more basic than IQ or physical perfection. Previous to this summer, both my experience with and understanding of children were very limited. Much of that has changed now. I have gained a genuine love and appreciation for the beauty that is children, regardless of intellectual status. This 'awakening,' in and of itself, would have singularly made the summer worthwhile."

This program is believed to be unique in the United States, antedating the similar program developed by the Western Interstate Commission for Higher Education (WICHE) by some three years. At the present time eight college students registered in the upper or graduate division of a recognized college are employed as student professional assistants at the hospital during the summer months. They experience training in the five clinical divisions of the hospital clinical psychology, psychiatric social work, rehabilitation therapy, special education, and nursing. An equal number of students of each sex are selected from different colleges throughout the Pacific Soutwest states, of various racial backgrounds and collegiate "majors" and live on the state hospital grounds. In that some of the earlier students now have made a career in the field of mental health, we believe the program to be a success.

(Signed) James T. Shelton, M.D. Superintendent and Medical Director

Porterville State Hospital,
California

University of Cincinnati College of Medicine

The faculty's comments indicate in general a warm interest in the idea of utilizing young persons in mental health facilities.

It is felt that there should be a carefully graded but complete orientation to the description, dynamics, and treatment of emotional problems. This orientation could take place initially in seminars, and then training could be continued through supervision in the clinics and wards with patients who are in active therapy. Several feel that this initial orientation should be carried out in the place of future service.

There are numerous suggestions about the ways in which the National Service Corps could be helpful in hospitals, clinics, research facilities, and courts.

In state hospitals "companionship therapy" could be carried out through the use of these young people as aides or as adjunctive social workers. They could rather quickly become useful as teachers or aides in occupational therapy, manual arts therapy, music therapy, library work, work therapy, and other therapeutic devices.

In outpatient facilities it is suggested that interagency liaison and some routine administrative or receptionist duties could be performed. They could follow up and help with difficult home situations that overworked casework staffs cannot handle. The corpsmen could administer simple questionnaires such as the Minnesota Multiphasic Personality Inventory.

Similar routine research questionnaires could be administered, and such routines as collecting long or short verbal samples can be carried out by intelligent nonprofessionals in research facilities.

In court clinics, which struggle with huge masses of outpatients, there is a great need for intelligent young "lay assistants" to act as Big Brothers and Sisters or probation officers. Harvard's "Streetcorner Research" has already demonstrated the therapeutic efficacy of "volunteer experimenters." Leenhouts has shown the usefulness of volunteer probation officers.

As to effects of the program, the faculty suggests that lasting effects will ensue only if the corps is a serious and long-term project. Not only may patients benefit, but the

3) For help in feeding selected patients.

4) Aid in various rehabilitation clinics.

5) Follow-up adjustment of patients in the community after their discharge from the hospital.

6) Help establish contact and create interest of relatives and friends in writing and visiting patients or taking patients home for visits.

7) Accompany patients on off-ward and off-station events on an individual rather than group basis.

8) Teach hobbies and leisure time activities that pa

tient may carry on after leaving the hospital.

9) Participate in areas of community relations so as to help resolve social and psychiatric obstacles that obstruct the return of the patient to the community.

10) Seek homes and constructive activities that will help patients find acceptance in the community and thus decrease their return to the protected atmosphere of the hospital.

(Signed) Henry Tanner, M.D. Hospital Director VA Hospital, Northampton, Mass.

Mary Thompson Hospital, Chicago, Illinois

Local supervision could take place from the immediate organization of our clinic. I would specifically use these young people in two ways: a) Resocialization therapy with clinic patients who are conditionally discharged; b) As agents to contact the local community and help integrate mental patients back into the community through the clinic, for example, seeking jobs, re-establishing them in their homes, encouraging social contacts, etc.

The type of preservice training that would be desirable to fit these young people for assignment to the clinic would be given by the clinic staff and by myself. I have had experience in teaching medical students, residents, nurses, and physical therapists and it would require a course of perhaps eight weeks with continued supervision to select and train the people to be involved in this program.

The type of in-service training that I would give them would be a lay-oriented course in normal and abnormal dynamics and development. The latter would specifically stress disturbances in behavior and would emphasize the fact that these people are able to be helped. I specifically refer to the therapy of the schizophrenic patient where we may reverse the steps of difficult interpersonal relationships, withdrawal, and disorganization by pointing out that the hospital will handle the disorganization and that the service corps volunteer may immeasurably aid in interpersonal relationships and in preventing withdrawal. I feel that it is necessary to maintain a high degree of enthusiasm for the volunteers, otherwise they are lost to the

project and do not provide the kind of attitude necessary for real help.

I do think that this service could be integrated into our program. I am especially interested in breaking the isolation of the therapeutic situation, that is, the staff, clinic and hospital, from the community at large and the National Service Corps might provide the necessary link in order to establish a therapeutic relationship to the community. I feel that psychiatrists are totally aware of the fact that the majority of the conditions that we call mental illness are really based on contingencies and social situations and if we are able to increase our therapeutic effectiveness we must get out of the clinic and into the community.

I think this idea is exceedingly feasible and very desirable. Resocialization techniques are not difficult to teach, particularly if one avoids esoteric terminology and trains the service corps volunteer to react with empathy to the patients who are suffering from emotional diseases. This can be an exceedingly exciting program and I would like to be a part of it.

(Signed) Thaddeus Kostrubala, M.D. Clinical Director, Mental Health Service Mary Thompson Hospital 140 N. Ashland Blvd. Chicago 7, Illinois

Department of Mental Health, Lansing, Michigan

First, I would like to state that the Department of Mental Health is extremely desirous of actively participating in this project and will do everything it can to make this state a desirable and satisfying environment for any of the volunteers. In the program development stage it may be necessary to concur or obtain approval from other segments of state government.

These individuals would be treated with the same concern and be generally subject to the same rules and regulations as our full-time employees. I would anticipate specific job assignments for specific periods of time and we would expect the volunteers to assume responsibility for meeting such schedules. This position does not stem from any theory of bureaucratic control, but rather from the conviction that the more totally integrated these people are in the operation of one of our agencies, the more effective their contribution would be. It is possible that they might be integrated into a volunteer program at some locations where the present volunteer programs are well organized. The precise manner of integration, it seems to me, would vary somewhat from agency to agency.

The corps volunteers would work in any job in which they express an interest or have any particular competence. Specifically, we could use them as attendant nurses, recreation workers, in a variety of social casework functions, in clinical laboratory services, as physiotherapists with our handicapped children, and in a variety of other situations with which you are familiar.

We would not anticipate any conflict with the Michigan Civil Service Regulations since these volunteers would not displace present employees and would not be considered as receiving preferential consideration over people on our current Civil Service registers.

We would also assume responsibility for adequate training for those individuals coming into our program here in Michigan. My first inclination would be to develop a central training center for the various activities to be performed. For example, we have a vital need for people who could carry out basic physiotherapy techniques and we could provide a three-month program of intensive training at one spot in the Detroit area and then assign these individuals to various hospitals. It is conceivable that in some situations the training would best be done at the place where the individual will ultimately work, and this would vary depending on the specific kinds of jobs. Most of these training

activities could be incorporated with our present training programs in the various areas.

(Signed) V. A. Stehman, M.D.
Deputy Director

Dept. of Mental Health
Lansing 13, Michigan

Newberry State Hospital, Michigan

Here at Newberry we operate an 1800-bed hospital for both the mentally ill and mentally retarded (400 beds for retarded) and render service to the entire Upper Peninsula of Michigan. I have asked the assistant superintendent, the business executive, the director of nursing service, the director of social service, and education director of the children's unit (retarded group), to present possibilities of utilization of these people and their various suggestions are attached hereto. It is hoped that this might give you a more detailed idea of possible utilization of these people in a state mental hospital.

COMMENTS BY ASSISTANT SUPERINTENDENT

They can aid in personality development of the mentally retarded, an area which has always been impossible to cover properly in any institution, and in many cases they can even function as foster parents and teachers, as many of the mentally retarded can learn to do things which we regard as simple if only someone has the patience to show them. They could also be helpful in a similar way with personality problems of the mentally ill. More specifically some of these workers could combine occupational therapy and recreational therapy for patients who are confined to the wards and, therefore, are unable to participate in our regular

classes.

COMMENTS BY BUSINESS EXECUTIVE

(Listed according to priority of personal patient needs)

1) More extensive work with special diets: a. Working with weight charts; b. Keeping close check on patients' progress with special diets.

2) Menu analysis determining which menus are preferred by patients and studying the waste we have with each

menu.

3) Patient clothing program: a. Helping sort clothing; b. Working with community groups in obtaining donated clothing; c. Fitting patients with clothing.

4) Transportation: Handling all patient movement to and from laboratory, X-ray, recreation, etc.

5) Testing all products we buy food, clothing, cleaning supplies, etc. Perhaps this should be set up as a central testing lot to service all state institutions. It seems to us these volunteer people would work very well in conjunction with a centrally located testing lab where the proper equipment would be available for quantitative and qualitative analysis of goods bought by all institutions. People working with the individual institutions could be used as a supplement to this testing lab and supply it with products and basic information for testing.

6) Sanitation and pest control: a. Applying products; b. Testing products; c. Helping to control Staphylococcus infections.

7) Safety: a. Inspecting of mechanical equipment; b. Checking on safety standards used by patients and employees; c. Helping in safety program to educate employees in good safety procedures.

8) Investigating surplus items from federal and state sources. Checking to see surplus items listed are needed and usable at the hospital.

9) Projects that will enable us to provide a brighter environment for our people: a. Painting areas we cannot cover with usual staff of painters; b. Repairing and refinishing furniture.

10) Landscaping improvement to make grounds more attractive to the patients.

11) Equipment inventory: Helping to set up a system for the control of movement of equipment and taking inventory.

COMMENTS BY DIRECTOR OF NURSING SERVICE

Volunteers from the National Service Corps can be utilized in the nursing department in various ways. Two considerations occur to me as being quite important to gain the fullest potential from these volunteers: First, it appears necessary that their assignments either blend into functions of current employees or are specific job assignments, for example, area clerks or ward clerks. Second, their assignments should challenge their intellectual capabilities, and, if possible, continue to whet their quest for knowledge so that they will become attracted to some facet of, or at least more sympathetic toward, the mental health field. These National Service Corps volunteers could also be assigned to a research project, in addition to vitalizing their assignments; this would provide the hospital with a heightened atmosphere of freshness and development.

With the above background in mind, these volunteers could have assignments in:

1) Positions comparable to that of attendant nurse with possible accents in areas such as remotivation and patient on-ward activities (things we already want to develop among our attendant nurse personnel).

2) Area and ward clerking, which would then relieve area and ward personnel of clerical functions so that they would have more time for patient interaction.

3) Rehabilitation service wards: these volunteers could be utilized in lieu of staff for guidance and supervision of patient government as well as companionship for these patients.

4) Messenger and escort service: Beyond the actual performance of duties relative to this program, these volunteers could teach patients the duties and responsibilities of this service.

5) Activity programs: Additional staff of this caliber could be utilized to work in conjunction with our attendant staff, to provide on-ward activities in conjunction with occupational therapy and recreational therapy.

COMMENTS BY DIRECTOR OF SOCIAL SERVICE

We would request that two be attached to this department to take care of arranging, scheduling, transporting, and other related matters concerning appointments for optical needs and personal shopping of the patients. A person in a similar capacity principally involved in shopping, and preferably a woman, would be needed for this procedure for the patients on the children's unit.

Personnel of this nature can also be utilized in a more administrative function. An individual would be of paramount help attached to our department to carry out the function of preparing and completing forms relative to the vital statistics concerned with the County Referral Program, Veterans Administration forms and applications, and to follow up Social Security requests and obtain information required annually by the Social Security office.

COMMENTS BY EDUCATION DIRECTOR

We could improve our program by assigning National

Service Corps people as follows:

1) Assistant home economics instructor
2) Assistant arts and crafts instructor
3) Two assistant classroom teachers

4) Two (later possibly more) on-the-ward recreation personnel.

(Signed) R. R. Cameron, M.D.
Superintendent

Newberry State Hospital,
Michigan

City of Chicago Board of Health

I can think of no other agency whose need is greater than those of us serving in the field of mental health and illness, with particular emphasis on community mental health programming. We have found in working with communities such as we have here in Chicago that the distinction between social illness and emotional illness is too fine a distinction to draw, and that the treatment of individuals lies not only in the hands of trained professionals, but also in the hands of their fellow community residents. The enthusiasm brought to such programs by young adults is therapeutic in itself. Too often it has been the cynicism grown out of long years of battling against major odds that has detracted from choosing alternative treatment techniques and approaches to the problem of mental illness and promoting mental health.

In our area we could use groups of twenty to forty young adults working within our organization. At this date we are making plans for such a voluntary organization regardless of the national service group. We would use them in a number of ways. The school drop-out program in Chicago presents major difficulties. We feel the relationship of young adults serving as guidance counsellors and teaching these individuals how to cope with their own internal stresses as well as the stresses piled upon them by the community, would be most therapeutic.

There has been a great deal of discussion in terms of the philosophy of who is the therapist in this area. We've come to the conclusion that the person who makes the most immediate rapport, the person who breaches the wall, whether it be of apathy, sullenness or anger, is the therapist. It then becomes the job of the community mental health program to serve as consultants, supervisors and resource personnel for these "therapists."

(Signed) Harold M. Visotsky, M.D. Director

Division of Mental Health
Services

Chicago, Illinois

Department of Public Welfare

State of Minnesota

As to needs, to begin with I think there is no question but what we need much additional service in the hospitals, and could certainly make use of corps volunteers. The manpower shortage is reflected in various ways. For example, we are short of clerks and stenographers, and this ties up the record-keeping, which is required for good hospital operation. The four major areas have always been patient care at the ward level (we do not have enough aides, and therefore have always tried to use other patients to help, especially in some of the basic business of feeding and washing those who are too infirm to do this themselves), laundry, food service, and the farms.

Thus there is no question as to the need for additional workers in just about every line of work. Although it would be difficult to have them all show up at once, there is no question but that ultimately we could use several hundred volunteers to work with us on a full-time basis, to help take care of the total of some 14,500 mentally ill and mentally retarded patients whom we have under our care. The best bet realistically, it seems to me, would be younger people who have not developed a specific professional skill and may be still in the early stages of trying to decide on a career. A high school graduate who had taken a secretarial course could be assigned in the medical records section, and under supervision learn something about medical records. This is a specialty in itself, and one which would be useful later on as a career. The type of training which we could provide in this, as in other areas, would be somewhat of the rough and ready school, but nevertheless would be extremely valuable. In the same way, we could make

use of younger people in some of the chemistry and other laboratories, the X-ray department, the pharmacy, etc.

In the laundry, food service, and farm assignments, there would be precious little of a specialized nature which would appeal to the young volunteer, I should think. Thus the problems of preparing food for our patients would not substantially differ from those of preparing food for any institutional group of similar size, and ditto with laundry. The only special problem on this is the ability to work with patients and to help them in their work assignments. In other words, from our point of view, having some volunteers of this sort in the food service could spell the difference between its being a simple work assignment, as it is now, and actually being something that one could dignify by the title of industrial therapy. Otherwise, I am afraid there would not be too much appeal from the volunteer's point of view. A particularly promising area, it seems to me, would be in the general area of patient activities, either in the rehabilitation therapies department or in nursing services. We could, without too much trouble, help the volunteers develop some skills as recreational workers, occupational therapists, music therapists, and the like. In some cases it would be pretty rough and ready. On the other hand, we have some very skillful people in our rehabilitation departments, and workers coming in could learn a great deal. As a matter of fact, we have several students in the summer months and sometimes at other times who come to us for this sort of training and experience. To some extent there would still be the problem I refer to above, namely, the amount of time required to supervise the inexperienced volunteer. Nevertheless, we are used to doing this in these particular programs, and I think this would be no great difficulty.

I think a particular area which could be explored with corps volunteers would be the development of psychotherapy

technicians or something of this sort. For example, following the normal aide training course of 120 hours, they could receive additional specific instruction in techniques of psychotherapy, both in individual and in group work. The aides that we get are usually of an intellectual level such that, although they may be very good and dedicated workers in the sense of providing bedside care and routine management of the wards, the higher subtleties of psychodynamics and interpersonal relationships, techniques of therapy, and the like, would really be beyond them. The use of volunteer college students to carry out one-to-one therapy with patients has shown that intelligent people can catch on very quickly and can be a tremendous boon to the hospital. An organized program in psychodynamics and psychotherapy could be carried out through the psychology department and could produce a level of skill which would be invaluable to the worker in a future assignment, and later on in life. Such a move, by the way, would be consistent with one of the important recommendations of the recent report of the Joint Commission on Mental Illness and Health, namely, that there be developed a profession of "Mental Health Counselors' who would be, in effect, people specialized to carry out psychotherapy under the supervision of a psychologist or psychiatrist. Along with this, or as another option after the basic aide training course is completed, would be to work in the social service departments in the capacity of "Case aides" (someone who carries out intake interviews, investigations, etc.).

(Signed) David J. Vail, M.D. Medical Director Department of Public

Welfare

Saint Paul, Minnesota