Reflections for Rosalynn: mental health policy and time lag.

PHYLLIS HERSCH CHARLES HERSCH

Vol. 3, No.3, August 1978 0360-7283/78/0303-0011 $0.50 © 1978, National Association of Social Workers, Inc.

HEALTH AND SOCIAL WORK,

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Reflections for Rosalynn: Mental Health Policy and Time Lag

OVER THE LAST THREE DECADES there has been considerable activity in the field of mental health on the part of the federal government. In 1949-early in this period of growth-the National Institute of Mental Health was created. Federal funds were provided, first for research, training, and demonstration projects, and later for the construction and staffing of mental health facilities. During this span of time, the first message to Congress on mental illness and mental retardation by a president of the United States was delivered. And, on two separate occasions, the U.S. Congress established joint commissions whose purpose was to study the condition of mental health in the country and to make rec-

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By establishing the President's Commission on Mental Health early in his Administration and by ordering the final report to be presented by mid-1978, President Carter appears to ha"ve insured that this commission will have direct impact on mental health legislation. The authors point out how the work of previous commissions was delayed to the point of being negated by changes in the SOciopolitical climate.

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ommendations for a national public policy that would be translated into federal legislation. In keeping with this tradition, on February 17, 1977, President Carter issued an executive order establishing the President's Commission on Mental Health. 1 During the 1976 presidential campaign, Rosalynn Carter had indicated that mental health would be a major interest of hers. In response to this interest, the president established the Mental Health Commission within the first 30 days of the new Administration. The president would have appointed Mrs. Carter as the official chairperson of the commission, but this. was prevented by a federal injunction against nepotism. The First Lady, therefore, was named honorary chairperson, but she made it abundantly clear that she intended to be an unusually active one. Provided with this early impetus, the commission began its work within the first 90 days of the Carter Administration. Mrs. Carter had said that although she wanted the commissions's report to be substantive and thoughtful, she did not want it to be the kind of in-depth study that "sits on a shelf forever." 2 Reflecting this wish, the timetable established by Carter's executive order stated that a preliminary report would be due by September 1, 1977, with the final report expected by April 1, 1978. In short, the final report was to be presented just one year from the time the commission began its work. Clearly, the active interest of the First Family bodes well for the potential impact of the commission's work. Far more important, however, is that in setting the date for April 1978, the recommendations of the commission will be delivered to the president with almost three years remaining in his first term of office. The outstanding significance of this fact can be seen in light


REFLECTIONS FOR ROSALYNN

HEALTH AND SOCIAL WORK

of what has happened with previous federal commissions on mental health whose reports were submitted in a changed sociopolitical climate and were too late to be implemented by the administration under which they were commissioned. If the present work is done quickly, the chances that the report will not "sit on a shelf" and that it will have the desired impact are substantially increased. As pointed out earlier, there have been two previous federal commisions on mental health. The first was the J oint Commission on Mental Illness and Health, which was established in 1955. The second was the Joint Commission on Mental Health of Children, established in 1965. It seems to have been taken for granted that if the work of a major commission is to be meaningful, the process must necessarily be a long one. The Joint Commission on Mental Health and Illness took six years to produce its final report, Action for Mental Health, which was published in 1961.3 In the case of the Joint Commission on Mental Health of Children, it took four years for its final report to become available. Crisis in Child Mental Health was not published until 1969. 4 The significant consequence of this time-consuming process was that a commission established, during one administration presented its final report at the time of a new administration that was affiliated with the opposing political party. The following time sequence makes this clear. 1952-Eisenhower elected 1955-Joint Commission on Mental Illness and Health established 1960-Kennedy elected


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1961-1oint commission report, Action for Mental Health, submitted 1964-10hnson elected 1965-10int Commission on Mental Health of Children established 1968-Nixon elected 1969-10int commission report, Crisis in Child Mental Health, submitted The passing of the presidency from one party to another, however, reflected far more than a mere popularity contest between two men or two parties. It reflected a fundamental change in the underlying sociopolitical tone and attitude of the country. It was this change that determined who the new president would be and which political party would be dominant. It was also this change that determined the fate of the final report and the recommendations of each of the joint commissions. REFORM VS. CONSERVATISM What actually happened is that in each case the recommendations that were developed within the context of one sociopolitical philosophy became translated into the intent of a different and in many ways an opposing sociopolitical philosophy. In so doing, the essential character and thrust of the original recommendations were lost. Commission members would be hard put to find the results of their labors in the federal legislation that ultimately ensued. A field such as mental health does not exist independently of the social framework of which it is a part. Particularly in the human services, it is not just


REFLECTIONS FOR ROSAL YNN

HEAL TH AND SOCIAL WORK

"It seems to have been taken for granted that if the work of a major commission is to be meaningful, the process must necessarily be a long one."

the internal scientific and professional advances that determine what course the field will take. Rather, there is a dynamic relationship between the field and the societal context within which it is embedded. In other words, the spirit and temperament of the times-its social, political, and economic characteristics-will strongly influence the type of problems that concern this country, how these problems are defined, and the type of programs that are developed to deal with them. Levine and Levine go beyond the simple statement that there is a relationship between the social framework and the direction of human services and specify what the particular form of that relationship will be. 5 They observe that, in general, the spirit of the times may be characterized as either one of sociopolitical conservatism or sociopolitical reform. Within the field of human services, there are essentially two approachesthe individual or personal on the one hand, and the situational or environmental on the other. Approaches directed to the individual will flourish in times of social conservatism, whereas approaches directed to the external situation will flourish in times of social reform. Looked at from a slightly different angle, the relationship can be formulated as follows: The conservative viewpoint sees the problem as residing in the individual and tries to change him; the reform viewpoint sees the problem as residing in the


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environment and tries to change it. A conservative viewpoint sees a troubled environment and blames it on individuals; a reform viewpoint sees troubled individuals and blames that on the enviroment. 6

Of course, neither the conservative nor the reform viewpoint will dominate an era exclusively. However, the tone of the era will be set by one viewpoint or the other, and public policy in the field of mental health will take the human service orientation associated with the prevailing viewpoint. The individual orientation in mental health, which has been identified with conservatism, has a number of underlying characteristics that are readily defined. 7 The individual, in this instance, is called a patient; what he has is called a disease. The patient deviates from some norm of health, and this deviation is considered abnormal. The disease, or abnormality, is regarded as being a part of the person. It can be named, classified, labeled, and, in short, diagnosed. It is complex and unusual and needs to be treated by a highly trained and skilled practitioner. The help that is given is designed to change the individual, to get rid of the disease or at least to reduce its symptoms. In its ultimate form, there is a sick person who needs medical attention. The environmental or situational orientation, which has been identified with social reform, also has definable underlying characteristics. In this case, the concern shifts from the a1Hicted individual in particular to large groups or populations. The emphasis is on prevention rather than cure, on circumstances rather than disease. Professional attention, not necessarily medical in nature, is directed at the damaging environments themselves as well as at the casualties they produce. Taken further, this orientation moves into the sphere of social




and political action. The concern is not only to prevent the disability of some but to provide for the well-being of all. The individual who is aftlicted is seen as victimized rather than as diseased. Intervention is therefore directed at changing the social and economic arrangements of society, the institutions that carry them out, and the values that underlie them. Given this background, the fate of the reports of the two joint commissions was inevitable. Each was conceived in one era and delivered in another. As times changed, so did the political authority, so did the mental health policy, and so did executive and legislative action. FIRST JOINT COMMISSION

The Joint Commission on Mental Illness and Health was established in 1955 by an act of Congress, the Mental Health Study Act. Legislation was drafted with the aid of Daniel Blain, MD, who was then medical director of the American Psychiatric Association. It called for a thorough analysis and evaluation of the human and economic problems of mental illness throughout the country. Jack Ewalt, MD, a highly respected member of the psychiatric community and identified with the state hospital system, was chosen to be the director of the" commission. Given the background and orientation of the joint commission, which emphasized individual psychopathology, the commission could accept Congress's charge comfortably. The focus here was directed toward the seriously disturbed, and the commission was given the responsibility of determining the needs and resources of the mentally ill in the country and of making


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recommendations for a national mental health program. The professional sentiment of the time was congruent with the prevailing political spirit. The results of the deliberations of the 1955 joint commission were published in 1961 in the book, Action for Mental Health. With respect to the responsibility that the federal government was to have for the care of the mentally ill, the joint commission outlined two major new roles. First, it proposed substantial financial participation on the part of the federal government for the care of mentally ill patients who, until then, had been considered the responsibility of the states. Second, it proposed that the federal government establish and maintain standards of care for the mentally ill. When it came to making proposals for specific programs, the recommendations of the joint commission focused on those people who exhibited major mental illness. The primary emphasis of the report was on improving the state hospital system by upgrading the hospitals to make them actual therapeutic institutions. Small outpatient clinics were recommended, but these too were to be used for the seriously ill, for care prior to or in lieu of hospitalization, for emergency care, for aftercare, and for rehabilitation. The role of mental health education was to foster a more benign attitude on the part of the general public with regard to the profoundly disabled and to have the public recognize its responsibility in providing support for mental patients. The joint commission took a derisive attitude toward mental health education for the sake of personal betterment-to help people manage their own lives. In sum, the Joint Commission on Mental Illness and Health regarded the central problem to be the pub-




lic care of individuals with major mental illness. Their recommendations were to provide this care through the state hospitals. IMPLEMENTATION

By the time the commission's report was published in 1961, John Kennedy had been elected president. He turned the report over to an appointive task force composed of Abraham Ribicoff, Secretary of Health, Education, and Welfare; Arthur Goldberg, Secretary of Labor; John Gleason, Administrator of Veterans' Affairs; and representatives from the Council of Economic Advisors and the Bureau of the Budget. The job of this task force was to analyze the report and develop an appropriate course of action for the federal government. The staff of the National Institute of Mental Health, under the direction of Robert Felix, served as staff to the secretaries' committee. The work of the committee took a year, and at its conclusion the report was turned over to the president's staff at the White House and the Bureau of the Budget for a further period of review. 8 The people selected by the president to make recommendations for the future course of action by the federal government were not people responsible for the mental institutions, nor were they people providing any type of direct services to the mentally ill. They were policymakers, planners, and federal administrators. Because they were not in positions that gave them an interest in maintaining the prevailing mental health system, they had the potential to take a broad outlook and to look for new approaches to the problems. The result of their efforts could be seen in President Kennedy's historic message to Congress on mental ill-


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"The recommendations that were developed within the context of one sociopolitical philosophy became translated into the intent of a different and in many ways opposing sociopolitical philosophy. In so doing, the essential character and thrust of the original recommendations were lost." ness and mental retardation, which was made early in 1963, and in the federal legislation that followed later in that year. 9 The "bold new approach" that Kennedy called for in his message and the legislation that followed represented a significant departure from the joint commission's report. In the 14 pages of his message, President Kennedy allotted only 5 sentences to improving care in the state hospitals. Rather, he emphasized prevention and the amelioration of harsh environmental conditions. He spoke of strengthening both the community and the basic institutions that provide services in the areas of social welfare and education. In short, he went far beyond the framework of the individually sick and into the realm of environmental and social change. The legislation that followed picked up the president's tone. Known as the Community Mental Health Centers Act, it proposed the establishment of community-based centers that would focus on prevention and treatment. Each center was to provide comprehensive care for all residents in a given service area. Continuity of care, to be provided by community resources, was stressed. Not only were the services to be located in the community, they were to involve the community both financially and psychologically.




The implications of the legislation were more far reaching than the mere provision of treatment services in the community. A new population was defined as the object of concern for the mental health system. This comprised not only those who were identified as patients, but the entire population of the community, particularly those who were most likely to suffer under the impact of adverse circumstances. For the first time, primary prevention in the form of consultation and education, became a mandatory component of a publicly supported mental health program. to Sanction was given to expanding the role of mental health education to include personal betterment. Consultation was to be provided to help strengthen other community agencies and institutions. Continuity of care was to be promoted by coordinating resources not previously included in the mental health system. Notwithstanding some controversy, the mental health center frequently became the locus for programs of social and political action that were directed particularly toward improving the wellbeing of the powerless, the disadvantaged, and the disenfranchised. Community mental health went beyond a program of services and took on the character of a social movement. It was inextricably linked to another social movement of the time. Just prior to taking his fateful trip to Dallas-and just about the time that the Community Mental Health Centers Act was passed-President Kennedy had proposed an examination of the circumstances of poverty in this country with an aim toward its alleviation. During President Johnson's administration, characterized as The Great Society, this examination emerged as the Economic Opportunity Program or the War on Poverty. The community mental health


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movement and the War on Poverty were related trends in the era of social reform. In summary, the Joint Commission on Mental Illness and Health was established in the mid-1950s, during a period of conservatism under President Eisenhower, a Republican. The Congress had asked for a study of "the resources, methods, and practices currently utilized in diagnosing, treating, caring for, and rehabilitating the mentally ill." 11 The political ideology of that time was translated into its associated concept in the human services, and the focus was placed on the individual who is seen as sick and who needs medical help. This orientation was congenial to the joint commission. It produced a final report, whose purpose, in Ewalt's words, was "to arrive at a national program that would approach adequacy in meeting the individual needs of the mentally ill people of America." 12 The report of the commission, however, did not appear until 1961. By that time, a period of social reform was under way. John Kennedy was its reflection and its instrument. The report of the joint commission was repudiated by the secretaries' committee. by the National Institute of Mental Health, bv the White House staff, by the president, and by the Congress. Essentially, it was repudiated by the times. SECOND JOINT COMMISSION In 1965, Senator Abraham Ribicoff, former Secretary of Health, Education, and Welfare during President Kennedy's New Frontier, introduced an article into the amendments to the Social Security Act that established the Joint Commission on the Mental Health of Children. Scarcely two years earlier, Kennedy had been assassinated by a man who had suffered emotional prob-


KEFLECTIONS FOR KOSAL YNN


lems in childhood that had been recognized but left untreated. This factor helped provide the impetus for the legislation that was known in some circles as the Oswald Amendment. The legislation called for a program of study on the diagnosis, prevention, and treatment of emotional illness in children. The body that undertook this extensive study was the Joint Commission on the Mental Health of Children, under the direction of a psychologist, Joseph M. Bobbitt. From the beginning there were indications that this second joint commission was different from the first. The charge by Congress called for prevention ,as well as diagnosis and treatment. In fact, the name of the commission included only the word "health," not "illness." Even the background of the director reflected the change in times. Bobbitt, a psychologist not a psychiatrist, was a social scientist in the federal administration rather than a service-provider in the mental health system. The Joint Commission on Mental Health of Children was established during the Johnson administration, a period of continuing social tempest and social reform. The report it produced, "Crisis in Child Mental Health," is much more a document of social action than a prescription for a mental health service system. In its 578 pages, including 12 chapters and 7 appendixes, there is a single chapter on emotionally disturbed and mentally ill children. In his foreword to the report, Senator Ribicoff set the stage for the orientation of the commission: The Joint Commission wants us to think not just about sickness and healtp. but about child development and growth, about the environment in which


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a child lives-his family, his schools, his friends, his community. For this is where the child learns and shapes himself and the world around him.13 This second joint commission directed itself to contemporary American society as a whole. It went beyond treatment, even beyond prevention, and set as its concern the improvement of the quality of community life in America. It emphasized the need for the elimination of poverty. It pointed to racism as the country's foremost public health problem. It called for "a network of comprehensive, systematic services, programs and policies which will guarantee to every American, from conception through age 24, the opportunity to develop to his maximum potential." 14 Its recommendations included programs of income maintenance, housing, education, food distribution, and guaranteed employment. At the core of these proposals was the recommendation that there be federal funding for the establishment of a system of child advocacy at the national, state, municipal, and neighborhood levels. Through this system, attention would be paid to the needs of children, and services for them would be insured. Thus, the 1965 joint commission had gone far beyond the boundaries of traditional mental health and had addressed itself to the essence of society's social and economic composition. To say the least, many mental health professionals were startled and discomfited by the report.15 They wanted more concern to be shown and more funding to be recommended for emotionally disturbed and mentally ill children. Nonetheless, many leaders believed that there was much of value in the work of the joint commission, and there was a general assumption that its report would be influential.




RETURN TO CONSERVATISM

However, the report did not appear until 1969-four years after the creation of the Joint Commission on Mental Health of Children. The mood of the country had shifted once more. President Nixon had been elected in 1968. A social action document-revolutionary in nature and encyclopedic in scope-was delivered to an unsympathetic administration. In terms of its impact on national mental health policy and legislation, the report had essentially disappeared. To begin with, President Nixon had his own approach to the problem of mental health and mental retardation. The report of the joint commission was presented in June 1969. Six months later, the president established a Task Force on the Mentally Handicapped. Charged with reviewing the field of mental handicap and making recommendations for legislative or executive action, the task force began its work. It was chaired by Mrs. Winthrop Rockefeller, a member of the President's Committee on Mental Retardation and a former president of the National Association for Mental Health. Its report, Action Against Mental Disability, was published in September 1970. 16 The language of their titles alone pointed out a clear difference between the Joint Commission on the Mental Health of Children and Nixon's Task Force on the Mentally Handicapped. Instead of "mental health," used during the Johnson administration, the words "mental disability" and "handicap" were used. The recommendations of the task force abandoned the concept of large-scale social change and concentrated on prevention and on the treatment and rehabilitation of the mentally disabled. Its emphasis was on the improve-


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"Unlike the previous commISSIOns on mental health, the present commission is a creature of the president rather than a creature of Congress. The First Family is directly involved in the deliberations, and it is almost certain that the recommendations will receive strong presidential backing." ment of mental health services, not on the restructuring of social institutions. Instead of a national system of advocacy, it recommended a Joint Council on Disabilities. Poverty, violence, and racism were all covered in a page and half of a 62-page report, and there were no recommendations associated with them. One senses in the report the struggle experienced by the task force in staying within the political and conceptual boundaries established by President Nixon. The members of the task force used the word "disabled" instead of "handicapped," because the former seemed to them less permanent and less severe. They did refer to environmental factors and social problems. They did endorse the work and the recommendations of the Joint Commission on Mental Health of Children, but they did not incorporate these within their own recommendations, nor did they stray far from the traditional orientation toward mental health services. In simplest terms, the task force was a reflection of the conservatism of the times. No less a reflection of the times was the mental health legislation that was passed in March 1970. These amendments to the Community Mental Health Centers Act provided, among other things, for the establishment of mental health programs for children. These pro-




grams were narrowly defined and were directed at the prevention and treatment of the mental health problems of children. This legislation showed no debt to the four-year work of the 1965 joint commission. There were no sweeping provisions for social and economic change, no enhancement of the general quality of life. Mental health programs for children were absorbed back into the traditional mainstream of the provision of services to individuals in need. The earlier time sequence reflecting the consequences of time lag on national mental health policy can be repeated to include federal legislative actions. 1952-Eisenhower elected 1955-Joint Commission on Mental Illness and Health established 1960-Kennedy elected 1961-Joint Commission Report, Action for Mental Health, submitted 1963-Community Mental Health Centers Act 1964-Johnson elected 1965-Joint Commission on Mental Health of Children established 1968-Nixon elected 1969-Joint Commission Report, Crisis in Child Mental Health, submitted 1970-Community Mental Health Centers Amendments (Children's Services)

LEGISLATION OF 1975 An interesting sidelight is the community mental health centers legislation of 1975. Known in political and pro-


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fessional shorthand as P.L. 94-63, these were the mental health amendments passed by the 94th Congress. As early as 1972, President Nixon had made known his desire and intention to eliminate federal funding for community mental health centers-a position that was later continued by President Ford. However, the desire of a Republican administration was denied by a Congress controlled by the Democrats. The administration's position was that the program had demonstrated its value and that federal funding should, therefore, be discontinued. The opinion of the Congress was that the program had demonstrated its value and that federal funding should, therefore, go on. The bill was met by a presidential veto, which in turn was met by an immediate Congressional override. Even this brief background captures some of the political spirit of the mid-1970s. The more extreme conservative position, which is typically unsympathetic to the public funding of human service programs, did not prevail. Amendments were passed that endorsed and carried on the intent of the legislation of 1963, but the amendments did not constitute any major breakthroughs of their own. Certainly they were not accompanied by the ringing rhetoric of New Frontier, Great Society, or Kennedy's plea for a bold new approach. The country followed the middle of the road, avoiding the extremes of conservatism or reform. The mixture of political philosophies is seen in the mental health legislation of 1975. The legislation provides for a continuation of funding for existing mental health centers and provides additional money to stimulate the development of new centers. It adds new services to what may be considered a comprehensive mental health program. It creates special grants for the pre-




vention-oriented activities of consultation and education. In expanding the role of citizen involvement in government and policy control, it continues a major trend of the 1960s. But, at the same time, the legislation abounds with more conservative themes--cost effectiveness, management information, various forms of accountability, selfsufficiency, better administration, evaluation, fiscal management. Many detailed requirements of this sort are written directly into the legislation. There is a strong emphasis on the collection of patients' fees to support the program, which in itself suggests a definition of medical services being provided to sick people. Although they endorsed the concept of community mental health centers, the amendments were, above all, a piece of legislation reflecting a managerial or administrative point of view. To the extent that the legislation was a reflection of its times, it was a harbinger of the presidential election that would take place in 1976. Fiscal prudence mellowed by a concern for human needs, faith in the ability of the ordinary citizen to provide wisdom in setting public policy, cost control and quality control combined-the federal mental health legislation of 1975 predicted the election of Jimmy Carter in 1976. The conservative Democratic businessman, who was also concerned about people, was elected over the conservative Republican politician whose record in social welfare was not distinguished. THE PRESENT COMMISSION

Unlike the previous commissions on mental health, the present commission is a creature of the president rather than a creature of the Congress. The First Family is di-


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rectly involved in the deliberations of the commission, and it is almost certain that the recommendations will receive strong presidential backing. The president established the commission shortly after taking office. Work was begun promptly. The final report is due early in the life of the administration. If this timetable is kept, the president's commission will have the opportunity to have a more direct impact than the preceding commissions. The same people who instituted the commission will have the opportunity to implement its report. It is unlikely that the report will be shelved and certainly unlikely that the ensuing legislation will not bear the commission's stamp. The same president will be in office, the same party will be in power, the same sociopolitical influences will be in operation. Given the fate of the previous commissions, Mrs. Carter's wish to have the work completed quickly is well founded. EPILOGUE

The president's commission fulfilled Rosalynn Carter's wish. It maintained the timetable set by executive order and delivered its report to the president in Apri11978. 17 A preliminary appraisal of the report suggests that it maintains and even advances the approach of a federal commitment to mental health. However, it does not strike off on new paths, but rather seeks an evolutionary continuation of what has gone before. It appears to be a document expressing a middle-of-the-road viewpoint; it reflects an informed and concerned conservatism and emphasizes technical and managerial adjustments rather than bold conceptual breakthroughs. In the title of an article, the American Psychological Association charac-




terized the report as follows: "Mental Health Panel Calls for Few New Initiatives, Much Fine Tuning." 18 What legislation will now follow remains to be seen. The report and its recommendations are available to the president early in his Administration. The Administration that conceived the commission can now propose legislation based on the commission's report. If the analysis presented in this article is correct, the legislation that is enacted should closely resemble in spirit and detail the recommendations of the president's commission because they are linked within one overall sociopolitical epoch.

About the Authors Phyllis Hersch, Ph.D., is Coordinator of Protective Services, Office of Social Services, Massachusetts Department of Public Welfare, Boston. Charles Hersch, Ph.D., is in private practice in Lincoln, Massachusetts.

Notes and References 1. Jimmy Carter, "President's Commission on Mental Health," Presidential Documents, Executive Order 11973, February 17, 1977, Federal Register, 42 (February 23, 1977), pp. 10677-10678.


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2. "Carter Creates Mental Health Panel; Sets Sights on Improving Services," APA Monitor, 8 (March 1977), p. 1. 3. Joint Commission on Mental Illness and Health, Action for Menta,! Health (New York: Basic Books, 1961). 4. Joint Commission on Mental Health of Children, Crisis in Child Mental Health (New York: Harper & Row, 1969). 5. Murray Levine and Adeline Levine, A Social History of Helping Services: Clinic, Court, School and Community (New York: Appleton-Century-Crofts, 1970). 6. Charles Hersch, "Social History, Mental Health, and Community Control," American Psychologist, 27 (August 1972), p. 749. 7. For a discussion .of the mental health orientation, see Wi1liam Ryan, "Emotional Disorder as a Social Problem: Implications for Mental Health Programs," American Journal 0/ Orthopsychiatry, 41 (July 1971), pp. 645-648, and Ryan, "A New Ideology for the 70's," Issues for Action (March 1971), unpaged. 8. See Bertram S. Brown, "The Impact of the New Federal Mental Health Legislation on the State Mental Hospital System," in Arthur J. Bindman and Al1en D. Spiegel, eds., Perspectives in Community Mental Health (Chicago: Aldine Publishing Co., 1969); and Alfred J. Kahn, Studies in Social Policv and Planning (New York: Russell Sage Foundation, 1969). 9. John F. Kennedy, Messa!?e from the President of the United States Relative to Mental Illne.vs and Mental Retardafion, 88th Congress, 1st Session, Document No. 58, House of Representatives, Washington, D.C.. 1963; reorinted in American Psychologist, 18 (April 1963), pp. 280-289. 10. See Stanley F. Yolles, "Past, Present and 1980; Trend Projections," in Leopold Bellak and H. H. Barten, eds., Progress in Community Mental Health, Vol. 1 (New York: Grune & Stratton, 1969). 11. Joint Commission on Mental Illness and Health. op. cit., p. 303.




12. Ibid., p. xxv. 13. Joint Commission on Mental Health of Children, op. cit., p. xv. 14. Digest of Crisis in Child Mental Hea!th (Washington, D.C.: Joint Commission on Mental Health of Children, 1969), pp. 9-10. 15. See Charles Hersch, "The Clinician and the Joint Commission Report: A Dialogue," Journal of the American Academy of Child Psychiatry, 10 (July 1971), pp. 406-417. 16. President's Task Force on the Mentally Handicapped, Action Against Mental Disability (Washington, D.C.: U.S. Government Printing Office, 1970). 17. Report to the President from the President's Commission on Mental Health (Washington, D.C.: U.S. Government Printing Office, 1978). 18. "Mental Health Panel Calls for Few New Initiatives, Much Fine Tuning," APA Monitor, 9 (May 1978), p. 1.

Do you subscribe to Social Work. Research & Abstracts? If not, look what you missed in the Summer issue: • Assessing Title XX at the local level

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