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! Selected resources as of June 30 are as follows: Unpaid undelivered orders, 1964, $532,000; 1965, $1,056,000; 1966, $988,000; 1967, $592,000,

Mr. FOGARTY. The committee will come to order. We have before us the request for St. Elizabeths Hospital. Dr. Cameron, are you ready with a statement?

Dr. CAMERON. Yes, sir; I am.
Mr. FOGARTY. Go right ahead.

GENERAL STATEMENT

Dr. CAMERON. Mr. Chairman and members of the committee, I welcome this opportunity to meet with you to present the program objectives and appropriation requests of St. Elizabeths Hospital for fiscal year 1967.

St. Elizabeths Hospital, the largest federally operated hospital for the mentally ill, fulfills its statutory mission by means of three major programs: treatment, training and education, and research. The hospital seeks, with all means available, to provide therapeutic, protective, and rehabilitative programs utilizing professional, scientific, and other resources from many fields. A spirit of freedom in developing new and original approaches to the treatment and rehabilitation of patients is encouraged, while maintaining a respect for the values of accepted techniques. Independence of thought and an intelligent display of initiative are encouraged. Through training and research, advantageously pursued at the site of treatment, the hospital seeks to advance psychiatric knowledge and improve treatment methods.

Fiscal year 1965 marked the end of a decade which has seen dramatic changes in the treatment of the mentally ill at St. Elizabeths. There have been sharp reductions in average periods of hospitalization and decreases in the number of resident patients despite increasing numbers of patients admitted. The hospital employs several relatively new approaches in pursuit of its objective of providing the best in treatment and care. Although time does not permit the enumeration of all these approaches, I should like to cite a few of the more significant ones.

"SMALL HOSPITAL" CONCEPT

First, there has been the gradual reorganization of St. Elizabeths into several small hospital units. This unit system involves decentralizing patient treatment organizational elements into smaller, more workable, semiautomonous hospital units in which patients are provided comprehensive treatment and care from admission to discharge. The continuity of treatment which results from this so-called "small hospital" concept evokes favorable responses from patients and enables the staff to make and carry out reasonably effective plans for patients' treatment. The psychiatric and nursing staffs are thus afforded a renewed challenge to remotivate longer term patients while carrying out treatment for the newly admitted patient. As part of the continuity of treatment program, all small hospital units have outpatient clinics which aid patients to adjust to community life when they leave the hospital on convalescent leave. Day center programs have also been established for patients who are able to move from the hospital but who still are in need of structured activity.

The process of decentralization to "small hospital" units has not yet been completed.

PHYSICAL AND PSYCHIATRIC REHABILITATION

Second, the hospital has placed increasing emphasis upon physical and psychiatric rehabilitation through the development and use of programs and activities designed to provide patients with the opportunity to live a life that is personally, socially, and economically productive. An example of an important part of the hospital's overall endeavor to prepare patients to live fuller lives both in the hospital and in the community has been an attack on the problem of deafness. Through improved equipment and staff realinement, deaf patients are receiving better diagnostic and therapeutic attention. Not only does hearing improvement increase a person's social acceptance and acceptability but may play a role in the specific treatment of some mental illness.

FOSTER CARE PROGRAM

Third, the hospital is now operating an increasingly successful foster care program under which patients are placed in supervised homes throughout the community and given an opportunity to take their first steps toward effective living outside a hospital setting. There were 268 such placements in 1965, a number double that of the preceding year.

Much more could be said, for example, concerning the rehabilitation of prisoner patients, our work in occupational and recreational therapy, pioneering efforts in the field of psychodrama, the establishment and operation of our youth center, and the invaluable contributions of hundreds of volunteer workers. All these activities have contributed substantially to the general improvement of treatment programs, the value of which is perhaps best attested to by the patient population statistics of the hospital.

PATIENT POPULATION DATA

During the past decade, the average daily resident patient load of St. Elizabeths Hospital was reduced approximately 14 percent. The rate of decrease in the latter part of the decade, however, was most pronounced, the load declining an average of 230 patients, or approximately 3.5 percent annually during the past 3 years. Most significantly, this reduction was achieved despite continued increases in the number of admissions, which rose from 1,692 in 1964 to 1,965 in the past fiscal year. During the last decade, the length of time patients remained in the hospital was substantially shortened. Of the patients admitted in 1955, only 36 percent were returned to the community by June 30 of that year; in 1965, the comparable figure was 57 percent, a most gratifying improvement. Approximately 50 percent of newly admitted patients are currently being returned to the community within 4 months and 80 percent within 12 months of their admission.

A significant recent development in the treatment of the mentally ill was the passage of the District of Columbia Hospitalization of the Mentally Ill Act (Public Law 88-597) which became effective in September 1964. Along with provisions for separating the issue of legal competency from that of commitment for treatment, the act has facilitated voluntary admissions and provides for admission of nonprotesting and emergency patients without a prior judicial order. This act

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