and clinics throughout the country. Differences in terminology and reporting systems prevent the results of treatment in one hospital from being compared accurately with results in another. Thus the findings of many research studies are not being used as effectively as possible to achieve better understanding of mental disease. The United States Public Health Service is striving to correct this in a pilot group of 15 States. All States should cooperate with the Public Health Service in the adoption of uniform terminology and statistical reporting procedures in the field of mental health. TRAINING 6. The adequacy of staff in State hospitals for the mentally ill has improved in the last decade. Substantial increases have been made in the number of attendants, occupational therapists, social workers, and psychologists. Despite the overall increase in staff, however, serious shortages of trained personnel today interfere with effective treatment of patients. The average number of patients per staff member in most mental hospitals fails to meet necessary standards of staff-patient ratios. Especially critical are the heavy case loads of psychiatrists and graduate nurses. Few State hospitals, therefore, are able to make full and effective use of present treatment methods, which could speed improvement of patients and increase the number returned to productive life. The States should appraise the personnel situations in their State mental hospitals and support, where necessary, training of increased numbers of personnel. They should take steps to encourage an increase in the number of students at the graduate and undergraduate levels in the professions immediately concerned with psychiatric treatment and also in the basic biological and social sciences which affect progress in mental health. State institutions which are not accredited for residency or as affiliate training centers for psychiatrists, clinical psychologists, social workers, nurses, and other professional groups should endeavor to raise the level of teaching and supervision in their institutions to secure accreditation. The current trend toward increasing the number of courses in basic psychological and psychiatric subjects in the curricula of other professions should be encouraged. Premedical and medical students in particular should receive a more comprehensive background in the fundamental psychological and social sciences, since those who do not specialize in psychiatry will receive little further formal training in them. Social workers, nurses, the clergy, teachers, lawyers, and law-enforcement officials also should be encouraged to include such courses in their training. 7. Inservice training in mental hospitals and other facilities is important for improving the competence of existing staff, for making the institutions attractive to new personnel, for maintaining staff morale and enthusiasm, and for integrating mental hospitals into the main stream of teaching and research in the country. More extensive and effective inservice training programs for all grades of personnel should be provided in State hospitals. In the larger hospitals such programs may be the responsibility of a training or a research and training officer. Narrow specialization within the field of mental health does not make for the best care and treatment of mental patients. Inservice training for all hospital personnel should include lectures and seminars designed to acquaint each professional group with the special knowledge and skills of the other professions represented. In many cases basic courses in hospital orientation, patient management, general psychology, psychiatry, the special therapies, and the functions of each occupational group can be organized advantageously into a common curriculum for most of the hospital staff. Inservice training also should provide for interchange of experience in the actual work of the different groups, so that each staff member may both understand and assist in duties other than those of his specialty. 8. The high cost of professional education and the relatively low salary scales in State employment now deter many competent people from entering State employment in the mental health field. Retention of existing staff and recruitment of teaching faculty and research scientists are made difficult because of large salary differentials that frequently exist between State and other medical and educational institutions. Stipends for graduate training are common incentives in many professions. They rarely are provided by States to encourage able students to enter the various mental health professions. It has been shown that in particular instances a high percentage of students given stipends or field training by particular agencies return to employment in such agencies. Individual States should consider the advisability of providing stipends for graduate training in psychiatry, psychiatric social work, psychiatric nursing, clinical psychology, physical and occupational therapy, public mental health and the basic biological and social sciences. Salary scales should be adjusted to reduce to the extent possible differences between public and private scales so that public mental hospitals may compete effectively for the limited personnel available to fill treatment, teaching and research positions. 9. Nonmonetary factors, however, are of great importance in recruiting staff, especially research scientists, for the mental health programs. The adequacy with which hospitals and clinics can be staffed is directly related to the quality of research and teaching in them. Contributing factors include the amount of moral support and recognition given to teaching and research activities by the staff, the extent to which staff are selected and retained on the basis of merit, the availability of academic, library, and laboratory facilities, and other conditions that influence morale. Hospitals, clinics and other agencies conducting research should make every effort to provide these factors, tangible and intangible, through administrative support of teaching and research programs. 10. The effectiveness of the hospital as a treatment, teaching and research center depends in part on the success with which it utilizes the resources of the community and becomes a community resource itself. An important step in this direction is to involve local physicians and other specialists in the hospital program as part-time staff members. This permits the community physician or specialist to maintain contacts with patients he has referred for hospitalization. It augments the hospital staff, increases the contact between institutional psychiatry and the remainder of medicine, broadens and strengthens teaching in the hospital and improves its community relations. Increased cooperation between community agencies frequently may be brought about by joint staff appointments among public and private hospitals and clinics, child guidance centers, community welfare agencies and correctional institutions. Hospitals and other mental health facilities, therefore, should use part-time services of professional persons within the community to as great an extent as other requirements permit. PREVENTION OF MENTAL DISORDER 11. An ultimate goal of research in mental illness is to prevent it. At present positive methods for prevention are limited to relatively few mental disorders. The urgent need for extending the area of prevention calls for increased research to determine the relative value of various new preventive measures. Future studies, for example, should evaluate scientifically the effectiveness of early treatment measures, such as those of clinics and child guidance centers, the results of improved prenatal care to reduce congenital brain damage, new chemicals which may prevent the onset of some diseases, the usefulness of school classes in "human relations" and the results of improvement in community and family environments. Since it is generally agreed that the foundations of mental disease are most commonly developed in childhood, studies of biological, psychological, and social development of children should be stressed. RESEARCH 12. The kinds of training and research programs to be undertaken by the States should be determined by individual State resources and needs. The following considerations, however, should be examined closely in formulating a State training and research program: (a) States which already possess major teaching centers, especially universities or medical schools, should coordinate their training and research activities to make maximum use of these institutions and their laboratories. They are natural centers for research scientists, technical personnel, professional meetings, etc. (b) State-sponsored research efforts should be concentrated in or near existing facilities: academic institutions, hospitals, clinics or other laboratories. The acute shortage of trained research scientists usually makes it unwise to set up new research centers isolated from existing facilities. (c) Many significant research problems, however-dealing especially with the effectiveness of existing treatment methods, with genetic, family and community factors in the cause of mental disorder, and with methods of preventing it—can be pursued advantageously in many areas without large research centers, (d) The most critical prerequisite to research is scientific personnel. training and research programs should emphasize the training of research personnel, making maximum use of the special talents and training of available academic and clinical personnel to every extent possible. State, (e) Since successful research normally requires continuity of personnel, facilities, and financial support, the States should make every effort to assure sustained financial support, and thus avoid wasteful interruptions of the research program. (f) Excellent opportunities for important research on mental disease exist in State hospitals, even where hospital personnel lack time or training to undertake it themselves. The States should encourage use of their hospital facilities by qualified scientists from other institutions. Such cooperative research arrangements may speed the discovery of more effective means of treatment, stimulate later research by members of the hospital staff, and improve community relations of the institution. 13. Although some mental hospitals, because of geographic isolation, overcrowding or inadequate staffing may not be suitable for major research projects, most of these can take advantage of potential opportunities for research effort more effectively than is now the case. Research thrives on original thinking and the free exchange of technical information. Private and industrial research laboratories have demonstrated the value of providing leaves of absence with pay for professional staff who wish to acquire further research training or attend scientific meetings. It also has been found beneficial to make maximum use of research consultants from other institutions. At present, however, the daily care and treatment demands of most mental hospitals do not permit time for staff members to participate in any except the most casual research. If headway is to be made against the rising number of admissions to mental hospitals, time and facilities for research should be made available to qualified research workers in them. Research activities in State mental hospitals should be coordinated under a research director. In small institutions, the research director may be the clinical director or superintendent; in other instances, the scope of the research program may require creation of a separate position. This may be particularly desirable if responsibility for the hospital's training program also can be placed under it. 14. Discovery of better ways to treat and prevent mental disorder is contingent on more fundamental studies in physiology, biochemistry, neurology, psychology, sociology and related fields. Research laboratories in State institutions should be encouraged to undertake fundamental research in the biological and social sciences as well as to seek practical solutions to immediate problems. 15. Research scientists working on problems of mental health and disease need to be in close touch with the latest findings of other scientists engaged in similar studies. There is need for communication among hospitals, universities, and other research centers throughout the country on research in progress or being planned. Such communication can take advantage of new findings quickly and avoid unnecessary duplication of research effort. A scientific clearinghouse new exists, the Bio-Sciences Information Exchange of the National Research Council, from which individual scientists may obtain brief reports on research projects related to their own which are currently in progress. It is suggested that all States arrange for the use of scientific exchange services by members of their hospital staffs to increase the economy and effectiveness with which research is conducted. Staff members also should be encouraged to publish completed research findings in scientific journals and personally to present papers at professional meetings. INTERSTATE COOPERATION 16. Where practical, it is desirable for States to provide adequate professional training in the graduate schools of their institutions of higher learning. However, many States which lack major teaching centers for the training of certain professions, are taking advantage of interstate compacts for this purpose. Physicians, dentists, veterinarians, social workers and public health officers are being 39087-53-pt. 4-18 trained, or plans are being made for their training, under interstate arrangements of the Southern Regional Education Board and the Western Interstate Commission for Higher Education, both created by compact. States already participating in interstate educational compacts may wish to consider extension of agreements under them to include specialized training in psychiatry, psychology, nursing, social work, and other specialized practices needed in hospitals and clinics. Existing training and research centers in a number of States could be utilized as regional institutes for the training of therapeutic teams and for important research programs in the field of mental health. It usually is more desirable for a group of States to support one teaching or clinical training center which can achieve accreditation and prestige through the high quality of training it offers than to attempt to maintain a number of isolated, unaccredited centers able to offer only marginal training. Where individual States find it impractical to provide adequate training for members of mental health professions in short supply, it is recommended that they enter into appropriate interstate arrangements for academic and clinical training. 17. No State lacks individual opportunity to contribute research toward prevention and improved treatment of mental disorders; but most States, especially those that lack major research centers of their own, could strengthen their research efforts through cooperation with nearby States. It is recommended that States participate jointly in mental health research suitable for such cooperation and that they investigate practical means to cooperate in supporting and enlarging the research activities of institutions in their regions, under arrangements by which the personnel and cost of facilities and equipment may be shared equitably. Interstate cooperation for research could be facilitated markedly through leaves of absence for hospital and university personnel in States lacking major research centers to spend periods of time at research institutions in other States. 18. Interstate mental health conferences may be devoted profitably to problems of research, training facilities and standards, treatment methods, hospital administration, forensic psychiatry and hospital-community relations. All States should cooperate in periodic regional mental health conferences. 19. It is difficult at present to obtain comprehensive data on many aspects of the mental health programs of the 48 States, particularly with regard to current training and research activities. State legislators, State officials, and others concerned with mental health repeatedly seek information on the experiences of other States, to learn what their institutions and agencies are doing to reduce the prevalence and severity of mental illness. It is suggested that the States establish an interstate clearinghouse, the functions of which may include the following: (a) To maintain up-to-date information on the mental health programs of all States, especially with reference to the scope, nature, and results of training and research activities, and to make the experiences of each State available to all. (b) To cooperate with Federal, local, and private agencies in making maximum use of existing resources in the promotion of mental health. (c) To aid in initiating arrangements, where requested, for interstate cooperation in academic and field training and in use of existing research institutions. (d) To provide expert field consultation for States wishing more detailed assistance in establishing effective mental health programs. The CHAIRMAN. I would like to say that if you have any additional comments or statements that you would like to have made a part of the record, bring them to the attention of the clerk of our committee, so that we can comply with your request. (Thereupon, the committee adjourned.) HEALTH INQUIRY (Hearing Defects) FRIDAY, OCTOBER 9, 1953 HOUSE OF REPRESENTATIVES, COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Washington, D. C. The committee met, pursuant to adjournment, at 11 a. m. in the committee room of the House Committee on Interstate and Foreign Commerce, Hon. John W. Heselton (acting chairman) presiding. Mr. HESELTON. The meeting will please come to order. I would like to explain that the chairman was unexpectedly called back to New Jersey and will not be here during the day. He regrets it very much, because he did want to be here for this hearing. Also, several of our members have been called back to their districts, but I am sure we will have a very satisfactory hearing. The previous hearings have been most interesting and most helpful. For the benefit of those who have just come in today for this particular subject, may I explain these hearings will be printed and will be available to every member of the committee, so that they will be familiar with all the testimony presented to us. We are to hear testimony this morning relating to deafness and the various hearing defects. The committee is eager to hear what the witnesses have to say on this subject, particularly in the areas of what deafness costs the American people, what is being done and can be done to diminish the problem, and what unmet needs exist insofar as facilities, research, and trained specialists are concerned. These inquiries this morning are part of a broad series of hearings seeking to lay before the American people facts they should know about health and disease. It is the chairman's impression that far too little attention, medical and otherwise, is paid to deafness and related disorders. He hopes that you gentlemen will do everything in your power to make the current situation clear to us. The procedure that has evolved during the health hearings is one in which a discussion leader chosen by the witnesses conducts what is in effect an informal symposium based on a prepared agenda. I understand that such an agenda is at hand and that Dr. William G. Hardy has agreed to serve as discussion leader. The members of the committee will want to ask questions rather freely, Dr. Hardy, and we hope the witnesses will ask questions of each other, also. Our purpose is to make this hearing as informational as possible. To make the record complete, to assist the recorder in indentifying you, and in order that you may be known individually to the members |