The Mental Health Programme of the United States
{Contributed by Federal Security Agency, U.S.A.) When the National Mental Health Act was passed by the United States Congress in 1946, a programme to improve the mental health of the nation became a public responsibility. It is traditional in the United States for the majority of severe cases of mental illness to be cared for in public mental hospitals, but the passage of the Mental Health Act was a significant step forward. It provided Federal support for (1) developing preventive and out-patient services in States and communities; (2) for mental health research; and (3) for the training of professional personnel in psychiatry and related fields.
Although no Federal funds were appropriated at the time the Mental Health Act was passed, the legislation stimulated States, communities, and interested organizations and individuals to begin at once to survey needs and to plan for the effective use of whatever funds might subsequently be appropriated. This activity received leadership and co-ordination from the National Advisory Mental Health Council, a group of well-qualified citizens who, by the terms of the Act, were made advisers to the Surgeon General of the Public Health Service, Federal Security Agency?the Federal body responsible for administering the Act. By 1947, when the first Federal funds were appropriated, the organizational pattern which the programme would follow was well established. It covers three major areas:
1. Research. To foster study of the nature, causes, treatment and prevention of mental illness, research grants-in-aid are made to universities, hospitals, laboratories and other non-Federal institutions and to qualified individuals. In addition, research fellowships are awarded to promising young investigators. Applications for research grants and fellowships are reviewed by a Research Study Section comprised of specialists who serve as consultants to the Mental Hygiene Division. Their reports are given to the National Advisory Mental Health Council members who make the final recommendations on what applications should be approved for support.
2. Training. To encourage the training of more psychiatrists, psychologists, psychiatric social workers and mental health nurses, training grants-in-aid are made to schools of medicine, nursing, social work and other training centres for developing and improving their facilities. Training stipends are given to graduate students. As with the research grants, applications for training grants and stipends are reviewed by outstanding authorities. They are members of the Committee of Consultants on Training and their reports form the working basis for the training grant recommendations made to the Surgeon General by the National Advisory Mental Health Council.
3. Community Services. To assist States and Territories in developing community mental health services which will be available to all citizens, grants-in-aid are made to States and Territories as soon as they submit a plan which is approved by the Surgeon General of the Public Health Service. These grants, as well as matching funds raised from State and local sources, are administered by a State Mental Health Authority which, in over half of the States, is the State Health Department. Each State’s share of the Federal fund is determined by its financial need, population, and the extent of its mental health problem. To receive its share, however, the State must raise one dollar for each two dollars provided by the Federal fund. Assistance is also given to State and local communities through the consultant services of civic leaders who, as members of the Community Services Committee, serve the National Advisory Mental Health Council in much the same capacity as do members of the Research Study Section and the Training Committee.
Activities in all three of the major areas of operation have been expanding rapidly. At the close of the first year of the programme, July 1st, 1948, funds had been awarded for 38 research projects and 24 research fellowships; training grants had been made to 59 institutions and training stipends were helping to support 227 students’ Mental health programmes had been started in 22 States and two Territories, and previously existing programmes had been expanded and strengthened in 22 States.
The mental health programmes planned by the various States differ widely, depending upon the degree of development of mental health services by a State prior to the passage of the Mental Health Act, the availability of personnel, the accessibility of teaching centres and many other factors. However, most State programmes include all or some of the following activities : central administrative services ; clinics; professional services; training programmes for State and local personnel; and preventive and educational programmes. In the mental health programme, as with other public health programmes in the United States, the Federal Government provides stimulation and support through grants and through professional and consultation services. However, the ultimate development of the mental health programme depends on the local men and women who are closely in touch with the resources of their community.
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