The court in deciding whether a confession to a crime was coerced and hence inadmissible at trial-consider all the relevant circumstances, and assess whether the mentally retarded defendant's state of mind was such as to preclude the confessions being voluntary in any meaningful sense; and that caution be taken against giving any probative weight to the fact that a mentally retarded defendant remained silent when accused of a crime. The mentally retarded individual who exhibits persistent uncontrolled behavior threatening the well-being of others requires special attention, which should be a subject of special study, since he is unsuited both to the typical prison and to most residential facilities for the retarded. LOCAL, STATE, AND FEDERAL ORGANIZATION Concerning local, State, and Federal organization and relationships, the Panel recommends that: There be available to every retarded person either in his community or at a reasonable distance: A person, committee, or organization to whom parents and others can turn for advice and counsel; life counseling services; and a sufficient number of qualified professional and informed nonprofessional people willing to assist in developing a program for an individual, and in developing a local or State program. Every health, education, and welfare agency provide a person, office, division, or other appropriate instrumentality to organize and be responsible for those agency resources or services relevant to mental retardation; and those agencies dealing with the retarded at a local, community, or State level establish committees with high-level representation to facilitate communication and cooperation. A formal planning and coordinating body made up of all appropriate segments of the community be established with the mandate to develop and coordinate programs for the retarded. The Federal Government take leadership in developing model community programs for the management of mental retardation in each of the Department of Health, Education, and Welfare regions. The objectives of such models would be: To develop concrete examples and demonstrations if what is believed to be the best possible care for the retarded on a coordinated basis; and to provide teaching resources in which present and future administrative and professional personnel could receive higher quality training. The Secretary of Health, Education, and Welfare should be authorized to make grants to States for comprehensive planning in mental retardation. Mr. COHEN. Next, I believe it would be appropriate to select out from the Mayo Panel's report a couple of pages which present their recommendations on the two provisions that are in the bill before you. The Mayo Panel report consists of some 90 to 100 different recommendations in the field of mental retardation, some involving appropriations, some involving administrative actions of States and localities and private groups, and some involving new legislative authority. The two suggestions that are incorporated in the bill before you today were recommendations made by the Mayo report, and each of them take a couple of pages. I believe it would be appropriate here to give you their reasons why the legislative authority for the new centers and for the construction of facilities is, in their opinion, needed and desirable. (The material referred to follows:) EXCERPTS FROM "A PROPOSED PROGRAM FOR NATIONAL ACTION TO COMBAT MENTAL RETARDATION" (THE REPORT OF THE PRESIDENT'S PANEL ON MENTAL RETARDATION, OCTOBER 1962), RELEVANT TO THE CONSTRUCTION OF MENTAL RETARDATION RESEARCH CENTERS AND OTHER FACILITIES EXPANSION OF RESEARCH In developing its proposals to expand the research effort, the Panel has been mindful of the significant advances in the attack on mental retardation which have taken place as a result of research findings. Such errors of inborn metabolism as phenylketonuria, "maple syrup urine" disease, and galactosemia have been intensively studied, and through the results of these studies, it has been possible to prevent many cases of mental retardation. The early findings of the collaborative perinatal project under the direction of the National Institute of Neurological Diseases and Blindness have pointed to some of the causes of prematurity, which is an important cause of brain damage and have focused on the association of oxygen deficiency at birth with abnormality of the offspring. Other important research findings have suggested how important it is that pregnant women be protected from both excessive X-rays of the fetus and German measles during the first few months of pregnancy. These are merely illustrative of research findings which have led to the prevention of a significant number of cases of mental retardation. Other findings bear on the detection of brain disorders, such as electroencephalograms of newborn infants. Rapid progress has been made, and yet unfortunately it has unlocked the answers to perhaps only half of the 15 to 25 percent of the cases for which specific diagnoses can be attributed. Research in the behavioral sciences is at present primarily addressed to therapeutic and rehabilitative possibilities. The most fertile unploughed area for further behavioral and social science research is indicated by the accumulating evidence that a host of social, economic, and environmental factors-often categorized as cultural deprivation-are correlated or associated to a high degree with the incidence of mental retardation, especially in its milder manifestations of low intellectual and social performance. The Panel recommends that high priority should be given to developing research centers on mental retardation at strategically located universities and at institutions for the retarded. The Panel believes that the importance of research in mental retardation and the very limited research resources now being devoted to this multifaceted problem require a special effort to create new centers of research competence. Such centers are needed for work in biomedical behavioral, and social science, and in interdisciplinary areas. Support for them should be drawn from State and private sources as well as from the Federal Government through the National Institutes of Health and other appropriate Federal agencies. Three such centers are desirable in the near future, established on a pilot basis, and on the basis of experience with them, decisions should be made on proceeding toward an ultimate goal of as many as 10 centers. The estimated cost of a center might be about $1.5 million for facilities and about $0.5 million a year for operating expenses. These centers might (1) conduct basic and applied research in the laboratory and the field; (2) serve as educational centers for the training of additional research and service manpower in this field; and (3) carry on experimentation in the application of new findings and techniques. In the biological and medical research areas, these centers might undertake basic studies in the neurobiological sciences and in clinical aspects of the problem of mental retardation. The heterogeneity of the disorders resulting in intellectual deficit would provide a wide and fruitful area for basic and clinical research and training. Classical techniques of neuropathology have not yet been exhausted in the search for important clinical pathological correlations. For example, the sciences of microbiology, particularly virology, pharmacology, toxicology, and nutrition, can help provide answers to prenatal and postnatal factors which interfere with normal development. Particular disorders which contribute to mental retardation need to be differentiated and their etiology and pathology characterized at the biological, psychological, and clinical level. More information is needed regarding the relationship of psychological deficits to known biological abnormalities. Longitudinal and prospective studies are also desirable to clarify the workings of complex factors in the etiology of mental retardation. Within the framework of these research centers, universities would be encouraged to establish clinical research programs through teaching hospitals, thereby permitting medical school and graduate departments to undertake research in mental retardation. In addition to providing an opportunity for clinical research, these clinical centers would also be important prototypes in stimulating the application of laboratory findings to clinical practice. The majority of the mental retardation cases are undifferentiated, with failures in the field of adaptive behavioral and intellectual functioning. As has already been indicated, this suggests the need for expanding both basic and applied research in the behavioral and social sciences with respect to such substantive areas as deprivation and developmental and learning processes. While a balance between basic and clinical research is essential, the fact that millions of retarded persons in our society require improved care, services, and education indicates that a high degree of applied research is needed in the behavioral sciences. Among the studies in the behavioral sciences which should be considered for special attention by the research centers are the following: The psychological and cultural factors in the etiology of mental retardation; the development of the behavioral processes of the retardate; studies on methods of measuring behavioral skills at all age and ability levels; the adjustment of the adult retardate in various community settings; comprehensive studies in learning, including intramural and extramural demonstrations; responses to stimulative and motivational factors at different ages from infancy to adulthood; and studies of the methods and programs of special education. Some focuses for research will necessarily represent interfaces among the various sciences to such an extent that meaningful explanation of the whole problem is dependent upon a multidisciplinary approach. Because such a large proportion of mental retardation is presently undifferentiated, it would seem only prudent to have centers concerned with interdisciplinary approaches as well as the other two areas discussed above. An important starting point for any specific study in the behavioral and even in certain of the biological areas is in comprehensive epidemiological study of deprived conditions-nationwide, statewide, and in particular communitiesfrom which arise the vast majority of the retarded and their possible direct or indirect causal role. In this connection, both cross-sectional studies and longitudinal studies of the development of behavioral processes of retardation as related to possible causal environmental and biological factors would be most helpful. No less important are careful studies of the factors which affect or help the mental retardate in attaining and maintaining satisfactory adjustment in family, community, educational, and employment spheres. The Secretary of Health, Education, and Welfare should review the requirements for construction of essential facilities for the mentally retarded under public and nonprofit auspices, including facilities which are not necessarily under direct medical supervision. This review should be coordinated with the current review of the Hill-Burton program, and with the review of the national mental health program now underway in the executive branch. It should provide a more definitive analysis of need in the light of desirable patterns of service outlined in this report and clarify the exact extent and character of facilities to be aided. There is a shortage of physical facilities for many types of needed programs for the retarded, including classrooms, workshops, "activity centers," day care, halfway houses, and full-scale residential care. High priority should be given, however, to construction of facilities for day and residential care and related community programs designed to express the new program concepts recommended in other sections of this report. It is estimated that when the full potentials of day care are realized, facilities for some 50,000 seriously retarded children and adults will be needed. Residential facilities are currently required for at least another 50,000 children and adults now not served; replacement for overcrowded and obsolete quarters now in use would bring the total to over 100,000. To assist it in developing its plans, and in preparing principles and guidelines for standards basic to Federal participation, the Public Health Service should be advised by an expert group composed of persons within the Department familiar with the program needs of the retarded, together with representative officials responsible for State programing in the various areas, and national agency consultants. The Panel recommends that local communities, in cooperation with Federal and State agencies, undertake the development of community services for the retarded. These services should be developed in coordination with the State comprehensive plan for the retarded, and plans for them should be integrated with those for construction and improvement of services in residential facilities. As the States and the boards of public and private institutions plan for the future, problems of the size of institutions, program, and personnel are paramount. Bringing the provision of services as close as possible to the local community is a basic tenet on which the Panel's recommendations rest. This would be consistent with the general movement of health and mental health services in this direction, in itself an important and key movement in developing new services of the retarded. Mr. COHEN. I believe that it would also be valuable to your further study for me to put into the record at this point the Federal percentages for the mental retardation construction grants for each State, State by State. (The material referred to follows:) Mr. COHEN. The Federal percentage under the bill may vary State by State in relation to a number of factors, and we have prepared here what is our best evaluation from the law and the authority thereunder as to what the Federal matching proportion for each State would be. Finally, taking the program in terms of the details given you, of the facilities which start at $10 million and in the fourth year $40 million, I have prepared here what the allotments would work out, State by State under the facilities construction part, and I am sure both of you and the rest of the committee would be interested, I will just quote the appropriate figures for Alabama. Under the $10 million in 1965 the Federal allotment would be $208,615. In 1968, with $40 million, Alabama would receive $943,139. The comparable figures for Florida would be $257,465 in 1965 and, in 1968, $1,163,985. The table I will submit for the record contains the appropriate figures for each of the several States. |