We advocate the establishment and support of research facilities and treatment centers whose efforts are directed toward the discovery and elimination of the factors responsible for mental subnormality. We join the American Dental Association in requesting that your committee and the Congress of the United States act favorably upon these bills. May I request that this letter be added to the record of the committee hearings? Sincerely, ROBERT I. KAPLAN, D.D.S., President. NASHVILLE, TENN., April 1, 1963. Re H.R. 3688. The Honorable OREN HARRIS, Chairman, House Interstate and Foreign Commerce Committee, DEAR CONGRESSMAN HARRIS: I am especially interested in the Federal bills now in House and Senate committees providing for assistance in the construction and initial operation of community mental health centers. In my local situation, for instance, there is a definite need for mental health clinics. In order to meet the needs of the population here, at least eight clinics should be maintained, and the three that we now have cannot possibly handle the load. Further, only one of these three, Vanderbilt, provides in-service treatment or day care, and this is only to a limited extent. This type of facility should be a part of a complete mental health center service. The center at Meharry might conceivably be expanded, but in the case of the Nashville Mental Health Center there are neither buildings or personnel to make this possible. Please do whatever you can regarding these bills which will improve these situations both locally and on a nationwide level. Sincerely yours, Mrs. DAVID H. SMITH. CONNECTICUT ASSOCIATION FOR MENTAL HEALTH, INC., Representative OREN HARRIS, House Committee on Interstate and Foreign Commerce, DEAR REPRESENTATIVE HARRIS: As president of the Connecticut Association for Mental Health, I would like to register our organization in favor of H.R. 3688 (an act to provide for assistance in the construction and initial operation of community mental health centers and other purposes). For several years now we have been convinced that, if we are to make any real progress in our fight against mental illness, we must concentrate on the development of community-based services for early detection, care, and treatment as well as prevention of mental illness. Attempts to develop such services have shown the cost, even at a minimum level, is well beyond the scope of nearly every community in our State, even with financial assistance from State tax funds. As you know, Connecticut is one of the wealthier States in the Union; if we are having these problems, undoubtedly every other State is, as well. Clearly therefore, we must have Federal assistance to develop the kind of community-based programs which President Kennedy called for in his message to Congress. We feel that the availability of Federal funds for the construction and for the initial operation of community mental health facilities would, in President Kennedy's words, "return mental health care to the mainstreet of American medicine and at the same time upgrade mental health services." To return the mentally ill to the communities where they live and work, near their families, friends, doctors, and clergymen, is one of the prime objectives of the Connecticut Association for Mental Health. We would like to go on record as urging a favorable committee report and eventually passage by Congress of H.R. 3688 and S. 755. Sincerely, GENENE L. BROWN President. Hon. OREN HARRIS, AMERICAN MENTAL HEALTH FOUNDATION, INC., House of Representatives, Office Building, DEAR MR. HARRIS: Yesterday we sent you the following telegram: "Respectfully request your permission to present to your committee the American Mental Health Foundation's objections to the administration's plans regarding mental illness and the National Institute for Mental Health. These plans-even though submitted in good faith by the administration-are not only obsolete and ineffective but will create an insurmountable obstacle to progress. An explanatory letter is being sent to you." The aforementioned problem arises from the fact that this program is based, to a large extent, on the final report of the Joint Commission on Mental Illness and Health. This document was carefully reviewed by the foundation, after its issuance, and the enclosed letter was sent to the President at that time. Unfortunately, we are certain that it never came to his attention. As you can see from the enclosed, the final report-and therefore the administration's program-avoid most important avenues for research and action based on valuable knowledge already available. Furthermore, even the greatest number of new hospitals, clinics and treatment centers cannot improve the present situation, because the treatment given therein is only as good as the practitioners. The foundation developed, over many years, reform plans which would result in a far better selection of future practitioners in mental health professions, and radically different and vastly improved educational and training programs for the same. It was most unfortunate that Congress entrusted the preparation of the final report to the very agencies which are interested in the status quo. We thank you in advance for your cooperation in this matter of national interest. Sincerely yours, DR. STEFAN DE SCHILL, P.S.-We are sending you under separate cover foundation brochures for the members of your committee. THE PRESIDENT, AMERICAN MENTAL HEALTH FOUNDATION, INC., New York, N.Y., May 10, 1961. DEAR MR. PRESIDENT: Thank you for your kind letter of December 9, 1960. It appears that my reply, sent to the Hotel Carlyle by messenger, arrived only after your departure. I do want to congratulate you on the choice of remarkable men to assist you in the arduous task ahead, and on the many welcome decisions you have already made. It is with a feeling of urgency that I would like to call your attention to the recent release of the final report of the Joint Commission on Mental Illness and Health. The entire final report can actually be summarized by these three quotations from it: "We who work in the mental health professions have not been able to do our best for the mentally ill to date, nor have we been able to make it wholly clear what keeps us from doing so." "Mental health scientists face this task with an incredibly small fund of knowledge about causes and cures." "We cannot do more than we are presently doing, taking account of present knowledge, past experience, and projected costs. Those who will legislate a national mental health program have this decision to make. Indeed, we can see only one matter that takes priority over all others in the program we propose and that is to obtain vastly increased sums of money for its support." Attached to this letter are comments refuting these statements of the final report. We have amassed a great wealth of knowledge and skill, and effective solutions have been available for quite a long time. The recommendations of the final report. if followed, would result in a waste of public funds of up to $3 billion yearly and, far more important, would create an obstacle to progress in mental health, perpetuating the completely needless suffering of untold numbers of people. The final report mirrors the deplorable national mental health situation. At this point only the Federal Government can effectively reverse the current trend by sponsoring urgently needed reforms. Please be assured that my writing has been motivated by a desire to assist you and your administration to overcome America's most serious and most poorly handled public health problem. In order to facilitate any further consideration you may want to give to this matter, I am sending a copy of this letter to the Honorable Abraham A. Ribicoff and the Honorable Robert F. Kennedy. With my most sincere wishes for your success and well-being, I am, Dr. STEFAN DE SCHILL, TOWARD THE SOLUTION OF THE NATIONAL MENTAL HEALTH PROBLEM The Joint Commission on Mental Illness and Health began its work on the final report, called "Action for Mental Health," in 1955. Costing $1,500,000 in public funds, it was a joint venture of representatives of the major organizations responsible for mental health in the United States, primarily the American Medical Association, the American Psychiatric Association, the National Association for Mental Health and the National Institute of Mental Health. 1. ANSWERING THE CLAIM OF "LACK OF AVAILABLE KNOWLEDGE" The final report touches on few of the existing problems and offers only insufficient and superficial solutions. Most of the surveys on which it is based lack scope and depth. The final report admits: "We who work in the mental health professions have not been able to do our best for the mentally ill to date, nor have we been able to make it wholly clear what keeps us from doing so." Even this statement, however, is a euphemism because hardly more than the worst has been done for mental health in this country. Although the final report states that it has not "been able to make it wholly clear" what factors prevent progress, many of the answers are well known. However, some of the solutions may seem to run counter to the interests of certain forces in the mental health field. Perhaps the most shocking thing about the final report is that since 1954 a far more expert and scientific program for national action has been available, worked out by the American Mental Health Foundation. This plan was considered so desirable by Mr. Richard Weil, Jr., president of the National Association for Mental Health, that he resigned from his post and joined the foundation in a leading capacity. The foundation's program, based on intensive research carried out over many years, specifies many new approaches urgently needed to deal with the national mental health situation-the most important and costly health problem of the United States. It is my firm belief that utilization of the concepts within the foundation's program might eliminate approximately 70 percent of the present serious shortcomings, even without any further discoveries or "research breakthroughs." By contrast, the final report of the Joint Commission states: "Mental health scientists face this task with an incredibly small fund of knowledge about causes and cures." This leads us to assume that the members of the Commission are not aware of the latest advances in the profession, nor of the very substantial body of knowledge, skill and experience which has been acquired by practitioners in this field over many years and which is readily available. II. ANSWERING THE CLAIM THAT SPENDING OF BILLIONS OF DOLLARS OF PUBLIC FUNDS IS NECESSARY After decrying the asserted lack of available knowledge, the final report continues: "We cannot do more than we are presently doing, taking account of present knowledge, past experience, and projected costs. Those who will legislate a national mental health program have this decision to make. Indeed, we can see only one matter that takes priority over all others in the program we propose and that is to obtain vastly increased sums of money for its support. The statement that "we cannot do more than we are presently doing" is simply not factual, and actually contradicts the claim that "we*** have not been able to do our best." Moreover, the entire statement places the burden on those who legislate, seemingly making the national mental health problem one which may be solved mainly by financial support. However, no indication is given that such spending will result in constructive and effective solutions. Throughout, the final report calls for a much larger appropriation of funds for mental health research but fails completely to spell out a precise and scientific research program and definite plan for national action. As a conclusion, the final report asks for $3 billion annually to be spent by the Federal, State, and local governments. However, furthering the public interest in this important health field is primarily not a question of more money, but of urgently needed reforms. Decisive changes, based on the best knowledge and solutions already available, must supersede a number of current practices. Much of the money now being spent represents an actual hindrance to progress and entails the perpetuation of the status quo. Unfortunately, there are strong forces within the mental health field that fight and try to eliminate any progressive groups, no matter how worthwhile, which either seem to constitute a threat to their financial position or denounce their activities. The foundation, throughout its entire existence, has maintained a policy of combating these forces, whose activities represent an obstacle to progress in mental health and the public welfare. III. SOME OF THE SOLUTIONS ADVANCED BY THE AMHF As can be seen in the enclosed brochure, the American Mental Health Foundation advocates far-reaching reforms in three major areas of great need: research, treatment, and professional education. For many years the foundation's primary emphasis has been placed upon research in the functioning and malfunctioning of the human mind, as well as the testing and establishing of fundamental tenets of psychotherapeutic theory and technique. Its findings, continuously utilized to increase treatment efficiency, have led to the development of mental health groups, an effective low-cost form of psychotherapy constituting an answer to the most urgent need in mental health. This new form of therapy combines both individual and extended group sessions. Data collected over a period of 7 years show clearly: (1) That the increase in treatment effectiveness within the mental health groups permits a decisive reduction in the frequency of individual sessions required; (2) that the vast majority of patients can now be placed in such groups from the beginning of treatment; (3) that many emotional disturbances previously considered not amenable to group psychotherapy can be treated in this setting. These factors contribute toward a substantial reduction of treatment costs. The method, first described at the Second International Congress for Group Psychotherapy in Zurich in 1957, has stimulated unusual national and international interest. The foundation's research publications on group psychotherapy and on the low-cost treatment method are now among the most widely used in the United States. I have just received an invitation from Dr. John R. Rees, director of the World Federation for Mental Health, to report on recent developments in this form of treatment at the Sixth International Congress on Mental Health in Paris this summer. The foundation's program offers specific and far-reaching innovations in the selection, education, and the clinical training of psychotherapists. In contrast, the final report repeatedly suggests that funds be made available for the education of young scientists in the mental health field, but does not delineate any definite program, IV. A FINAL EVALUATION The value of the final report lies in the fact that it reflects the thinking, attitude, and level of understanding of those who are in charge of mental health in the United States. However, when examined as a scientific document or as a survey conducted by experts by mandate from the people, this document is tantamount to an admission of failure in the past and ignorance of constructive solutions for the future. The effective solution of the mental health problem lies in the direction of the various specific approaches proposed by the foundation, such as the widest application of better and less expensive treatment methods, combined with training of a far greater number of psychotherapists. VERMONT ASSOCIATION FOR RETARDED CHILDREN, INC., Hon. WINSTON PROUTY, U.S. Senate, Washington, D.C. Montpelier, Vt., April 4, 1963. DEAR SENATOR PROUTY: As past president of the Vermont Association for Retarded Children and as a father of a retarded child, I actively participated in forming that organization within our State. I became well aware of the urgent need for legislation to bring the potential of these children to the attention of our education system. As a result, I feel that during the past 6 years our efforts have been well received in this State in view of the continued appropriations by legislature in supporting the expanding program of special education for the handicapped. Therefore, in behalf of those who are unable to speak for themselves, I urge you to support the following bills: Senate bills S. 755 and S. 756, and in the House, H.R. 3688 and H.R. 3689. These measures have been introduced at the request of the administration as part of the program outlined by President Kennedy in his message to Congress. If you were also to express this desire of the Vermont Association to Senate Labor and Public Welfare Committee Chairman Lister Hill, of Alabama, and to House Interstate and Foreign Commerce Committee Chairman Oren Harris, of Arkansas, I assure you, your efforts will be greatly appreciated. Very truly yours, J. CLIFTON COATES. INDIANAPOLIS, IND., April 2, 1963. Hon. KENNETH A. ROBERTS, Chairman Health and Safety Committee, DEAR SIR: The legislation H.R. 3688 and H.R. 3689 are bills upon which I request action to kill them. The U.S. Government has no basis or constitutionality to enter the mental health field. Needless to say this is another way to add to Federal spending and the debt burden, all of which is already much too high. Please defeat this legislation. The Honorable JOHN L. BRADEMAS, MRS. ROGER JACOBSON. WESTVILLE, IND., February 14, 1963. House of Representatives, Washington, D.C. MY DEAR SIR: President Kennedy has presented a program by which Federal funds will be made available to State and local governments so that community mental health centers may be established. I am not acquainted with all the details of his proposal but I do understand that this would be in the nature of matching funds (1) for the training of personnel in the mental health professions; (2) for paying of salaries of staff; and (3 for the setting up of the facilities, including the physical plant. I am very much in favor of a proposal to set up small mental health community centered facilities. The large institutions too often have the effect of taking the patient away from the community, isolating him and then finding it difficult, if not impossble, to integrate him back into the community. Community facilties could be of the following types: (1) Providing psychotherapeutic and other mental health services for individuals who would come in for the therapy session during the day or evening; (2) providing a treatment program for day-care patients; that is, persons who would come in only for the day and live with their families: (3) giving service to individuals who might need to keep a full-time or part-time job in the community while they are participating in some therapeutic |