Exactly fifty years ago John F. Kennedy was inaugurated President of the United States, and during the past week we have been reminded both of his inaugural address and also of the death of one of his last living close associates, Sargent Shriver. Let us also look back on Kennedy's commitment with persons who display mental illness and mental retardation. His message "To The Congress of the United States" (from "Message from The President of the United States relative to Mental Illness and Mental Retardation; February 5, 1963; reprinted in American Journal of Psychiatry, Feb. 1964) was the impetus for many of his fellow citizens to know more about, conduct research on, and treat these two conditions--fulfilling, at least from my view, mandates included in the Sermon of the Mount:
It is my intention to send shortly to the Congress a message pertaining to this Nation's most urgent needs in the area of health improvement. But two health problems--because they are of such critical size and tragic impact, and because of their susceptibility to public action is so much greater than the attention they have received--are deserving of a wholly new national approach and a separate message to the Congress. The twin problems are mental illness and mental retardation.
Mental illness and mental retardation are among our most critical health problems. They occur more frequently, affect more people, require more prolonged treatment, cause more suffering by the families of the afflicted, waste more of our human resources, and constitute more financial drain both upon the public treasury and the personal finances of the individual families than any other single condition.
This situation has been tolerated far too long. It has troubled our national conscience--but only as a problem unpleasant to mention, easy to postpone, and despairing of solution. The Federal government, despite the nationwide impact of the problem, has largely left the solutions up to the States. The States have depended on custodial hospitals and homes. Many such hospitals and homes have been shamefully understaffed, overcrowded institutions from which death too often provided the only firm hope of release...
There are very significant variations in the impact of the incidence of mental retardation. Draft rejections for mental deficiency were 14 times as heavy in states with low incomes as in others. In some slum areas 10 to 30 percent of the school-age children are mentally retarded, while in the very same cities more prosperous neighborhoods have only 1 or 2 percent retarded...
We must act--to bestow the full benefits of our society on those who suffer from mental disabilities; to prevent the occurrence of mental illness and mental illness whenever and wherever possible; to provide for early diagnosis and continuos and comprehensive care, in the community, of those suffering from these disorders; to stimulate improvements in the level of care given the mentally disabled in our State and private institutions, and to re-orient those programs to a community-centered approach...to reinforce the will and capacity of our communities to meet these problems, in order that the communities, in turn, can reinforce the will and capacity of individuals and individual families...
These words have had a massive effect, from creating an awareness and charitable response among citizens in the entire nation, saving many lives that would have been lost, to building many effective programs while introducing the opportunity for waste and even fraud in others. From my view Head Start is one of the valuable and functioning legacies--the greatest cause of mental retardation is now not the slum areas Kennedy noted, but rather genetic causes, many identifiable in the womb. Early intervention programs for children have brought a normal or near-normal life and subsequent economic productivity to many who would have been a burden on society or their families. Research studies funded through the National Institute of Mental Health and Veteran's Administration have brought greater effectiveness in treatments for schizophrenia, depression, post-traumatic stress disorder, and other conditions. There are community mental health centers, funded by Medicaid, where quality psychological help is available for poor people. Perhaps one of the greatest positive effects has been in brightening the lives of the mentally retarded, many who have been allowed the opportunity to be proud citizens of their communities.
Despite all of these wonderful things occurring, Kennedy's words have not been a panancea, and as Christ would note, the poor in Spirit--those with mental retardation and mental illness--still reside with us. When the large psychiatric institutions were closed--some of these had over 5,000 residents--too large a number of patients were unable to adapt, and now we deal with the problem of too many homeless people on our streets. They are there, not by their own free will, but because of insurmountable emotional and psychiatric problems. I surmise--lacking research findings or statistics--even that some of the unstable and dangerous persons who live among us have slipped through the cracks, and may have found, in a system with larger institutions, places of care and asylum. And still another problem we deal with in the gigantic bureaucracy is Medicaid Fraud--a two edged sword which can allow public monies to be stolen while at the same time keep eligible persons away from the help they deserve.
Can we learn from Kennedy's "national mental health program and the national program to combat mental retardation" which he proposed and which found great support after he was assassinated? Kennedy's words have gone beyond being fond memories or inspiration--they are now part of history, and with this perspective perhaps their real consequences can be separated from their ideal hopes, and we can apply this knowledge and discussion to similar national issues which face us today.
William Van Ornum