COMMUNITY MENTAL HEALTH

ADVANCESs

F.

'Ay 2 1934

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COMMUNITY MENTAL HEALTH CENTERS ACT USHERS IN NEW ERA

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NEW LEGISLATION IN THE STATES

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`CRISIS UNIT' RETURNS MOST PATIENTS TO COMMUNITY

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DAY HOSPITALS SHOW RAPID GROWTH

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CALENDAR OF EVENTS

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CURRENT READING: `THE PREVENTION OF HOSPITALIZATION'

The "bold new approach" to problems of mental illness reflected inthe passage of the Community Mental Health Centers Act of 1963 (Title II,P.L. 88-164) is based on the conviction that many forms and degrees ofmental illness can be prevented or ameliorated effectively and economicallythrough community-oriented services . As we move forward in the develop-ment of these services, it is important that knowledge gained from programsinvolving new modes of treatment be widely disseminated and utilized .This publication, which the National Institute of Mental Health will issuefrom time to time, will report innovations in State and local mental healthprograms and services in an effort to assist the increasing number of personsconcerned with developing and strengthening those programs .

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R. H. FELIX, M.D.,Director,National Institute of Mental Health .

COMMUNITY MENTAL HEALTHADVANCES

April 1964

U .S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFAREPublic Health Service

National Institute of Mental HealthBethesda, Md . 20014

CONTENTS

Federal Legislation : PageA Bold New Program 1Community Mental Health Centers Act 1Planning Grants 2Hospital Improvement Program 2Inservice Training Program 3Facilities and Services for the Retarded 4

State Legislation :Community Mental Health Services Acts 6Services for Children 7New Facilities and Services 7Alcoholism 7Drug Addiction 8

What's Going On :Hospital Population Drops Again 9Compensated Work as Therapy Helps Patients in Various Settings9"Crisis Unit" Returns Most Patients to Community 11Insurance Coverage for Mental Illness 12Day Hospitals Show Rapid Growth 13Here and There in the States 14

Calendar of Events-1964 18Current Reading :

The Prevention of Hospitalization 20Guides to Psychiatric Rehabilitation 21Briefly Noted 21

Editor

Contributing SpecialistsEvelyn S . Myers

Mildred Arrill

Jack WienerPublications and Reports Section

Community Research and Services Branch

National Institute of Mental Health

For sale by the Superintendent of Documents, U .S. Government Printing Office, Washington, D.C ., 20402 - Price 20 cents .

A new era in the treatment of the mentallydisabled of the United States has been usheredin by actions of the 88th Congress. Focusedin the community, the bold new program willprovide facilities and services to prevent andameliorate the waste and tragedy of mentalillness and mental retardation .

As enacted by Congress, the program au-thorizes Federal funds to :

1. Assist in the construction of compre-hensive community mental healthcenters .

2. Aid the States in broad planning forthe mental health needs of their citizens.

3. Help State'mental hospitals and insti-tutions for the retarded improve theirtherapeutic services .

4. Provide inservice training for person-nel of State mental hospitals andinstitutions for the retarded .

5. Provide expanded services and re-search programs related to the men-tally retarded (including grants for theconstruction of mental retardationcenters), and aid the States in plan-ning for mental retardation needs .

COMMUNITY MENTAL HEALTHCENTERS ACT

The Community Mental Health Centers Actof 1963 (Title II of P .L. 88-164) authorizes atotal of $150 million for fiscal years 1965

FEDERAL LEGISLATION

A Bold New,Program

through 1967 for the construction of com-munity mental health centers, which will formthe core of the new national program.

The authorized Federal grants-totaling $35million in the fiscal year ending June 30, 1965,an additional $50 million the following year,and $65 million the third year-are to beallotted to the States on the basis of population,financial need, and extent of the need for com-munity mental health centers . The Federalshare will range from one-third to two-thirdsof the cost, with a minimum allotment of$100,000 to each State for each of the 3 years .

When fully developed, a comprehensivecommunity mental health center will includethe following elements :

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Inpatient services•

Outpatient services•

Partial hospitalization,night and weekend care

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Community services including consul-tation to community agencies andprofessional personnel

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Diagnostic services•

Rehabilitative servicestional and educational

including day,

including voca-programs

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Precare and aftercare community serv-ices including foster home placement,home visiting, and halfway houses

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Training•

Research and evaluation

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Within 6 months after enactment of thelaw, or by April 30, 1964, the Secretary ofHealth, Education, and Welfare was to issueregulations governing the new program .

States seeking to qualify for center construc-tion funds must submit, for the approval ofthe Secretary, plans that among other things :(1) designate a single State agency for ad-ministration of the plan, (2) provide for aState advisory council, (3) set up a programfor construction of the centers, and (4) pro-vide for a system of determining prioritiesamong center projects.

After the State plan has, been approved, in-dividual project applications may be sub-mitted by local public or private agencies (ora combination) through the State agency . Atthat time reasonable assurance must be giventhat adequate financial support will be avail-able for the construction of the project andfor its operation when completed .

Funds for the first year of the center con-struction program are included in the Presi-dent's budget for fiscal year 1965 . Adminis-tration of the program will be the joint re-sponsibility of the National Institute of MentalHealth, NIH, and the Division of Hospital andMedical Facilities, Bureau of State Services,both of the Public Health Service .

PLANNING GRANTS

Closely integrated with the community men-tal health centers legislation are the appro-priations made by Congress in fiscal years 1963and 1964-over $8 million in all-for grantsto the States to aid in the preparation of State-wide plans for comprehensive mental healthprograms .

Applications for planning grants from allthe State Mental Health Authorities have beenapproved by the Public Health Service, thusenabling all the States to use these matching,grant-in-aid funds.

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For the first time in the history of our coun-try, each of the States is thus being helped toformulate a comprehensive approach to theproblems of mental illness as they affect itsresidents .

Funds have been made available for suchactivities as the development and use of meansfor gathering data, the integration and analysisof information, the determination of needs, theselection of goals, priorities, and methods, andthe allocation of available resources to achievethe selected goals .

The planning grants program is being ad-ministered by the Office of the Director, Na-tional Institute of Mental Health .

HOSPITAL IMPROVEMENTPROGRAM

Funds for a new program to improve thera-peutic services in State mental hospitals andinstitutions for the mentally retarded were in-cluded in the 1964 appropriation for the De-partment of Health, Education, and Welfare .During the first year of the program, $6 mil-lion will be awarded by NIMH in the form ofMental Health Project Grants to support thenew program .The grants, accompanied by consultation

and technical assistance, are designed to stimu-late the institutions in initiating a sequence of

improvements which will spread throughouttheir entire program . They are also designedto help the hospitals and institutions . achievea more positive role as an integral part of thecomprehensive community-based effort againstmental illness and mental retardation .

The $6 million will make possible at leastone grant in each State which submits an ap-provable project for fiscal year 1964 ; an in-dividual hospital or institution may receive amaximum of $100,000 in any one year for aproject or series of projects. Funds to assistadditional hospitals and institutions will berequested in the future .

By the December deadline, 101 of the 289eligible State mental hospitals and 65 of the134 State institutions for the mentally re-tarded had submitted applications . In all, ap-plications from 48 of the 54 States and Terri-tories were received . The proposals are beingreviewed initially by a special committee ofpersons selected for their experience in theoperation of mental hospitals and institutionsfor the retarded and later will be reviewed bythe National Advisory Mental Health Council .

Among the project proposals are : special-ized intensive treatment programs for emo-tionally disturbed children and adolescents,for the aged, or for the seriously regressedchronic patient ; hiring key staff to developalternatives to full inpatient care ; and de-veloping pre- and post-hospital services whichwill bring about more effective use of inpatientfacilities .

This grant program is being administered bythe Community Research and Services Branch(formerly Research Utilization Branch) in co-operation with the regional offices of DHEW .

INSERVICE TRAININGPROGRAM

A total of $3.3 million will support a newprogram of inservice training of personnel in

FEDERAL LEGISLATION

State mental hospitals and institutions for thementally retarded during fiscal year 1964 .Approximately 225 hospitals and institutionshave applied for the NIMH grants, funds forwhich were included in the 1964 appropriationfor the Department of Health, Education, andWelfare.

The new program will enable about one-third of the State mental hospitals and insti-tutions for the retarded to receive up to$25,000 each during the first year of the pro-gram, with at least one grant in operation ineach State . It is hoped that funds to expandthe program will become available in succeed-ing,years .

The long-range objectives of the programare to increase the effectiveness of staff in theseinstitutions and in other community mentalhealth-centered agencies, and to translaterapidly increasing knowledge into more effec-tive services to people. Because personnelsuch as psychiatric aides, attendants, houseparents and others involved in direct patientcare constitute such a large and importanttreatment resource, the first major support isbeing extended to this category .

Grant requests are being considered ini-tially by a new subcommittee of the MentalHealth Training Committee and will later bereviewed by the National Advisory MentalHealth Council .

In connection with the new program, sevenregional conferences were held throughout thecountry in which more than 700 State leadersincluding governors, legislators, heads of men-tal health and mental retardation agencies, anduniversity heads and staff participated . Con-ferees discussed program planning for inserv-ice training and broad questions of currentthinking and practice in this area . They alsoexplored ways in which State mental healthagencies, colleges and universities, and theNIMH can work together to formulate moreadequate inservice training programs .

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This program is being administered by theTraining Branch of NIMH in cooperation withHEW regional offices .

FACILITIES AND SERVICES FORTHE RETARDED

Two important pieces of legislation whichwill benefit the mentally retarded were enactedby the 88th Congress .

Titles I and III of the Mental RetardationFacilities and Community Mental HealthCenters Act of 1963 (Public Law 88-164)authorize $126 million for the construction ofresearch centers and facilities related to mentalretardation between fiscal years 1964 and 1967and $53 million for the training of teachersof handicapped children and for research anddemonstration projects in this area betweenfiscal years 1964 and 1966 .

Under Title I, $26 million is authorized forthe construction of research centers, $32 .5

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Program

Construction of research centers .

Construction of university-affiliated fa-cilities .

Construction grants for facilities formentally retarded.

Training of teachers of handicappedchildren .

Research and demonstration projects inthe education of handicapped children .

million for the construction of university-asso-ciated facilities, and $67 .5 million for grantsto the States for the construction of facilitiesfor the care and treatment of the mentally re-tarded . In order to receive the constructiongrants, the States must present a constructionprogram based on a Statewide inventory ofexisting facilities and survey of need . It mustalso indicate the priority order of projects .

Title III authorizes $47 million for trainingteachers of handicapped children-includingthe mentally retarded, emotionally disturbed,and physically handicapped-for fiscal years1964 through 1966, and $2 million a year forthe same period for research and demonstra-tion projects relating to the education of hand-icapped children .The 1964 supplemental appropriation for

the Department of Health, Education, andWelfare included funds for the first year of thenew program, for which the following units ofthe Department of Health, Education, and Wel-fare have administrative responsibility :

DHETE Unit

Division of Research Facilities andResources, NIH, in cooperation withNational Institute of Child Healthand Human Development, bothPublic Health Service.

Division of Hospital and MedicalFacilities, Bureau of State Services,PHS.

Division of Hospital and MedicalFacilities, Bureau of State Services,PHS.

Division of Handicapped Children andYouth, Office of Education .

Division of Handicapped Children andYouth, Office of Education .

The Maternal and Child Health and MentalRetardation Planning Amendments of 1963(Public Law 88-156) encompass four pro-grams related to mental retardation :

1 . Expansion of existing programs ofmaternal and child health and crippledchildren's services, with funds to beincreased by steps from $50 million infiscal year 1964 to $100 million in1970 and afterwards .

2. A new $110 million program of grantsfor maternity care projects designed toprevent mental retardation .

3. A new program of $8 million a yearin grants or contracts for research inmaternal and child health and crippledchildrens' programs .

4. A one-time grant to the States to en-courage planning. A total of $2 .2million is authorized to assist in devel-oping public awareness of the problemsof mental retardation, coordinatingexisting resources, and planning otheractivities leading to State and com-munity action to combat mentalretardation .

FEDERAL LEGISLATION

The 1964 supplemental appropriation forthe Department of Health, Education, and Wel-fare also included funds to get these programsunder way . The first three programs will beadministered by the Division of Health Serv-ices of the Children's Bureau, Welfare Ad .ministration, and the planning grants by theDivision of Chronic Diseases, Bureau of StateServices, Public Health Service .

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COMMUNITY MENTAL HEALTHSERVICES ACTS

Three States-Michigan, North Carolina,and Colorado-passed Community MentalHealth Services Acts in 1963, raising the totalnumber of States with such laws to 18 . Sev-eral other States amended their acts .

MICHIGAN's new law provides for Statematching grants to localities ranging from aminimum of 40 percent to a maximum of 60percent of local expenditures . The grantsmay not exceed $1 per capita of the popula .tion served by the local program . Over a5-year period, State-administered clinics areto be turned over to local control and soeventually will become eligible for participa-tion in the State matching program .

State grants to localities may be used to helpsupport inpatient and outpatient diagnosticand treatment services ; rehabilitative services ;consultative services to courts, public schools,and health and welfare agencies ; informationand education services ; and cooperative pre-ventive services with public health and othergroups .NORTH CAROLINA's law provides for

joint operation of local community mentalhealth clinics by the new State Department ofMental Health and the local mental health au-thority, representing the local governmentalunit. State funds will pay for two-thirds ofthe first $30,000 of the approved budget of thelocal mental health authority and half of theremainder .

The North Carolina law is unusual in the

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In The Statesamount of authority it gives to the State Men-tal Health Department . According to the law,the local participating clinics will operateunder the "supervision" of the department,and the appointment of a clinic director re-quires the approval of the State Commissionerof Mental Health .The COLORADO law, which differs even

more from the typical Community MentalHealth Services Act, makes it official policy forthe State Department of Institutions to pur-chase services from local community mentalhealth clinics, thus giving legal sanction to asubsidy program already in effect . Duringthe first 3 years of clinic operation, the Statemay pay 75 percent of hourly costs of services,and afterwards, 50 percent . The State De-partment of Institutions was also authorizedto set standards for participating clinics .

Among the States amending their Com-munity Mental Health Acts was NEW YORK,which became the first State to removethe per capita ceiling on State reim-bursement for local community mental healthexpenditures . Under the revised law, theState matches local expenditures, dollar fordollar, without limit . Safeguards are pro-vided to insure that the additional funds willexpand local programs in accordance withthe State Mental Health Commissioner's planfor State-local mental health services .

In CALIFORNIA, State reimbursement tolocal mental health programs (Short-DoyleAct) will be raised from 50 to 75 percent inthose counties which expand their programsto specified levels . NEW JERSEY raised the

ceiling on State matching of local expendi-tures from 20 to 25 cents per capita .CONNECTICUT's Community Mental

Health Act had been limited to psychiatricclinics for children ; the 1963 law expandsState support to include clinic services foradults .

ILLINOIS legislation authorized localitiesto levy an annual tax of one-tenth of 1 percentof their taxable property, to be used to estab-lish and operate community mental healthfacilities . Approval of the tax through areferendum is required. Under previouslegislation the State Department of MentalHealth already had authority to make grants-in-aid to localities .

SERVICES FOR CHILDREN

Two State legislatures approved programswhich will benefit special groups of children .

In CALIFORNIA, special educational serv-ices will be provided for "culturally disad-vantaged" children . The State Departmentof Education was authorized to provide grantsto local school districts for "compensatoryeducation" programs, including broadening ofcultural experience, stimulation of educationaland cultural interests, guidance and counsel-ing, work with community agencies, individu-alized instruction, and remedial assistance .The ILLINOIS legislature approved a $6 .8

million matching program to encourage schooldistricts to develop special programs for giftedchildren . Current plans call for establishingdemonstration centers and experimental proj-ects and for training specialists who will be-come experts in counseling gifted children .

NEW FACILITIES AND SERVICES

A 1963 law in MISSOURI authorized theestablishment of three mental health centers :Western Missouri Mental Health Center inKansas City, Mid-Missouri Mental Health Cen-ter in Columbia, and Malcolm Bliss Mental

725-395 0 - 64 - 2

STATE LEGISLATION

Health Center in St . Louis, all to be operatedby the Division of Mental Diseases of the StateDepartment of Health and Welfare . The fa-cilities are to serve as receiving and intensivetreatment centers. When they are in opera-tion, it is planned that all patients in the Statewill be admitted to one of them, with the Statehospitals receiving only those patients who donot respond to treatment at the centers . Thelegislation was accompanied by a $9 millionappropriation .

Legislation in OHIO provides for outpatientservices at all State mental hospitals . The newlaw states that any person, including ex-mentalhospital patients, may apply to the hospital for"therapy and medication." Services will in-clude individual and group therapy, day care,medication, activity and industrial therapies,and vocational rehabilitation . In several hos-pitals Community Services Units have alreadybeen established and staffed . Gradually, alloutpatient services of the mental hospitals arebeing consolidated in these units .

ALCOHOLISMThe trend to strengthen State organization

of alcoholism programs was reinforced byaction in four States. The MONTANA legis-lature set up an Alcoholism Service Center aspart of the Montana State Hospital. Therehad been a small alcoholism program at theState hospital, and the State Board of Healthhad been responsible for alcoholism educa-tion . In TENNESSEE, legislative action cre-ated an alcoholism program in the State De-partment of Mental Health and provided anappropriation of $25,000. Under the newprogram, arrangements have been made infour of the State hospitals to accept and treatalcoholic patients, and mental health clinicshave also agreed to treat such patients .

In WEST VIRGINIA, a new law created aDivision of Alcoholism in the Department ofMental Health and appropriated $25,000 for

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its activities. Formerly, the Department hadhad legal responsibility for such a program butno clear mandate. The ILLINOIS Depart-ment of Mental Health was authorized to makegrants-in-aid for the care, treatment, and re-habilitation of alcoholics and for educatingthe public about alcoholism. Grants-in-aidfor alcoholism had previously been limited toresearch .

DRUG ADDICTION

CONNECTICUT passed a law providing forthe admission of narcotic addicts to separatefacilities in State mental hospitals . Admis-sion may be voluntary or by court commitment .A new OKLAHOMA law directs the StateDepartment of Mental Health to establish a

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STATE LEGISLATION

room or ward for the treatment and rehabili-tation of minors who are drug addicts .

In MASSACHUSETTS, the legislature au-thorized the establishment of a Drug AddictRehabilitation Board . The Commissioners ofCorrection, Mental Health, and Public Healthare administering the program which will bein-but not under-the Department of PublicHealth. The board has power to appoint aDirector of Drug Addict Rehabilitation and toestablish a State center in any public or privateinstitution by contracting for services . Ad-dicts may enter the institution on a voluntaryor civil commitment basis or through thecourts. The sum of $93,000 has been appro-priated for the first year's operation of theprogram .

What's GoingOnHOSPITAL POPULATION DROPSAGAIN

For the eighth consecutive year, the residentpatient population in the Nation's State andcounty mental hospitals decreased, accordingto the NIMH Biometrics Branch . The 1963figure of 504,947 resident patients in thesehospitals represents a decrease of 2.1 percentfrom the 1962 figure .

Since the downward trend began in 1956,there has been a reduction of 53,975 or 9 .7percent in the hospital population-an averagedecline of 1 .2 percent per year .Admissions, on the other hand, continued

to rise-from 267,068 in 1962 to 285,244 in1963-a jump of 18,176 patients or 6 .8 percentof total admissions. This upward trend beganin the mid-1940's .

Also rising was the number of net releases(live discharges from the hospital to the com-munity or to other inpatient facilities) . Be-tween 1955 and 1963 the number of net re-leases almost doubled-rising from 126,498to 247,228 .

The number of full-time personnel in theState and county mental hospitals stood at194,516 at the end of 1963-a ratio of 2 .6resident patients per full-time employee. Thiscompares with 146,392 full-time personnel in1955, a ratio of 3.8 resident patients per full-time employee .

WHAT'S GOING ON

Maintenance expenditures for the publicmental hospitals have also continued to climbduring this 8-year interval-from $618,087,-247 ($3.06 per resident patient per day) in1955 to $1,084,713,931 ($5 .81 per residentpatient per day) in 1963 .

COMPENSATED WORK ASTHERAPY HELPS PATIENTSIN VARIOUS SETTINGS

The success of a number of work therapyprograms in which the patient is paid for hiswork was documented at a recent workshopat the Institute of the Pennsylvania Hospital,Philadelphia . This workshop was one of aseries being held with support from SmithKline and French Laboratories .

The program at the Brockton, Mass ., Vet-erans Administration Hospital was describedin detail as a means of stimulating interestamong mental health professionals in ini-tiating compensated work therapy programsin other settings .

The Community-Hospital-Industry Rehabili-tation Project (CHIRP) at Brockton wasstarted early in 1961 following a trip to Europeby two Veterans Administration psychiatristswho were impressed with the effectiveness ofcompensated work programs there in aidingthe rehabilitation of long-term mental patients .

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A specialist in physical medicine and re-habilitation was assigned to make contactswith private industry in the area to secure sub-contracts for work to be done in the hospitalby patients. The type of work found mostsuitable has been assembling, burring, simplegrinding, inspecting and wrapping . Often afactory does not have enough space or person-nel to perform these operations on its own andwelcomes an opportunity to subcontract thework .

All CHIRP candidates must be referred bya physician. After starting in the program,they usually reach the production standard in1 to 14 days . When this is achieved (or ap-proached within 80 percent) the worker ispaid an hourly wage of $1 .25, the prevailingminimum in the area . A realistic factory set-ting is created, including time clocks and coffeebreaks, and factory discipline is expected .

Each patient accepted in CHIRP continuesin the program for 60 days. If he is not readyfor discharge, he may continue for another 60days . In the first 21 months of operation(through March 1963), 192 patients were as-signed to the program ; there were 24 remain-ing in it as of April 1, 1963 . A total of 121patients had been separated from the hospitalwith medical approval ; only 6 of these werereadmitted .Several other compensated work programs

were also described .At the Veterans Administration Mental

Hygiene Day Care Center, Providence, R .I .,a program similar to CHIRP is in existence aspart of a day care program . An average of25 patients participates three times a week .Designed to help people who are "salvage-able," the program includes males with chronicpsychiatric conditions who have not workedfor at least 3 months. The emphasis is onpreventing hospitalization of the patients . Atthe same time, an effort is made to improvetheir home situation . Once the patient has

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met the production standard, efforts are begunto place him in a job .

Rosewood State Hospital in Maryland, aninstitution for the mentally retarded, began anew contract work program more than a yearago . It was found that a planned sequenceof learning was necessary, and only contractswithout a time factor were accepted . In addi-tion, Rosewood has been sending out womenpatients to work in factories in the community .In one such instance a rush call for 10 factoryworkers was received, and the staff acceptedit with a great deal of apprehension . An in-structor was sent along to the factory with thewomen to give them initial assistance and sup-port . After the first few days, the women inthe program were able to manage the timeclock and other details, and after a week theybehaved like the other employees. After afew months, the hospital was able to recall theinstructor, and by the end of a year the womenhad lost their "retarded" behavior and hadbeen completely assimilated in the jobs. Atpresent, Rosewood has 60 women who havebeen "cleared" for day work in the community,and 25 go out each week .

The program at Philadelphia State Hospitalincludes a PREP (Preparation for Return toEvaluation and Production) shop for patientswho need to reinforce work habits and over-come dependency feelings before returning tothe community . After a 2-week trial period,the patients are evaluated by the medical staff

and if found qualified, are transferred to theproduction shop . Patients usually meet pro-duction norms on the subcontract factorywork in 2 to 3 months .The Jewish Employment and Vocational

Service, Philadelphia, had a job placementprogram of long standing but found that manyof the people it placed could not keep theirjobs. To solve this problem it set up a short-term sheltered workshop to enable participantsto learn social skills. The workshop occupiesa floor of an industrial building, and the peopleconsider themselves workers. During the first4 weeks the worker is given work samples,graduated in difficulty, to discover his prefer-ences and his achievement level . At the be-ginning there is a very benign atmosphere butlater it is firmer, with an insistence on adequateinterpersonal relationships . Of 339 personsreferred, all of whom had previously beenjudged unemployable, 55 were placed in posi-tions and still were holding their jobs at a 3-or 6-month followup .

"CRISIS UNIT" RETURNS MOSTPATIENTS TO COMMUNITY

A high percentage of patients admitted tothe intensive treatment unit at Northern StateHospital, Washington, are able to return to thecommunity after an average stay of 22 days .Treatment in the unit is based on encouragingthe patient to be as self-sufficient and self-directing as he can .

The unit admits all patients under the ageof 60 entering the hospital from SnohomishCounty. The first phase of the treatment pro-gram is characterized by rapid service : thepatient is greeted by a receptionist who servescoffee and calls the doctor, who usually arriveswithin 10 minutes. The doctor interviews thepatient and does a physical examination . Thepatient then goes with a nurse to choose aroom . In almost all cases, somatic treatmentis begun within 2 hours of the patient's arrival .

WHAT'S GOING ON

He is told to rest, sleep, eat, and postpone anyeffort to solve his problems until he feelsbetter .When acute symptoms have subsided, the

patient is transferred to the readjustment sec-tion . Here he abruptly enters a quite differ-ent situation, one which attempts to approxi-mate living in the community. The programis designed to convey to the patient the expec-tation that he is a responsible, capable, self-respecting person . The patients keep and taketheir own medicines . They are expected togo home every weekend and to make their ownarrangements for doing so. They decidewhether they wish to participate in industrialor occupational therapy and hospital recrea-tional activ'ties . Each patient is assigned acounselor with whom he discusses plans andproblems related to returning home . In thecounseling, emphasis is placed on workingjointly with the patient and his family, andmost families have participated in this plan-ning activity .After the patient has returned home,

a detailed report of his hospital treatment isforwarded to his family . physician, and anearly appoinment with the family physicianis recommended . The Snohomish CountyHealth Department has a social worker whoacts as a mental health consultant for thecommunity, and a resource coordinator who isin touch with the public health nurse, publicassistance department, vocational rehabilita-tion facilities, etc. When necessary, the re-source coordinator arranges for the use of theappropriate service to the patient returning tothe community .

Of the 72 patients admitted to the intensivetreatment unit during a 6-month period, 66returned to the community and 6 were trans-ferred to other facilities, including other sec-tions of the State hospital .

This project is an example of the use ofMental Health Project Grant funds to test outinnovations in treatment programs .

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INSURANCE COVERAGE FORMENTAL ILLNESS

FEDERAL PLANS IMPROVEBENEFITS

Five of the health insurance plans partici-pating in the Federal Employees Health Bene-fits Program began offering some benefits forpsychiatric disorders for the first time Novem-ber 1, 1963, and four other plans improvedsuch benefits on that date, according to anannouncement by the Civil Service Commis-sion, which administers the program .

Among the plans with expanded psychiatriccoverage is Group Health Insurance, Inc., ofNew York City, which now provides both in-patient care and care outside the hospital, in-cluding individual and group psychotherapy .The feasibility of insuring this kind of cover-age was demonstrated in a 30-month researchproject at Group Health Insurance, completedin 1962 and supported by NIMH funds. TheKaiser Foundation Health Plan of SouthernCalifornia, in addition to new benefits whilethe patient is hospitalized for psychiatric ill-ness, also provides 75 percent of the first $120of charges for outpatient evaluation .The Government-wide Service Benefit Plan

(Blue Cross-Blue Shield) increased its in-patient benefits for nervous and mental dis-orders to 120 days under the high option and30 days under the low option, the same num-ber of days allowed for other illnesses .The fourth contract year for the program

began November 1 with 38 different plansparticipating, including 2 Government-wide,13 sponsored by employee organizations, and23 direct-service plans . Most of the employeeorganization plans and the two Government-wide plans (Blue Cross-Blue Shield andAetna) have offered substantial benefits formental illness since the inception of the Fed-eral employee program .

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The Civil Service Commission, in announc-ing the new psychiatric coverage, said it wasgratified at the progress made in this area,which came about in response to the late Presi-dent John F. Kennedy's Special Message onMental Illness and Mental Retardation . TheCommission anticipates that psychiatric bene-fits will be improved in future years as carriersgain experience .

AVERAGE LENGTH OF STAY 10 DAYS

Reporting on experience under the Govern-ment-wide Service Benefit Plan (Blue Cross-Blue Shield), "Inquiry," a Blue Cross Asso-ciation publication, noted that under the high-option plan for the period November 1, 1961to October 31, 1962, the average length of stayfor mental disorders was 10 .0 days comparedto 6.7 days for all conditions . Mental dis-orders accounted for 2 .6 percent of all admis-sions, 3 .8 percent of all hospital days, and 3 .1percent of the total amount of hospital charges .

CLEVELAND BLUE SHIELD UPS IN-HOSPITAL PAYMENT

What may be the first Blue Shield plan of-fering premium benefits for intensive psy-chiatric care in the hospital is now in effect inCleveland after several years of negotiationsbetween the Cleveland Academy of Medicineand Blue Shield . Under the new agreement,Blue Shield will reimburse subscribers forphysicians' services for treatment in a generalor private mental hospital for major mentaldisorders in the following amounts : $25 forthe first day and $10 for each subsequent day,up to 30 days . Reimbursement then revertsto $44 a day for the remainder of the benefitperiod, which is usually 120 days .

To cover hospital expenses, Blue Cross inCleveland offers full reimbursement for a maxi-mum of 120 days if the patient is treated in ageneral hospital and $10 a day towards thecosts in a private psychiatric hospital .

DAY HOSPITALS SHOW RAPIDGROWTH

The emerging importance of the day hos-pital in the treatment of mental illness wasemphasized at a Day Hospital National Work-shop held in Kansas City, Mo ., September 16-18, 1963, by the Greater Kansas City MentalHealth Foundation under an NIMH MentalHealth Project Grant .

In a day hospital program, the patient livesat home but goes to the day hospital for treat-ment and planned activities from Mondaythrough Friday (or sometimes fewer days),usually from 9 until 4 or 5 o'clock .

Reports on a number of such programs al-ready in existence suggest that roughly halfthe mental patients who formerly would havebeen admitted to a 24-hour treatment facilitycan be treated in a day hospital . This kindof care is less expensive than 24-hour treat-ment, decreases the tendency toward depend-ency and regression, and retains the patient'sties with family and community .

"Once a day hospital is established, thedoor to the community seems to open moreeasily, and it never closes," Milton Greenblatt,M .D., Superintendent of Boston State Hospital,noted in his lead-off speech at the workshop.

A report to the workshop on the first na-tional survey of psychiatric day-night servicesrevealed that as of May, 1963, there were 114such programs in the U.S. in which a psychia-trist assumed medical responsibility for allpatients . The major growth in the numberof day hospitals has taken place in the past3 years; only 37 were in existence prior to1960 .The study, undertaken by the NIMH Bio-

metrics Branch, showed that half of the centerswere located in four States-California, NewYork, Ohio, and Pennsylvania . Of the 114,85 offered day services only, 27 both day andnight services, and 2 only night services

WHAT'S GOING ON

(where the patient goes to the hospital in theevening for treatment and activities and sleepsthere, but carries on his normal activities awayfrom the hospital during the day) . Almost3,600 patients were under care in such servicesduring the week of May 19, 1963-2,900 inday care and 700 in day-night care .

Forty-eight of the facilities were connectedwith a mental hospital and 16 with a generalhospital . In addition to 7 centers affiliatedwith a community outpatient psychiatric clinic,4 with a community mental health center and7 with other community agencies, there were19 day centers associated with Veterans Ad-ministration outpatient clinics .

Among the reports at the workshop was oneby Alan M . Kraft, M.D ., Director of the FortLogan Mental Health Center, part of the Colo-rado mental hospital system serving residentsof Denver . Dr. Kraft told of a study of 235patients admitted to the center from July 1 toDecember 31, 1962 . Of the 235 patients, 116(49 percent) were admitted as 24-hour pa-tients and 119 (51 percent) as day patients,suggesting that about half the patients enteringa State hospital can be admitted to . a day set-ting . A study of the characteristics of the twogroups of patients revealed that while thoseadmitted as inpatients were more disturbedand more severely impaired than the day pa-tients, many who were very seriously impairedcould be treated in the day hospital .

13

Among the other speakers at the workshopwas H. Douglas Bennett, M.D., physician ofthe Bethlem Royal Hospital and Maudsley Hos-pital, London, England, who reported on thesharp acceleration in the growth of day hos-pitals in Great Britain in the past few years .The first day hospital in Great Britain opened15 years ago and in 1959 there were only 38 .But by 1961 there were 116 and by the end of1962 there were 153, treating a total of 8,840patients during the year .

Great Britain is planning to reduce thenumber of inpatient beds for mental healthservices from 30 per 10,000 population to 18per 10,000 population within 15 years . Muchof this planned reduction is based on the in-creasing use of day hospitals and day centers .The latter are independent of the hospital butoffer a limited amount of medical supervision .It is expected that 103 day centers, which willprovide a "sheltered workshop" type of setting,each with a capacity of 30-40 patients, will bebuilt by 1975 .

Some of the issues and questions raised atthe workshop were :

1. Organization structure and its implica-tions for the kind of patient to betreated and the orientation of the treat-ment program-day programs as partof established general and/or mentalhospitals vs . physically and adminis-tratively separate facilities .

2. The modification of traditional rolesof the various mental health profes-sionals in the day hospital program .

3. Homogeneity vs. heterogeneity of pa-tients according to age, diagnosis, andsocio-economic status .

4. Role expectations of patients in a "hos-pital without beds ."

5. Optimum size of patient groups .6. Advantages and disadvantages of com-

bining day patient and inpatient ac-tivity programs .

14

Attending the workshop were about 275mental health professionals from 32 States,some of whom are now actively engaged inday hospital programs and others represent-ing institutions or agencies contemplating dayhospitals . The proceedings will be publishedthis year .

HERE AND THERE IN THE STATESCALIFORNIA PSYCHIATRISTS MAKEHOME VISITS

A recent survey of 266 psychiatrists innorthern CALIFORNIA revealed that 90 per-cent had made a home visit at some time intheir private practice and that nearly half hadmade two or more home visits in the year priorto the survey.

Private psychiatrists made most of theirhome visits to patients they were seeing forthe first time. These were usually patientswho were markedly disturbed and whosefamily or family physician requested a psychi-atric evaluation at home .

The survey indicated that when a patient-particularly an acutely ill one-is seen at home,a more complete and accurate evaluation of hiscondition and his environment is obtained thanin the psychiatrist's office . In the casesstudied, it appeared that most of the patientsbeing seen for the first time and most of thosealready in office treatment avoided hospitaliza-tion as a result of the visit .

FLORIDA EMERGENCY SERVICEPREVENTS HOSPITALIZATION

Impressive results in preventing hospitaliza-tion as a result of a county-wide EmergencyPsychiatric Service are reported lby the PinellasCounty (FLORIDA) Health Department.Several emergency teams, each consisting of aphysician and a public health nurse, with psy-chiatric consultation available, have beenorganized and answer requests for aid anyhour of the day or night .

During the first year of operation, 1,215emergency calls were received, the majorityfrom the patient's family, a neighbor or friend,the police, or a physician . Results includedthe following :

•

Forty-seven percent of patients receiv-ing emergency care remained at home,receiving treatment at a clinic or froma family physician . Eight percentwere referred to nursing homes, and44 percent received evaluation and/ortreatment in local general hospitals .

•

New admissions to State hospitalsfrom Pinellas County were reduced by15 percent, although the population ofthe area increased .

• The team found it was not unusual forother family members to be in needof psychiatric help . Home visitingproved to be a new, relatively in-expensive, and effective case-findingtechnique .

•

Jail detention of the mentally illvirtually eliminated .

was

AVERAGE COST OF TREATINGMARYLAND PATIENT FALLSThe MARYLAND Department of Mental

Hygiene reports that despite rising daily costsfor maintenance expenditures, the total cost oftreating a mental patient in the State hospitalshas dropped 40 percent in the past 10 years .

WHAT'S GOING ON

This dramatic drop is due to the increaseddischarges and shorter periods in the hospitalresulting from improved treatment methods .The average total cost of treating a patientfrom admission to discharge was cut from$5,207 in 1952 to $3,109 in 1962 .

"TEACHER-MOMS" AID NEW YORKCHILDREN

The public school system in suburbanElmont, NEW YORK, is using "teacher-moms"

to educate and treat severly emotionally dis-turbed children who cannot be handled inregular classrooms . The "teacher-moms" arewarm, emotionally stable mothers who arewilling to contribute two mornings a week toworking with the children . A local synagogueand Kiwanis Club provide classrooms and fi-nancial support .

The key to progress in the special classesappears to be the one-to-one relationship withthe children and the communication by the"teacher-mom" of warmth and affection ; forexample, she holds the child on her lap whenshe thinks this is necessary .Of the 21 children in the program during

its first 3 years, 11 have been returned toregular classrooms . Because of the relativelylow cost of the program-$680 per pupil forone school year-it has a potential for use ona widespread basis .

15

MANHATTAN AFTERCARE CLINICSHOWS DAY CARE EFFECTIVENESS

Day hospital treatment was as effective asinpatient treatment for relapsing ex-hospitalpatients, a recent study at the Manhattan After-care Clinic, NEW YORK City, indicated . Agroup of acutely disturbed relapsing ex-pa-tients was treated in the day hospital as part ofa research project and the results comparedwith those from a similar group returned to theState hospital for treatment .

Among the findings of the study, which wasfinanced by an NIMH grant, were :

1. Acutely psychotic symptoms can bebrought under control in a day hos-pital and remission of symptomsachieved within 7 weeks .

2. Day hospital patients are able to re-turn to gainful employment or homeresponsibilities as soon as, or soonerthan, inpatients . After 2 months oftreatment, 40 percent of the day hos-pital patients were employed as com-pared with 10 percent of the State hos-pital patients . Day hospital patientsdid not give up their job ; they tooksick leave instead .

3. Remission of symptoms among the dayhospital patients lasted as long as forthe group which received inpatienttreatment.

RHODE ISLAND HOUSEWIVES GETHELP FROM REHAB SPECIALISTS

The RHODE ISLAND State Division of Vo-cational Rehabilitation and the University ofRhode Island have teamed up to assist men-tally ill housewives in the critical period oftransition from hospitalization to home life .More than 300 women have participated in thenew program thus far .

Just prior to discharge, women patients fromthe Neuropsychiatric Department of ChapinHospital are given one or more demonstrations

16

on how to simplify their housework by the uni-versity's home management specialist . Topicsrange from ironing to household budgeting .Another faculty member discusses problemsrelated to child rearing, family relationships,and meeting emotional needs . Films andsmall group discussions accompany the talks .

After the patients return home, they are pro-vided with individual homemaking instruc-tion and other services such as vocationaltraining, job placement, and demonstrationmarketing trips .

TEXAS HOME TOWN PROGRAMEXTENDED

An experimental program of treating a largeproportion of mental patients in their home .town (El Paso, TEXAS) instead of ina distant State mental hospital has proved sosuccessful that the 1963 State legislature ap-propriated $546,000 for the next biennium toextend the program to other communities .

The El Paso County Hospital is used as atreatment facility for many patients who pre-viously would probably have been sent to BigSpring State Hospital, 400 miles away . Thecounty furnishes the beds, nursing care, medi-cine, and outpatient clinic space ; the Statepays for professional services, particularlypsychiatrists' fees . Local psychiatrists decidewhich patients should be treated at the countyhospital and also carry on their treatment .

In a 7-month period, only 97 patients fromEl Paso were admitted to Big Spring State

Hospital, although based on previous experi-ence at least 324 patients would have been ex-pected . Stay in the county hospital averaged9 days . Through the outpatient clinic, manymore patients were reached than formerly .Also, aged patients were maintained in theirown homes and in nursing homes so that fewhad to enter the State hospital .

IDAHO FAMILY CARE PROGRAMSUCCESSFULAn NIMH Mental Health Project Grant

assisted IDAHO to develop a successful familycare program at its State Hospital, North, andthe program is now being financed from Statefunds .

During the pilot phase of the project 93patients, of whom 12 were mentally retarded,were involved . All were considered ready fordischarge but still in need of fairly closesupervision. After placement in family care,only 18 of the 93 had to return to the hospitalfor continued care ; all the rest were reported tohave made successful adjustments in thecommunity .

WHAT'S GOING ON

Often two or three patients were placed withthe same "sponsor" family. It was found thatwhen placed in the same home with other ex-patients, most of the patients made a betteradjustment than when living completely apartfrom ex-patients .

CONNECTICUT DEVELOPS MENTALHEALTH SERVICE CORPS

As an outgrowth of the CONNECTICUTproject in which students from six collegesparticipated in a student-companion programat Connecticut Valley Hospital, the State De-partment of Mental Health last summer devel-oped a Mental Health Service Corps .

Thirty-three carefully selected students,after special training, served for a month at aState hospital and a month at Camp Laurel,the Department's camp for mental hospitalpatients . Paid only a modest amount, thestudents performed so well that Departmentofficials are eager to expand the program nextsummer.

17

18

Calendar of

Apr. 8-10 National Council on Alcoholism New York City

Apr. 9-11 American Medical Association : Confer- Aurora, Ill .ence on Mental Retardation .

Apr. 22-24 Academy of Religion and Mental Health__ New York City

Apr. 26-May 2__ NATIONAL MENTAL HEALTH WEEK

Apr. 30-May 1__ President's Committee on Employment of Washington, D .C .the Handicapped .

May 4--8 American Psychiatric Association Los Angeles

May 5-9 American Association on Mental Defi- Kansas City, Mo .ciency .

May 24 National Association of Social Workers : Los AngelesAnnual Institute on Social Work in Psy-chiatric and Mental Health Services .

May 24-29 National Conference on Social Welfare Los Angeles(Annual Forum) .

June 8-10 National Association of State Psychiatric St. LouisInformation Specialists .

June 15-19 American Nurses Association Atlantic City

June 19-20 American Geriatrics Society San Francisco

June 21-25 American Medical Association San Francisco

Aug.3-7 World Federation for Mental Health Berne, Switzer-land

Events-1964CALENDAR OF EVENTS

19

Aug. 17-22 First International Congress of Social London, EnglandPsychiatry.

Aug.24-27 American Hospital Association Chicago

Aug. 30-Sept . 4- American Sociological Association Montreal

Sept . 3-9 American Psychological Association Los Angeles

Sept. 28-Oct . I-- American Psychiatric Association : Mental DallasHospital Institute .

Oct. 5-9 American Public Health Association New York City

Oct. 7-10 National Association for Retarded Chil- Oklahoma Citydren .

Oct. 9-10 American Medical Association : Council Chicagoon Mental Health, National Congress(Theme : Community Mental HealthCenters) .

Oct. 22-30 American Occupational Therapy Associa- Denvertion .

Oct. 29-31 Gerontological Society Minneapolis

Nov. 8-11 National Rehabilitation Association Philadelphia

Nov. 18-21 National Association for Mental Health___ San Francisco

Nov. 19-22 American Anthropological Association____ Detroit

Dec. 1-2 National Social Welfare Assembly New York

CurrentReadingOF SPECIAL INTERESTTHE PREVENTION OF HOSPITALIZA-

TION. A detailed report on the study "Pre-vention of Hospitalization of Psychotic Pa-tients Referred to the Massachusetts MentalHealth Center," by Drs . Milton Greenblatt,Robert F. Moore, Robert S . Albert, and MaidaH. Solomon, Grune & Stratton, New York,1963, 182 pages . $7.50 .

In the belief that large numbers of the men-tally ill are accepted and admitted to mentalinstitutions with too little attention given to thepossibility of care in the community, NIMHgrantees conducted a study among hospital re-ferrals to determine how many could be suc-cessfully treated outside the hospital .For this purpose a Community Extension

Psychiatric Service was created at the Massa-chusetts Mental Health Center (formerly theBoston Psychopathic Hospital) . The Servicewas staffed by psychiatrists, psychiatric nurses,psychiatric social workers, and research per-sonnel . During the study, 128 patients cameto the Service by way of the waiting list foradmission to inpatient wards . Half of themwere reported not to require hospitalization,and were managed by other means so that theyremained in the community for at least a year .

Each patient had been referred for full-timeward care . Sixty-two were hospitalized afterdiagnosis and study by the Community Exten-

20

sion Service . The other 66 were not hospital-ized, and of those, 13 were treated in the Cen-ter's day care program 2 or 3 days a week .The other nonhospitalized patients weretreated through such means as individualpsychotherapy, drugs, electric shock therapy,social casework, and other specialized services,such as vocational counseling . The goalswere to explore means of preventing the hos-pitalization of acute mentally ill patients byproviding patients with prompt psychiatric, so-cial service, and nursing attention, and to as-sess the value of those alternative techniquesand resources .

When the Community Extension Service pa-tients were compared with a sample of thoseeither waiting for admission or being treatedin the inpatient wards, no substantial differ-ences were found in diagnosis or history .

As a result of the study, investigators con-cluded that similar units operating in connec-tion with mental hospitals can provide a newfocus of thought and energy on the pivotalquestion of who among the mentally ill requireinpatient treatment .

Among recommendations were : a screening-plus-service program should be instituted as apart of every mental hospital in collaborationwith social agencies and medical authorities incommunities ; hospital psychiatrists should ac-tively participate in deciding on admissions ;

family physicians who refer patients for hos-pital admission because appropriate alterna-tives are either not available or are not consid-ered can benefit from the psychiatric orienta-tion provided by a CES unit ; and finally, sucha unit can be a training milieu for psychiatricresidents and nurses.

GUIDES TO PSYCHIATRIC REHABILI-TATION: A Cooperative Program with a StateMental Hospital. A report of a three-yearproject on rehabilitation of psychotic patientsin a mental hospital, edited by Bertram I.Black, Altro Health and Rehabilitation Serv-ices, Inc., New York, 1963, 96 pages . $2.50.

Initiated by Altro Health and RehabilitationServices in 1958, this rehabilitation projectwas developed in cooperation with the Rock-land State Hospital in the New York StateDepartment of Mental Hygiene and with theNew York State Division of Vocational Re-habilitation in the State Department ofEducation .

The book describes the problems the projectteam encountered in introducing the conceptof rehabilitation into a traditional mental hos-pital program ; states the approaches, bothsuccessful and unsuccessful, that the team tookin its work ; summarizes the results of the pro-gram ; and presents a series of guidelines tothe rehabilitation of psychotic patients basedon the team's experience and analysis .

Pointing out that "no single service can beconsidered rehabilitation," the book declaresthat rehabilitation consists of "hospitalization,psychiatry, casework, vocational counseling,recreational services, employment agencies,sheltered workshops, residential arrangements,and financial support-not necessarily allworking together with the same individual butall integrated into a program in which any,some, or all of them are available for anindividual ."

A major part of the report is devoted to thecomplex procedure involved in considering a

CURRENT READING

patient's readiness for discharge from the hos-pital . Case histories are used to throw lighton the principles and guidelines derived fromthe human experiences described in thereport .

Guides to Psychiatric Rehabilitation is in-tended primarily for use by administrators,psychiatrists, and nurses in mental hospitals ;vocational rehabilitation counselors ; occupa-tional therapists ; and social caseworkers andsupervisors. It will also be useful to psy-chologists, educators, and others who help thementally ill in their rehabilitation and in theirreturn to the community .

BRIEFLY NOTEDBIBLIOGRAPHIES. A number of bibli-

ographies have been prepared by the ResearchUtilization Branch of NIMH and published bythe National Clearinghouse for Mental HealthInformation . Single copies are available freeof charge from the Publications and ReportsSection, NIMH, Bethesda, Md., 20014. Thebibliographies include :

Bibliography on Planning of CommunityMental Health Programs

Bibliography of Informational Publica-tions Issued by State Mental HealthAgencies

Selected Bibliography on Foster Homeand Family Care for Mental Patients

Selected Bibliography on HalfwayHouses

Selected Bibliography on EmergencyPsychiatric Services

Selected Bibliography on PsychiatricDay-Night Services

Selected Bibliography on Mental HealthCommunications

Bibliography of Published Reports ofCompleted Studies Supported by Men-tal Health Project Grants

NEW APPROACHES TO MENTAL RE-TARDATION AND MENTAL ILLNESS.(November 1963 issue of Indicators, monthly

21

publication of the U.S. Department of Health,Education, and Welfare .) Fifty-four pagesof informative articles, illustrated with graphs,relating to : (1) the recent White House Con-ference on Mental Retardation ; (2) legisla-tion recently passed in Congress relating tomental illness and mental retardation ; and (3)programs and activities in these two areas . Alimited supply of free copies of the issue isavailable from the Publications and ReportsSection, NIMH, Bethesda, Md ., 20014.REHABILITATION IN DRUG ADDIC-

TION, A Report on a 5-Year Community Ex-periment of the New York Demonstration Cen-ter (Mental Health Monograph 3) reports anNIMH demonstration project in which addictsdischarged from the U .S. Public Health Serv-ice Hospital in Lexington, Ky., were counseledand referred to community health and welfareagencies . Project findings emphasized theimportance of integrated, long-term com-munity programs and services to provide thestep-by-step support needed by the returnedaddict . Single copies of the 48-page pamphletavailable free of charge from the Publicationsand Reports Section, NIMH, Bethesda, Md .,20014 .HIGHLIGHTS OF DEVELOPMENTS IN

MENTAL HEALTH PROGRAMS, 1962, de-signed for persons concerned with developingand strengthening mental health programs,emphasizes major developments of nationwidesignificance and innovations in State and localmental health services . Among topics coveredare treatment facilities, including communitymental health centers, court decisions, Statelegislation, insurance coverage of mental ill-ness and special problem areas such as agingand juvenile delinquency . Single copies ofthe 57-page pamphlet available free of chargefrom the Publications and Reports Section,National Institute of Mental Health, Bethesda,Md., 20014.NARCOTIC DRUG ADDICTION PROB-

LEMS is the 212-page report of an NIMH sym-

22

CURRENT READING

posium which represented the first full dis-cussion of this subject by all the professionsconcerned with addiction. Public HealthService Publication No . 1050, for sale at $1 .75by the Superintendent of Documents, U.S .Government Printing Office, Washington, D.C .,20402 .THEY RETURN TO WORK . . . The Job

Adjustment of Psychiatrically Disabled Vet-erans of World War II and Korean Conflict,reports the results of a Veterans Administra-tion study of the employment experiences ofveterans with psychiatric disability . Of thesample group of 2,049 veterans studied, includ-ing those with major psychotic disorders, 1,421were found to be employed . The 210-page re-port is available from the Superintendent ofDocuments, U .S. Government Printing Office,Washington, D.C ., 20402, at 70 cents .DIRECTORY OF RESOURCES FOR MEN-

TALLY ILL CHILDREN IN THE UNITEDSTATES, 1964., lists and describes 147 resi-dential and day facilities that provide serviceto seriously disturbed children in separateunits, distinct and apart from adult care . Bothpublic and private resources are listed . The96-page directory, published jointly by the Na-tional Association for Mental Health and theNational Institute of Mental Health, is avail-able for $2 from the NAMH, 10 ColumbusCircle, New York, N.Y ., 10019 .SALARY RANGES FOR PROFESSIONAL

PERSONNEL . . . Employed in State MentalHospitals and Institutions for the MentallyRetarded, September 1963 . Report No. 10,Psychiatric Studies and Projects, published bythe Mental Hospital Service of the AmericanPsychiatric Association . Listed under type ofposition, data are presented concerning num-ber of positions and annual salaries in eachState . The 36-page study is available at $1per copy from the American Psychiatric Asso-ciation, 1700 Eighteenth Street, NW ., Wash-ington, D.C ., 20009 .

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