TABLE 3.-NIMH extramural program expenditures: By problem areas,1 fiscal year 1962

Amount Percent Amount Percent Amount Percent Amount Percent Amount Percent Amount Percent Amount Percent

1. Research.-From its inception in 1948 until the end of fiscal year 1962, the National Institute of Mental Health supported over 2,900 distinct research projects through its program of research grants. These projects-ranging in duration from 1 year to 14-account for nearly 6,200 annual grants and a total of nearly $122 million in awards. This history of the Institute has been marked by a steady growth and diversification of research effort-reaching a level in fiscal year 1962 of 1,343 grants and $30,158,896 in awards for studies in a variety of specific problem areas.

The growth of the NIMH research program has been accompanied by the initiation of a number of administratively distinct grant programs to meet special needs in the mental health field. Among the major substantive concerns of the Institute have been the areas of mental retardation, child health and development, juvenile delinquency, schizophrenia, alcoholism, aging, drug addiction, and psychopharmacology.

In the area of mental retardation, the total expenditure of research funds between 1948 and 1962 was nearly $8 million; the level of support in 1962 was over $2 million. Among the major areas included here are studies of etiology of mental retardation; the diagnosis and treatment of the retarded; the psychological and social adjustment of the retarded and their families; and the care, management and training of the retarded.

Effort in the area of schizophrenia has also been heavy. From the inception of the NIMH research grant program in 1948 until the end of fiscal year 1962, 1,209 awards totaling $32,047,114 were made for projects in the area of schizophrenia; this represents roughly one-fourth of the total research grant effort to date. In 1962, over 220 projects, totaling nearly $8 million were devoted to studies of schizophrenia. Here too, the emphasis of the research varies over a broad area—including, for example, studies of brain and body biochemistry; social and cultural factors; epidemiological studies; and analyses of treatment methods.

Research on psychopharmacological treatment of mental illness has grown from a very small proportion of the program to approximately one-quarter of the grant program in the past few years. From 1948 until the end of fiscal year 1962, 1,223 awards totaling $29,590,866 were made for research on the use of drugs for the treatment of mental illness. In 1962, 281 grants totaling $7,798,112 were awarded for this area of research.

National Institutes of Mental Health has responded to the increased public interest and concern about the problem of juvenile delinquency by increased research grant support through the years. A total of 105 research grants has been awarded for the total sum of $6,108,822 between 1948 and 1962. In fiscal year 1962, 26 grants totaling $1,054,044 were awarded for juvenile delinquency studies.

Other special program areas which NIMH has supported include problems of the aging, alcoholism and drug addiction. Two hundred and twenty-seven grants totaling $6,546,235 were awarded for studies of aging from the years 1948 through 1962. In 1962, 37 grants totaling $1,357,467 were devoted to studies of aging. Between 1948 and 1962, 202 grants totaling $5,186,412 were awarded for studies of alcoholism, while in 1962, 43 grants totaling $1,627,053 were devoted to this psychiatric and social problem. One hundred and thirtyseven research grants totaling $2,710,982 have been awarded for studies of drug addiction between the years 1948 and 1962. In fiscal year 1962, 23 grants totaling $641,414 were supported for studies of drug addiction.

It should be noted that a number of projects supported by NIMH are overlapping in their areas of emphasis. A single study may be relevant, for example, to both the field of psychopharmacology and schizophrenia, or to both mental retardation and juvenile delinquency. As a result, the figures noted above should not be interpreted as representing wholly discrete parts of the program, but rather areas of overlapping, interrelated effort.

An important segment of the total program has been devoted to basic research in the behavioral sciences. As part of this effort, scientists in the biological, psychological, and social sciences are being supported in their attempts to identify baseline data regarding human behavior. Such data are of considerable importance in the planning, execution and interpretation of clinical studies in mental health and illness.

All of the research described above has been supported through the NIMH extra mural research programs other than the title V program. The Institute's total effort includes also a large intramural research program covering a broad spectrum of basic and clinical studies in the mental health field. In 1962, the NIMH intramural research activities totaled $9,180,000.

2. Training. Since its establishment in 1948, the Institute has directed a major proportion of its total effort to the problem of mental health manpower. Initially, the primary concern was with the major professional mental health fields the so-called four-core groups of psychiatry, clinical psychology, psychiatric nursing, and psychiatric social work-those shortage areas that deal with the care and treatment of the mentally ill. The Institute supports graduate training in all these areas and has continued to invest a major share of its training efforts in the production of such personnel.

A second concern was the problem of mental health research manpower-to add to the scientific manpower pool and to seek some of the answers to the cause, the etiology of mental illness, and ultimately its prevention. To accomplish this the Institute supports programs for research training in psychiatry, psychology, social work, and nursing, as well as programs in the biological and social sciences of relevance to mental health.

Now, as the needs in the field continue to grow and as efforts to improve mental health have become more extensive, a wide variety and an ever-increasing number of various kinds of personnel have become important to the further progressoccupational and recreational therapists, the legal profession, the clergy, and of course the psychiatric aid and mental health attendant. In sum, the seriousness and extent of the mental health problem is such that the broadest possible spectrum of manpower must be utilized to meet this problem. The Institute's training program is dedicated to this total effort.

The growth of the training program is exemplified in the contrast between the $1,140,079 awarded in 1948 for a total of 62 grants and the $39,374,975 awarded in 1962 for a total of 1,145 grants. Over this entire period of time the Institute supported almost 1,500 distinct training projects, whose awards have totaled approximately $185 million.

These awards have gone to training centers of all kinds, although over 80 percent has been awarded to colleges and universities, of which approximately one-half has gone to medical schools. For example, of the $39.4 million awarded in 1962, $32,049,000 went to colleges and universities, including $15,594,000 to medical schools. Hospitals and other institutions received $4,154,000, clinics received $1,145,000, and various State and local agencies, professional associations, and independent community service organizations received a total of $2,027,000, in 1962.

The growth in the program has been accompanied by a corresponding increase in the numbers of trainees supported. In 1948 a total of 219 graduate trainees received stipends. In 1962, this total had increased to 4,570. In 1962, this included 1,152 stipends for residency training in psychiatry, plus an additional 373 such stipends in the special general practitioners program. Also included were 976 stipends in psychology, 1,143 stipends in social work, and 451 stipends in nursing. Almost 500 additional stipends were awarded in various areas such as research training in the biological and social sciences, pilot projects and stipends in schools of public health. The total award for all graduate stipends in 1962 was almost $17.5 million.

In addition, a total of 494 research fellowship awards were made in 1962. This compares with 19 awards made in 1948, the initial year of the fellowship program. As of 1962, every major medical school department of psychiatry is receiving some support through a training grant from the National Institute of Mental Health. Of those other schools with appropriate mental health specializations, all the major graduate departments of psychology, graduate schools of social work, and graduate schools of nursing also receive NIMH training grants. In most cases these include traineeships. University departments in the biological and social sciences with programs of mental health relevance also receive support. Other training centers, including many of the major psychiatric training hospitals, child guidance clinics, and private, nonprofit psychiatric treatment centers, as well as clinical psychology internship centers, provide training facilities and traineeships supported by NIMH training funds. Grants are also provided to almost 100 schools of nursing with basic collegiate programs, for strengthening the mental health content of the undergraduate nursing curriculum. The total operation of this training program is a major influence on the field of mental health today. The evidence is clear that over the past 15 years the growth of the individual mental health specialties in the basic professions of medicine, psychology, social work, and nursing has been more rapid than the growth of most of the other specialties in these generic professions.

Psychiatry, clinical psychology and psychiatric social work have each grown more rapidly than their total respective fields. Psychiatry has been one of the

most rapidly growing medical specialties over the decade from 1950 to 1960, increasing almost 21⁄2 times in that period from 5,500 to 13,000, while the total number of physicians increased less than 25 percent. In 1950, psychiatrists represented approximately 3 percent of the 194,000 active physicians. This figure increased so that by 1960, psychiatrists represented approximately 6 percent of the 231,500 active physicians. Psychiatric social work also increased almost 21⁄2 times in the same decade, from 3,000 to 7,200, while the total social welfare personnel increased about 40 percent from 74,000 to 105,000. Clinical psychology is today the largest subspecialty in psychology and has grown vigorously in the past 15 years.

In toto, the number of persons with recognized graduate training in the four core mental health professions increased almost 21⁄2 times between 1950 and 1960, while the grand total in all health professions increased about 30 percent over that same period of time.

3. Community mental health services—Technical assistance.—A staff of expert consultants work actively with the representatives of public and private mental health organizations to communicate research findings and to advise and assist in their prompt and effective application in the treatment of mental illness nationally. Collectively these consultants serve as a bridge between the research laboratories and the mental health practitioners-those who work directly with mental patients and those who are engaged in the administration of clinics, mental hospitals, general hospitals, day centers, and the host of community facilities with a concern for the care of the mentally ill. New knowledge from research into clinical practices or mental health services administration is critically analyzed with the most promising new information translated into mental health treatment practices for further evaluation in clinical settings through special studies and demonstrations. States are encouraged to adapt new treatment techniques in expanding the community mental health services currently provided into a comprehensive system of mental health care. Some of the new or improved services are designed to meet the special needs of individual population groups such as the aged, alcoholic, and juvenile delinquent. This work began in 1948. A total of $381,000 was allotted to support these activities in fiscal year 1950. The fiscal year 1962 budget was $1,336,000.

Several special techniques were developed to disseminate new information in regard to the conduct of mental health services and to demonstrate the application of clinical techniques developed from research findings. Demonstrations are primarily implemented in areas where the needs for new and improved treatment procedures have not been met. The demonstrations focus on the translation of new knowledge into treatment practices or the implementation of recently developed treatment practices to new settings. In fiscal year 1958 $65,000 was allotted for these demonstrations. The amount allotted for this activity in fiscal year 1962 is $319,000. During the intervening period 12 demonstrations have been conducted or are in progress.

Intensive workshops called technical assistance projects were started in 1955 to disseminate new information to State mental health representatives on the application of modern principles and methods to administer mental health services programs. These technical assistance projects are planned with representatives of the State mental health authorities and are financed by the National Institute of Mental Health. Since 1955 a total of 135 technical assistance projects have been held in 46 States at a cost of $540,000. Thirty-three technical assistance projects were held in 1962.

Grants to States.-The National Institute of Mental Health has administered the mental health grant-in-aid to States since 1948. This program is administered under authority of section 314 (c) of the Public Health Service Act. Grants which States must match dollar for dollar are made to the agency in each State designated as the "Mental health authority." Funds are made available to assist States in prevention and control of mental illness through establishing, maintaining, and expanding community mental health services.

In fiscal year 1948 a minimum grant of $20,000 was made to each State with the States expending an aggregate of $1,653,454 of grant-in-aid funds. The State community mental health programs expanded and additional funds were appropriated to stimulate further activity on the part of the States in community mental health. The minimum grant to each State in fiscal year 1955 was reduced slightly to $17,750 but the total amount expended by States increased to $2,339,627. Further increases in grant appropriations enabled the minimum grant to be raised to $65,000 in fiscal year 1962 and the total of grant funds expended by the States reached $6,633,839.