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FOR RELEASE UPON DELIVERY

Address*
by

Abraham Ribicoff
Secretary of Health, Education, and Welfare

When Dr. Jack Ewalt, director of the Joint Commission on Mental
Illness and Health, presented the Commission's findings to the press
in March, he said: "The mentally ill are not as yet a part of the New
Frontier." :

I understand this remark elicited wry chuckles from the reporters
present. Think of the incongruity: the alert young New Frontiersman and
the hapless inmate who cannot make it in society.

This morning I would like to take Dr. Ewalt up on his remark. I
would like to say that the New Frontier is very much concerned with the
mentally ill, as with other Americans, sick and well.

The New Frontier--said President Kennedy in Los Angeles--is not a
set of promises but a set of challenges.

Before you distinguished experts in the field ana other leaders,

I accept the challenge of mental illness in this Nation. And I say to
you that the administration does not plan to sit and wring its hands over
this problem. The administration is ready to accept responsibility in
this field as in all others--to consider it positively and act con-
structively.

For we know that when this Nation--settled by stouthearted pioneers,
built on the hopes of a free strong people--when this Nation wills, it can.

We admit that the problem of mental illness in the United States is

staggering. Adjectives do not do it justice. It is great, it is extensive,

it is appalling. Worse still, it is static. Despite numerous attacks

 

*Before the Mental Health Institute, Saint Elizabeths Hospital, Washing-
ton 20, D. C., May 3, 1961, 10:00 a.m., EDT.
we Olas
and sporadic shocking exposures, despite the dedicated work of many, many
people, in both public and private life, the care of the mentally ill has
lagged behind the care of any other of our sick.

Some three-quarters of a million patients fill our mental hospitals,
occupying more than half our hospital beds. <A quarter of a million more
men, women, and children are admitted every year. All told, mental illness
costs this country more than $1.7 billion every year. It cost over $850
million in 1959 to run the Nationts mental hospitals, and even this was not
enough to do a proper job.

4 The cost in dollars only introduces the story. In terms of loss
of precious human talent, in terms of family misery, in terms of infi-
nite personal tragedy, the cost! caundk te measured.

The facts are in. The Joint Commission on Mental Tiipaee and
Health, which was authorized by the Congress, took more than 5 years,
spent some $1.5 million, to gather them for us. I commend the Commis -
Sion's 10 monographs and its final report, "Action for Mental Health,”
to you, to the Governors of our States, to members of the Congress
and State legislatures, and to citizens across the land. I urge
you and your colleagues to read and consider them carefully.

These Piniings startle even persons knowledgeable in the field of
mental illness. They show that 80 percent of our 277 State mental hos-
pitals still provide only custodial care for patients; only 20 percent
have participated in modern advances designed to make them truly thera-
peutic. They define the "unfinished business of mental health" in this
way: more than half of the patients in most State hospitals receive no
active treatment of any kind designed to improve their mental condition.

This is so despite the fact that the outlook for the schizophrenic patient,
 

 

 

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the main tenant of our mental hospitals, can be good under the best treatment
conditions.

These findings show that many of the patients in State hospitals do not
need to be there at all.

Now, what to do? Can we take the Joint Commission's bold, carefully
documented report and subject it to the process of public discussion and
debate? Can we then take tatelligent, constructive action?

I think we can.

Mental illness traditionally has been the burden of the States. And,
traditionally, there have been great differences in the manner in which the
States met their responsibilities to the mentally ill--differences in provid-
ing facilities, differences in the level of care given patients, and differ.
ences in making care available.

Some States have done well. But some States, unfortunately, lag far
behind. »

Today, mental illness, like heart disease or cancer, is a.problem that
concerns us all. We must move as 4 whole people--through our democratically
elected Federal, as well as State Governments, "to promote the general welfare"
of each citizen,

And we must remember that our public officials, coming from diverse
backgrounds and bearing a wide assortment of responsibilities, will need to
be informed and alerted to the active participation of concerned citizens.

This very institution--now over one hundred years old--resulted from the ef-
forts of one of the most persistent lobbyists the country has ever known. To
this day, in a corner of Dr. Overholser's study there stands the small mahogany

schoolhouse desk on which Dorothea Lynde Dix drafted an Act of Congress to
Pound an institution whose "objects shall be the most humane care and enlightened

curative treatment of the Insane,"
mee

We do not need to start afresh as a Federal Government. ‘The
National Institute of Mental Health, in the years from 1950 to 1961, spent
a total’ of $379 million on the pursuit of new knowledge and the training of
much needed personnel,

The Federal Government has also aided in the construction of mental
hospitals. Since the start of this program, 131 mental hospitals have been
finished or are under construction--at a total cost to the Government of
nearly $50 million. Saint Elizabeths Hospital and the Veterans Administra-
¢toncsaiweac eager to seek new knowledge and try nei ways--have pioneered
in mental hospital care.

No, we do not need to start afresh. But we do need a fresh approach.

I like the approach the Joint Commission offers to us. Courageous
and imaginative, it-is yet practical and humane. It suggests a hard,
creative scrutiny of our present mental hospital system.

It suggests that this ‘hospitel system eventually be replaced by a
constellation of psychiatric resources in the heart of the community.

It suggests the gradual conversion of State hospitals oe more than
1,000 beds into excellent professional treatment centers for all chronic
diseases (including psychiatric disorders) and their replacement by community
clinics, general hospital psychiatric units, special intensive treatment
centers, and such after-care and rehabilitation services as day hospitals,
night hospitals, or foster family care,

It suggests the redefining of what treatment is and who may do it.
the adoption of a broad liberal philosophy of treatment which wed enable
many professional and nonprofessional workers without medical training to

share the workload,
~ 5 =

It suggests the recruitment of sorely needed qualified people into
mental health fields, \

It suggests an increase in our basic research and more varied and long-
term research to predict and prevent various forms of mental illness.

All parts of this projected program are important, At this moment, I
submit, we must move in three directions. We must increase our research
efforts. We must find and train people to put such knowledge as we have to
work, And, we must, with all possible speed, reduce our reliance on the big
public mental hospital in favor of community treatment services.

Let us, in and out of Government, reevaluate our thinking about mental
illness and how we have dealt with it. ‘Let us ask ourselves=-are even the
modest advances we have made in vanent years on the right track? Or do we
need an entirely new point of departure? Are we exploring every possibility
and innovation~-psychological, social, and biological? Are we properly
evaluating each scientific research program? Are we using our hospitals--the
piaces where the patients are--as the logical place for constructive research?
Are we as individuals ready to accept and act on the findings provided for us?

This administration has proposed a program of Federal grants to aid in
the construction of new medical schools and grants to expand the schools we
now have. It has also, along with a general scholarship program--proposed a
specific program of scholarships for talented youngsters who cannot afford: the
cost of a medical education.

Can we do more to attract young people into this field? Can we find
new ways of reaching them; new methods of training them? Can we get further
help from the nurses, the sotial workers, the chaplains, the volunteers who

already are working with the mentally i11?
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Are we leaving any stone unturned in our efforts: to find a cause. or
causes, a cure or cures? In our efforts to apply what we do now? In our
efforts to better the structure of our mental hospital system?

A rightful answer to these questions, you will rightly say, costs money.

But we need something more than money. What we need is a commitment to
do a job--by all imaginative and constructive means.

It seems to me that we are asking the citizen, not only to loosen his
purse strings for some poor fellow out there in the hospital but to accept the
notion that the mentally ill oes come back--with his help.

It is not true, says the Joint Commission, that people with mental ill-
heeses are exactly the same as the ordinary sick. In certain ways they are
different. Only if we recognize this fact--in the towns and cities of this
land--will they resume their rightful place in society.

Whatever program we arrive at-~-whether it's more open hospitals, more
psychiatric units in general hospitals, more community centers or some combina-
tion of the lot--whatever we do,’ we must convince the average citizen of what
the professional knows--that a vast number of patients could, if given a chance,
perform social tasks in the eimai dey and this get better if not always
completely well.

We must move forward in research, treatment, training, and the preven-
‘tion of a greater incidence of mental disorder. And we must also work to remove
the great stumbling block which is the public attitude toward mental illness.

I am glad of the opportunity to say these things during Mental Health
Week at Saint Elizabeths Hospital. The history of Saint Elizabeths is a proud
one, and I am proud that it is one of the operating agencies of the Department

of Health, Education, and Welfare. It ig my earnest hope that in the months and

Ww
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years ahead, Saint Elizabeths will continue to serve as a pace-setter for the
mental institutions of this Nation. It is my hope that here we try new ideas,
search for new methods, experiment in a scientific fashion in the spirit of the
Joint Commission's new approach,

It is my hope that Saint Elizabeths--pioneer of a hundred years standing--
which already has a research program in conjunction with the National Institute
of Mental Health~-which already is developing an extensive training and educa-
tion program--that Saint Elizabeths will lead the way in @ great national
endeavor. It is my hope that Saint Elizabeths will become the model institution
for the United States and possibly the world in the care and treatment of mental
illness.

For if we are to meet the high national goals to which we are now committed,
we must have citizens with healthy minds as well as healthy bodies.

As the gifted writer, Paul Horgan, has said: ‘In the last analysis, the

realm of the mind and spirit is the dwelling place of man's enduring power."

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