Toward a New Frontier

Every U.S. President in recent years has dutifully urged more strenuous efforts to prevent and treat mental illness. But to John Fitzgerald Kennedy, whose own oldest sister, Rosemary, is mentally retarded, the problem is particularly poignant. Last week he sent Congress the first presidential message in history that dealt solely with the twin blights of mental illness and mental retardation.

Wary of opposition from budget-conscious Congressmen, Kennedy argued that the states and the nation are now indulging in the worst kind of false economy. There are 600,000 Americans in institutions for the mentally ill, and more than 200,000 in those for the mentally retarded. The average spent on their care is only $4 a day; in some states it is a niggardly $2. The direct cost to the taxpayers is $2.4 billion a year, but, said President Kennedy, the indirect costs to the taxpayer are far greater.

Priming the Pump. Nearly half of the 530,000 Americans in state mental institutions are jammed into hospitals that are so large the patients get no individual care. With a patient-psychiatrist ratio of 360 to 1, effective treatment is almost impossible. The mentally ill remain in the hospitals and get worse. The average stay for schizophrenics is eleven years. With drugs and other new treatments, said the President, two out of three schizophrenics can now be sent home within six months. "If we launch a broad new mental health program now, it will be possible within a decade or two to reduce the number of patients now under custodial care by 50% or more."

His program, said the President, is based on the proven advantages of having many community health centers for immediate, intensive treatment. To help communities plan such centers, he asked for $4,200,000 in fiscal '64. By fiscal '65, he forecast, the communities could be ready to start building. Congress should then help with 45% to 75% of the first costs of new centers, and make short-term grants to pay staff costs in the first few months. The President urged that private physicians, family doctors as well as psychiatrists, should join in treating patients in their home towns. With the prospect that the costs of mental illness can be predicted and reduced, said the President, patients should soon be covered far more than they are at present by local as well as state tax funds and by private insurance.

"Mental retardation," Kennedy noted, "disables ten times as many people as diabetes, 20 times as many as tuberculosis." About 400,000 children are so retarded that they need constant care; more than 200,000 are in institutions, in many of which "the standard of care is so grossly deficient as to shock the conscience of all who see them." Each year, 125,000 recruits are born to join the ranks of the retarded.

What to do? The first thing is to learn more about retardation's causes, said the President. So far, only about 25% of cases can be medically explained by mongolism, birth injury, infection in infancy, German measles early in gestation, the Rh factor, lead poisoning, or uncommon defects in the body's enzyme chemistry. Where no such factors can be detected, retardation is commonest, said Kennedy, in urban and rural slums, in places where women get little or no doctoring during pregnancy. And there is much retardation among these mothers' abnormally high proportion of premature babies. Children's minds also seem to wither under conditions of severe neglect, said the President, in an atmosphere of hopelessness, where there is no impetus to learning. "This self-perpetuating intellectual blight should not be allowed to continue."

No More Procrastination. To stimulate local action, Kennedy asked for $2,000,000 to help states develop study projects. Then he recommended that Congress authorize matching grants to build centers for treatment, training and care of the retarded. To get such centers tied in with university hospitals and help them establish clinics, he asked an initial $5,000,000 a year, soon to be raised to $10 million.

The main problem in improving care for the mentally ill and retarded is the lack of trained help. Kennedy recommended federal assistance through the Office of Education to train hospital workers and teachers for the handicapped. "Shabby treatment of the many millions of the mentally disabled" has gone on too long, said the President. "We can procrastinate no more."

This file is automatically generated by a robot program, so reader's discretion is required.