INTRODUCTION

Tt is frequently asserted that ours is a nation devoted to its children.

We repeatedly state that they are our most precious natural resource. Our acts,
however, belie our words. Contrary to what we proclaim, we have yet to commit
our vast resources to eliminating the innumerable ills which hinder the healthy
development of our young.

Going back as far as the first White House Conference on Children in 1909 we
have repeatedly, and with considerable eloquence, announced our intentions to develop
a strong, imaginative program to care for emotionally disturbed children. For
example, the 1930 White House Conference on Child Health and Protection, composed
of several thousand citizens and government officials, proclaimed that:

"The emotionally disturbed child has a right to grow up

in a world which does not set him apart, which looks at him not

with scorn or pity or ridicule -- but which welcomes him exactly as

it welcomes every child, which offers him identical privileges and

identical responsibilities."

The 1930 White House Conference estimated that there were, at that time, at
least two and one-half million children with well-marked behavioral difficulties,
including the more serious mental and nervous disorders.

In the four decades since the issuance of that report, the care of the
emotionally disturbed child in this country has not improved -- it has worsened
considerably. During the three years of its deliberations and fact-finding efforts,
the Joint Commission has gathered together an impressive body of descriptive material
on the plight of the emotionally disturbed child in America today.

Our major national, professional organizations estimate that there are now
approximately four million children under the age of 18 who are in need of some
kind of theraputic intervention because of emotional difficulties. Of this number,

anywhere from one-half million to a million children are so seriously disturbed that

they require immediate treatment.
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Are they getting this treatment? A recent survey undertaken by the National
Institute of Mental Health concludes that at least two-thirds of the children under
18 in the United States who need psychiatric care are not getting it. The survey
reported that, in 1966, only 473,000 of the 70 million children under the age of 18
in this country received some service at a psychiatric facility. Based on estimates
that two percent of all school children need psychiatric help of some sort, the survey
concluded that an additional 1,400,000 youngsters should have received care that year.
Furthermore, many professional leaders in the field of child mental health criticize as
much too low the estimate that two percent of all school children need some psychiatric
help -~ they contend, and they base their contentions upon surveys made among the school
populations of a number of cities, that the percentage of emotionally disturbed children
is closer to 10% than the two percent yardstick used in the NIMH study.

What happens to these emotionally sick children for whom there are no services
in the community? Each year, increasing numbers of them are expelled from the community
and confined in large state hospitals so understaffed that they have few, if any, pro-
fessionals trained in child psychiatry and related disciplines. It is not unusual in
this year 1969 to tour one of these massive warehouses for the mentally ill and come
upon a child, aged nine or ten, confined on a ward with 80 or 90 sick adults. Our
present data indicates that at least 25,000 of these children are confined in state
mental institutions. On the basis of a trend which has been developing over the past
few years, the National Institute of Mental Health estimates that by 1970 the number
of children aged 10 - 14 hospitalized in these institutions will have doubled.

The National Institute of Mental Health also reports that thousands upon
thousands of elderly patients now confined on the back wards of these state institutions

were first admitted as children 30, 40, and even 50 years ago. A recent report from
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one state estimates that one in every four children admitted to its mental hospitals
"can anticipare being permanently hospitalized for the next 50 years of their lives".

After a two year study of the situation, the Clinical Committee of our Com-

mission had this to say of the hospitalization of these disturbed children:
"The admission of teen-agers to the state hospitals has

risen something like 150% in the last decade...Instead of being

helped, the vast majority are the worse for the experience. The

usual picture is one of untrained people working with outmoded

facilities within the framework of long abandoned theory (where there

is any consistent theory), attempting to deal with a wide variety of

complex and seriously sick youngsters and producing results that are

more easily measured by a recidvism rate that is often 30 to 50%,

anc occasionally higher.

"What we have, in effect, is a state of quiet emergency,

unheralded and unsung, silently building up its rate of failure

and disability and seemingly allowed to go its way with an absolute

minimum of attention from the public, the legislators, or the

clinical professionals. Nor is it difficult to understand why this

state of affairs obtains -- no one likes a delinquent youth, a bad actor,

and when he is sent away the chief wish is just that, that he 'go away'.

Out of sight. Out of mind."

What happens if the disturbed child is fortunate enough to escape the state in-
stitution treadmill? Ina few of the major cities in this country, there are private,
residential treatment centers which care for about 2,500 children a year. Since the
average cost to the parents of such hospitalization ranges from $50 to $75 a day, it
is obvious that only those of our citizens who are in the higher income brackets can
take advantage of such services. Even among these rarified income brackets the situation
is far from satisfactory; for every child admitted to one of these private facilities,
10 or more are turned away because of lack of space. In 15 of our states, there are

no such facilities for children, either public or private; in 24 of our states, there

are no public units to care for children from low and middle income groups.
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What about all the rest of our four million children who need some kind
of help for an emotional disturbance? Here the statistics become much less precise,
since a vast majority of these children are literally lost. They are bounced around
from training schools to reformatories to jails and whipped through all kinds of
understaffed welfare agencies. No one is their keeper. No agency in the community
is equipped to evaluate either the correctness of their placement, or the outcome
of such placement.

If they are sent to a training school, as recent testimony before a Senate
Committee revealed, they receive poorer treatment than caged animals or adult convicts.
Appearing in 1969 before a Senate Committee, Joseph R. Rowan, an expert on delinquency
who is now director of the John Howard Association of Illinois, characterized these
institutions for ‘uveniles as "crime hatcheries where children are tutored in crime
if they are not assulted by other inmates or the guards first". Another witness,
Arlen Specter, the District Attorrey of Philadelphia, told the same committee that
these so-caliec correctional institutions for juveniles take a 13 year old and, ir
12 years, turn out "a finely honec weapon against society".

Commenting on the failure of juvenile courts and juvenile correctional
facilities to ever begin to meet the manifest needs of emotionally disturbed and
sociopatnic children, Judge David Bazelon, a member of the Joint Commission, noted in
a recent talk that although this nation is aware of the problem, it does not support

funds to treat and care for these children because it has really given up on them.

 
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In essence, we have developed through indifference and inadvertence a non-
system for the care and treatment of emotionally disturbed children. Put yourself
in the position of the mother of a very disturbed boy. His behavioral problems has
reached the point that the mother is told he can no longer attend the local public
school. She talks with the school guidance counselor, who points out that he has
responsibility for anywhere from 300 to 500 children; he is sorry he can't do any more
for her boy. He suggests the advisability of private psychiatric treatment. He
isn't very optimistic about this -- he tells her that there are only two child
psychiatrists in thig city of 300,000, and both are impossibly overworked. She ex-
plains that there are two other children in the family and that her husband makes only
$8,500 a year, but she is willing to borrow money -- take out another mortgage on the
house -- if it can help her boy. The guidance counselor suggests that she contact
the one child guidance clinic in the city. She takes the boy there and is interviewed
by a social worker. She is told to bring the boy back in six weeks for psychological
testing. When this is completed, she is informed that they would like to start treat-
ment for the boy but they are swamped with cases -- would she come back in six months
and see what the situation is then?

The boy is at home and is very disturbed. One afternoon, he runs off and
is not found for four days. He has been picked up by the police, along with several
other boys, for stealing from a number of stores in the neighborhood. His case comes
before the iuvenile court and, after a two month wait because of a crowded docket, he
is sent to the state training school. From there on, the record is all down hill.
Only 13 years of age when committed to the juvenile training school, he spends nine
of the next 12 years in and out of various institutions. During his three years on

the outside, he is picked up at various times for petty street thievery,hustling girls,
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an armed holdup when he is 15, a tour of duty as a small time dope smuggler for
organized crime, and so on. At age 25, the once troubled boy is a bitter, hardened
criminal. Society has already spent $31,000 on him while incarcerating him in
various institutions; keeping him in jail will now cost another $5,000 a year.

The above story is not fiction -- it is an actual case history recently re-
lated to a Senate committee.

Case histories such as the foregoing, plus independent research, led the
Clinical Committee of the Joint Commission to the following inescapable conclusion:
"As of today, the treatment of the mentally ill child in

America is uncertain, variable and inadequate. This is true on

all levels, rich and poor, rural and urban. The problems are most

widespread among the poor, as are all health problems, but the fact

is that only a fraction of our young people get the help they need

at the time they need it."

From all of its studies, the Joint Commission concludes that it is an
undeniable fact that there is not a single community in this country which provides
an acceptable standard of services for its mentally ill children, running a spectrum
from early theraputic intervention to social restoration in the home, the school
and in the community.

In issuing a mandate to establish the Joint Commission on Mental Health of
Chiidren, Congress gave netiona. recognition to this need. In fulfillment of its
task, the Joint Commission declares:

--This Nation, the richest of all world powers, has no
unified national commitment to its children and youth.
The claim that we are a child-centered society, that
we lock to our young as tomorrow's leaders, is a myth.

Our words are made meaningless by our actions -- by our

lack of national, community, and personal investment in
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maintaining the healthy development of our young, by

the minuscule amount of economic resources spent in

developing the young, by the sheer number of ill-fed, ill-
housed, ill-educated, mentally ili, and discontented youngsters

in our midst.

--This Nation, which prides itself on democratic values
and equal opportunity, still subjects its young to the

mentally unhealthy consequences of poverty and racism.

--This Nation, richly endowed with the knowledge to
develop its youthful resources, has yet to fill the

gap between knowledge and action.

--This Nation, increasingly sophisticated and knowledgeable
about mental health and child development, continues its
very limited planning and programming largely around the

concept of treating, rather than preventing, mental illness.

--This Nation, despite its emphasis on treatment, has yet
to develop adequate mental health services and
facilities for all children, regardless of race and
economic circumstances. As a result, many receive
no care. The number of young, particularly adolescents,

who are committed to mental institutions continues to rise
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markedly. Yet, we have not provided the resources

and manpower to assist those who are devoted to caring
for these children. As a result, any possible benefits
of confinement are lost in the tragic waste of the back
ward. Even less effort is made to develop community
services so these children can be kept as closely as

possible within their normal, routine setting.

While the Joint Commission strongly urges better treatment for the mentally
ill, the handicapped, the retarded, the delinquent, and the emotionally disturbed,
we join forces with those wha propose a broader but more meaningful concept of
mental health, one which is based on the developmental view with prevention as the
major goal. We contend that the mentally healthy life is one in which self-
direction and satisfying interdependent relationships prevail, one in which there
is meaning, purpose, and opportunity. We believe that lives hemmed in by rigid
conformity, impulsivity, and hostility, lives which are uprooted, thwarted, and
denied the growth of their inherent capacities are mentally unhealthy. Unfulfilled
lives cost us twice -- once in the loss of human resources, in the apathetic, un-
happy, and violent souls in our midst, and again in the loss of productivity to
our society, and the economic costs of dependency. We believe that, if we are to
promote the mental health of our young and if we are to develop our human resources,

every infant must be granted:
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-~-the right to be wanted

 

yet, millions of unwanted children continue
to be born -- often with tragic consequences --
largely because their mothers have not had

access to birth control information and devices,

--the right to be born healthy

yet, approximately one million children will be
born this year to women who get no medical aid
during their pregnancy or inadequate obstetrical
care for delivery; because of this lack of pro-
fessional care, many will be born with brain
damage from disorders of pregnancy, some of which
might have been avoided simply by protein and

vitamin supplements,

--the right to live in a healthy environment
yet, thousands of children and youth become
physically handicapped or acquire chronic damage
to their health from preventable accidents and
diseases, largely because of impoverished en-
vironments; even greater numbers living in such
environments will become psychologically handi-
capped and damaged, unable to compete in school
or on a job or to fulfill their inherent capabilities --

they will become dependents of, rather than contributors

to our society,
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--the right to satisfaction of basic needs

 

yet, approximately one-fourth of our children

face the possibility of malnutrition, inadequate
housing, untreated physical and mental disorders,
and all the other now well-known crippling effects

of economic insecurity,

--the right to continuous loving care
yet, millions of our young never acquire the
necessary motivation or intellectual and emo-
tional skills required to cope effectively in
our society because they do not have consistent
emotionally satisfying care, either. in or out-
side the home; there are few programs which aid
parents in developing more adequate child-rearing
techniques; and especially there are few adequate
child care facilities to serve working mothers,
to aid in times of temporary family crisis, or

for those children who are neglected or abused,

--the right to acquire the intellectual and emotional skills
necessary to achieve individual aspirations and to cope

effectively in our society

 

yet, each year almost a million of our youth drop
out of school and enter the adult world without
adequate skills and with diminished chances of

becoming productive citizens; countless others are
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denied the opportunities to develop to their
fullest potential through training or higher
education; and for all of our children and youth
the transition to adulthood is made more difficult
because w. fail to provide avenues for learning
aduit roles -- or any approved means by which
youth's voice might be heard and be influential

in a worid in which they too must live.

We know that when these rights are granted, development will proceed
favorably for the normal intact infant. Few children, however, encounter continu-
ously those ideal circumstances that enhance their hereditary potential for health,
competence, and humanity. There are vast variations and inequalities in the
start and maintenance which children receive and, undoubtedly, many will continue
to be psychologically damaged. Tf our more unfortunate are to become functioning

and productive citizens, we believe they must be granted:

~-the right to receive care and treatment in facilities which

 

are appropriate to their needs and which keep them as closely

 

as possible within their normal social setting

 

yet, several millions of our children and youth ~-- the
emotionally disturbed, the mentally ill, the mentally
retarded, the handicapped, and the delinquent -- are not
receiving such care. The reasons are innumerable.

Many receive no services because the services are
fragmented, nonexistent, or too costly. Others are

diagnosed and labeled without regard to their level
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of functioning and subsequently removed from their
homes, schools, and communities to be confined on
hospital wards with psychotic adults or to de-
personalized institutions which deliver little

more than custodial care.

We must ask ourselves whether we can continue to deny our children their
inalienable rights? Can we continue to gamble with our Nation's future by allowing
children to grow up in environments which we know are psychologically damaging -- and
compound this by lack of adequate care and treatment?

We have the knowledge and the riches to remedy many of the conditions which
affect our young, yet we lack a genuine commitment to do so. We blind ourselves

to the fact that we create most of the social problems of our young which we so

deplore -- infants who fail to thrive - seriously disturbed children in mental
institutions - adolescent drug addiction - senseless acts of violence and destruction
by youth.

Our lack of commitment is self-defeating. We know already that it is more
fruitful to prevent damage to our young than to attempt to patch and heal the wounds.
We know that much of the damage could be avoided in the first three years of life.

We know that mental development and competence are largely set by the age of six.
Yet we do not act on this knowledge. Studies indicate that children in general,
regardless cf class cr race, do not receive the needed support and assistance from
ovr society. But, it is the damaged, the vulnerable, and the pcor who are given
the least opportunities to overcome early deprivations. They benefit least from
our health, welfare, and educational services. Those who are the most helpless

are the most neglected.
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Essentially, we propose a shift in strategy for human development in this
Nation. We must truly concentrate our resources on the new generation and thus
eliminate problems which exact so high a price later on.

In the allocation of these resources, the Commission recommends the following
priorities of effort:

1. The diagnosis and treatment of the emotionally
sick child;

2. The prevention of illness;

3. The optimization of growth and capacity.

These services should cover the entire range of childhood, from the prenatal
care of the pregnant mother at one end of the spectrum to the transition of the
college age youth into young adulthood at the other.

So that the major thrust of this report will be crystal clear to all who
read it, we quote again from the final report of our Clinical Committee:

"The priorities for the establishment of services and

training programs, and for the overall distribution of monies should

follow this order of goals: First, the treatment of every child

as well as the family around the child wherever demonstratle illness

is found; then, and, often enough as part of the same effcrt, the

attempt to prevent illness and disturbance by large scale planning;

and, ultimately, the reorganization of social structures in a way

that will encourage the maximum flowering of each person's individual
potential for self-realization and social contribution."

Fostering the development of human beings in this country is a means to
an end -- a means to stem the increasing proportions of people damaged by an
economy which cannot use them and to whom increasing proportions of the gross national
product must be delegated; a means to cecrease the number of people alienated from
the mainstream of our soceity who are living lives with little hepe, ready impulses

to violence, and diminished chances for becoming productive, contributing citizens.
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The first step in accomplishing this goal is a genuine commitment to
our children and youth. We must look honestly at the scope of the problem and
begin now to follow our words by acton. For in our children lies our future and
our hope for the fulfillment of our national goals. We must not -- cannot --

afford to do less.

Mike Gorman