A PEOPLES' ARMY IN THE FIGHT AGAINST MENTAL ILLNESS

Speech at Annual Luncheon
Mental Health Association of Delaware
Tuesday, May 2nd, 1961
DuPont Hotel, Wilmington, Delaware
by
MIKE GORMAN, Washington, D. C.

Executive Director, NATIONAL COMMITTEE AGAINST MENTAL ILLNESS

As part of its massive six-year study of the problem of mental illness
in this country, the Joint Commission on Mental Illness and Health became
aware early in its deliberations that it had no solid information on how
Americansevaluated their mental health and what they did if they felt
troubled.

The Commission therefore asked the University of Michigan's Survey
Research Center to poll a sampling of Americans to find some answers to these
fundamental questions.

Nearly one in four persons interviewed admitted that he had had a
serious personal problem in which professional help would have been useful.
However, only one in seven actually sought such assistance,

Where did they go for help? 42% consulted clergymen; 29% their family
physicians; 18% psychiatrists and psychologists, and 10% social agencies or

marriage clinics.
page two

As a corollary to the aforementioned study, the Joint Commission assembled
data nationally -- the first time this has been attempted =~ on the supply of
basic health, welfare and psychiatric resources in the 3,103 counties in the
United States. As you can probably surmise, only a small percentage of the
counties had the necessary health and psychiatric resources to meet the needs
of people in trouble.

The Commission monograph, "Community Resources in Mental Health", notes
that "local community leaders are hungry for advice and help on what to do
and how to do it. This interest runs all the way from how to conduct local
studies to advice on what kinds of mental health service and programs to
establish. . . But too many communities are left on their own to work out
pfograms as best they can, They cannot move ahead intelligently without
professional help. Initiative must be taken most logically by the states to
provide consultation in depth for local community planning."

The Commission's special study of psychiatric resources in the schools
comes to similar: conclusions. .The demand is great -- one out of every ten
children needs special educational or psychological services. However, out~=
side of a few of the wealthier city school districts in this country, the
professional personnel to provide these services is non~existent, Furthermore,
training programs designed to equip school teachers with diagnostic and
referral skills are very few in number...

On the basis of these findings and a special, comprehensive study of the
availability of psychiatric personnel in this country, the Joint Commission

came to this forthright conclusion:
page three

"The Joint Commission made an intensive study of the demand for, and
supply of, mental health professional manpower - particularly
psychiatrists, psychologists, psychiatric nurses and psychiatric
social workers. . . Our manpower study concluded, with frank
pessimism, that sufficient professional personnel to eliminate the
glaring deficiencies in our care of mental patients will never

become available if the present population trend continues without

a commensurate increase in the recruitment and training of mental
health manpower. The only possibilities for changing this negative
outlook would require a great change in our social attitudes, and

a consequent massive national effort in all areas of education,
including large increases in the number of mental health personnel. . .

“

However, it is most useful to know the extent and dimensions of a problem,
and the various studies of the Joint Commission clearly point the way to a |
number of solutions.

First of all, the Commission notes the need for a “national manpower
recruitment and training progran, expanding on and extending present efforts
and seeking to stimulate the interest of American youth in mental health work
as a career."

In this recruitment effort, we have the advantage of a great mass of
material which indicates that a large percentage of career decisions are already ~
made by the time a student graduates from high school, For example, recent
studies made in several medical schools indicated that well over 80% of their
students chose a medical career by their seventeenth year,

In that connection, the work of the National Health Council in distributing
more than 100,000 copies of its Health Careers Guidebook in the nation's 30,000

high schools is to be commended. Furthermore, the concentration of the National

Association for Mental Health on careers in mental health is another important

step in the right direction,
page four

While we must devote a great deal of effort to recruitment and training
programs designed to increase the supply of professional psychiatric manpower,
it is sheer folly to think that this will even begin to meet the increasingly
sophisticated demand for psychiatric care at all levels in our communities.

Recognizing this fact the Joint Commission, with its psychiatric and
medical members in full accord, recommended the short-term training of a whole
host of non-medical personnel capable of helping the mentally ill -- clergymen,
teachers, probation officers, public health nurses, public welfare workers,
Séoutmasters, county farm agents, etc.

As an example of this use of non-medical personnel, the Commission cites
the use of educateurs in France in the care of emotionally disturbed or mal-
adjusted children,

The educateur is a combination of therapist and teacher and has been
described as a trained substitute parent. He is given two years of training
providing him with some of the skills of the psychologist, social worker and
special teacher,

Dr. Nicholas Hobbs, who has studied the role of the educateur in France,
notes the healthy tendency t6 "choose among people rather than professions" in
outlining the qualifications of thosehandling various gradations of emotional
disturbance. |

Fundamentally, the use of these trained, non-medical workers demonstrates
a deeply held conviction that mental illness is not something horribly alien,

requiring that its victims be rushed off to an institution in the country.
page five

The very fact that many people with serious emotional problems can feel
free to try and solve them within the limits of the community is evidence that
we in America are overcoming our cruel rejection of them, In England and the
Netherlands, for example, where most mental illness is treated on a home visit,
general hospital or community mental health center basis, there is a much
more realistic appreciation of the thin dividing line between those who break
under stress and those who manage to handle it.

The healthy growth of volunteer programs in this country is evidence that
we are beginning to tear down the walls. The students at Harvard and other
universities in the Boston area who have worked on the back wards of Metropolitan
State Hospital have shown the effectiveness of human kindness in breaking down
the horror and isolation of mental illness.

There has been no gilding of the lily in this program. J. Lawrence Dohan,
the Harvard student who sparked the volunteer program, introduced several
hundred of his fellow students to the back wards of Metropolitan State with
these unvarnished words:

"You are about to see the most shameful, the most wasteful thing in

the country today. People who are sick and miserable just left to

vegetate, Partly, no one knows what to do for them. Mostly nobody

is even trying. They lie of the floor or they sit. They don't do

much else. Most of them don't even have shoes to wear, and many

haven't been outdoors in years. Maybe it's not too late for some of

them. Maybe we can help. But remember this: They are human beings,

just like you and me, They have their hopes, aspirations, their fears.

They're not monsters. They have their problems, just as you and I

have, only theirs are magnified.

"you'll see them now. You'll smell the foul air they must breathe

all day. You'll see the rotten chairg they use and the rags they

wear, As citizens of this country, I want you to know that I hold
each of you personally responsible for this thing."
page six

The dividends from this type of courageous participation have been
enormous.

Over and above improving conditions on the back wards, the volunteers took
an active interest in placing patients ready for discharge to the community --
they met the patient's family, investigated job possibilities and continued to
visit the patients after their release. Recently the group opened a halfway
house to help the patients make the difficult transition from the hospital to
independent community life.

One woman, on the same chronic ward for five years, caught the whole impact
of the program in this simple statement to a volunteer who had worked closely
with her over the years:

"What you did for me was to treat me like a human being. Like someone

you wanted for a friend and could like, What you did for me is too

much to explain,"

I am happy to note that six organizations have combined in Delaware to
appraise the quality and adequacy of Delaware's mental health services.

In your deliberations, I hope you will use the “Suggestions for a Community
Mental Health Survey" developed by the Joint Commission. Approximately 4,000
copies of this suggested survey have been printed and it has already been of
great help in analyzing the resources available in each community.

As you progress with this survey, I hope you will not concentrate too
narrowly upon existing institutions and existing professional manpower.

There are tremendous untapped resources in Delaware -~- in the home, the

churches, the schools, the offices of the, family physicians and in many social

and welfare agencies.
page seven

May I remind you that in the last analysis the state mental hospital is
a monument to failure -- the failure of the community to provide the necessary
conditions for stable emotional living. |

In undertaking the survey, you have an enviable task in charting a new
day for the mentally ill in Delaware.

By so doing, you will also add a great deal to the stature and meaning of

the work of every citizen who lives in this state.

- 30 -