FOR RELEASE UPON DELIVERY WE ARE WINNING THE FIGHT AGAINST MENTAL ILLNESS SPEECH AT ANNUAL LEGISLATIVE DINNER, ASSOCIATION OF CHOSEN FREEHOLDERS 8:00 P,.M., Monday, February 4, 1957 Hotel Hildebrecht, Trenton, New Jersey by MIKE GORMAN, Washington, D, C, Executive Director, NATIONAL MENTAL HEALTH COMMITTEE Author, "EVERY OTHER BED", Governor Meyner, Members of the Legislature, Chosen Freeholders, Guests: Since 1773, when the first public mental hospital was built in Williamsburg, Virginia, there has been a seemingly inevitable annual increase in the number of patients in our state mental hospitals, Starting in 1945, when reliable national statistics were collected for the first time, there has been an annual rise of 9,400 hospitalized mental patients, In the decade since 1945, this has meant the construction of approximately 100,000 new beds costing the taxpayers approximately $2 billion, In 1955 alone, $750 million was appropriated by state legislatures for the construction of beds for mental patients, In 1956, we saw the first reduction of hospitalized mental patients in 183 years, Although this reduction of 7,000 patients is not of major proportions, its significance lies in the fact that the first step has been taken in the fight to reduce the number of men- tal patients resident in our state hospitals, - o- You have participated in that reduction right here in the State of New Jersey, Over the past decade, you have had an average in- crease crease of 500 hospitalized mental patients a year, In 1956, you not only prevented the seemingly inevitable rise of 500 patients, but you actually recorded a reduction of 271 patients, It is important to examine the factors responsible for this significant development, I believe most of us would agree that the advent of the tranquilizing drugs has been the major factor in this remarkable reduction, I think we sometimes fail to appreciate the nature of this revolution, Prior to the new drugs, there was no mass medication which could be given to great numbers of mental patients in understaffed institutions, The shock treatments, for example, re- quired a great number of skilled professional people and therefore could never really be applied on a wide scale, In assessing the importance of the new drugs, I commend to you a statement made recently by one of the nation’s outstanding psychia- trists, who said to me: "The tranquilizing drugs gave those of us in mental hospitals much more than a specific therapy, They gave us the feeling and the hope that we had something we could apply to people in distress, They lifted up the morale of our staffs because they shook up the deadening atmosphere of the back wards, If this be their only accom- plishment, it is a major one," At the present time, we are in an unfortunate wave of sensational publicity about these drugs, Little distinction is made between the potent tranquilizers used under proper medical supervision in the State hospitals, and the mild tranquilizers used for the neuroses, We have a sickening series of magazine and newspaper articles about the so-called "Happy Pills". This is really not our business here tonight, because we are concerned with more important matters [than the movie star or television actor who took se MMeAN TS: the 1930's, barbiturates in the 1940's and now is on the "Happy Pills" in the 1950's, Furthermore, I don't think we have to concern ourselves with those defenders of the past who always decry a new therapy and always warn about side effects, In this category, I include the National Institute of Mental Health, Last year, after politely suggesting for two years that the Institute had a responsibility to assess a medication which was being given to millions of Americans, the United States Congress rammed down the unwilling throats of the epidemiology-lovers at the Insti- tute an appropriation of $2 million for an honest, nationwide evalua- tion of the new drugs. I say, with all the conviction at my command, that the National Institute of Mental llealth has used this money to flout the will of the Congress and the American people, It held a conference last fall Stacked with non-clinical investigators who proved, to their own Satisfaction, that you couldn't do a mass-scale evaluation of a drug, Nonsense} What about the Veterans Administration's superb ten-year evaluation of drugs used against tuberculosis, and what about the current V,A, evaluation of the tranquilizing drugs, This attitude against mass evaluation has not prevented the In- stitute from releasing superficial, unscientific "studies" on the new drugs, In August, 1956, it released Public Health Monograph No,4l, a thinly veiled diatribe against the drugs. Sounding the alarm, the author of the monograph cries out that he knows of no studies of how many people are on the drugs in this country. Does he not know that many of us have been begging the Institute to do just this kind of survey for two years? Furthermore, he lanents the fact that widespread use of the drugs "can result in situations that could tax seriously the limited psychiatric resources of the Nation." Is this the kind of drivel up with which the taxpayers of America must continually put? Is it not incredible that the men- tal health arm [of the Federal Government laments a therapy which highlights our critical shortage of psychiatric personnel? Shouldn't the Institute be rejoicing that thousands of untreated patients sre now being treated and returned to their homes, and shouldn't it issue a clarion cal] for more psychiatric personnel to spread the henefits of these therapies to all of the suffering ones in ovr mental hospitals? In December, 1956, in a formal report to Congress on the effect of the drugs, the Institute stated that "reports from mental hos- pitals indicate that the reduction in restlessness and aggressive be- havior made accessible, to other forms of therapy, patients who otherwise could not be reached, There is as yet insufficient reliable experinental evidence to support these claims," From this statement, I conclude that the Institute puts no credence in the figures on in- creased discharges recently released by the Council of State Govern- ments, Furthermore, it impugns the accuracy and integrity of reports from practically every state mental health commissioner and state nospital superintendent in the country that the new drugs have brought a about a tremendous reduction in restraints, the almost total aholi- tion of the former "violent" wards, and the accessibility of thousands of additional patients to therapy. The Institute really possesses unmitigated gall in asking for "reliable experimantal evidence" on tne efficacy of the new drugs, In its own reports, for example, it grabs at any unscientific cudgel to flail the drugs. In one report, it raises the implication that continued use of the drugs may shorten the life span, Where is the "scientific evidence" for this? [as the Institute made 30-year studies of drug usage to support this implication, or to support a Similar implication that the drugs, when used on children, may in- terfere with normal learning and personality development? I re- spectfully suggest to the Institute that it get about the business of doing the painstaking evaluations ordered by the Congress, | and that it cease and desist from using taxpayers' money to conjure up imaginary ghosts designed to alarm both mental patients and their families, In addition to the new drugs, there are a number of other im- portant factors which have contributed to the dramatic reduction of hospitalized mental patients. In the past decade, we have almost tripled the daily expenditure for each mental patient. Even when we take into account the rise in living cost, this is an appreciable advance, liere in New Jersey, your per diem of $3.89 is considerably above the national average, It is higher than New York and Pennsyl- vania, but considerably below, for example, Connecticut, Kansas, Michigan and Delaware, The Veterans Administration spends approxi- mately $10 a day for a tax-supported mental patient, So I don't think I need emphasize the fact that you have a long way to go. Another major factor in the current happy turn of events is the steady increase of psychiatric personnel in our state and county mental hospitals, Over the past decade, despite a tremendous rise in new admissions, state and county mental hospitals have almost doubled the ratio of staff employees to patients, Here in New Jersey, you have progressed from one staff employee for every five patients in 1945 to one employee for every three patients in 1956, Your staff ratio is one of the best in the country, and you are to he congra- tulated for it. But now I want to come to the heart of the matter, Does this beginning reduction of mental patients mean that we have whipped the problem - that we can now sit back and rest on our oars? Far from it, We have a much bigger problem in front of us, and I want to cite the example of tuberculosis as an indication of what I mean, For decades and decades, there seemed to be an inevitable in- crease in the number of patients hospitalized for tuberculosis, State governments were saddied with enormous construction costs for thousands of additional beds for the ever continuing flood of victims of this disease, During the last decade, the tice began to turn, With the advent of aew drugs and new surgical techniques, we brought about a remarkable reduction in the death rate from tuberculosis, Tuberculosis, the number one killer in the early 1900's, soon dropped out of the list of the ten diseases with the highest mortality. Many hospitals for the tuberculous closed their doors, some of them among the most famous in this country, Millions of dollars in new construction costs were saved. Thousands upon thousands of people, who would have died years ago, are alive today. The average hos- pital stay of the tuberculous patient was cut in half. Now comes the rub, The problem of tuberculosis was transferred from the isolated sanatorium off in the woods to the heart of the community. The patient was now back among his neighbors, going to the clinic once a month for a supply of drugs. What happened? Two thiags: In the first flush of seeming victory we slackened our efforts; secondly, the community, for decades comfortably removed from the problem of tuberculosis, had never developed the preventive facilities to handle this new flood of patients. Result? During 1956, we witnessed an alarming rise in newly discovered cases of tuberculosis in the community, This was not due to more intensive case finding; on the contrary, the Federal govern- ment and the states had reduced their appropriations for case finding. It was primarily due to the fact that more patients, treated in the community, passed the disease along because the proper precautions were not taken, In a number of communities, the wheel turned full circle; patients who were themselves discharged from the hospitals and who thus emptied beds, infected persons in the community who then filled the beds so recently emptied, There are certain profound lessons in this experience for all of us in the mental health field, First of all, how much mental illness is there in the community right now? In the past we used a very rough approximation - we said that one in ten persons would probably become mentally ill at some time during his life span, A recent study, done with superb precision and professional knowledge, indicates our estimates have heen far too low, At the 1955 convention of the American Public Nealth Association, a team of nsychiatrists and public health doctors from the Commission on Chronic Illness reported on a four-year survey of mental illness in the city of Baltimore, Their conclusion; ten out of every 100 per- sons walking the streets of any large city right now are mentally il]. (In their report, they point out that their figures are conser- vative, because they excluded all in the community who were receiving treatment for mental illness at the time of the survey. Furthermore, the study excluded patients in mental hospitals, children suffering from behavior disorders, and adults who were alcoholic or had minor personality defects, What are the implications of this report? Here is what the authors conclude: “Our findings that approximately one-tenth of an urban population have one or more of the relatively well defined mental disorders is sufficiently alarming and one obviously calling for serious and prompt considera- tion. We doubt very much that a population having more than this rate of mental illness, in addition to the heavy load of chronic and acute disease found in the Caltimore survey, could function as a society." we are all part of this community which the aforementioned re- port deals with - the Governor, State Legislators, County Officials and citizens, What, then, are all of us doing to bring about this transition from the handling of mental illness/ gs an isolated problem in the woods to the progressive and intensive treatment of it in the community? T want to make one point crystal clear here, From the time of the establishment of the first public mental hospital in 1778, the mentally ill have been coaveniently categorized as "wards of the State", In a number of states, county and city governments have used the state mental hospitals as a dumping ground for all of their unwanted indigents, As Dr, Paul !loch, the able Commissioner of the New York Department of Mental tlygiene, has pointed out on a number of occasions, these unfortunates are not wards of the state - they are wards of ajl of us. ‘We have a common and joint responsibility to care for and treat these people, our own brothers and sisters caught in the web of misfortune and iisery. In New Jersey, you have not been guilty of putting up these artifical walls. Your state government and your 21 counties share in the cost of mental illness, You have state operated and county operated mental hospitals; you do not believe that Trenton has the sole responsibility for the care of mental vnatients., ‘tlowever, I do not mean to imply by this that all is perfection in the Garden State, A report came to me recently that in one of your larger cities, attempts to improve a run-down psychiatric facility were met with the argument that the state should do it all. This is utter nonsense. The fight against mental illaess is an enormous one and we need every ally working full time - the Federal government, the state, tue city, the county and the citizen, Tf we grant the premise of Dr. Franklin Ehaugh that our state mental hospitals are monuments to the failure of our communities "to -~ 10 - create the necessary conditions for the full, healthy adjustment of individual minds", what resources must we then build to cut down the incidence of mental illness in the community? In the short space of time available to me, I can list only a few: 1. Our foremost job is provsably the education of the general practitioner in the handling of routine emotional disturbances, We have come a long way from the period when the general practitioner would take no interest in the problem of mental illness, Today, he is avidly seeking training in this field, [lis national oryanization, the American Academy of General Practice, has formed a committee to work with the American Psychiatric Associa- tion in the education of the general practitioner in psychiatry. help finance The state and the counties have an obligation to/jthe training of the general practitioner in the newer psychia- Lric therapies, The professional organizations also have a great responsibility in this area and I am delighted to note that the New Jersey State Medical Association, in cooperation with the American Academy of General Practice, wil] sponsor a series of training seminars for the general practitioner this spring at your very fine New Jersey Msychiatric Institute. 2. Equally important is the support of psychiatric units in general hospitals, This is the natural facility in which to treat most mental illnesses, It tears the stigma away from mental illness, and it keeps the patient close to his family and his community. -~ll- T am continually amazed at the old guard resis- tance to psychiatric units in general hospitals, Is it not a shocking thing that 950 large general hospi- tals in this country do not have a single psychiatric bed? In my native city of New York, it is estimated that only six of 35 large general hospitals have psychiatric units, In Washington, D, C, most of our large general hospitals have made| no provision for psy- chiatric units, I dare say the situation is fairly com- parable in the State of New Jersey. The state and the counties have a responsibility to support these psychiatric units,