Unless

population, or about 9 million people, have serious mental disorders. something more is done to prevent and control mental illness, 1 out of every 12 children born today will spend part of his life in a mental hospital.

Few families have the resources to pay for the prolonged treatment required for serious mental illness. After the family resources have been exhausted, there remains a tremendous financial burden upon the taxpayers of the Nation. The direct dollar cost for care of the mentally ill in hospitals, and for benefits to veterans with mental disorders, is more than $1 billion a year. This cost is rising at the rate of $100 million a year.

Hospitalization of the mentally ill accounts for a major share of the cost of mental illness.

Half of the hospital beds in the United States are occupied by mental patients, and 98 percent of the beds they occupy are tax-supported.

The human suffering of families and individuals as a result of mental illness is beyond calculation. Of greater concern than the dollars and the mathematics involved is the loss of human resources represented by the mentally ill-and the impact of this loss on our national well-being.

SOME SIGNS OF PROGRESS

Research and experience are creating new opportunities in the prevention and treatment of mental disorders. At the same time, there has been a change of attitude toward those who suffer from the illness. In the light of this new knowledge and understanding, we are better able to assess the effectiveness of our national effort to combat mental illness and to press forward toward greater accomplishments.

Progress is being made on many fronts. For example, the experts tell us, half or more of the persons suffering from schizophrenia can be helped by modern treatment methods.

With use of shock therapy, we have greatly increased the recovery and discharge rates of patients suffering with certain types of psychosis.

A recent study in one State hospital indicated that by the use of new drugs and new therapeutic techniques, the chance of recovery for long-term mental patients can be tripled.

These advances benefit patients in mental hospitals. But not all mental patients require hospitalization. Increasingly, mental illness is being detected in psychiatrists' offices and in mental-health clinics. This permits early treatment, and thus often avoids more serious illness.

THE NATIONAL EFFORT

Many groups, both governmental and private, are working effectively to increase knowledge of the prevention and treatment of mental illness, and to encourage the application of this knowledge. Regional, State and local activities reflect the growing awareness of the American people that mental illness is a serious problem which must be attacked on all fronts.

Groups of States are working together on regional problems. The governors have met several times to consider a program of concerted action against mental illness. State appropriations for mental-health activities have increased significantly in some instances and the States are concerning themselves not only with care and treatment, but with prevention and education as well. It is this kind of response which demonstrates the potential of the Federal-State-local partnership, and helps to clarify the proper role of the Federal Government. As for the mental-health activities of the Federal Government, they are of three kinds, spread among several bureaus and agencies.

First, the Federal Government operates special services for the care of the mentally ill who are its beneficiaries or wards. The agencies which provide these services include the Veterans' Administration, the Armed Forces, St. Elizabeths Hospital, the Public Health Service, and the Federal prisons.

Second, the hospital survey and construction program of the Public Health Service provides financial assistance to States for building mental institutions. Third, the Federal Government maintains and supports programs aimed at the prevention and control of mental illness. Several of these programs are centered in the Department of Health, Education, and Welfare. The Children's Bureau, the Office of Vocational Rehabilitation, and the Office of Education all have special reasons for being concerned with mental health. But the most extensive

program is centered in the National Institute of Mental Health, a division of the Public Health Service.

THE NATIONAL INSTITUTE OF MENTAL HEALTH

The program of this Institute is known to many of you. This committee was instrumental in the passage of the National Mental Health Act in 1946. Since then, we have had ample proof of the wisdom of this legislation.

A brief review of the current activities of the National Institute of Mental Health may be helpful in portraying the relationship of the proposals in title VI to the present mental-health program of the Public Health Service. In general, the Institute deals in research, in training, and in community services.

In the study of mental illness, research ranges from studies of the central nervous system to exploration of factors which affect human behavior. The Institute conducts research in its own facilities and makes research grants to independent investigators in medical schools, universities, and other non-Federal research centers. The Institute also supports a number of research fellowships, permitting young scientists to obtain supervised research experience.

Under the training program of the Institute, grants are made to professional schools to improve the quality of training and to increase the number of competent professional workers. There is a serious shortage of qualified personnel in the mental-health field. Trained people are needed for clinical services, teaching, research, and administration.

The community-services program carries out those provisions of the National Mental Health Act which authorize assistance to the States in the prevention, diagnosis, and treatment of psychiatric disorders. Grants are made to the States and Territories for mental-health programs conducted outside mental hospitals and other institutions. Money is allotted on the basis of population, financial need, and the extent of the problem in each State. Two Federal dollars must be matched by not less than $1 of State or local funds expended for the same purposes. Although this is the required ratio, by 1953 the States as a whole were matching each Federal dollar with more than $5 of their own.

The National Institute of Mental Health works through the mental-health authority in each State. It provides technical assistance and consultation, makes special surveys on request, sets up demonstrations, and assists in program planning.

I should like at this point to ask Dr. Robert H. Felix, Director of the National Institute of Mental Health since its beginning, to illustrate and describe briefly the current program of the Institute.

Dr. Felix.

Chart 1.-Federal Interest and Participation

Dr. FELIX. The first chart indicates the broad range of Federal participation in mental health programs.

The Veterans' Administration operates a number of psychiatric hospitals, general hospitals with psychiatric services, and outpatient mental hygiene clinics. The Armed Forces have developed services for early recognition and prompt treatment of mental and emotional disorders in order to maintain the mental health of the Armed Forces at the maximum level. The Federal Bureau of Prisons provides hospital care and treatment for prisoners who are mentally

ill.

In the Department of Health, Education, and Welfare, in addition to St. Elizabeths Hospital, other constituents are contributing to better mental health. The Children's Bureau is concerned with the growth and development of the child and the special needs of handicapped children. The Office of Education has an interest in the educational needs of these children and in the mental health problems of schoolchildren generally. The Office of Vocational Rehabilitation assists those who have been mentally ill and those whose physical handicaps may raise psychological barriers to satisfactory rehabilitation.

In the Public Health Service, there are several programs which have mentalhealth components; but the principal unit, one in which the National mental health program is focused, is the National Institute of Mental Health.

Chart 2.-Research at the National Institute of Mental Health

In this, as in all health fields, research is the base for most of the new developments leading to progress.

Scientists are conducting clinical and laboratory investigations at the Clinical Center in Bethesda; at the Addition Research Center in Lexington, Ky.; and at the Mental Health Study Center in Prince Georges County, Md. Studies range from the analysis of severe emotional disturbances in children, evaluations of the effectiveness of psychotherapy, and the relation of disordered brain function to the major psychoses, all the way to such fundamental research as the biochemistry and metabolism of the nervous system and the causes and mechanisms of drug addiction.

Research grants are awarded to non-Federal scientists after their applications have been reviewed by a technical panel of non-Federal scientists and by the National Advisory Mental Health Council. The Surgeon General awards grants on the basis of council recommendations.

Research fellowships are awarded to encourage promising young scientists to follow careers in the mental health specialty fields.

In addition, the Institute collects nationwide data on mental illness in all of its forms, working closely with the States to develop a model system for the reporting of data. Information of this kind is essential to program planning and direction by the States and the Federal Government.

Chart 3.-The Mental Health Training Program

The National Institute of Mental Health maintains a training program to help meet the acute needs for personnel in the various mental health professions. Teaching grants and grants for traineeships are made to centers of higher learning. Assistance is given for training in psychiatry, psychology, psychiatric social work, psychiatric nursing and public health. In addition, the Institute sponsors a number of conferences for the development of new training programs or for the orientation of persons in other professions to problems of mental health.

National Institute of Mental Health grants currently sponsor 229 graduate programs. More than 3,000 trainees have received individual support since the program started. Approximately 48 medical schools have been aided in the undergraduate teaching of psychiatry. This effort has helped alleviate the manpower shortage, but the shortage is still acute and there is need for additional emphasis on the training program of the Institute.