Letter to the President, Board of Commissioners of the District of Columbia, on Mental Illness and Mental Retardation.

Dear Mr. Tobriner:

We have the knowledge and the capacity to relieve great suffering and to rehabilitate untold numbers of our fellow citizens affected with mental disabilities. But to attain these goals within a reasonable span of time, we must act promptly and wisely. I have recently set forth my views on the subject in a Special Message to the Congress on Mental Illness and Mental Retardation. It sets forth recommendations for important legislative and budgetary action.

Basic to a sound program for improving the lot of the mentally ill and the retarded is comprehensive community planning and action, making use of the rapidly growing body of scientific knowledge.

The States and the Federal Government should work principally with the urban communities of the Nation by providing leadership, technical assistance, and matching funds to develop and execute effective community plans. In the field of mental health, Federal funds to assist the States and the District of Columbia to develop such plans are available this year through the National Institute of Mental Health. Funds will be available to the District for this purpose as soon as the District Government submits, and has approved, a plan for their utilization.

It is my earnest hope that the District of Columbia will be a leader in adopting and demonstrating the new concepts in the treatment of mental illness. These concepts call for a community based program providing a range of services to meet community needs. They involve greatly increased preventive work; early diagnosis and outpatient treatment in comprehensive community health centers close to the homes of patients; prompt and intensive treatment when hospitalization is necessary; rapid restoration of patients to useful life using follow-up treatment techniques wherever necessary; and flexible use of day care and residential treatment centers to handle patients who are on their way out of hospitals and those who might otherwise be on their way into hospitals. Rehabilitation efforts would be enhanced with a well-functioning foster care program, counseling and training programs, and close liaison with community employment services. Schools, health and welfare agencies, and the courts, as well as the professional schools and societies and the research organizations, need to develop new patterns of cooperation and action.

A community mental health program should be centered around comprehensive community mental health centers providing both a focus for community resources and better community facilities for all aspects of mental health care. It should also be committed to the belief that most mental illness can either be cured or ameliorated so that long hospitalization is not needed. Such a program should go far toward reducing the tragedy of thousands of long-term patients in mental hospitals and the consequent heavy financial burden.

I am gratified to learn that the Commissioners have already started surveying the mental health problems and needs of the District and developing a comprehensive community mental health plan. I trust that both the pending grant of funds to aid in this planning and the program recommended in my Special Message will be of major assistance to the District in moving toward its objectives.

I am asking the Secretary of Health, Education, and Welfare to be of every possible help to the District in this important endeavor. Your planning should include the development of cooperative policies which will minimize the hospitalization of patients as well as the development of reciprocal policies between Saint Elizabeth's Hospital and the District which will facilitate the placement in nursing homes and foster homes of a large number of patients who no longer need to be in a mental hospital but for whom there are not at present suitable alternative facilities. It should also provide for the systematic and expeditious transition in the care of the District's mentally ill to the new comprehensive community mental health center approach as a demonstration to the nation of how the program I have proposed to the Congress can be effectively carried out. In addition, your plans should enlist the many local institutions in related training programs to assure that needs for professional and supporting manpower can be met.

Mental retardation is the second devastating mental disability which we must vigorously attack--and here, too, a comprehensive community-centered approach is necessary. Because mental retardation usually strikes in childhood and because its facts tend to be permanent once the damage is done, prevention must be given a high priority. This is especially necessary in areas which contain a substantial concentration of economically and culturally deprived families among whom the incidence of retardation is likely to be exceptionally high. Success in prevention will require a combination of improved maternal and child health, welfare, and educational measures of the sort outlined in the recent report of my Panel on Mental Retardation.

Action must also be taken to improve the care, the training, and the rehabilitation of those who are already afflicted by retardation. This is not only a duty but offers real and heretofore untapped possibilities for returning many such individuals to a more useful and happy life.

I hope that the District can move forward toward the goal of preventing much of the retardation which now occurs and in demonstrating how services for those who are retarded can be improved. Proposals to authorize new Federal programs for planning grants and for various action programs are now before the Congress. However, it is my hope that the District will proceed in initiating plans and action on its own accord for the broad spectrum attack necessary to make progress against mental retardation. Here again, the Department of Health, Education, and Welfare, as well as other Federal agencies, will stand ready to assist in every way possible.

There would appear to be no better place for these forward-looking programs to be started than in the Nation's capital. I would urge, therefore, that the Commissioners consider these matters of the utmost importance. The District of Columbia thus can and should serve as a model for the Nation in these important areas of human need.

Sincerely,

JOHN F. KENNEDY

[Honorable Walter N. Tobriner, President, Board of Commissioners of the District of Columbia, Washington 4, D.C.]