Meeting The Manpower Crisis In Staffing The Mental Health Facilities: The Role Of The Federal Government

by Milton Wittman, D. S. W.[2]

Editor’s Note: This was a speech given at Annual Meeting of Conference of Chief Social Workers in State and Territorial Mental Health Programs, Cleveland, Ohio, May 17, 1963. [1]

It seems inappropriate to consider the “manpower crisis” only in terms of numbers of social workers, psychiatrists, psychologists, and nurses. Rather, it seems more important to discuss the use which is made of these professions in the structure of mental health programs as they function today and as they may function in the future. The program of the National Institute of Mental Health has been oriented from the first to the problem of increasing the quality and the quantity of trained personnel in the United States. The purpose of the Mental Health Act of 1946 was explicit on this point. In providing funds for increased support for training, the extension of research, and for expansion of services throughout the United States, the major decisions have been based on the central objective of ultimate provision of complete coverage for the total population in terms of mental health diagnostic and treatment facilities.

The French study published in 1940[3] revealed that in 1937 there were 409 members of the American Association of Psychiatric Social Workers, 140 of whom were placed in mental health clinics and in mental hospitals. The psychiatric social work facilities. The Federal program has provided an increasing investment of teaching and scholarship funds in social work education. The amount has increased from $211,000 in 1947-48 to a projected $7.5 million in 1963-64. These funds will support students in psychiatric social work, school social work, corrections and delinquency, community organization, and a variety of other fields of social work practice with relevance to mental health. It should be noted that while there is no legal commitment for placement of graduates in a given field, students receiving traineeships are expected to state a career objective in the field for which the grant is made. A number do enter immediately into psychiatric social work positions, while others take such positions later in their careers.

A recent study of 597 former trainees who have received NIMH support reveals that 47% are in hospital and clinic facilities; 32% are in social service agencies; and the remainder are scattered through various other teaching, correctional, health and welfare institutions.[4] This study has also revealed that the states which have training centers tend to employ proportionately larger numbers of graduates who have received these grants. The regions which have the largest numbers of states without schools of social work have the fewest of these graduates. These are the New England states, the Southeast and Southwest regions, and the Mountain states. It is certainly obvious that some extended planning must take place if there is to be a better distribution of trained manpower.

A number of state mental health programs have done a great deal to develop training resources within their states. They have worked out programs of scholarship aid and inservice training and have made every effort to assist in the general recruitment effort. Others have done little beyond the operation of hospital and clinic services intended to meet the immediate mental health needs of people. In too few instances has there been evidence of an active effort to coordinate state mental health program activities and the work of academic centers. The hospital and clinic system should provide an increasing number of field resources which are state supported. The Federal program cannot meet the total need for support of field instruction personnel for faculty and for student aid required by expanding programs of social work education. It is evident that state and local resources will also be needed to match the Federal efforts in this field.

The Federal program is providing increased research support under the mental health projects program to permit demonstrations and research on personnel utilization. It is obvious that there is too little research in this field when viewed against the magnitude of the problems involved. There is too great a tendency to accept the status quo of present structures and to attempt to staff these even though it is unrealistic in terms of numbers of graduates available.

The state mental health programs have an opportunity to develop experimental approaches to personnel utilization and to relate these to training activities. The impetus which could result from innovations in training is lacking in the main because too few in the field are putting their minds to the development and activation of research in this field.

In a paper presented before this group in Philadelphia in 1957 on the subject of “Education for Community Mental Health Practice,” the writer suggested that:

“The social work role in prevention will become better known and will take more of our professional effort. New social inventions beyond the social agency and the child guidance clinic may pave the way for such a development.”[5]

In the President’s mental health message in February 1963, there is reference to the comprehensive community mental health center as an institution which might represent within the complex of mental health structures a program directed toward the best possible coordination of services and a focal point for the investment of professional effort. The implications in the proposal that every state take steps to plan for and develop such a group of comprehensive community mental health centers suggests that the time has come to take a giant stride in the revision and re-structuring of mental health concepts to modify the more typical institutional pattern of service. The standard hospital and clinic provide basic diagnostic and treatment services, but unfortunately do not tend to become well integrated into the community structure. The adjective “comprehensive” suggests multiple functions, some of which will take the application of a new philosophy, a different variety of skills and the introduction of new concepts of professional roles.

An opportunity to move into this field is presented in the suggestion for the comprehensive community mental health center as the modality for the provision of services. A mental health center is neither solely a hospital nor solely a clinic. It is a combination of facilities intended to provide early and effective care, treatment and rehabilitation. It is oriented toward close community involvement with the network of community agencies and other resources. As these centers are developed, the training and research component should be established as integrated parts of the whole. It is completely appropriate that students in this field should become aware at an early stage in their professional training of the opportunities for creative and innovative practice. Such centers should also provide a ready opportunity for social work research and for experimentation with subprofessional levels of practice. Combination of group-work and casework and the injection of strong component of community organization should become easily possible in such a framework.

Conclusion

There is an acute need to anticipate increased enrollments in social work education and the possibility that the field will lose out in recruitment if means are not found to permit an expansion of educational resources to meet the impending demands. This implies clearly that old schools will need to be expanded (where possible) and new schools will need to be initiated.

Since it is obvious that the Federal program cannot meet all of the program needs in training for educational field instruction personnel, the state mental health programs should provide more direct support for training activities. Implied in this is an active inservice training and staff development program which will provide a career line for bachelor’s degree graduates who are not prepared to enter professional school or who actively seek a job placement requiring less than full professional training. The state investment in inservice training is still at a minimal level in terms of the need for such activities.

There is an inherent need for improved communication between practice and education. My impression in 1957 was that a large gulf existed between education and practice in mental health. This gap seems to have closed somewhat during the intervening years, but there is still too little evidence of joint program planning on the part of faculty in schools of social work and mental health program administrators. There is a great need to envision the manpower situation not as an acute crisis, but as an endemic problem which will always require direct attention. Only with coordinated planning on the part of professional education and consumers of their product can we have an expansion that will take into account the needs of the field.

Notes:

[1] Speech given at Annual Meeting of Conference of Chief Social Workers in State and Territorial Mental Health Programs, Cleveland, Ohio, May 17, 1963.

[2] Chief, Social Work Section, Training Branch, National Institute of Mental Health, National Institutes of Health, U.S. Department of Health, Education, and Welfare, Bethesda 14, Maryland.

[3] French, Louis M., Psychiatric Social Work, (The Commonwealth Fund: New York, 1940), page 80.

[4] Beatrice M. Shriver, Ralph Simon, Current Professional Status of Mental Health Personnel Supported Under NIMH Training Grants, PHS Publication No. 1088 (U.S. Government Printing Office, Washington, D.C., 1963), page 46.

[5] Wittman, Milton, “Education for Community Mental Health Practice: Problems and Prospects,” Social Work, Vol. 3, No. 4, October 1958, page 69.

Source: Milton Wittman Papers. Box 24. University of Minnesota, Twin Cities, Social Welfare History Archives. Minneapolis, MN.