Under this system, we should be considering this niggardly, this thoroughly niggardly program which helps just a handful of people doesn't make sense to me.

Dr. WISE. I agree. I am not an authority on how much money can be afforded to be spent but, as you say, every dollar that is spent is a saving of apparently $10, a ratio of 10 to 1. Every dollar spent will be $10 returned. We cannot afford not to train people.

Senator PURTELL. Of course, this is not a question of appropriations here, but it is a question of a program. The appropriation is another matter and will be handled at another time by another committee.

Evidence that we have here presented to us would indicate that this 5-year plan outlined here is about as fast, in the opinion of some people, as we can go. We have got to provide the facilities and the personnel. You have got to be able to use the money wisely and well and you could not jump into it tomorrow if you haven't got the personnel and the facilities.

Dr. WISE. There are limits on both sides. I think a sufficient appropriation for facilities will attract personnel through those facilities. Thank you.

Senator PURTELL. Thank you, Dr. Wise. It is most interesting to have you and very helpful, too.

We are changing the schedule of witnesses here a bit.

We are now asking for Mr. Kenneth Barnes, director of rehabilitation therapy of the Maryland State Department of Mental Hygiene.

STATEMENT OF KENNETH BARNES, DIRECTOR OF REHABILITATION THERAPY, MARYLAND STATE DEPARTMENT OF MENTAL HYGIENE

Mr. BARNES. Rehabilitation is a team effort and I have Mrs. Henrietta B. DeWitt, director of psychiatric social services of the State department of mental hygiene for the State of Maryland with me. Senator PURTELL. Do you have a prepared statement?

Mr. BARNES. Yes, sir.

Senator PURTELL. Do you wish to read it or summarize it?
Mr. BARNES. I would like to summarize it.

Senator PURTELL. It will become a part of the record.

(Prepared statement of Kenneth Barnes is as follows:)

POLICY STATEMENT SUBMITTED BY R. K. BARNES, JR., DIRECTOR OF REHABILITATION, AND HENRIETTA B. DEWITT, DIRECTOR OF PSYCHIATRIC SOCIAL WORK, MARYLAND STATE DEPARTMENT OF MENTAL HYGIENE, IN BEHALF OF MRS. MARCINE GABELL, EXECUTIVE SECRETARY, AMERICAN ASSOCIATION OF PSYCHIATRIC SOCIAL WORKERS

GENERAL STATEMENT

The American Association of Psychiatric Social Workers enthusiastically supports the objective of the President's program to increase the number of handicapped citizens rehabilitated in the United States each year. The association approves the approach which the above legislation would take to increase rehabilitation services for the handicapped by providing Federal assistance for the purpose of training personnel, for research, and by establishing new and expanding present existing rehabilitation facilities.

PRESENT VOCATIONAL REHABILITATION FOR THE MENTALLY ILL

The association would like to emphasize how little is being done to rehabilitate the emotionally ill and how much needs to be done in this area of rehabilitation.

For example, last year the joint Federal-State program of vocational rehabilitation rehabilitated into employment 61,308 handicapped persons; of this number only 4,114, or about 7 percent, were mentally handicapped individuals (and this total includes mentally retarded as well as mentally ill). Since the United States Public Health Service tells us that 52 percent of the hospital beds in the country are occupied by the mentally ill, and since, at the present rate, 1 of every 12 children born each year will need to go to a mental hospital sometime during his life because of severe mental illness, it is obvious that the mentally ill citizen cannot be reached satisfactorily by existing rehabilitation programs. We realize that the undertaking of meeting the needs of this large group of mentally handicapped persons requires the combined efforts of public and private organizations including the professional groups.

State rehabilitation agencies are just beginning to work with the mentally handicapped, and additional funds and personnel will enable them to do a much more complete job. In Maryland, the State with which we are most familiar, only 1 full-time vocational rehabilitation counselor serves the 10,400 mentally handicapped patients in our 5 State institutions. Each institution

could more than keep one counselor busy in providing vocational training and placement opportunities for patients who have been treated but who need this type of assistance before they can be returned to the community.

NEED FOR TRAINED PERSONNEL

Money alone cannot provide rehabilitation services for the 9 million Americans presently suffering from a mental or emotional disorder. However, additional moneys are needed to attract more personnel to provide these rehabilitation services. In the area of psychiatric social work about 16,000 psychiatric social workers are needed nationally: This compares to 4,500 psychiatric social workers who are currently available. At present in the 52 universities offering degrees in social work there are 4,065 students in all branches of social work enrolled full time and only 627 of these are specializing in psychiatric social work. As you can see this number will not begin to meet the need. There are not more than 15 States with professionally organized psychiatric social work programs. Federal grants to encourage training in this and other areas of professional personnel shortages should stimulate the interest of potentially suitable personnel in this field.

FINANCING REHABILITATION SERVICES

The association believes that if Congress decides to change the method of financing rehabilitation programs care be exercised to prevent reducing funds in any State below the current level that the State presently receives. Our experience indicates that no State, at present, has a vocational rehabilitation program adequately serving the mentally ill. Accordingly, no State grants should be decreased, and increased funds would stimulate the providing of services to these disabled persons.

CONCLUSIONS

The American Association of Psychiatric Social Workers is interested in expanding present rehabilitation services because of both the humane and economic benefits which can be derived from these services. We are interested in being more effective in our own specialty. And psychiatric social workers can provide more complete services to their mentally handicapped patients when sufficient rehabilitation personnel and facilities are available to assist them in the social and vocational aspects of treatment.

Mr. BARNES. The American Association of Psychiatric Social Workers has no bones to pick with the present program except that it is not wide enough in scope to do the job we would like to see it do. They have, at present, excellent counselors. They have good men, but there are just not enough to go around.

We are particularly interested in the present bill that you are considering in that we think it does widen the scope and will give us more people to work and, therefore, we can be more effective in our work. We think that it is a joint health, education, and welfare problem and,

for that reason, we feel that not only psychiatric social work but vocational rehabilitation people have to work together.

As my prepared statement will tell you, only about 60,000 people were rehabilitated nationally last year. Only 4,114 were mentally ill people, which is something less than 7 percent. Fifty-two percent of all hospital beds in the country right now are hospitalized mentally ill people. More than half of our people who are hospitalized have mental illness as their problem. In Maryland we have only 1 vocational rehabilitation counselor working with 10,000 mental patients. If this program of State-Federal vocational rehabilitation is expanded so that more counseling service can be available to our hospitals, our patients can move out much better than they are at present. For example, in our hospital, of every 8 patients who come in, 5 are going out as sufficiently improved that they can return to their jobs and homes. That is as the result of the occupational therapy which they receive in the hospital and assistance from the psychologist and so forth. When these people leave, the most important thing to them is how are they going to earn money and make a living. If they do not have someone to call on and someone who can provide vocational advice, we are really slowed down in our job.

In our State, it costs about $10,000 to build a bed for a mental patient. If we cannot get them out, it means additional State as well as Federal expenditure.

Mrs. DeWitt has been in this work for some 20 years and is one of the founders of this work. It was through her efforts that vocational rehabilitation did get inside the hospital. We have innumerable cases where the team together have been able to move patients out.

I will mention briefly only one, a case of a girl very depressed from overwork in her job with the telephone company in town. The pressure of the big city switchboard got her down. When she was ready to go back, she could not go back to her old job. Through social work and what she could possibly do and through calling in the vocational rehabilitation counselor, it was determined that possibly this girl might do well as a beauty operator. The hospital has a beauty shop. The girl was assigned there and it was found that she had the aptitude for it and was capable of doing it. The social service worker found her a home in the community to live in and vocational rehabilitation provided the training and, in this case, the girl herself found her own job. She has not had to come back to the hospital. I think it is safe to say that if she did not have the training, she would have had to come back.

I will ask Mrs. DeWitt to pick it up from this point.

STATEMENT OF MRS. HENRIETTA B. DeWITT, DIRECTOR OF PSYCHIATRIC SOCIAL WORK, MARYLAND STATE DEPARTMENT OF MENTAL HYGIENE

Mrs. DEWITT. I have an interest in training and also I have the interest of the taxpayer and the patient at heart, primarily the patient.

With all of our programs that we have had nationally, the pending program, the improvements of mental hospitals, there needs to be and there has not been the emphasis that there should be on the training of personnel.

In Maryland, while our facilities are improving, we still are seriously handicapped because of the lack of personnel and trained personnel.

Senator PURTELL. Does there appear to be a lack of attraction in that work to people, or is it because of the money for that type of work, or what is it that causes, apparently causes the shortage or lack of facilities.

Mrs. DEWITT. There really are not enough trained people. We have to have better facilities to attract them. It is very hard to get trained social workers in general, and that is because it is such a discouraging job.

Senator PURTELL. Because of the type of work, the facilities, or the remuneration, or the combination of all of them?

Mrs. DEWITT. It is the combination of all, but one of the important things is the lack of facilities. I have worked at Springfield Hospital for 20 years, and there the problem is that the patient is an individual and we think of a hospital where a person is trained. A person who has a mental illness is in there for some time and he has to live while he is there, and in addition to the medical treatment we give him, we have to consider him as an individual and everything we do is to build up his self-respect also.

To have patients sitting around week in and week out and months in and months out throughout their life because they have lost the ability to use themselves and they have no opportunity for retraining is certainly something that none of us wish to see, and certainly is very expensive.

Throughout this country there are thousands of people whose mental symptoms have long since disappeared and who sit in mental hospitals because of the lack of opportunities for training and rehabilitation.

Years ago, before the Division of Vocational Rehabilitation was permitted to help mental patients, per se, I used to try every way to get patients at the point where we could say his mental symptoms are no longer the problem. This is a physical handicap he has. Will you take him, and then after a time that has been the thing that has brought the patient out of the hospital. Today, with all the cooperation, and we get 100 percent cooperation and I think we were almost pioneers in our working together, we have always gotten 100 percent cooperation for them. But they can give us, with their heavy caseloads, 1 counselor who serves 5 hospitals. Last year I think he probably got 75 people back to work. Well, if you do not consider the thousands of dollars it costs to build a bed, you might consider that it costs over $1,000 a year to keep those patients in the hospital. Economically, it is ridiculous. Now, 75 patients is $75,000 a year just in maintenance, to say nothing of people who are clamoring to go.

On my way over here today, Mr. Barnes and I talked about one case we worked out some years ago, who was a youngster who came into the hospital. He had every problem that we read in the papers there is. Here was a youngster 18 years old who came to the hospital. He was a typical dead-end youngster who had been neglected. He had been in courts, convicted of stealing. He was cross-eyed. He had one leg amputated. He was epileptic mentally retarded, and a very discouraged youngster who had no opinion of himself at all.

46293-54-pt. 2- -14

At that time, to himself, he had no chance in life. There are many, many such patients who land in State hospitals at such an early age and we can look forward, the taxpayers can look forward to supporting them for the next 50 years. They just live there.

We give them the new disease of chronicity because we do not have trained personnel to treat people. This youngster was not psychotic to begin with. We began working with him in the social service department and called in the vocational rehabilitation counselor and got him a job in the hospital. We worked with him to help him build up his self-respect and that there was something he could do and we thought he could show us that he could do something. Therefore, as I mentioned, we did get this counselor to help him get training outside. He was walking around with a peg leg and the vocational rehabilitation got him the proper glasses for his cross-eyes to correct his vision. They got a leg for him so that he could stand on two feet and feel like anyone else. The took him to a training center in Baltimore and he had a series of aptitude tests and we found out what he could do, even with his limited intelligence. He had been with our hospital 3 years and was discharged. Just the other day Mr. Barnes saw him in Baltimore. He has a job as a handyman. He was very proud of himself.

That is the kind of story we can tell you of over and over again.

Mr. BARNES. According to the bill as I read it, there is a possibility that some States would get less than they get at the present time. We know of no State which has an adequate program for the mentally handicapped. We believe that the committee should consider giving no State less than it gets at the present time.

Senator PURTELL. Thank you very much, Mr. Barnes and Mrs. DeWitt.

Do you have any questions, Senator Lehman?
Senator LEHMAN. No questions.

Senator PURTELL. Do you have any questions, Senator Neely?
Senator NEELY. No, thank you, Mr. Chairman.

Senator PURTELL. Thank you very much, Mr. Barnes and Mrs. DeWitt.

I understand that you would like to present the next witness, Senator Neely, I thought you had some remarks to make concerning him.

Senator NEELY, No, Mr. Chairman, not at this time.

Senator PURTELL. Our next witness will be Mr. Paul A. Strachan, president of the American Federation of the Physically Handicapped. Mr. Strachan.

STATEMENT OF PAUL A. STRACHAN, PRESIDENT, AMERICAN FEDERATION OF THE PHYSICALLY HANDICAPPED

Mr. STRACHAN. Mr. Chairman, among other disabilities, I am totally deaf. I respectfully request that I be permitted to make my oral statement, after which the committee may desire to ask me some questions through our secretary, Miss Mildred Scott.

Senator NEELY. May I say for the record that of all the folks who are striving to make life easier and better for individuals physically handicapped, Paul Strachan is the most diligent, the most tireless