropriation back in 1947.
In the 6 years since 1947 in the field of research 203 research projects have received grants.
These grants were in support of research in such areas as psychosisorganic and functional, neuroses, child behavior disorders, psychopathy, behavior disorders, psychosomatic disorders, menal deficiency, problems of general psychological adjustment of children and adults, problems related to marriage, the aged, chronic crippling diseases, situational stress, speech and reading disabilities, and so forth.
Until the creation of the National Institute of Neurological Diseases and the first appropriation therefor, the National Institute of Mental
Health also supported research in the area of the neurological disorders.
Now, another area, and a very important area in which these grants have been made is in the fields of development of new therapies and treatment for the mentally ill from a psychological standpoint, and utilizing biological, chemical, and social science treatment methods and a combination of methods.
In addition to this program for the assistance of research projects as such, there is a fellowship program in which we are authorized to assist young scientists at the postdoctoral level to develop research techniques and skills and to stimulate their interest in making a career of research in mental health problems rather than going into some other field of investigation.
During this period of time, since 1947, we have made fellowship grants to 183 individuals.
Some of these individuals have received a second year fellowship award. Some of our most promising young scientists in the country have come from this fellowship program.
Last year at a symposium in New York under the aegis of the Milbank Memorial Fund I heard one of these young men—I felt paternalistic, as he had received his support under our fellowship grant-give a very full discussion of some of the psychological implications of animal behavior, and how this can be related to human behavior.
In our own intramural program, which is another aspect of the research carried on out at Bethesda, and at our field stations we have had laboratory studies going on in some areas for several years. For example, at our Addiction Research Center which is located at Lexington, Ky., we have been studying the nature of drug addiction, and some of the psychological and physiological effects of narcotics. With the completion of the new clinical center, we are now getting under way on an extended program of laboratory and clinical research.
In the field of training we try to expand existing facilities for training so that these good facilities can accommodate more students, without compromising the quality of what the students are offered. In other words, increase the faculty, and so forth.
Second, to improve the submarginal facilities so they can give a good high type of training to students.
Third, where the regional need indicates, we try to assist in the development of training facilities in order that students who live in that area will be able to receive specialized training there and not have to go elsewhere for it. So many students remain in the area where they receive their training.
A recent study in that connection showed that most of the professional people locate within a radius of 200 miles of their alma mater.
So, it is rather important to get these training centers in the areas of need.
Since 1947, in a 6-year period, 117 training centers have received grants from us in the fields of psychiatry, clinical psychology, psychiatric social work, and the techniques of nursing and public health as part of general mental hygiene.
Before the creation of the National Institute of Neurological Diseases and Blindness, the National Institute of Mental Health handled that.
In addition to those 117 training centers, 42 medical schools in the country have received grants as part of their undergraduate medical training program to develop a good teaching program in the field of psychiatric and psychosomatic disorders for the medical student.
Over 6,000 students have graduated from these schools and are now practicing somewhere in the country with this additional knowledge.
In addition to the grants to institutions we also, under the authorization of the National Mental Health Act and the appropriation act each year make stipend payments of not to exceed $10 per diem to qualified individuals to assist them in maintaining themselves and to pay for their training while they are in training status.
Å bout 2,245 individuals have received such stipend grants in these fields which I mentioned a moment ago. There have been 2,979 traineeships awarded.
At the present time, in the fiscal year 1954, there are 669 such trainees receiving assistance.
I believe Dr. Wortis has told you about the high percentage who went into public service, into teaching, and into research.
Eleven percent are still in training, and the remainder are in military and private practice.
In addition we have made grants to professional organizations, such as the American Psychiatric Association, the American Psychological Association, the American Association of Psychiatric Social Workers in order that conferences could be held at which the chairmen of departments and other teachers could come together and discuss problems of curriculum improvement. As a result of this we are seeing some rather significant changes in the impact on teaching, making it more up to date and more awake to the problems that these people who are receiving training will face upon the completion of their studies.
Now, this has assured an increase in the participation of the States as a result of the stimulation of the Federal grant-in-aid money.
In addition to that we have a program of technical assistance which is furnished to the States in which consultants are located in the regional offices of the Department throughout the country, and on the invitation of the States we have assisted them by consultation and conference in the development of programs.
As a result of this we have seen a lot of States come in with effective programs where none existed before.
You might be interested in knowing that there were 24 States which had a mental health program other than in the hospitals prior to the passage of the National Mental Health Act. Today all of the States, the District of Columbia, and the Territories have such programs.
One problem that we are now meeting a little better is knowledge of the number of mentally ill in the country, but on how long they stay in the hospitals much information is needed.
We are now working with the States on the adoption of what we call model reporting, so that we can know the caseload and how many people are ill, and what we can or must provide for the future. Now, there is a great deal more that I could tell you, and there are details which I could go into, but I will not because of the shortness of time.
I will be glad to try to answer any questions if you wish, but, as I say, time is fleeting, and I will rest on that, if you please, sir.
The CHAIRMAN. Mr. Carlyle.
Mr. CARLYLE. Dr. Felix, I think we see many signs that disclose that the people of the country are demanding better and more modern facilities in the treatment of the mentally ill. Do you agree with me on that?
Dr. Felix. I do sir.
Mr. CARLYLE. There is a large program now under way in several of the States to improve these facilities.
Only last week in North Carolina a statewide bond issue was carried by a large majority in order to provide more modern and better facilities for those who are mentally ill, and I think that is true in many of the other States. So, that is encouraging.
Dr. FELIX. Yes, sir; it is.
Dr. Felix. I might say, Mr. Carlyle, and if I may, Mr. Chairman, that North Carolina is very fortunate in having one of the honored members of our profession, a man whom all of us have heard and know about, to head your mental health program down there, Dr. David Young.
Mr. CARLYLE. Yes, I know Dr. Young.
Dr. FELIX. You are extremely fortunate in having him, and you can expect great things from him.
Mr. CARLYLE. Dr. Young is doing spendid work in North Carolina.
Mr. PRIEST. Dr. Felix, did I understand correctly that since 1947, when your first appropriation was made, you had placed 203 research grants? I was not sure I had that figure right.
Dr. Felix. Yes, sir; 203 is right.
Mr. PRIEST. Doctor, have they been fairly well distributed in hospitals, universities, and clinics across the country?
Dr. Felix. Yes, sir.
Of course, when you see it put on a map you get a pattern which coincides almost exactly with the distribution of the scientists in the various parts of the country. Where the people are who are interested in research is, of course, where the research money has to go. There are areas of the country where there are fewer than others, and, therefore, you will find fewer spots on the map in those places, but as far as the facilities, both physical and human, are distributed you will find a distribution which coincides with that very closely.
(The prepared statement of Dr. Felix follows:)
(Prepared for the Committee on Interstate and Foreign Commerce of the House of Representatives, October 8, 1953, by the National Institute of Mental Health, National Institutes of Health, Public Health Service, United States Department of Health, Education, and Welfare)
BACKGROUND AND HISTORY OF PUBLIC RESPONSIBILITY FOR MENTALLY ILL The concept of public responsibility for the care of the mentally ill reaches back into antiquity. In Grecian history it is recorded that the priests of the temples assumed a responsibility for providing shelter and care for the mentally disordered. The first instance of a state institution specifically designated for the care of the mentally ill and the epileptic is recorded in Arabian history about the years 500-600 A. D. Both before and following this time, the mentally disordered