FOR RELEASE
AM'S FRIDAY, FEB. 17

NATIONWIDE EVALUATION OF NEW PSYCHIATRIC DRUGS IS URGENT NEED,

TESTIMONY BEFORE
HOUSE APPROPRIATIONS SUBCOMMITTEE ON LABOR -H.E, W. HEARINGS
ON FISCAL 1957 BUDGET (REP, JOHN FOGARTY, CHAIRMAN)
10:00 A.M., THURSDAY, FEBRUARY 16, 1956
BY |

MIKE GORMAN - Washington, D. C.
Executive Director, NATIONAL MENTAL HEALTH COMMITTEE

(Mr. Gorman is a former newspaperman and magazine writer who has special-
ized in the mental health field for the past eleven years. In 1948 he received the
Lasker Award of the National Committee for Mental Hygiene. That same year his
book, "OKLAHOMA ATTACKS ITS SNAKE PITS" was condensed as a book supplement
in the READERS DIGEST, His new book, "EVERY OTHER BED", a study of the cur-

' rent status of psychiatric research, will be published in April. He has written numer-

ous magazine articles on mental illness. )

Mr. Chairman and members of the Committee:

"The treatment of mental illness is in the throes of a revolution, For the first
time in History, pills and injections (of two inexpensive drugs) are enabling psychia-
trists to (1) nip in the bud some burgeoning outbreaks of emotional illness; (2) treat
many current cases far more effectively, and (3) in some instances reverse long-

standing disease so that patients can be freed from the hopeless back wards of mental
hospitals where they have been "put away" for years... At the same time, even the
most enthusiastic advocates of the drugs were at pains to emphasize that by them-
selves the pills and injections probably do not cure anything; in the main, they make
other treatments. more effective. They are not going to empty the state hospitals,
and far from reducing the need for more intensive research into psychic disorders,
they accentuate it and facilitate the work,"'

The above statement appeared in TIME magazine almost a year ago. Extensive
experience since then has served to document the basic conclusions contained in the
article. I think it is fair to state that we are just on the threshold of the great new
chemical advances which will eventually make vast in-roads upon the problem of
mental illness. Before we can announce a major victory, we have a generation of
hard work cut out for us.

There is mounting evidence that the new drugs are creating an increased demand
for psychiatric services. In the excellent Public Affairs Pamphlet, ''New Medicines »
for the Mind - Their Meaning and Promise", there is this sober warning:

‘Even when the hospitals are supplied as well as possible with drugs, personnel,
workshops and recreation equipment, there will be a delay before costs can be expected
to come down. This is because there is a big backlog of would-be patients awaiting
admission. The number is estimated as high as the present mental health population,
or about 750,000. More effective treatment, quicker recoveries, and earlier dis-
charges for patients as a result of the new drugs will empty hospital beds faster,
make them available for new patients, and thus actually increase the number of admis-

sions in the next few years. This is sound economy."
It is gratifying to note that state governments, aware of the increased demands
for personnel and research stimulated by the advent of the new drugs, have increased
their expenditures enormously in the field of mental health during the past several
years. Just a month ago the Council of State Governments published a remarkable
66-page summary of increases in mental health appropriations by the states in the
various 1955 legislative sessions.

"In a survey of appropriations for the maintenance and operation of mental hos-
pitals, the Council of State Governments found that 38 out of 42 states from which
replies were received had increased their appropriations in 1955, and*primarily to
' obtain needed personnel," the official report noted. ''... Increases in state appropri-
ations averaged around 10 percent and ranged up to 45 percent. "

In the area of mental deficiency, the Council report has this to say:

"Measured in dollars and cents, the states in 1955 are giving unprecedented at~-
tention to mental deficiency. Of 34 states from which the Council of State Governments
received information in its survey, all except two increased appropriations for care
and treatment of their mentally deficient. The average increase was close to 20 per-
cent. "'

I wish I] had time to go into a detailed analysis of increased state appropriations
in the areas of training and research, With all figures not yet in, the Council of State
Governments estimates that psychiatric research expenditures have more than doubled,
while increases for the training of personnel have increased more than fivefold. For
further documentation, I respectfully refer the Committee to the official summary

prepared by the Council of State Governments.
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Even with these heartening developments, the problem of mental illness is still
very much with us, The average state hospital is still 30 percent overcrowded. In
January of this year, the National Mental Health Committee and the American Psy-
chiatric Association sponsored a tour of mental hospitals by twenty of the nation's
leading science writers. These writers were shocked to see many hospital wards
built for 50 patients jammed with more than 100 patients.

The states are still dipping into borrowed reserves to construct enough beds to
care for the continuing flood of patients.. In 1954 the voters of just five states ap-
proved bond issues totaling $750, 000, 000 for bed construction alone. In December,
1955 the American Psychiatric Association released the results of a survey of state
mental hospital construction. In 1955, $357,000, 000 in mental hospital construction
was either completed or under way. In 1956, $322, 000,000 in construction monies
has already been contracted for, And the end is not yet in sight.

At the federal level, expenditures for the care of the mentally ill are rising at
a staggering rate. In 1945 the Congress appropriated $44, 000, 000 for the care of
mental patients in VA hospitals. By 1955 appropriations had soared more than
500% - to in excess of $200,000,000. Over and above this, the Congress is now
appropriating more than $400,000, 000 annually in compensation costs for service-
connected psychiatric disabilities, More than 50 percent of VA beds are devoted to
care of the mentally ill and new construction costs have exceeded $200, 000, 000 over
the past few years, A Hoover Commission report recently estimated that our bill
for mentally ill veterans would soon reach a billion dollars a year,

How can we reverse this rising tide of expenditures? Obviously, the only way

is through intensive treatment and research for new and effective therapies. In an
address to a joint session of the Michigan legislature on January 26th of this year,

Dr. William Menninger, one of the giants of American psychiatry, pointed out that
Kansas had been able to cancel $38,000, 000 in new hospital construction already in

the blueprint stage because intensive treatment and new therapies were discharging

74 percent of new mental hospital admissions, most of them within the first six months.
Over the past five years, the number of patients in the Kansas mental hospitals has
dropped seven percent as against a 15 percent average risein the 15 states included

in the model reporting area of the National Institute of Mental Health.

At Topeka State Hospital, where the Menningers are most active, there has been
a drop from 1, 850 patients in 1949 to 1, 340 in 1955 - a remarkable 26 percent reduc-
tion. Since 1949, Topeka State Mental Hospital has discharged 737 patients who had
been there ten years or more. Of these discharged patients, 140 had been there
twenty years or more. One patient in this group had entered Topeka State Hospital
at the age of 13 in 1882, three years after the hospital opened. She was discharged
in December, 1955 at the age of 86 years, seventy-three of which she had spentina
tax- supported public hospital.

Among the new therapies currently in use, the so-called tranquilizing drugs
offer the greatest promis«. They are now in widespread use - it is estimated that
more than 200, 000 of the 750,000 patients in our public mental hospitals have either
completed treatment with these drugs, or are currently being given them,

It is still too carly for a definitive analysis of the real impact of these drugs.
However, the carly signs are most encouraging. At an American Psychiatric Asso-
clation Research Conference held in Galesburg in September, 1955, there was peneral

apreement, even among the most conservative clinicians, that the drugs were petting
five to seven percent more patients out of the hospital. Taking the lower percentage,
this would mean the eventual release of 37,500 patients. Since the average cost of

a mental patient to the taxpayer is approximately $1,000 a year, this would meana
minimum annual saving of $37,500,000.

Equally as heartening, studies in New York, Ohio and other states point toa
significant drop in re-admission rates among those patients who have received the
drugs. While the national average is approximately one patient returned to the a
pital for every three patients discharged, pilot studies indicate that less than one out
of seven patients treated with drugs must return to the mental hospital.

I want to stress that 1am using the most conservative figures here, A number
of psychiatrists have reported discharge rates of 15 and 20 percent after use of the
drugs on selected patients. The State of New York has reported a tentative 19 per-
cent increase in discharges during the past six months or so. Illinois has also re-
ported a remarkable inerease in discharge rates for all mental hospitals in that state.

However, we do not have any firm and final figures. Ina talk to the aforemen-
tioned group of science writers at the Rochester State Hospital in New York, Dr. Henry
Brill, New York's Assistant Commissioner of Mental Hygiene, estimated it would be
at least five years before we began to accumulate solid and definitive answers,

Mr. Chairman, that is why there is a desperate need for a nationwide evalua-
tion and scientific study of the new drugs. Amid the welter of claims and counter-
claims in the technical psychiatric publications, there is a paucity of hard statistical
evidence based upon scientifically controlled experiments.

How are we to exploit and extend the usefulness of current and new drugs unless

we investigate in detail their mode of action? There is need for a precise study in
depth of the physiological results of these drugs upon various types of mental illness.
This would be analogous, in some degree, to the carefully controlled evaluation of
the Salk vaccine,

We have only a scattering of technical information on these new drugs and most
of this information is not centrally coordinated and readily available. For example,
we know some of the clinical effects of these drugs but almost nothing about how these
drugs work in the human metabolism, What effect do these drugs have upon the hor-
mones? What part or parts of the brain do they influence and how?

The Congress, and particularly this Committee, have been exceedingly far-
sighted in past years in supporting this type of investigation on all new drugs which
offer hope of cutting down the toll of disease.

Back in 1947, the Congress appropriated $1,000, 000 to the Public Health Service
for the purchase and evaluation of streptomycin. it also encouraged a separate evalua-
tion of streptomycin by the Veterans Administration. The current and thrilling reduc-
tion of tuberculosis deaths by 66 percent in the past few years is in no emalt part due
to the farsighted action of the Congress in supporting the evaluation of new drug treat-
ments for tuberculosis,

In 1950 the Congress appropriated $2, 500, 000 for the purchase and evaluation
of cortisone. In testimony before a Congressional Appropriations Committee two years
ago Dr. Cornelius Traeger, one of the country's leading neurologists, paid this tribute
to the Congress for its farsightedness in making the cortisone appropriation:

"We would still be puttering with cortisone if we had not had the stimulus of
that $2,500,000 available to many researchers throughout the country ... A whole
new vision of medicine has been brought up by this development of cortisone. We

would not be anywhere near where we are today without that appropriation, "'
In 1954 the Congress appropriated $750, 000 for the purchase and use of glutamine
and asparagine in epilepsy. Of this appropriation, Dr. Traeger testified:

"If glutamine pays off as I think it will, you can blow up the Clinical Center and
plow the field in peanuts and come up with a great profit to us in terms of dollars. If
it is the only thing that comes out of that Institute, you have justified your expendi-
ture."

There is a recent Congressional action in the field of cancer which supports ex-
actly the kind of thing we so desperately need in the field of mental illness. Over the
past few years, more than 40 chemical compounds have been used in the attempt to
arrest cancer, Because of the multitude of these compounds, and the claims and
counterclaims of technical investigators, there was need for an overall mechanism ‘to
coordinate all these separate and relatively isolated efforts. Two years ago, the
Congress therefore requested the National Cancer Institute to set up a Cancer Chemo-
therapy Committee as a special division of the Institute. Its main job, as the Congress
outlined it, was to evaluate and support investigations of the many new chemical com-
pounds being used against cancer.

This Committee has had a remarkable history in two short years. Asa natural
outgrowth of its task, it soon found it necessary to coordinate efforts with many other
organizations having a stake in the fight against cancer ~ the American Cancer Society,
the Damon Runyon Fund, the Food and Drug Administration, the Atomic Energy Com-
mission, the pharmaceutical and chemical companies, etc. Out of this natural devel-
opment came the formation of a National Cancer Chemotherapy Committee. Serving
as the over-all evaluation and coordinating body in the chemical attack upon cancer,

the National Committee has a permanent staff and a group of the most distinguished
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cancer consultants in the country. In this effort the Congressional action, in initiating
an evaluation study, has grown into a vast voluntary cooperative effort which Dr. Sidney
Farber, chairman of the National Committee, describes as "the first truly national
effort'' in the chemical offensive against cancer. It is most encouraging that the
Congress saw fit last year to appropriate $2,000,000 asa special allocation to the
vital work of this Committee.

We think the need for a nationwide evaluation of this kind is much greater in the
field of mental illness. While the history of the chemical offensive against cancer
really goes back to developments during World War II, chemotherapy in mental ill-
ness did not have any real beginning until 1954, It has burst upon the scene with
astonishing rapidity and there are many who feel that it will run away with us unless
we get hold of it and put it in proper perspective, The National Mental Health Com-
mittee therefore proposes that the Congress request the National Institute of Mental
Health to set up a Committee on the Chemotherapy of Mental Illness. We propose a
first year appropriation of $1,000, 000 to this committee for a technical evaluation and
study of both the adeqiiacies and inadequaWes of all drugs currently being used against
mental illness. We propose that this committee have a permanent staff for this important
work. We further propose that this committee join forces with all other organizations
interested in the chemotherapy of mental illness - the American Psychiatric Associa-
tion, the Society for Biological Psychiatry, the National Research Council, the Veterans
Administration, the Council of State Governments, the pharmaceutical and chemical
companies, etc, - in an effort to create a coordinated chemical offensive against men-

tal illness,
-~ 10 -

We propose that an additional appropriation of $1,000, 000 should go for grants-
in-aid in support of researchers in all parts of the country willing to conduct funda-
mental research leading to the development of new and more effective drugs in the
field of mental illness, Itis important to note that the two drugs now in most common
use against mental illness - Chlorpromazine and Reserpine - were both developed by
foreign scientists, It is about time that this wealthy country, which spends more than
a billion dollars a year in tax monies for care of the mentally ill, began to support
psychiatric research ona major scale, Itis encouraging to note that in the past
year, American pharmaceutical companies have produced a number of new drugs
and compounds for use in this field, These must be carefully investigated and money
must also be made available to researchers who will develop newand more effective
compounds,

Mr. Chairman, I have devoted the major part of my testimony to this problem
of drug evaluation because it is by far the most urgent one, facing all of us in the field
today. During the past year, I traveled in 23 states and talked to hundrecs of state
hospital superintendents, state mental health officials and private psychiatrists.
Everywhere I went I encountered a constant plea for the creation of a nationwide mech-
anism to evaluate the impact of the new drugs. This is a problem which transcends
state boundaries. Only the Congress can authorize this kind of evaluation and only
the National Institute of Mental Health, the federal arm in the field of psychiatry, is
equipped to do it. .

In conclusion, I wish to submit the fiscal 1957 budget proposals of the National
Mental Health Committee. For the coming year we are requesting $35,197, 000 for

the varied activities of the National Institute of Mental Health. A detailed bre akdown

of this budget is appended to my formal statement.
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The biggest increase we are asking - $5, 000, 000 - is for the training of psychi-
atric personnel. It is a crying shame that the new drugs and other new therapies are
not being used upon thousands and thousands of mental patients because there are not
enough psychiatrists and auxiliary personnel available to give these treatments. Fur-
thermore, the new drugs have resulted in a fantastic increase in demands for psychi-
atric services, Thousands of formerly "hopeless" patients have benefited from the
drugs to the point where they are in need of additional psychotherapy. If they could

obtain this psychotherapy,: many would be able to return to their homes.

American industry, faced with a like demand for its services, would waste no

time in training the personnel needed to deliver it. We must follow industry's example.

We must double and treble our grants to the psychiatric teaching institutions and we
must provide for a like expansion of training etipends and scholarships to people inter-
ested in entering the field of psychiatry.

We are also asking for a substantial increase in research. Beyond the horizon
of these new drugs there is an enormous amount of research yet to be done on the
nervous system, the chemistry of the brain, the process of aging, the metabolic causes
of mental deficiency, etc. Weare only scratching at the surface of many of these prob-
lems because we have far too few investigators in the field.

Mr, Chairman, for a detailed explanation of our proposal for an evaluation of the
psychiatric drugs I would like to call upon two doctors who have had as much experience
with these drugs as anybody inthe country. Dr. Nathan Kline, presently research
director at Rockland State Hospital, New York, was the first psychiatrist on the North
American continent to use the drug Reserpine on mental patients. Dr. Henry Brill,

Assistant Commissioner of Mental Hygiene in charge of research and training for the
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State of New York, is administering the largest clinical drug program in the country.

New York State has already treated 41,000 patients with two of the drugs, and Dr. Brill

is currently engaged in making an evaluation of the New York experience.
NATIONAL INSTITUTE OF MENTAL HEALTH

 

Minimum 1957

 

 

 

 

 

 

1956 1957 BOB Advisory Council Citizens
Current Budget Allowances Recommendations Request
GRANTS
Research grants 3, 937, 000 5, 687, 000 9, 000, 000 10, 000, 000 *
Research fellowships 300, 000 300, 000 600, 000 1, 000, 000
Training 5, 885, 000 7,246, 000 8, 885, 000 12, 246, 000
Grants to States 3,000, 000 3, 000, 000 6, 000, 000 6, 000, 000
13, 122, 000 16, 233, 000 24, 485, 000 29, 246, 000
DIRECT OPERATIONS
Research 3, 724, 800 4,065, 400 4, 330, 000 4,065, 400
Review & approval 182, 900 255, 000 ( 500, 000
Administration — 332, 700 334, 400 (1, 000, 000 334, 400
Technical Assistance 773, 600 810, 200 800, 000 1, 000, 200
Training activities 51,000 51, 000 51,000
5, 065, 000 5,516, 000 .6, 130, 000 5,951, 000
TOTAL 18, 187, 000 21, 749, 000 30, 615, 000 35, 197, 000
including proposed supple-
mental due to pay increases - 186,000
ACTUAL APPROPRIATION 18, 001, 000 21, 749, 000 30, 615, 000 35, 197, 000

* - $2,000, 000 of this $10, 000, 000 earmarked for drug evaluation.