MENTAL HEALTH TRAINING AND PUBLIC HEALTH MANPOWER By StepHEN E. GoLpston, Ed. D., M.S.P.H. Special Assistant to the Director National Institute of Mental Health and ELENA Pappa, Ph. D. Professor, Department of Psychiatry College of Human Medicine Michigan State University National Institute of Mental Health 5600 Fishers Lane Rockville, Md. 20852 JULY 1971 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 - Price $2.75 (paper cover) Stock Number 1724-0168 PREFACE This book is based on findings of a research project about professional public health workers. The findings are derived from the 3,115 replies to a questionnaire mailed in August-October 1968 to those American citizens who had received a master’s degree from one of 11 schools of public health in the United States during the period 1961-67. The research project dealt specifically with issues in public health work, and indirectly with schools of public health, their role in mental health training, and their relevance to professional activities as perceived by those professional public health workers who participated in the survey. Underpinning the inquiry were the notions: (1) That mental health con- cepts, techniques, and practices enrich and facilitate the operation and acceptance of public health programs and enhance the effectiveness of public health workers; (2) that mental health considerations should be an essential aspect of the training programs provided by schools of public health; and (3) that in view of the magnitude of mental health problems and of the concerns of public health with the overall health of communities and populations, schools of public health are also appropriate educational settings for the development of mental health specialists. Thus, the focus of the inquiry fell on studying how professional public health workers were trained, the kinds of mental health training that they ob- tained, and their views as to the pertinence of this training in the context of their occupational settings and jobs. The findings presented in this book are related to larger issues of the American health crisis, viz, health manpower, health expenditures, and the organization and delivery of health services, and to the place of the continuing controversy between the fields of public health and mental health to this crisis. The increased emphasis on health care with a component of prevention, pro- tection, and health maintenance as a part of the scope of public health and the trends toward community mental health, comprehensive health planning, pre- payment programs, and comprehensive health services systems bring into closer urgency the need to clarify the interfaces and areas of common or complementary concerns between public health and mental health. Such clarification is a first step toward conceiving and implementing more effective training programs and organizing services designed for meeting with efficiency the health needs of all population groups throughout the country. This volume is an attempt in that direction. The specific background of the research itself can best be understood within the framework of a broad administrative program review plan at the National Institute of Mental Health (NIMH) concerned with mental health training in schools of public health which had as its objectives— (I) to review and appraise the mental health training grant pro- gram to schools of public health whose primary source of support has been Federal funds obtained from the NIMH; (2) to identify the parameters of these mental health training programs with particular concern as to their objectives, resources, con- tent, methods, and progress; public fe lth ibrary iii iv (3) to increase the visibility and relevance of public health-mental health concepts in training efforts; (4) to create a forum for the discussion of mental health training issues among deans of schools of public health and those public health faculty members whose areas of specialization impinge on mental health concerns; (5) to develop curricular materials which would be of value in promoting mental health concepts in schools of public health; and (6) to obtain systematic data about graduates of schools of public health and how they viewed their public health-mental health training so as to add this dimension for mental health program development in the schools of public health and in continuing education programs. The need for this research emerged while the first-named author had both administrative and program development responsibilities for NIMH training grants to the schools of public health from 1963 to 1969. In reviewing this pro- gram, consistent baseline information was lacking in two crucial areas: The ex- posure to mental health considerations received by students, and the kinds of public health-mental health role models that they had acquired in their graduate training. These two areas, although central to training concerns, were also deemed crucial to future professional activities. What are the impacts of the philosophical and practical differences between the public health and mental health fields on the socialization of professional public health workers who would be able and willing to bridge the gap between both fields and carry with them a unified approach into their professional performance? What professional models are available for such graduates throughout their training? The extent of these prob- lems, in turn, appeared to obscure approaches as to how schools of public health could contribute optimally to the national mental health effort. Furthermore, during the period covered by the study, while continuing to attend to the process of role and function redefinition, schools of public health, like other institutions of higher education, were faced with rapidly expanding knowledge and tech- nology, vast social changes, and new and increasing expectations. From the stand- point of program planning, analysis, and review it was clear that research was needed to yield a data base that might serve for program guidance as well as to stimulate future research into health manpower and training evaluation by the schools of public health themselves. As a result, the study reported in this book was undertaken. This volume has been organized into six sections. Part I (chs. 1-4) is con- cerned primarily with presenting the contextual background for the research findings. Part II (chs. 5-6) describes the characteristics of graduates from schools of public health who participated in this study. Part III (chs. 7-9) presents the appraisals which respondents made about their mental health training in a school of public health and its relevance to their current work. Part IV (chs. 10-11) presents the respondents’ views on the relationships of mental health to public health, and the place of mental health in public health. Part V (ch. 12) discusses the findings on needs for further training and improvement of mental health training programs. Part VI (ch. 13) contains a summary of the research findings with implications for training, service, and curriculum development. To make clearer the presentation of certain items of information, selected tables are contained in the text; other cited tables and references are in the appendixes. The authors hope that these findings will be of interest and concern to mental health and public health leaders, to educators in the health professions, to health planners, and to public health practitioners who are involved in developing continuing education activities. Mental health specialists who are concerned with extending their effectiveness in their consultative and training functions with public health workers and others in the community; e.g., police, judges, clergy, educators, and advocates, may be particularly interested in the perceptions of public health workers to mental health and its relevance to their work. Also, sociologists and other behavioral scientists hopefully will view this volume as a contribution to the sociology of the professions. Lastly, the authors wish to contribute to a better understanding of the public health profession, professional public health workers, the mental health professions, and the rele- vance of mental health in public health work. Many people shared the investigators’ belief in the importance of this study and thus provided sustained encouragement and assistance to make it a reality. Without the cooperation of the deans of the 11 schools of publc health this study could not have been undertaken. Profound appreciation goes to the respondents who took the time to complete the questionnaire and thereby expressed their interest in the future of public health-mental health training and practice. Acknowledgment is extended to several persons at the National Institute of Mental Health: Dr. Stanley F. Yolles, former Director, who authorized the study; Dr. Raymond J. Balester who while Acting Director, Division of Man- power and Training Programs was always available for helpful comment and facilitated the required administrative support; Dr. Thomas F. Plaut, Associate Director for Program Coordination who reviewed the final manuscript; Mrs. Jean Santucci who provided unhesitantly, efficient and thoughtful assistance in typing drafts, proofreading, and handling the secretarial aspects of the study; and Mrs. Margaret C. Parsons who did the layout for the survey questionnaire. The data gathering and processing aspects of this study were conducted under a contract between NIMH and the Professional Examination Service, American Public Health Association. The close working relationship established with Mrs. Ruth S. Shaper and her staff from the outset of the study, particularly with Dr. Norman Stander, deserves special mention. Appreciation is also expressed to Dr. James L. Troupin, former Director of Professional Education, American Public Health Association, who shared with the investigators his extensive knowledge of the schools of public health, com- mented on study procedures, and read portions of the manuscript. Dr. Andrew D. Hunt, Jr., Dean of the College of Human Medicine, Michigan State University is also thanked for authorizing time to complete work on this manuscript. Early in the planning of the study the investigators had the benefits of comments about the proposed work from the following members of the Advisory Committee of the National Conference on Mental Health in Public Health Training: Drs. Viola W. Bernard, Columbia University School of Public Health and Administrative Medicine; Edward M. Cohart, Yale University Department of Epidemiology and Public Health; Paul V. Lemkau, Johns Hopkins University vi School of Hygiene and Public Health; Philip Margolis, University of Michigan School of Medicine; and Myron E. Wegman, University of Michigan School of Public Health. Their assistance is also acknowledged. StepHEN E. Govrbpston, Ed. D., M.S.P.H. ELENA PapiLLaA, Ph. D. SpriNG 1971. CONTENTS Page PREFACE ............ iii PART I—Background of the Research Project CHAPTER 1 Introduction ................ 3 Health and Mental Health Manpower ........................ .. 3 Mental Health and Public Health as Distinct Fields of Activity ...... 5 Historical Antecedents ......................................... 7 Toward Interfaces Between Public Health and Mental Health ...... 13 CHAPTER 2 The Study Framework and Methodology ............................. 16 Why the Study Was Conducted ................................ 16 Methodology ................. 17 Underlying Assumptions ................................... 17 Criteria for Selection of the Respondent Population ........... 19 Locating Respondents ...................................... 22 Conduct of the Field Survey ..................................... 22 Questionnaire Construction . ................................ 22 Mailing the Questionnaire .................................. 24 Responses Received ........................................ 25 Tabulations and Presentation of Data ........................... 26 CHAPTER 3 Overview of the Schools of Public Health ............................ 28 Early Beginnings ......................... lL. 29 Accreditation .......... LL 31 Educational Objectives and Functions ............................ 32 Administrative Organization ................................... 34 Students ........ LL 35 Programs of Study ................. oo. 38 Faculty ..... 39 Financing .......... 40 CHAPTER 4 Mental Health Training in Schools of Public Health .................. 41 Initial Efforts .......... 41 Program Development and Expansion ........................... 44 Continuing Issues ...................... 50 vii PART II—The Public Health Professional as Trainee and Worker CHAPTER 5 Educational and Demographic Profiles of Public Health Workers ...... Background ...... School of Public Health Attended ........................... Types of Master's Degrees Received .................. .. ... Demographic Characteristics .................................... Age Sex Education and Experience Before Entering a School of Public Health Highest Professional or Advanced Degree ................ .. .. Primary Professional Discipline ............................. Professional Experience in Public Health Prior to Enrollment in a School of Public Health ............................. Mental Health Work Experience and Feeling of Need for Mental Health Training Prior to Entering a School of Public Health ............. Major Programs of Study ...................................... Mental Health Program Majors ............................. Other Program Majors .................................... Comparisons Between Mental Health and Other Program Majors Primary Professional Discipline and Choice of Major Program Area LL. CHAPTER 6 Public Health Workers in the Labor Force .......................... Geographic Distribution of Public Health Workers ......... ... ... Employment Status .................... 0... Employment in the Health Field ................ ............. Unemployment ............................................ Professional Public Health Work Experience .................... Current Work Area and Major Program Pursued in a School of Public Health ..................... .......................... Public Health Workers at Work ................................ Functional Professional Titles ............................... Professional Roles ................................ ......... Patient Care Functions . ............................ .... .. Principal Sources of Professional Income .................. .. .. Work Settings ............. PART III—Assessment of Mental Health Training CHAPTER 7 Public Health Workers Appraise Their School of Public Health viii Training and Practice in Mental Health ............................ Page 55 55 55 56 61 61 63 64 64 67 70 72 74 74 75 78 88 93 93 94 95 95 95 98 100 100 100 103 104 107 115 Page Views on Mental Health Training in Public Health ............. .. 115 Mental Health Courses Taken at a School of Public Health .... 116 Concerns of Mental Health Course Work .................... 120 Public Health Contexts of Mental Health Course Work ..... 122 Mental Health Issues in Public Health Course Work ..... .. .. 126 Interest of Public Health Faculty in Mental Health ........ 127 Interaction With Faculty Members From the Mental Health Professions ............ 128 Contacts With Psychiatrists ................................. 129 Contacts With Psychologists ................................ 129 Contacts With Psychiatric Nurses ............................ 130 Contacts With Psychiatric Social Workers ..................... 130 Contacts With Other Mental Health Professionals .......... .. 131 CHAPTER 8 Appraisals of Mental Health Aspects Covered in Public Health Training 133 Coverage of Mental Health Aspects of Public Health Topics . ..... 134 Public Health Topics Most Frequently Covered in Relation to Mental Health in Schools of Public Health .............. .. 136 Public Health Topics Least Frequently Covered in Relation to Mental Health in Schools of Public Health ............. .. 139 Quality of Presentation ...................... ........ 142 Mental Health Aspects of Public Health Topics Most Fre- quently Considered Well-Presented in Schools of Public Health 144 Mental Health Aspects of Public Health Topics Least Fre- quently Considered Well-Presented in Schools of Public Health 145 Usefulness in Work ........................... 148 Of Great Use ..................... iii 148 Of Moderate Use .......................................... 151 Of Little Use . ................. ii 152 OVEIVIEW 154 CHAPTER 9 Appraisals of Mental Health Topics Covered in Public Health Training 156 Coverage of Mental Health Content Topics ....................... 156 Mental Health Topics Most Frequently Covered in Schools of Public Health ........................................... 158 Mental Health Topics Least Frequently Covered in Schools of Public Health ................. ....................... ... 164 Quality of Presentation ........................................ 168 Mental Health Topics Most Frequently Considered Well- Presented in Schools of Public Health ..................... 170 Mental Health Topics Least Frequently Considered Well- Presented in Schools of Public Health ...................... 172 Of Great Use ................. .......... i. 175 Of Moderate Use ........................... i... 175 Usefulness in Work ....... 179 ix X Of Little Use . .. OVEIVIEW PART IV—Mental Health in Public Health Practice CHAPTER 10 Relationships of Mental Health to Public Health Training and Practice. Interest in Mental Health Prompted by Training in a School of Public Health ........................................... ... Importance of Mental Health Training to Public Health Practice .. Usefulness of Total Public Health Training to Present Work Functions ............ CHAPTER 11 The Place of Mental Health in Public Health ....................... Acceptance of Mental Health Aspects by Public Health Administrators Public Expectation of Public Health Workers’ Knowledge of Mental Health Public Expectation of Public Health Workers Assuming Mental Health Roles ........ Relationships of Current Professional Work to Mental Health CONCerns .......... PART V—Mental Health Training Needs and Suggestions for Curriculum Modifications CHAPTER 12 Needs for Further Training and Improvement of Mental Health Instruction in Schools of Public Health .............................. Felt Need for Further Training in Mental Health .............. ... Views on Improvement of Mental Health Instruction by Schools of Public Health ..................... .................. ....... Interest in Further Training if Opportunities Were Made Available Preference for Auspices of Further Mental Health Training ........ Suggestions for Improving Mental Health Instruction by Schools of Public Health ................. .............................. PART VI—Review of Findings CHAPTER 13 Review of Findings ................... iii... Appendixes .............. Page 181 182 187 187 189 191 194 194 197 199 202 211 211 213 215 217 220 BACKGROUND oe OF THE RESEARCH PROJECT INTRODUCTION CHAPTERS CHOOLS of public health train professional workers for a wide variety of roles and tasks in the health field. These workers are unique with respect to their approaches to health improvement and protection measures for communities and population groups and for their focus on prevention and containment of disease on a large-scale basis. Although graduates from schools of public health constitute a relatively small part of the total health manpower labor force in the United States, they have key roles in the health field since many health policymakers in the public sector—in Federal, State, local, and county governments—have been trained or have experience in the field of public health and are exposed to the philosophy and approaches of this field. Of increasing concern to the public health field has been the magnitude of mental disorders in the general population of the country and the potential roles for public health workers to carry on preventive and promotional activities in this area as well as to extend their concerns to the rehabilitation of the mentally ill who have returned to their com- munities after hospitalization. Working toward the realization of this ob- jective has not been a simple academic or administrative task. This process has been unfolding in periods of rapid growth and differentiation for both public health and mental health. Both fields have been experiencing increasing demands for manpower and services, the introduction of new technologies, explosions of scientific knowledge, and vast social changes. Although a full discussion of these issues would be beyond the scope of this volume, the particular emphasis of this chapter is to present a sketch of the larger contexts of public health and mental health professional manpower, and an identification of divergences and junctures at which public health manpower training and practice find common or comple- mentary purpose and method with mental health work. HEALTH AND MENTAL HEALTH MANPOWER Health manpower today is developed in a variety of educational and service settings ranging from universities and health professional schools to community colleges, vocational high schools, labor unions, special train- ing centers, hospitals, and health and mental health agencies. The Armed Forces also have played an important role in training health manpower, and currently an effort is being made to recruit such personnel into civilian health careers following their military experience. The health field employed some 3.7 million persons in 1966, being the third largest industry in the United States in terms of number of workers. An additional 1.6 million persons or an increase of 45.7 percent in employ- ment is expected by 1975.1 During the period 1966-75, a monthly aver- age of 8,300 new health workers are projected to enter the field.? Whether the country is able to meet such expectations or not, the demands for increased health manpower and for changes in methods of planning, organ- izing, financing, and approaching health problems all will affect the train- ing and development of public health and mental health administrators, clinicians, educators, planners, and research specialists. Yet, the problems are by far more complex than one of increasing numbers. In the national efforts to increase health manpower and to improve its utilization, major changes in the content, direction, and methods of training will be required. The opinion is currently held that even if the manpower requirements projected during the 1960's were met, these would no longer suffice given the unprecedented rise in demand for services and in- flationary trends resulting largely from such programs as Medicare and Medicaid, unless measures and incentives are instituted to increase the capacity of health services, improve their organization and utilization, and management of health manpower is carried out more efficiently. The preparation of others to be trained in shorter time to undertake many roles now performed by highly experienced and long-trained health man- power is being recognized as crucial, and a variety of programs have emerged already to produce such personnel and to facilitate their entry in the field. Undoubtedly these pressures for expansion of health personnel, for new directions in the use of manpower, and for reorganization in the delivery of health services will have an impact on the future direction of schools of public health as well as on other health professional training. Redefinition of philosophies, reorganization of services, and creation of new professional roles and functions are required. Manpower and other problems in the mental health field, further- more, have been singled out for special attention by the mental health pro- fessions, associations, and interest groups. These efforts were intensified by the development of the NIMH as a locus for both expanding the role of the Federal Government in resource development and for stimulating the expansion of other governmental and nongovernmental actions in the field. Thus, the growth of mental health personnel in the four core professions of psychiatry, psychology, social work, and nursing increased from 44,200 to 63,947 or by 44.0 percent between 1960 and 1965—that is, more than twice the percent increase in the five major health professions combined—medicine, dentistry, nursing, environmental health, and health 1 U.S. Department of Labor, Bureau of Labor Statistics, Health Manpower 1966-75, Report No. 323. (See app. A, table 1, p. 239, “Estimated Employment in the Medical and Health Service Industry by Selected Occupation, 1966 and 1975 Projections.” See also “Health Care in America,” hearings before the Subcommittee on Executive Reorganization of the Committee on Govern- ment Operations, U.S. Senate, 90th Cong., Second Sess., pt. II, Apr. 26; July 9, 10, and 11, 1968, Washington, D.C., Government Printing Office, 1968, pp. 485 and 652. 2 U.S. Department of Health, Education, and Welfare, “Job Development and Training for Workers in Health Services,” Indicators, August 1966, p. 4. research.? In spite of the increases experienced, however, manpower short- ages in mental health have continued. “The baseline was so low,” accord- ing to NIMH, “that the increases have not yet been sufficient to eradicate the gap” between mental health manpower needs and the number of persons presently working in this field. The training programs for developing public health workers who can use mental health concepts and practices in their work or for training mental health specialists in schools of public health have been part of the effort to close the gap both by opening up different settings as new sources of mental health manpower and for producing the capacity and skills in public health manpower to include within their scope the mental health dimensions of public health work. The appropriate utilization of such personnel is not only a matter of training. It would also depend on the capacity of the public health and the mental health professions to perform differently and on the receptivity and acceptance of such changes by the public as well. In terms of social policy, two issues impinge on this receptivity: (I) Who (what kinds of personnel) does society consider to be responsible for leadership and practice in mental health work? and (2) What activities are entailed and expected from the conduct of those responsibilities? The overlaps of responsibility and the stakes of the various professions and administrative agencies involved have generated conflicts which have continued to engage many from both mental health and public health while others have worked to negotiate operational relationships addressed to soothe professional and interagency rivalries and to bridge the underlying conceptual gaps between these two fields. MENTAL HEALTH AND PUBLIC HEALTH AS DISTINCT FIELDS OF ACTIVITY Historically, mental health and public health have been and still com- prise distinct areas of endeavor, each with its own focal problems and interests, conceptions, personnel, and methods of organizing and de- livering services. The health requirements of communities and populations today, however, call for viable interrelations between these two fields to enhance their capacity to deal with the major health problems confronting people. With the rest of the health field, public health and mental health face the social urgency for modernizing the organization and methods for the delivery of comprehensive personal health care, providing methods of financing which will yield the greatest return to health dollar expenditures, assuring quality health services for all citizens as a right, and improving the quality of the environment to reduce physical, psychological, and social hazards which increase disease and reduce the span of life. In facing © 2US. Department of Health, Education, and Welfare, Division of Manpower and Training Programs, NIMH, “Mental Health Training and Manpower, 1968-1972,” Washington, D.C., Government Printing Office, 1967, p. 2. ¢ Ibid. up to these social goals and objectives, change must occur in both the mental health and the public health fields as well as in other areas of public concern which impinge on human health. Linkages between both fields have been difficult to achieve, both in training and in practice. There are as yet unresolved conceptual and operational problems involved in bringing together the two endeavors since traditional, historical, and practical factors make each field responsible for a vast domain of expertise, and for separate investments in professional, administrative, and organizational capacities. The methods of public funding by categories of disease have further stimulated this separation. These factors have tended to reinforce the respective distinctiveness of public health and mental health programs at one extreme by promoting their separateness in goals, purposes and methods, and on the other, ironically, by negating their distinctiveness. On this latter theme Yolles has written that a belief that the two fields are synonymous or that mental health is an offshoot of public health arises from the erroneous tendency to equate public health with the total universe of health: But public health is not the universe of health, or synonymous with health. It is, rather one aspect of the broad scope of health, which also includes clinical medicine and the basic medical sciences and is be- ginning to include prevention and intervention in terms of the whole range of man’s behavior in his total living context.’ Yolles assessed this reductionism as ‘‘a mere play on words, without substance or meaning.” ® In examining the related assumption that “public health is mental health and mental health is public health” he further added: Any truth that may lie in this aphorism results from the implementation of programs and activities in which mental health and public health seem to blend, rather than from any presumed ‘given’ that each field is inextricably interwoven and based each on the other.” As the health field addresses itself more to the positive qualities of health and its maintenance and improvement rather than continuing to emphasize curative and treatment functions as separate activities, new opportunities for bridging the gaps now existing between public health and mental health would appear more feasible. The accent on comprehensive health planning and comprehensive health services for populations, the increas- ing national interest in health insurance coverage and prepayment pro- grams, and the emphasis on broadening the overall base of health 5Yolles, S. F., “Social Policy and the Mentally Ill,” address presented at the 20th Mental Hospital Institute, American Psychiatric Association, Washington, D.C., Oct. 2, 1968, mimeo- graphed, p. 17. ®Yolles, S. F., “Public Health and Mental Health: Some Thoughts on the Nature of the Relationship,” in Goldston, S. E. (ed.), Proceedings of the National Conference on Mental Health in Public Health Training, Public Health Service Publication No. 1899, Washington, D.C., Gov- ernment Printing Office, 1969, pp. 6-7. 7 Ibid. manpower would appear to support and provide greater thrust toward increasing the integration of now largely departmentalized and frag- mented health programs including those in public health and in mental health agencies. Furthermore, the movement of health consumers, par- ticularly among the poor, has emerged as an additional force working in similar directions. The barriers between both fields although perhaps lowered have not yet been removed. The historical antecedents of both fields serve to clarify the directions which tend to set them apart and the currents which have brought them closer toward common areas of action. HISTORICAL ANTECEDENTS For over 100 years efforts have been made to involve public health in certain aspects of mental health work although the social institutions for attending to the public health of communities have largely remained separate and distinct from those ministering to the mentally disordered. These separate frameworks have been reinforced both by societal views of the mentally ill and by the professional competencies deemed necessary to deal with the problems posed by public health on the one hand and by mental disorders on the other. Although mental health work is more encompassing than activities and programs for the mentally ill, the care and treatment of mental illness and other emotional disorders have been and continue to be its major concern. From colonial days to the middle of the 19th century the mentally ill, the poor, and criminals were accorded similar place in society. The mentally ill were jailed or placed in almshouses supported by local govern- ments, or were just hidden in their homes by their families. Only a few State and private custodial institutions were developed. The “moral treat- ment” reforms initiated by Pinel in France and Tuke in England also in- fluenced the patterns of care to be provided to the mentally ill. By the end of the 19th century, as a result of Dorothea Dix’s reformist crusade, responsibility for care of the mentally ill was transferred to State govern- ments.® As a result, large State mental hospitals often isolated from the expanding industrial and urban centers and from community life were built. In the first decades of the 20th century, however, innovations related to present-day community mental health practice began to be initiated although these were only slowly introduced and extended. These innova- tions departed from ‘moral treatment” concepts into psychobiological concerns which had a therapeutic direction. They included the establish- ment of psychiatric wards in general hospitals, the introduction of social work activities in psychiatric care, the initiation of outpatient and after- 8 Dain, H., Concepts of Insanity in the United States, 1789-1865, New Brunswick: Rutgers University Press, 1964, 304 pp. care programs, and the founding of psychopathic hospitals for examination and precare of patients prior to commitment to mental hospitals. Sup- porting the therapeutic concerns for the mentally ill was the emerging mental hygiene movement founded by Clifford Beers. In 1909 Freud made his first visit to the United States; subsequently his theories, his students, and the psychoanalytic movement began to have major impacts on the evolution of American psychiatry. In fact, many of the leaders of the psychoanalytic movement were European exiles who had come for political asylum to the United States. Still, however, care for the mentally ill con- tinued to be primarily a responsibility of State government, and admis- sions to State hospitals and determination of mental illness continued to be largely a judicial matter with care having a custodial emphasis. Patients had little opportunity for being released to their communities and supporting community treatment and rehabilitative services were sadly lacking. In the 1950s, one-half of all hospital beds in the United States were in State mental hospitals. As the extent of the problems of mental ill- health and the human and economic costs to society were publicized, mental illness came to be described in the professional literature as “a major public health problem.” Emerging community mental health pro- grams, although largely oriented toward the treatment of persons on an individual basis, began to adopt certain concepts and procedures common to public health administration and practice. The concepts of prevalence and incidence rates derived from epidemiology became commonly ac- cepted, and the vocabularies of prevention and health education also made their way into the field.? This development has been characterized as the third “psychiatric revolution”—community psychiatry which is in effect a development from psychoanalysis and the social and behavioral sciences, particularly the anthropological theories related to personality and cul- ture developed by Ruth Benedict, Edward Sapir, and Margaret Mead. Bellack notes that advances in public health, in epidemiology, and other related fields have also contributed to the development of community psychiatry.1® Slowly, also, but over a much greater timespan, public health has also been moving its interest toward mental health. Traditionally, public health has concerned itself with the control of major diseases affecting whole com- munities and population groups. During the 19th century its emphasis was on environmental sanitation and the control of communicable dis- eases with the objectives of preventing their inception, halting their course, and reducing their impact. These objectives required surveillance and early identification of cases, the development of measures to determine the magnitude and vulnerability of populations, and the development of service programs addressed to control the agents of disease. With the in- ? Bellack, L. (ed.), Handbook of Community Psychiatry and Community Mental Health, New York: Grune & Stratton, 1964, pp. 1-3. 10 Ibid. crease of chronic disorders in the population and the realization of the emotional aspects of health and illness, mental health considerations have thus become a logical concern for public health. The classic Shattuck Report of 1850 had called attention to a role for public health in mental health by recommending that a board of health be designated in Massachusetts and that one duty of such a board would be to determine whether mentally ill persons should be institutional- ized.'* This recommendation was not adopted at the time, but over 20 years hence, Henry Putnam Stearns, following the same principle, urged State boards of health to appoint physicians to study and report the conditions which lead to mental disorders.!2 In the 1920’s the superintendent of the Boston State Hospital called attention to the New York plan which empowered health officers, among others, to hospitalize the mentally ill. In addition, Rosen notes that between 1915 and 1935 public health agencies were dealing with certain mental health matters chiefly in relation to maternal and infant care.!* During these years mental health problems however were largely peripheral to public health concerns, but of emerging interest to a point at which “there were intimations that public health officials would do well to broaden their concern with mental health.” * Illustrative of these attempts was the program established in 1916 by the Detroit Department of Health to integrate mental hygiene instruction into the staff education of public health nurses. One major effort toward identifying points of convergence between public health and mental health was a short-term training institute held in Berkeley, Calif. in June 1948, under the sponsorship of the Common- wealth Fund and the California State Department of Health. Through this institute a group of 30 city and county health officers came together with a faculty composed of eight psychiatrists, three pediatricians with psy- chiatric training, and five public health leaders for a 2-week workshop to explore and identify the relationships between mental health and public health work. As reported in the volume Public Health Is People, this train- ing experience led both participating faculty and public health officers to the realization that mental health factors intimately affect the health department in all its parts and relationships.’® Jules Coleman, one of the psychiatrists who served on the institute faculty, commented on its major emphases: 1 Rosen, G. (ed), “Public Health and Mental Health: Converging Trends and Emerging Issues,” in Mental Health Teaching in Schools of Public Health, Association of Schools of Public Health, Columbia University, 1961, p. 7. 2 1bid., p. 54. 18 Ibid., p. 54. 1 Ibid. 15 Jefferies, B., and Burke, M., “Mental Health in a City Health Department,” American Journal of Public Health, 44: 1038, August 1954. 1 Ginsburg, E. L., Public Health Is People, Cambridge: Harvard University Press, 1950, 241 PP- 10 The central idea was that public health served large segments of the population in promoting health and in preventing disease and that it might make an important mental health contribution through its own services by incorporating psychiatric concepts and procedures in rela- tion to such problems as the emotional components of illness, principles of child rearing, public education, public relations, health interviewing, and the intragroup tensions of the public health staff itself.1? Periodically over the past 20 years the public health literature has con- tained articles on mental health functions and responsibilities of local health departments. Preventive mental hygiene methods were specifi- cally utilized in the child health conferences of the Baltimore Health Depart- ment in 1949,’ introducing anticipatory guidance, a technique concerned with prognosis of events to be expected, which in the 1960's was to become a prominent tool in Peace Corps training programs. In the late 1940’s the Attitude Study Project introduced mental health concepts into the daily activities of the Kips Bay Child Health Station staff in New York.’ In 1957, Hanlon pointed out that “a local health department has the same responsibility for the mental health of a given community as it does for the community's physical health,” particularly with respect to early casefinding and prevention.” That same year, Norton et al. defined areas for the conduct of mental health roles for health officers, indicating that through conferences with psychiatrists, workshops, and inservice training, the departments of health can assume mental health responsibilities.?! In 1957 also, Lemkau cited the following mental health-related activities in which public health personnel could be involved productively: laboratory services for the diagnosis of central nervous system syphilis, the determination of bromide levels, and the estimation of lead content in blood or other tissue; biostatistical services to obtain data on the incidence and prevalence of hospitalized behavior disturbances; means for sanitary engineering staff to cope with potential litigious personal- ities; maternal health and prenatal clinics to deal with the prevention of complications of brain damage as well as behavioral health; involve- ment of school health personnel in mental health problems; and concern 7 Coleman, J., “Relations Between Mental Health and Public Health,” American Journal of Public Health, 46: 805, July 1956. 8 Stine, O. C., “Content and Method of Health Supervision by Physicians in Child Health Conferences in Baltimore, 1959,” American Journal of Public Health, 52: 1858-1865, November 1962. ® Belkin, M., Suchman, E. A., Levinson, B., and Jacobziner, H. “Mental Health Training Program for the Child Health Conference,” American Journal of Public Health, 55: 1046-1056, July 1965. * Hanlon, J. G., “The Role of the Mental Health Service in the Local Health Department,” Public Health Reports, 72: 1094, December 1957. # Norton, J. W. R., Applewhite, C. C., and Howell, R. W., “Efforts To Define and Help the Health Officer To Fulfill His Role in Mental Health Programs,” American Journal of Public Health, 47: 812-818, July 1957. with the mental health implications of institutional licensing for such facilities as nursery schools, day-care centers, and nursing homes. In 1962 the U.S. Surgeon General's Ad Hoc Committee on Mental Health Activities called attention to the areas in which public health person- nel could participate and contribute to the field of mental health. The com- mittee earmarked the following areas: (I) In primary prevention through health information and educa- tion of the general public; (2) In early case finding through observation and identification of behavior in interpersonal relationships in child health clinics, school health and industrial health services, and environmental health practices; (3) In secondary prevention by provision of supportive and/or referral services to individuals and families during crisis periods; (4) Through cooperative planning for adequate comprehensive mental health program activity; (5) Through provision for an encouragement of training activities for mental health and public health personnel; (6) Through epidemiological and program research and surveys needed to identify ‘target’ populations, and improve preventive, thera- peutic, and rehabilitative practices.?3 Organizational approaches toward bringing a functional interrelation between mental health and other health programs have been taking place at every level of government. Over the past decades also, two major trends have been set into motion regarding the administrative structures for both public health and mental health services at the State and local levels. One trend has been toward merging mental health and public health agencies either as divisions of a more encompassing health agency or as parts of other types of agencies such as welfare. The opposite trend has been toward establishing separate and distinct departments of mental health. These arrangements have also affected relationships between Government and the private sector. Whatever the administrative arrangements, program linkages and continued staff cooperation have not always succeeded. Yolles has pointed out that even where public health and mental health services are organiza- tionally and administratively linked together, there may be a “lack of cooperation between practitioners in these two groups in implementing rograms which are of mutual concern.” 2 Why does this condition of prog y “separateness” continue to exist? * Lemkau, P. V., “Mental Health Tasks in General Health Programs,” American Journal of Public Health, 47: 797-801, July 1957. # U.S. Department of Health, Education, and Welfare, Report of the Surgeon General's Ad Hoc Committee on Mental Health Activities, “Mental Health Activities and the Development of Comprehensive Health Programs in the Community,” Public Health Service Publication No. 995, Washington, D.C., Government Printing Office, 1962, p. 8. * *Yolles, S. F., “Public Health and Mental Health: Some Thoughts on the Nature of the Relationship,” in Goldston, S. E. (ed.), Proceedings of the National Conference on Mental Health in Public Health Training, Public Health Service Publication No. 1899, Washington, D.C., Government Printing Office, 1969, p. 7. 11 12 One may point first to the primary professional orientation of the practitioners of each of these fields. While public health workers have traditionally been community, group, and prevention oriented, mental health professionals still primarily receive their basic training within a framework which is individually and clinically oriented. Second, few mental health professional workers are trained in or are exposed to public health concepts and thus are not able to seize opportunities to work productively with public health people or to employ public health approaches in their programs. Third, when a mental health service is administratively part of a local health department, neither the mental health staff nor the health officer may perceive that such staff could effectively contribute to public health programs or vice versa. Where mental health staff have been engaged by health departments in situations where no organized mental health service exists, such appointments have usually been part time and the ac- tivities pursued most frequently relate to mental health consultation with public health nurses to the exclusion of other health department staff. An- other factor to be considered is that the higher salary scales paid to mental health professionals for clinical work deter them from seeking public health work. Furthermore, the kind of mental health training received by public health workers or the absence thereof may be an additional contributing factor. If public health workers are not adequately trained in mental health, there would appear to be little room for expectancies that mental health workers can be of assistance in, or that mental health concepts have applicability to, public health work. Yolles has advanced the argument that a key reason for the distance between mental health and public health “lies heavily in the absence of a conceptual basis for mental health training in the schools of public health * * *” and that “the existing psychiatric, psychological, and psycho- analytic models are no longer appropriate for teaching mental health in schools of public health.” 2» He continues: The ambiguous and even amorphous status of mental health in schools of public health today is a reflection of the ambiguities of the status and relationships of mental health to public health on one hand and to psychiatry, psychology, and psychoanalytic thought on the other * * * In short, mental health training for students in schools of public health cannot mirror the content or curricula provided for the basic training of mental health specialists in psychiatry, psychology, and social work. If a new model is needed for mental health training in schools of public health, and I argue that it is needed, then such a model can only evolve through the integration of mental health concepts into the basic public health sub-specialty fields * * * 26 In the light of this statement, it may be further argued that schools of public health being the basic institution for the socialization of public * Ibid. » Ibid., pp. 7-8. health professionals have a major leadership role in developing what would amount to the integration of mental health concepts within the total spectrum of public health practice. TOWARD INTERFACES BETWEEN PUBLIC HEALTH AND MENTAL HEALTH Modern public health preceded the emergence of modern community mental health. Indeed, as indicated in the previous section, the historical antecedents of the two fields have generally followed different lines of development. Nonetheless, at present there is no open disagreement or conflict between community mental health and public health with respect to such broad concerns as early casefinding, the utilization of epidemio- logical approaches and techniques, and applications of public health-social science in research and evaluation. Beyond these common areas, there re- main more distinct interests, approaches, and even ideologies that give specific identity to each field and pull them apart. How can both fields eventually be brought together into a public health-mental health con- tinuum? What advantages would there be to such a development? What convergences have already emerged? After the end of World War II, the community mental health move- ment began to gain momentum in this country. The initial thrust was an outgrowth of national defense manpower analyses which revealed that high proportions of rejections for military service, and of military dis- charges were due to mental disorders. As a result of these findings, the in- volvement of the Federal Government in mental health matters took off at an accelerated pace. Funds for research, manpower training, improve- ment of mental hospitals, and the establishment of community programs for care, treatment, and rehabilitation of the mentally ill became avail- able. The impetus provided by Federal aid to the States stimulated the adoption of State legislation to provide a basis for State-local-private sharing in financing mental health services. Through such legislation, lo- cally organized mental health programs began to gain increasing public support. During this period also a trend ensued to reduce the utilization and length of patient stay in State mental hospitals. Administrative re- forms, reorganization of mental hospitals, and the mass use of psycho- tropic drugs resulted in a reduction in the number of patients in the census of State hospitals. In a few years, these hospitals became one of a variety of facilities for care and treatment of the mentally ill, although they con- tinued to be the major organization for care of the mentally ill. General hospital psychiatry, short-term hospitalization, day- and night-care pro- grams, outpatient hospital and free-standing clinics, and private office serv- ices began to expand rapidly. Mental health consultation to police, courts, schools, welfare agencies, and health care agencies and institutions became part of the total range of service programs offered by locally 13 14 organized mental health agencies in the communities. As facilities and services increased, so did their utilization by those needing help. The field of community mental health also expanded its boundaries and brought its resources into areas which previously had been in other domains of human behavior such as education, medicine, law, social serv- ice, and police work. Its concerns became interdisciplinary, although its central focus remained clinical since demands for services, and professional interests and rewards continued to be directed to the treatment of in- dividuals and families suffering mental and emotional problems. Two new subspecialties of psychiatry, community psychiatry and social psychiatry, emerged. Within psychology, the subspecialty of community psychology also developed. These trends suggested that the mental health field had outgrown psychiatry and that it was different from the aggregate of psy- chiatry, psychology, social work, and psychiatric nursing, the professions which comprised the clinical team concerned with the care and treatment of the mentally ill.2” What the mental health field comprises thus would depend on those specific activities in which professionals and organizations within the field are generally engaged, their techniques and methods, and the theories upon which they base their program actions in relation to con- trolling disordered behavior and feelings. In the framework of this enlarged community interest of mental health work, attention has been given to the possible applications of public health principles and methods to mental health programs. Thus, in this sense community mental health represents an interface between mental health and public health. Another interface concerns the utilization of mental health principles and practices within public health work itself. Both have the potential to increase the reach into populations and com- munities and to affect the development of more integrated programs of service as well, and only careful evaluation of such programs would give measures of their impact in improving the health of the community. IN suMMARY, schools of public health train workers to discharge re- sponsibilities related to the overall health of the population. Of in- creased concern for public health has been the magnitude of mental health problems and the capacity which public health workers could bring to their control. The mental health field has traditionally concentrated on the care and treatment of the mentally ill, and the increases obtained in pro- fessional mental health manpower have made but little dent on mental health problems. Training of public workers in mental health concepts # Laswell has observed that in the future the scope of psychiatry is likely to be diminished and that many programs now conceived as mental health may be more plausibly referred to as “the cultivation of human resources,” “cultural reconstruction” (p. 62), and the like, while research programs on neurology and brain chemistry will be budgeted as components of “gen- eral research programs in physiology and neurology” (pp. 62-63). (Harold D. Laswell, “The Politics of Mental Health Objectives and Manpower Assets,” ch. 3, in Arnhoff, F. N., Rubinstein, E. A., and Speisman, J. C. (eds.), Manpower for Mental Health, Chicago: Aldine Publishing Co., 1969.) and practices have been a part of the effort toward dealing more effec- tively with mental health problems as an aspect of public health work; also, schools of public health have been deemed as another suitable setting for training mental health specialists. Training such personnel is related to the issues of collaboration of public health and mental health personnel and to the integration of mental health and public health concepts and practice. These issues are not yet resolved. New avenues must be found other than already tried empirical approaches which seem to ignore the lags between the ways in which professional workers are trained, their values, traditions, and identity, the political and social contexts of the bureaucracies, and the cultural systems of rewards and recognition of the society in which they live. Within bureaucracies, mental health like any other health program is based on operational and political definitions couched in professional or technical terms. There is no fixed and universally accepted definition of the field or of the scope of mental health programs. The demands for mental health services and the magnitude of the problems of mental illness and other behavioral disorders have culminated in sustained and expanded national efforts to stimulate research, training, and service de- velopment at the State and local levels both within the public and private sectors. The crisis in health manpower and the demands for technically and financially manageable comprehensive health services have added a note of urgency to the need for clarifying the areas in which public health and mental health programs can reinforce and strengthen each other, thus eliminating the fragmentation of costly and scarce resources. One of the tasks before the field of mental health itself is an effec- tive rapprochement with public health, welfare, education, and other human services. A similar task faces public health. Historically, both fields have generally followed different paths. At this time, however, professional judgment favors community-based and oriented comprehensive health services with emphasis on prevention, early care, and health protection and maintenance. Thus, new challenges are facing both professionals and training institutions. Revised, or yet to be invented organizational or inter- organizational mechanisms may be required as well as new arrangements in planning, in the logistics of service provision, and in the leadership and control of programs. 15 16 THE STUDY CHAPTER 2 FRAMEWORK AND METHODOLOGY WHY THE STUDY WAS CONDUCTED HIS study was conducted to establish systematically the profiles of recent American graduates from schools of public health in the United States, and to explore relationships between their characteristics and perceptions of training and professional practice with particular emphasis on the mental health aspects of public health work. Graduates from 11 different schools in the 7-year period 1961-67 were compared along those dimensions. Five major content areas were covered: (I) demographic, educational, professional, and occupational characteristics of public health workers; (2) awareness of exposure to mental health in public health training and practice; (8) assessment of the training experience received in public health and in mental health; (4) assessment of the usefulness of the mental health training experience in current professional public health work; and (5) views on how to improve mental health training in schools of public health. As a corollary to the above, the study probed into: (1) The appraisals that graduates from schools of public health now in the practice of professional public health work have made of their mental health-public health training, (2) the identification of curricular areas and content which in their judg- ment were covered and are useful to their professional work, and (3) the opinions, views, and knowledge about those gaps which they perceived between instruction and professional practice in regard to public health- mental health. Still in another sense, the study was also concerned with exploring the impacts of public policies designed to stimulate and to pro- vide support for mental health training in schools of public health. Although controversy persists as to the conceptual and operational relationships between public health and mental health practice as well as to the extent and scope of mental health content in public health training, systematic studies are lacking which examine the place of mental health training in public health or its relevance to the performance of public health work. Neither have questions related to the development of mental health manpower by schools of public health been the subject of research inquiry. This study was a first effort to begin to develop infor- mation and clarification of these issues and their pertinence to planning and replanning health manpower resources and organizing professional activities for the delivery of all types of health services. METHODOLOGY The findings reported in this volume pertain to one single point in time; namely, the summer and early fall of 1968 when the questionnaire survey was answered. The questions asked were related to events, actions, or opinions on matters which took place within three different time levels or stages in the life careers of respondents: (1) Prior to admission to a school of public health, (2) while attending a school of public health and pursuing a master’s degree, and (3) subsequent to graduation from a school of public health. In examining the replies, the investigators placed primary emphasis in determining the characteristics of respondents along those dimensions which would cast light on public health manpower in mental health. Since the instrument was not designed to establish developmental, career se- quences, or time-series relationships, those analyses which are concerned with events pertaining to different time periods are not intended to be nor can they be construed as implying any direct cause-effect relationships. Underlying Assumptions Any professional service activities and functions depending on new scientific knowledge and its application are dynamic and in a state of change. Since the spread and acceptance of change and innovation is not a uniform or mechanical process in professional behavior, controversy thus becomes an intrinsic part of the dynamics of change. There are many professional controversies in public health including the subject of this volume, viz, mental health-public health. In view of such recognition, the underlying assumptions of this study are paramount: first, it was assumed that graduates from schools of public health, both as former consumers of public health training programs and currently as providers of health and mental health services, were in a crucial position to comment on the kind of mental health training that they had received, the relevance of mental health considerations to public health work, and the role of public health workers in mental health programs. The investigators also assumed that certain selective factors operated in attracting public health students to mental health such as the visibility of the mental health fac- ulty, and of course work as well as of mental health components in overall public health training. A further assumption was that the professional background and previous interest of the respondents in mental health would also determine their pathways into mental health work. Consideration was also given to characterizing current trends in public health and mental health professional practices and their possible 17 18 impact on schools of public health and on the respondents. In this con- nection, it was assumed that when public health-mental health profes- sional practice is subsumed organizationally under the rubric of public health alone, the mental health component tends to be obliterated and to lack salience in the tasks of professional service and performance. The tend- ency toward conceiving of the mental health field as a distinct interdisci- plinary activity anchored in and germane to psychiatry, psychology, casework, and psychoanalysis ! was considered to place mental health outside the context and responsibility of the public health field. This conception was believed to limit the role assigned to mental health in public health training and research, and to influence the organization and delivery of health and mental health services. It was assumed also that if schools of public health were to respond to the crosscurrents and ideological con- straints pressing on the profession and its activities, they would be limited in making an optimal impact on the mental health aspects of public health training and on its implementation in future public health work. Their graduates then could be expected more likely to be unaware or acquiescent than aware and responsive to mental health as a component of public health training and of its overall relevance to public health practice. Further, it was assumed that since the mental health aspects of public health are not yet clearly defined and resolved in professional practice, mental health training in schools of public health to a certain extent would reflect the ambiguities that characterize the field. Moreover, it appeared that mental health as a component of public health train- ing has not been distinctly visible in training programs at schools of public health and thus might have been overlooked or not considered of enough importance by segments of the population of graduates. In addition, it was considered that the lack of working or operational relationships between mental health and public health professional practices may be reinforced in the context of administrative settings where public health professionals are employed. Since public health and mental health programs often are in contention for funds and other resources, in actual practice the compartmentalization of their respective functions has tended to be reinforced. Meanwhile, although philosophically, the inte- gration of all health and mental health programs is generally considered desirable, successful program coordination has been difficult and still awaits solutions on society's agenda for health administration. The context of work experience—the degree to which mental health is accepted or potentially accepted as a distinct part which fits within the overall spectrum of public health work—was considered to affect the degree of interest and recognition of need for mental health skills on the part of public health workers. 'Yolles, S. F., “Public Health and Mental Health: Some Thoughts on the Nature of the Relationship.” In Goldston, S. E. (ed.): Proceedings of the National Conference on Mental Health in Public Health Training. U.S. Department of Health, Education, and Welfare, Public Health Service, Publication No. 1899, Washington, D.C., Government Printing Office, pp. 7-8. No direct cause-and-effect relationships between training and practice were assumed, but rather that training would be one of the factors to in- fluence the direction of professional practice and its implementation. The study was not conceived or structured either technically or in purpose as an evaluation of mental health training in schools of public health or of mental health aspects of public health work; neither was it designed as a device to measure the merit or weakness of any training program or programs conducted by schools of public health. The intent was to determine through the responses of graduates from public health training programs who are primarily engaged in public health professional work to what extent, in their judgments, they had obtained mental health training and, if so, to what extent was such training useful in their profes- sional work. Respondents were also questioned about their public health professional practice and as to the acceptability of mental health in public health by the profession and by the general public. Such queries were deemed to be consistent with the assumption that schools of public health although relevant could not be considered to be a single determinant of professional practice behaviors in the field. Several hypotheses were constructed to set parameters and guide- posts for the study, although the objective of the study was not hypotheses- testing and theory-building. In effect, the investigators were primarily concerned with studying practical questions regarding the training of public health manpower equipped to apply their skills in the control of com- munity mental health problems. In approaching these problems, it was essential to construct an instrument which would provide verifiable data, and to design tables which would clearly and accurately yield facts relevant to the issues posed in the study. Criteria for Selection of the Respondent Population The plan for selection of respondents called for designating a well- circumscribed and sufficiently large but manageable population which would provide information relevant to mental health training in schools of public health, as well as to the relationships of mental health to public health practice in the United States. Accordingly, and as further explained below, the study population was defined as consisting of American citizens who had received a master’s degree from an accredited school of public health in the continental United States during the period 1961-67. For practical reasons of economy, no effort was made to sample such a population. The investigators had anticipated that graduates from these schools might be difficult to locate due to their geographic mobility and thus that sufficient responses might not be forthcoming. In order to locate respondents, a request was made to the schools of public health for complete lists of their graduates meeting the criteria for selection of respondents. It was also decided that the most efficient technique to contact potential 19 20 respondents dispersed throughout the country was a questionnaire by mail. The following factors were specifically considered in defining the study population: American Citizens.—Since a primary concern of the study was to ob- tain information on the relevance of mental health considerations in public health practice in the United States, only American citizens were included in the study population. All citizens from other countries who had received a master’s degree from an accredited school of public health in the United States were excluded. Included were persons who were citizens of another country at the time of training, but who had become citizens of the United States by the time of the survey. American citi- zens trained in Canadian schools of public health were excluded. A further consideration affecting the decision to select American citizens was that stipends from the National Institute of Mental Health for the train- ing of mental health specialists in the schools of public health are intended primarily for citizens of the United States and only in selected instances such stipends may be awarded to noncitizens who are admitted to the United States for permanent residence or to noncitizens holding temporary visas. Because of the heterogeneous backgrounds of persons attending schools of public health, the selection of only American citizens also was considered a means to reduce further variabilities which might have been introduced by inclusion of diverse foreign nationals. Moreover, limitation to American citizens would still make it possible to draw on a large major- ity of graduates from schools of public health who would most likely be residing and working within the United States, and thus reduce the prob- lem of locating respondents. According to information available from the American Public Health Association, 69.9 percent of all graduates from accredited schools of public health in the United States and Canada dur- ing the period 1961-67 were American citizens, the remaining 30.1 percent were nationals of Canada and other countries (see app. B, table 1, p. 240). Accredited Schools of Public Health in the Continental United States Awarding Degrees During 1961-67. —A second criterion was to limit the study to graduates from accredited schools of public health in the conti- nental United States which awarded degrees during the entire study period, 1961-67. Accordingly, graduates from the following 11 schools of public health were included in the research study: University of California (Berkeley) , University of California at Los Angeles (UCLA), Columbia, Harvard, Johns Hopkins, Michigan, Minnesota, North Carolina, Pitts- burgh, Tulane, and Yale. Not included in the study were graduates from the two Canadian schools (Montreal and Toronto) and from three American schools initially accredited after 1961, and which therefore did not graduate classes through- out the entire study period (Hawaii, Loma Linda, and Oklahoma). The Department of Preventive Medicine and Public Health at the University of Puerto Rico School of Medicine, which is an accredited school of public health, was excluded due to social, cultural, and language complexities which would have required another type of inquiry. The 11 schools whose graduates were surveyed had all received public health-mental health training grant funds from the National Institute of Mental Health for several years, starting in a span from 1948 to 1963. Therefore, considerable background information about grant history and mental health program development in each of the 11 schools was available to the investigators. Master’s Degree Recipients.—Another criterion in defining the study population was to focus only on master’s degree recipients. The vast ma- jority of graduates from United States and Canadian schools of public health during the period 1961-67 were awarded a master’s level degree— 6,573 master’s degrees or 94.7 percent out of a total of 6,940 graduate degrees awarded (see app. B, table 2, p. 241). By limiting the study popula- tion to master’s degree graduates it was possible to define an aggregate which by and large had shared in various forms a similarity of curricular experiences as a result of a common level of training in a school of public health.? In other words, while the curriculums of the various schools differ, and each school is unique in its capabilities and emphases, there are some common subject elements to which students attending a school of public health generally will be exposed; e.g., biostatistics, epidemiology, environ- mental health, and public health administration. Study Period, 1961-67. —The rationales for studying graduates from this 7-year period were as follows: (I) The intent of the investigators was to study a ‘“‘uni- verse” of graduates, inclusive of the broad range of professional backgrounds and graduate professional preparation in the vari- ous subspecialty areas of public health. The 7-year period chosen for study offered a sufficiently large number of potential respond- ents necessary for this type of survey. (2) All 11 schools whose graduates were included in the study had received NIMH training grant funds at some time during or throughout this 7-year period. Eight of the schools had received such grant funds during the entire period (UCLA, Columbia, Hopkins, Michigan, Minnesota, North Carolina, Pitts- burgh, and Yale). Three schools had received NIMH funds dur- ing the following years: Harvard, 1961-66; Tulane, 1962-67; and University of California (Berkeley), 1963-67. (3) The 7-year timespan was assumed to provide for the inclusion of graduates subsequent to receipt of their public health degrees within a continuum of work experience and * Operationally, the definition of the study population permitted the inclusion of doctoral candidates or doctoral holders if such respondents initially also had received a master’s degree from one of the 11 schools of public health any time during the period covered by the study. 21 22 involvement in public health to permit inquiry as to the relation- ship of their work to mental health. In addition, since respond- ents’ perceptions and to some extent recall were to be evoked, the investigators felt that within this 7-year time period training experiences at a school of public health would still be within remembrance. (4) Last, and of major importance, the 7-year period 1961-67 had been characterized by great changes in the scope and practice of public health, and by significant growth and development within the field of mental health. Locating Respondents Shortly after the study population was defined, a letter was sent in November 1967 to the heads of the 11 schools acquainting them with the intent and purposes of the proposed study and requesting a list of names and addresses of all the American citizen, master’s degree graduates, dur- ing the period 1961-67. This communication stated that by definition the awarded master’s degree may be an M.P.H., M.S.,, M.S.P.H., M.S. Hyg., M.H.A., or any other type of master’s degree awarded by a school of public health. By the end of March 1968 all the lists had been received. CONDUCT OF THE FIELD STUDY Questionnaire Construction Development of the questionnaire took place over a 10-month period. Eighteen major revisions of the instrument were made prior to the final form in which it was mailed to graduates (see app. B, pp. 242-250) . During the process of questionnaire development, consultations were held with representatives of the U.S. Public Health Service, the American Public Health Association and its Professional Examination Service, the members of the Advisory Committee to the National Conference on Mental Health in Public Health Training, and several survey research workers in the United States. Revisions were made in accordance with suggestions made by reviewers and on the basis of two pretests conducted with individuals familiar with mental health and public health. As the questionnaire was being developed, the literature was reviewed for further clarification of objectives, historical backgrounds, and modifications to the questionnaire itself. The content of the questionnaire was organized around the following five major areas— (1) demographic characteristics, education and professional backgrounds, and experience in public health and in mental health work of the study population; (2) exposure to mental health-public health training in re- lation to major program, to mental health aspects and subject matter, to mental health course work, and to interaction with mental health faculty during their training experience in a school of public health; (8) occupational characteristics and the extent to which mental health content is relevant and accepted in the professional work of the graduates; (4) opinions of the graduates with respect to their percep- tions and satisfactions both with their formal training and their professional activities as related to mental health; and (5) felt needs for additional mental health training and views on improvements in mental health instruction at schools of public health. To provide a basis for comparisons and generalizability, formats and questions from other research studies and from routine data-gathering sys- tems were used whenever appropriate. Previous surveys by the Manpower and Analytic Studies Branch, Division of Manpower and Training Programs, NIMH provided a guide for the structure and content relating to such items as work setting, source of income, and functional title. Some ques- tions on employment status were included to provide data on professional public health workers in the labor force for program planning activities in other components of the U.S. Public Health Service. The Student Census Card maintained by the American Public Health Association provided a format for obtaining information on the primary professional discipline of graduates prior to formal public health training and on the major programs of study pursued in a school of public health. No definition of mental health was given in the questionnaire itself in order to allow respondents the broadest possible latitude in conceiving of the mental health aspects of public health. Certain questions, nonethe- less, by connotation clearly suggested and defined specific mental health inputs; e.g., mental health content areas covered, role relationships with mental health faculty, and catalog listed mental health course work taken. Two listings of topic areas were constructed to obtain appraisals of the extent of exposure of graduates to mental health subject matter and the degree to which such mental health content subsequently has been useful in their work. The first list identified a series of public health topics classified under two main headings—socioenvironmental, and family and child health. Included under these two headings were 31 topics covering areas generally considered of public health concern in professional journals, texts, classroom, and practice. The questionnaire was then structured to elicit: (a) Whether the mental health aspects of the public health topics were covered during training, (b) the quality of the presenta- tion, and (c) the extent to which the mental health aspect of the public health topics has been useful in subsequent professional practice. 23 24 The second list included a total of 43 mental health topics classified under three headings—basic, general, and specialized—which were then further categorized. As with the first list of topics, respondents were asked to in- dicate if the topics were covered, and to note the quality of presentation, and their usefulness in practice. Two main sources were used in devising the list of mental health topics. The first was Mental Health Teaching in Schools of Public Health, the report of the Arden House Conference of December 1959 which identified three sets of mental health curricular content: (a) A core mental health curriculum content for all students in schools of public health, (b) a core curriculum content which has general application, and (¢) mental health curriculum content areas for special groups of public health students. The second major source was Mental Disorders: A Guide To Control Methods, an official publication of the American Public Health Association prepared by its Program Area Committee on Mental Health. This guide was first printed in September 1962, and has subsequently been reprinted three times with about 15,000 copies distributed. The two above-mentioned publications were prepared jointly by pub- lic health professionals and mental health professionals, and their contents were specifically directed at public health workers. Other topics were based on national legislation and on articles in the American Journal of Public Health and other national health and mental health publications. Thus, the topics itemized had been identified publicly by professional workers, journals, and educators in the fields of public health and mental health. A limited number of new items were included which have taken on increased emphasis recently. Examples of this kind include: The role of the private sector in mental health programing and financing, compre- hensive community mental health centers, principles of comprehensive mental health planning, psychiatric registers, and social breakdown syndrome (SBS). Mailing the Questionnaire Mailing of the questionnaire, management of its distribution and control, and data processing were done by the Professional Examination Service of the American Public Health Association under a contract with the NIMH. While the questionnaire was being developed, a pattern of collaboration was started between the investigators and the Professional Examination Service, APHA which continued until the completion of the survey. The survey questionnaire was a precoded, nine page booklet consisting of 25 major questions, and a maximum total of 270 responses. Except for the last question which was open-ended, respondents were only required to check one answer to each question or its parts. Based on pretests, it was estimated that the questionnaire would take about half an hour to complete. The questionnaire was mailed to 4,459 individuals named on the lists of graduates provided by the 11 schools of public health whose American citizen, master’s degree recipients from the years 1961-67 were to be sur- veyed. The names on the lists, addresses, and code numbers of respondents were subsequently machine-processed; one such machine-generated list was used as a master control list of the questionnaires mailed. The first mailing which took place in midsummer, on August 19-20, 1968, was accompanied by a covering letter from the Director of the Na- tional Institute of Mental Health introducing the study to respondents. In addition, an announcement about the study with a request for cooper- ation was published in the American Journal of Public Health of August 1968. Three followup communications were sent to nonrespondents. On September 4, the day after Labor Day, a followup postcard was mailed to those persons who had not yet responded. A second reminder, followup letter No. 1, was mailed on September 16. A third and final reminder, followup letter No. 2, with a second copy of the questionnaire enclosed, was sent to those who had not answered by September 26. October 9 had been set as the cutoff date for inclusion of questionnaires in the study; due to the lapse in responses by mail, this date was extended to October 25. Thus, slightly over 2 months were required to collect the data. Upon receipt, each questionnaire was noted into the master control list, and periodically, during the field period, lists of nonrespondents and tables of responses received were generated. Some unexpected difficulties developed from errors in the lists of names submitted by the schools. At first, these errors were called to the attention of the investigators by persons listed who wrote letters indicating that they did not belong in the study population. Other problems connected with the mailing and distribution were originated by agencies in which the questionnaire was routed to some individual other than the addressee. Letters were also re- ceived from relatives indicating that the addressee was overseas, as well as from persons on the list who refused to fill out questionnaires. Others completed only part of the form and returned it. Still a few others filled the questionnaire with obviously conflicting and implausible information. Such problems were minor, but they were detected since every question- naire was reviewed prior to inclusion in the final data analysis. The inter- nal consistency and validity of responses was done both by a series of automated internal filters and exclusion checks or program subroutines included in the main research program developed for the survey, and by professionally editing and reviewing each questionnaire received. The preliminary marginals and analyses as well as the final results were generated by a CDC 6600 computer system. Responses Received By October 25, 1968, a total of 3,345 or 75.0 percent of all the questionnaires mailed had been received (see table 2:1). 25 26 TABLE 2:1.—Questionnaires mailed and received, by school of public health Total Number of Percent of School number of mailed questionnaires questionnaires questionnaires received received Berkeley ................. 725 530 73.1 Columbia ................ 364 268 73.6 Harvard ................. 322 250 717.6 Hopkins ................. 278 192 69.1 Michigan ................ 780 601 77.1 Minnesota ............... 468 345 73.7 North Carolina .......... 663 504 76.0 Pittsburgh ............ ... 253 201 79.4 Tulane .................. 128 98 76.6 UCLA ................... 307 218 71.0 Yale ..................... 171 138 80.7 Total ............. 4,459 3,345 75.0 Of the 4,459 mailed questionnaires, 3,115 or 69.9 percent were usable and 1,344 were lost. The lost questionnaires included 389 unusable returns (66 of which arrived after the cutoff date of October 25, and 323 which had been answered by unqualified respondents, had errors, or were incom- plete). A total of 955 individuals did not respond at all (see table 2:2). TABLE 2:2.—Distribution and response rate to mailed questionnaires Percent Total number of mailed questionnaires ...................................... 4,459 100.0 Answered, usable ..... 3,115 69.9 Answered, unusable ....... LL 389 Not on time .............. 66 With errors, etc .............. ..... 323 Not answered ........ 955 Total lost (unusable and not answered) ...................................... 1,344 30.1 The goal of obtaining a 70.0 percent response rate from among the graduates from each school was set; this goal was reached by respondents from eight of the schools. The response rates of usable to mailed question- naires ranged from 64.7 percent for Hopkins respondents to 73.4 percent from Tulane graduates. This response rate reflects a rather high level of interest by graduates of schools of public health in professional matters and on research into their professional activities (see table 2:3). TABULATIONS AND PRESENTATION OF DATA The data presented in this volume comes from over 100 marginal tables and almost 200 cross-tabulations of selected variables. Replies by TABLE 2:3.—Distribution of response rate to mailed questionnaires, by school of public health Number of Number of School mailed ] usable ] Response questionnaires questionnaires rate Berkeley ....................... 725 513 70.8 Columbia ...................... 364 257 70.6 Harvard ....................... 322 226 70.2 Hopkins ....................... 278 180 64.7 Michigan ..................... 780 565 72.4 Minnesota ..................... 468 315 67.3 North Carolina .... ...... .. .... 663 462 69.7 Pittsburgh ................ 253 180 71.1 Tulane ........................ 128 94 73.4 UCLA ......................... 307 201 65.5 Yale ........................... 171 122 71.3 Total ................... 4,459 3,115 69.9 respondents from each school have been compared to each other with emphasis on both the highest and the lowest percents of replies given to each item in a question. In presenting findings from cross-tabulations, the pro- cedure followed also has been to compare the highest and lowest percents of respondents replying to given questions. Replies by majorities of respond- ents (50.0 percent or over) both for marginals and cross-tabulations have been explicitly noted. Only tabulations for which the number of respond- ents was 50 or more have been used. Although the total number of respondents was 3,115, different, smaller bases may appear in the tables and in the text since only the actual denominators have been used in re- lation to those questions requesting that only a segment of the population would answer. All illegitimate responses were filtered out. In all instances, the N or actual base used in tables is mentioned. The findings also were inspected whenever appropriate in relation to data reported by Troupin? in the annual reports about schools of public health issued by the American Public Health Association. Although no precise comparisons between these findings and Troupin’s reports were possible due to differences in methods of gathering information and man- ner of categorization, inspection of findings from this study and Troupin’s reports reveal a general consistency in direction. Last, the tables on the geographic distribution of respondents were generated from the list of addresses. Repondents’ addresses were coded and counted by regions and by statistical metropolitan areas. ? Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada, for each of 7 years covered by the study, mimeographed annual reports. See app. B, tables 3 and 4, pp. 251-252. 27 28 OVERVIEW OF CHAPTERS THE SCHOOLS OF PUBLIC HEALTH ROFESSIONAL education in public health as a field of organized knowl- edge is a product of the 20th century and is concerned with the applica- tion of epidemiology, the biological and medical sciences, administration, and more recently the social sciences, to the solution of health problems in populations or communities. At the time of this writing, there are 18 ac- credited schools of public health in North America: 14 are within the continental United States, two outside the continent (Hawaii and Puerto Rico), and two in Canada (Montreal and Toronto) .! These schools train professional health manpower, primarily by offering educational programs at the master’s degree level. Their student bodies consist mainly of persons who already have been trained in a health or health-related discipline and/or who have experience in health work. In this connection, Wellin has characterized training in a school of public health as a process of “secondary professionalization” since most students who attend these schools have already acquired a primary profession. He observed that: * * * (the) basic and explicit functions (of schools of public health) are in the area of secondary professionalization. That is, the prevailing pattern is for public health schools to provide post-graduate public health training for individuals who have already received basic professional training in a broad range of professions * * * By contrast, virtually all other professional schools are devoted to primary profes- sionalization; i.e. to the induction of individuals, who begin training as novices, into the technical and attitudinal subculture of a given pro- fessional field.? Among the members of many primary professions seeking public health training are chemists, dietitians, dentists, engineers, nurses, physicians, teachers, and veterinarians. Public health workers who have been trained in schools of public health constitute a relatively small segment of the total force of professional health manpower in this country. In fact, between 1961 and 1967, the total number of American citizens awarded master’s degrees by all the accredited schools of public health in the United States was 4,680 (see app. D, table 1, p. 273). * Subsequent to the preparation of this chapter, in late fall 1970 a new school of public health at the University of Washington in Seattle became the 17th such accredited institution in the United States. ? Wellin, E., “Uses of the Behavioral (Social) Sciences in Public Health,” Report submitted to the National Institute of Mental Health, July 1961, 63 pp., mimeographed, pp. 14-15. EARLY BEGINNINGS As indicated before, at the beginning of the 20th century, the major emphasis of public health work was communicable disease control through environmental sanitation and bacteriology. Most public health training was provided in medical schools, except for a training program in sanitary engineering established by Sedgwick at the Massachusetts Institute of Tech- nology at the turn of the century. In the first decade of the 20th century McGill, Toronto, Pennsylvania, Harvard, MIT, and Michigan were offer- ing courses and degrees in the public health field.* In 1913, a school of public health was organized jointly by Harvard University and the Massa- chusetts Institute of Technology. According to Smillie, the “basic courses were: (1) public health administration, (2) epidemiology, (3) biostatis- tics, and (4) environmental sanitation. Emphasis was placed on micro- biology; field experience was combined with lectures, symposia, and laboratory work.” * In 1922, 9 years later, the Harvard-Technology School for Health Officers was discontinued since a court proscribed these institu- tions from awarding a joint academic degree. Subsequently, both the Harvard School of Public Health and the School of Sanitary Science at the Massachusetts Institute of Technology were established as separate entities.” In 1913 at the initiative of the Rockefeller Foundation, the Committee on Medical Education of the General Education Board explored the issues of professional training for public health work. Abraham Flexner made an inquiry into training available in medical schools and late in the year 1914 a conference was held on training for public health services. Among the conclusions of this conference were: (1) That there was a fundamental need for adequately trained public health personnel, (2) that a distinct contribution toward meeting this need could be made by establishing a school of public health of high standards, (8) that such a school should be closely affiliated with a university and its medical school, and (4) that it should be organized as a separate entity with an institute of hygiene as the nucleus. These recommendations led to the establishment in 1916 and the official opening in 1918 of the School of Hygiene and Public Health at the Johns Hopkins University.® Rosen has asserted that the school of public health at Hopkins, as well as those at Harvard and Toronto, have influenced the subsequent development of other schools of public health from that time to the present. Indeed, in his opinion, contemporary schools “are all recognizable as variants of the model initially created at Johns Hopkins.” 7 3 Hiscock, I. V., “The Beginnings of Our School of Public Health,” dedication address, School of Public Health, University of North Carolina, 1963, Chapel Hill, N. C., 10 pp., mimeo- graphed, p. 3. ¢ Smillie, W. G., “The Beginning of Formal University Training of Public Health Personnel in the United States,” dedication address, School of Public Health, University of North Carolina, 1963, Chapel Hill, N. C., 3 pp., mimeographed, p. 3. 5 Ibid. ®Rosen, G., “The School of Public Health: Its Derivation and Objectives,” dedication address, School of Public Health, University of North Carolina, 1963, Chapel Hill, N.C., 10 pp., mimeographed, p. 4. 7Ibid., p. 6. 29 30 The Hopkins school was specifically proposed for the development of personnel for public health administration, including health officers, sta- tisticians, epidemiologists, sanitary engineers, chemists, bacteriologists, pub- lic health nurses, and sanitary inspectors for local, State, and Federal service.® The goal of such a school was to be “the preservation and im- provement of health.” The suggested curriculum “included practically all the subjects that have been offered in the schools of public health to the present * * * (jt also) * * * urged that students receive training in social science, and emphasized the need to relate the school of public health not only to the medical school but also to the social science department.” ? This was a period when public health was beginning to shift its focus of attention from the environment to man himself. The Hopkins school was established to help overcome what the Rockefeller Foundation considered— first, the lack of a sufficiently broad and sound basis of scientific knowl- edge for the systematic promotion of public health and personal hy- giene; second, the lack of a well-defined career as an attraction to the able men whose interest is in this field rather than in the practice of medicine; third, the lack of due emphasis, in the training of practi- tioners of medicine, upon the importance of hygiene and of the practitioner’s role as an apostle of hygiene no less than therapy.!! In addition, the existence of well-organized, properly staffed schools of public health would make possible “a more general recognition of public health work as offering to the ablest talent an attractive career, comparable in dignity and importance with medicine and the other established professions.” 12 In the decade 1910-20, when less than 100 degrees in public health were awarded, 11 medical schools and MIT offered formal instruction in the field. Most of the public health degrees (C.P.H., M.S., Diplomas, M.P.H., Dr. P.H.) were granted by Pennsylvania, Harvard, and MIT, with foreign students outnumbering American citizens.!® 14 In the fall of 1919, the American Public Health Association estab- lished a committee on training, and in 1932 formed its standing Committee on Professional Education.!® By 1939, 45 institutions offered 18 different kinds of degrees in public health. In Vaughan’s words: “the time had arrived to concentrate the training programs in those universities blessed with finance, faculty, and 8Ibid., p. 5. ° Ibid. 1 Ibid. * Rockefeller Foundation, Annual Report, 1916, pp. 27-28. 2 1bid., p. 31. 3 Hiscock, op. cit., p. 3. “Rosen, G. (ed.), “Public Health and Mental Health: Converging Trends and Emerging Issues,” in Mental Health Teaching in Schools of Public Health, Association of Schools of Public Health, Columbia University, 1961, p. 53. * Vaughan, H. F., “Schools of Public Health—The Past,” dedication address, School of Public Health, University of North Carolina, 1963, Chapel Hill, N.C., 5 pp., mimeographed, p. 4. facilities to offer degree work to those who possessed acceptable under- graduate education and experience warranting graduate instruction in areas of learning essential to career work in public health.” '® In 1941, seven schools of public health (Columbia, Harvard, Hopkins, Michigan, North Carolina, Yale, and Toronto) organized the Association of Schools of Public Health for the “exchange of information of mutual interest concerning the graduate education of professional personnel for service in public health and to promote and improve the education and training of such personnel.” 17 In the following year, a memorandum from the Committee on Pro- fessional Education of the American Public Health Association identified the minimal educational facilities for graduate courses in public health, and further noted the “considerable advantage in having all necessary facilities for training all types of public health personnel in the same institution so that they may participate together in certain basic courses.” 8 According to Shepard, the 1942 memorandum “intended to discourage students from taking specialized courses in poorly equipped schools and to point out to schools the undesirability of offering courses in public health unless adequate facilities were available.” ** However, little immediate im- pact was made toward setting standards for professional training and eliminating inadequate facilities. Indeed, in 1945, 3 years after the memo- randum was issued, there were 700 trainees in 41 different schools, while many of those institutions were deemed to lack the essential resources for training professional public health personnel. ACCREDITATION As Federal grants increasingly became available for training public health personnel, the U.S. Public Health Service, as the agency responsible for disbursement of these funds, joined with the Association of Schools of Public Health in 1945 to request that the American Public Health Associa- tion establish criteria for accrediting graduate training in public health. The Commonwealth Fund awarded a grant to the Committee on Profes- sional Education of the American Public Health Association to formulate accreditation criteria and to review the facilities of applicant schools.?! C. E. A. Winslow as Consultant on Accreditation to the Committee de- 1 Ibid., p. 5. 1” Rosenfeld, L. S., Gooch, M., and Levine, O. H., Report on Schools of Public Health in the United States, Public Health Service Publication, No. 276, Washington, D.C., Government Print- ing Office, 1953, p. 8. 18 American Public Health Association, Committee on Professional Education, “Memorandum Regarding Minimum Educational Facilities Necessary for the Postgraduate Education of Those Seeking Careers in Public Health,” American Journal of Public Health, 32:534, May 1942. Shepard, W. P., “The Professionalization of Public Health,” American Journal of Public Health, 38:149, January 1948. 2 Ibid. # “Accreditation of Schools of Public Health” (editorial), American Journal of Public Health, 35: 953-955, September 1945. 31 32 veloped the original criteria in cooperation with the directors of the schools of public health. These criteria have since been amended twice.?> Up to 1962 accreditation focused on the degrees awarded; since then, it has been extended to encompass the whole institution—its organization and admin- istration; its mission, its faculty, and its interrelationships; its educational program as well as the degrees awarded. The accreditation process was started in the academic year 1946-47. By May 1947 the first list of schools accredited for providing the master of public health and doctor of public health degrees was released. Nine schools of public health in the United States were accredited to award the master of public health degree: California (Berkeley), Columbia, Harvard, Hop- kins, Michigan, Minnesota, North Carolina, Vanderbilt, and Yale. The same schools, except for Minnesota and Vanderbilt, were accredited to award the doctor of public health degree. Accreditation for master’s degree programs in health education, usually the M.S. degree, was initiated in 1949. During the latter part of 1947, Tulane was accredited to grant the master of public health degree; in 1948 the school at Vanderbilt was discontinued. In 1950 the University of Pittsburgh and in 1957 the Uni- versity of Puerto Rico were accorded accreditation. During the decade of the 1960's five additional schools in the United States were accredited: UCLA (1960), University of Hawaii (1965), Loma Linda University (1967), University of Oklahoma (1967), and the University of Texas at Houston (1969). Thus, at this writing, 16 schools in the United States and two schools in Canada are accredited for graduate education by the Committee on Professional Education of the American Public Health Association. EDUCATIONAL OBJECTIVES AND FUNCTIONS All accredited schools of public health share certain basic functions although their individual programs differ. The promotion of uniqueness and autonomy of each school was a concern since accreditation criteria were first developed in 1945. Shepard has pointed out: “From the outset it was agreed that too much standardization was undesirable. Schools were encouraged to develop their own methods and special interests so long as they met reasonable requirements.” 2* The Committee on Professional Ed- ucation while in keeping with this aim in 1966 formulated five general guidelines to be considered by schools of public health in carrying out their specific mission. These are— (1) to provide the broad professional education required by com- munity health leaders who need: (a) the essential knowledge basic to the field, found in the biologic, physical, and social sciences; and (b) # See app. C, pp. 253-263 for current accreditation criteria (1966). # Shepard, op. cit., p. 151. the mastery of skills in educational methodology necessary to apply scientific and technical health knowledge in the changing economic and political contexts of modern society; (2) to prepare specialists in several academic and professional disciplines for service in community health agencies, and for careers in related teaching and research; (3) to contribute to public health knowledge through the conduct of community-based health research, particularly epidemiological, be- havioral, and operations research, to include an emphasis on the grow- ing number of new health hazards, and the complex area of multiple etiology of diseases, and methods in use or proposed for their allevia- tion; (4) to provide, in so far as feasible, continuing education for person- nel serving in community health agencies and educational institutions, for community planners, for health leaders (at all community levels— local, state, regional, national, and international), and to the public; (5) to provide community service, especially in the form of profes- sional and technical consultation to individuals, groups, and communi- ties, and through direct participation in community health diagnosis, field investigations, and planning improved comprehensive health services. Although the relative weight which the schools assign to their functions may differ, Anderson has commented forcibly as to the primacy of preparing professionals of multiple competencies for solving community health problems: * * * the fundamental obligation and responsibility of a school of public health as distinguished from an institute of biologic, physical or social research is that it has been established to prepare persons to adapt their professional competencies to the solution of community health problems. Just as the primary function of a medical school is to prepare physicians for the practice of medicine, or an engineering school to prepare engineers, a school of nursing to train nurses, or a college of education to prepare teachers, so the distinguishing mark of a school of public health is its responsibility to prepare persons to fill the many positions in public and private health programs. If this be not our primary function then we have lost our very reason for existence.?® Instruction in the schools of public health has two principal objectives: The development of a broad understanding of the fundamentals of public health and its approaches and methods by all students, and the training of specialists in various types of community health teaching, research, and service. Generally, the student body and the variety of program areas and 24 American Public Health Association, Committee on Professional Education, “Criteria and Guidelines for Accrediting Schools of Public Health,” American Journal of Public Health, 56: 1311, August 1966, see app. C. » Anderson, G. W., “Schools of Public Health—Past-Present-Future: The Present,” dedica- tion address, School of Public Health, University of North Carolina, 1963, Chapel Hill, N.C., 10 pp., mimeographed, p. 2. 33 34 academic goals of a school of public health differ from those of academic departments in a university. In this respect, Mayes has noted that “collectively the American schools of public health are at once profes- sional, graduate, post-graduate—and in a sense post-postgraduate—institu- tions * * * 26 In addition, as Freeman has observed, “the role of the school of the public health in developing and delineating public health practice appears to be expanding.” 7 Thus, schools of public health do not respond to a single standard, nor are they uniform with respect to their mission, program content, or em- phases. As a class of institutions of higher education, however, they share certain characteristics both as a result of historical forces and of common interest. With such observations in mind the description of the schools which follow has been undertaken. ADMINISTRATIVE ORGANIZATION In accordance with accreditation criteria, each school of public health in the United States must be “an integral part of a university” which is “a member of one of the regional associations of colleges and schools.” 28 By contrast, in some other countries such schools are organized and operated by a national or provincial ministry of health. Although a variety of administrative and professional arrangements exist with the universities, each school has practical autonomy to the extent that “requirements for public health degrees are effectively determined by the public health faculty.” ?* The relationships of the schools to their parent university are either: (a) As a department of the medical school under a director who like any other department head is administratively respon- sible to the dean of the medical school (Yale); or (b) the school of public health is related administratively to a unit of health or medical affairs headed by a coordinator, vice president or dean (Columbia, Minnesota, North Carolina, Oklahoma, Pittsburgh, Puerto Rico, and Tulane); or (¢) the school of public health is directly under a vice president for aca- demic affairs (Hawaii) ; or (d) the school of public health is directly under the president or chancellor of the university (Berkeley, UCLA, Harvard, Hopkins, Michigan, Loma Linda, and Texas) .*® Schools which are not integral parts of medical schools may be “generally considered as relatively * Mayes, W. F., “Future Role of the Schools of Public Health,” dedication address, School of Public Health, University of North Carolina, 1963, Chapel Hill, N.C., 8 pp., mimeographed, p- 5. * Freeman, R. B., “Schools of Public Health From the Standpoint of a Producer of Public Health Personnel,” dedication address, School of Public Health, University of North Carolina, 1963, Chapel Hill, N.C, 8 pp., mimeographed, p. 3. * American Public Health Association, Committee on Professional Education, op. cit., p. 1310. # Ibid. # Organizational relationships provided directly by the deans in personal communications, May 1970. Other information regarding training programs, students, faculty, organization, and financing has been drawn primarily from the annual reports on schools of public health pre- pared by J. L. Troupin, American Public Health Association. autonomous, and as occupying organizational positions on a par with other schools of the university, such as law, business, etc.” ** Regardless of whether they are located in a medical school or are separate from the medical school, the faculty and student body in a school of public health are drawn from a variety of disciplinary and professional backgrounds. Nine of the 16 schools of public health in the United States are part of the State-sponsored higher education program: Berkeley, UCLA, Michigan, Minnesota, North Carolina, Hawaii, Oklahoma, Puerto Rico, and Texas. Seven of the schools of public health are part of privately sponsored uni- versities: Columbia, Harvard, Hopkins, Pittsburgh, Tulane, Yale, and Loma Linda. (Of the 11 schools included in this study, five are under public and six are under private sponsorship.) Schools are organized into administrative units, departments, bureaus, or divisions which reflect their major components and fields of emphases and which are responsible for teaching, research, and field service programs in one or more subjects. Between the years 1961 and 1967, the period covered by this study, the average number of such administrative units in schools of public health in the United States and Canada ranged from 8.1 per school in 1961 to 9.2 per school in 1967.32 Certain subject areas or related fields may be known by different names or may be organized separately in different schools. While basic public health courses are taught in all schools, Troupin has observed that “the variation in organization gives greater or lesser relative emphasis to the range of subjects, depending upon the interests within a school of public health.” 33 The largest numbers of organizational units in the schools center around the areas or subfields of public health administration or practice, biostatistics, environmental health, and epidemiology. Three schools have organized administrative units in the mental health area—Columbia, Hop- kins, and North Carolina. Other areas such as tropical medicine and in- ternational health, radiological science, public health economics, and physical education are each distinct organizational units in not more than one school (see app. C, table 1, p. 264). STUDENTS A marked characteristic of all schools of public health is the hetero- geneity of the student body both by level of previous preparation and by professional background and experience. Wegman has commented on the diversity of the student body as a requirement of the field itself: # Troupin, J. L., “Schools of Public Health in the United States and Canada: 1959-1960,” American Journal of Public Health, 50: 1771, November 1960. #2 Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967), mimeographed, p. 3. 3 Troupin, J. L., “Schools of Public Health in the United States and Canada: 1959-1960,” American Journal of Public Health, 50: 1771, November 1960. 35 36 Public health is no single profession, but a field for the efforts of many groups and specialties. There are statisticians, nutritionists, adminis- trators, physicians, educators, engineers, laboratorians, and experts in a variety of specific health and disease problems. They are united by the responsibility of working together to do those things for the health of the community, and the human beings who make it up, that are better done by organized community effort. The school of public health today recognizes its responsibility to be sure that each of these groups acquires its needed specific skills and acquires also a concept of how they work together. Anderson, writing on a similar vein as Wegman, opposes the restriction of public health training to one or two professional groups since in his view, many professional disciplines are needed to bring their competencies to public health work: * * * the school must give something more than lip service to the various professional groups that must inevitably comprise the public health team. If public health is indeed a synthesis of the contributions of diverse professional disciplines, each of which focuses its special com- petencies upon the many facets of a community problem, then it must follow that a true school of public health cannot restrict its instructional program to one or two professional groups, rejecting the rest as though they did not exist or, if existing, deemed unworthy of the attention of the school and its faculty.35 A total of 2,592 graduate students were registered in the 15 schools of public health in the United States and Canada in the academic year 1966— 67. In 1962-63, the first year that the APHA collected discrete data on graduate students, 1,464 were enrolled in 14 schools.?® 37 Almost all of the graduate students were in full-time attendance enrolled either in programs of 1, 2, or 3 years duration. In addition, students registered in other parts of the university also pursued part of their studies in a school of public health. How many applications do the schools of public health receive from candidates to pursue graduate study? What is the rate of acceptances to applications? During the years ending June 1961 to June 1967, the number of applications increased annually, as did acceptances through 1966; with the number and percent of acceptances decreasing in 1967 from those of the previous year. The rate of acceptances in 1961 was 65.9 percent; in 1967 it was 57.7 percent. In the years ending June 1966 and 1967 less than one-half of the # Wegman, M., “School of Public Health—Present,” dedication address, School of Public Health, University of North Carolina, 1963, Chapel Hill, N.C., 7 pp., mimeographed, p. 2. % Anderson, G. W., “Schools of Public Health—Past-Present-Future: The Present,” dedica- tion address, School of Public Health, University of North Carolina, 1963, Chapel Hill, N.C, 4 pp., mimeographed, p. 2. * Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967), mimeographed, p. 9. Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1963), mimeographed, p. 16. applications became admissions to schools of public health (44.6 percent in 1966, and 43.9 percent in 1967); of the number of acceptances, 70.7 percent became admissions in 1966 and 76.0 percent in 1967 (see app. C, table 2, p. 265) . Two factors may account for such ratios: (a) The schools receive and screen far more applications than students that they could actually absorb within their programs or they are highly selective in their acceptances, and (b) there may be duplications among qualified applicants who are accepted by more than one school. Schools in turn have reported that admissions are limited by such factors as a “relative scarcity of well- qualified candidates” in certain professional categories and major fields of study, the lack of financial assistance for some promising candidates, lack of adequate physical space, language handicaps of students from overseas, age of applicants, and the desirability of maintaining a favorable student-faculty ratio.®® By professional backgrounds, the largest groups of applications during the years 1961-67 originated among: Physicians, administrators/hospital and medical care administrators, educators/health educators, nurses, and sanitarians. In these five professional categories were 67.6 percent of all applications and 66.2 percent of all acceptances to all schools of public health. During this same period, the largest numbers of acceptances to schools of public health were for: Physicians, mathematicians /statisticians, biolo- gists, engineers, veterinarians, and nutritionists/dietitians. Proportionately, the ratio of applications to acceptances was lower for administrators/hos- pital and medical care administrators, and physical educators (see app. C, table 3, p. 265). The major programs pursued by the largest groups of master’s degree graduates from all accredited schools of public health in the United States and Canada during the years ending June 1961 through June 1967 were Administration or Practice of Public Health, Medical Care and Hospital Ad- ministration, Health Education, Environmental Health, and Public Health Nursing; graduates with these five majors accounted for 57.1 percent of all master’s degrees awarded. During the same 7-year period a total of 123 master’s level graduates majored in Mental Health, or 1.9 percent of all such graduates; an additional seven Mental Health majors received a doctoral degree in this period (see app. C, table 4, p. 266) . By profession prior to enrollment, the largest groups of graduates from all schools of public health in the United States (among those indi- cating residence in the United States at the time of enrollment) during the years 1961-67 were physicians, nurses, administrators, educators/health educators, and sanitarians. Better than six of ten (63.3 percent) of all graduates who held residence in the United States at the time of enrollment came from these five professional backgrounds; and physicians, by far, comprised the largest group of all those graduates (23.0 percent) (see app. C, table 5, p. 267) . # Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967), mimeographed, p. 9. 37 38 Men predominated among the graduates; and the men were slightly younger than the women. During the year ending June 1961, the percent of women receiving graduate degrees was 27.8 percent; the percent of women graduates increased to 32.0 percent in the year ending June 1967. The median age for men in the year ending June 1967 was about 32 years, for women about 33 years. Typically, students attending schools of public health receive financial assistance to pursue their graduate training. The U.S. Public Health Serv- ice is by far the single most frequent source of assistance for American citizens attending schools of public health in the United States. Other major sources of support include a students’ own State, local, or county government or employer, the Agency for International Development, some other U.S. Government agency, the World Health Organization, or a pri- vate foundation. During the year ending June 1961, 15.0 percent of all graduates were self-sponsored; among June 1967 graduates this figure was 15.6 percent. The claim that schools of public health are national and international resources is upheld in terms of the permanent places of residence cited by students at the time of their enrollment as well as by the affiliations of many of their faculty members with international health programs. During the year ending June 1967, graduates had come to the schools from 51 States and territories of the United States, and from 62 other countries including Canada. Schools, however, also tend to be regional and the ac- creditation guidelines suggest that relationships be fostered with service agencies in the communities where they are located. PROGRAMS OF STUDY In 1966, over two dozen different degrees were offered by schools of public health in the United States and Canada. The Committee on Pro- fessional Education has in effect recommended a regrouping of degrees awarded to reflect the two basic programs offered, viz, (a) One for gen- eralists or administrators, and (b) the other for technological or scientific specialists.39 40 The educational programs combine basic areas of public health with the specialized interests and approaches of individual schools. In providing flexibility, the Committee on Professional Education requires no particular courses of instruction by schools of public health provided that each can comply both with the broad CPE criteria and guidelines and with the stated objectives and purposes of the schools themselves.** The Committee on Professional Education recommends that candidates for any master’s * American Public Health Association, Committee on Professional Education, op. cit., p. 1312. “ A more detailed discussion on degrees is presented in ch. 5. “ American Public Health Association, Committee on Professional Education, op. cit., p. 1314. degree at a school would take one or more courses dealing with community health concepts and with public health sciences and fulfill other require- ments equivalent to those for candidates for a similar master’s degree at the parent university. In specific relation to the generalist degree, M.P.H., however, the Committee has indicated that “instruction in certain fields basic to public health be included as required content” for every candidate for that degree. Such fields of knowledge are outlined below: I. The nature of man, his physical and social environment, and his personal and social interaction—as they affect his health. 2. The basic technics of investigation, measurement, and evaluation, including biostatistics and epidemiology. 3. The basic technics of administration (organization and manage- ment), particularly as applicable to comprehensive health care programs. 4. The economic and political setting relevant to health services. 5. The application of these knowledges in the promotion of com- munity health 42 The minimum length of training for a master’s degree is one full-time academic year. For the M.P.H. degree some schools have extended this training period to include in addition part or all of a summer session or to comprise two full academic years.*? Among the principal programs of study offered in various schools are: Administration or Practice of Public Health, Aviation Medicine, Behavioral Sciences, Biostatistics, Chronic Diseases /Gerontology, Dental Public Health, Environmental Health/Public Health Engineering/Sanitary Science, Epi- demiology, Health Education, International Health, Maternal and Child Health, Medical Care and Hospital Administration/Administrative Medi- cine, Mental Health/Administrative Psychiatry/Community Psychiatry, Microbiology /Laboratory Public Health, Nutrition /Biochemistry, Occupa- tional Health/Industrial Hygiene, Physiological Hygiene /Environmental Medicine, Population Studies /Family Planning /Demography, Public Health Nursing, Radiation Health, Rehabilitation /Physical Therapy, Social Work in Public Health, Tropical Medicine /Entomology/ Parasitology, and Veteri- nary Public Health. FACULTY Schools of public health must have a full-time faculty, supplemented by part-time faculty and by faculty holding joint appointments in other schools or departments of the university and/or with appointments in agencies. For accreditation purposes, they must have at least one full- time faculty member for each area in which a specialty major is offered. In the year ending June 1967 the 15 accredited schools of public health in the United States and Canada had an equivalent of 1,341.1 faculty and staff; © Ibid. “ Ibid., p. 1813. 39 in terms of full-time equivalents the faculty numbered 735, or an equivalent of 1 to 3.5 students enrolled in 1967 #* (see app. C, table 6, p. 268). In the year ending June 1967, the equivalent of more full-time faculty and staff taught subjects in the following specified areas than in any other: Medical Care and Hospital Administration, Epidemiology, Administration or Practice of Public Health, Biostatistics, and Environmental Health. These had been the areas of largest concentration of faculty and staff in 1965 although in a somewhat different rank order. Between 1965 and 1967, the largest increase in the equivalent of full-time faculty and staff was in the area of Medical Care and Hospital Administration. The largest decline in any area was in Maternal and Child Health. During this period, there was a slight increase in the full-time faculty and staff equivalent in Mental Health (see app. C, table 7, p. 269). According to Troupin’s reports, the faculty and staff of schools of public health by far are constituted by individuals whose primary profes- sions are that of physician, mathematician and statistician, and behavioral scientist (see app. C, table 8, pp. 270-271) . FINANCING Overall, American schools of public health are largely financed by the Federal Government. The Canadian Government has a similar role with respect to accredited schools of public health in that country. During the year ending June 1967, the largest source of income for the schools collectively was funds for research grants and contracts, ap- proximating 44.0 percent of all their income. Income in the combined categories of: (a) Teaching and training grants and contracts, and (b) traineeships and fellowships approximates 32.0 percent of all income, while basic institutional support accounts for about 20.0 percent of the schools’ funds. Other sources contribute about 4.0 percent of all support. For the year ending June 1967, the average income for each of the 17 schools was $3,712,416 (see app. C, table 9, p. 272). “It should be noted that equivalent faculty includes both part time and full time as well as persons not in instructional roles. Also the combined total for all schools do not provide the range of ratios of students per faculty in each school. The figures cited above are only suggestive of the overall volume of faculty involved in schools of public health. MENTAL HEALTH CHAPTER 4 TRAINING IN SCHOOLS OF PUBLIC HEALTH INITIAL EFFORTS HE inclusion of mental health training in schools of public health T emerged from an historical context in which public health work increas- ingly has been expected to encompass certain responsibilities in the mental health area. The climate in which such expectations have developed is one in which the scope of public health itself has transcended from narrower specific technical concerns for the control of specific disease entities to a much broader ecological concept of health. By necessity this shift has taken place since new health problems have appeared which are associated with longevity, social and economic conditions, social and technological change, behavior disorders, and environmental factors. Similarly, the mental health field has undergone major changes, although it has retained a clinical emphasis since mental and emotional disorders of many kinds continue to be major burdens on resources and to be costly to the community. That the mental health field has moved toward public health approaches may be seen in the development of locally organized community mental health programs concerned with whole populations, prevention, early identification and short-term treatment, and rehabilitation. Schools of public health virtually have assumed a responsibility for developing junctures between mental health and public health in the educational sphere. Articulating mental health with public health in an educational framework within schools of public health has been somewhat gradual and besieged by many still unresolved problems, particularly since other institutions responsible for the training of health and mental health personnel have remained rather isolated from such developments. In ad- dition, political, economic, and social factors as well as vested interests have served as deterrents to a satisfactory clarification of the role of mental health in public health training and service. Against this backdrop the following description of mental health training program develop- ment in schools of public health has been reconstructed. Since early in their development several schools of public health have included mental health content in their curriculum. Mental health training activities were initiated in the 1920's and 1930's at the Harvard, Hop- kins, and Yale Schools of Public Health. Between 1922 and 1938 the Harvard School of Public Health offered mental health courses covering 41 42 the subjects of mental defects, delinquency, and child guidance. Opportunities also were made available for clinical instruction and research. Although the first mental health faculty appointment at Hopkins was not made until 1926, the initial prospectus for the school written in 1915 included mental hygiene among the content areas in which students would receive instruction.” Lemkau notes that the preliminary announce- ment of the Hopkins school issued in January 1918 identified “social and mental hygiene” as areas for study by candidates for the degree of doctor of public health.? In 1932, the Eastern Health District of the city of Baltimore in collaboration with the Hopkins school became a community laboratory for research and practice in public health, including programs of epi- demiological studies of mental illness. With the formation of the Mental Health Study Group in 1934, teaching and research in mental hygiene at Hopkins were strengthened. Beginning in 1941, Hopkins offered its first course relating personality development to public health practices; later, courses in community organization for mental health services and clinical opportunities were added. The first degree of doctor of public health with specialization in mental health was awarded by Hopkins in 1941, and in 1942 a group of students who specialized in mental hygiene received their degrees. At the Yale school, mental health content was covered in public health courses starting in 1930; however, mental hygiene courses were not offered until 1938 with the introduction of a required course entitled “Psychiatry in Relation to Public Health.” In that year, nine elective mental health courses were offered.’ These early teaching efforts in mental health at the schools of public health were generally concerned with the prevalence, etiology, and manage- ment of mental disorders, and with the organization and administration of mental health clinics. “Apparently,” writes Rosen, “there was no organ- ized mental health teaching unit; teaching was more or less an isolated effort, and was not truly integrated in the curriculum.” ¢ Since all initial mental health teaching was done by psychiatrists, two of the issues at- tendant to developing and conducting mental health teaching programs in schools of public health were related to both the competence and to the availability of psychiatrists who would be properly suited to function within a public health setting and able to accept public health values, methods, and objectives. In examining the roles of psychiatrists in public health education and in the mental health movement Rosen has observed Rosen (ed.), op. cit, p. 55. ? Lemkau, P. V., “Notes on the Development of Mental Hygiene in the Johns Hopkins School of Hygiene and Public Health,” Bulletin of the History of Medicine, 35: 169, March— April 1961. *1bid., p. 171. *1bid., pp. 173-174. ®Rosen (ed.), op. cit., pp. 56-57. ¢Ibid., p. 57. that there may be shortcomings in the competence of those psychiatrists who must shift from therapeutic roles to roles as educators, social scien- tists, and community organizers. He also noted that there was actually a shortage of full-time psychiatrists on the faculties of schools of public health.” Arguing in favor of broader disciplinary approaches in mental health, Rosen stressed that “just as the total prevention and control of most health problems are beyond the competence of medical personnel alone, the mental hygiene program is too broad to lie within the jurisdiction of any one individual or profession.” ® Shortly after 1959, other kinds of mental health professionals in addition to psychiatrists were to be found on the faculties of the schools of public health, largely as a result of finan- cial support from the Federal Government. However, issues bearing on the professional competence of mental health faculty members still persist particularly in relation to professional jurisdictions and program leader- ship, mostly revolving around the status and role of psychiatry in public health-mental health training. In 1950, Hiscock and Gruenberg highlighted the importance of mental health backgrounds for all public health students and faculty, and the relevance of mental health skills in the discharge of professional re- sponsibilities by public health workers. They noted that the prime re- sponsibility for the prevention of mental ill health lies with the public at large and specified those aspects of public health work which called for a background in mental health work. They wrote: It is essential * * * to provide an opportunity for all graduate students in public health to have at least some orientation in mental hygiene, in order that they may understand the community problems and opportun- ities, and be competent to work effectively with consultants and their professional associates who are more intimately identified with responsi- bilities and services in psychiatry and mental hygiene. All students and faculty members need this background of experience and understand- ing * * % 9 They further observed that there was no single pattern to attain the said objective and suggested five major aspects of mental health concern to be included in the preparation of public health students and faculty: . Personal relations in an organization, department, or agency. . The personality problems of physical illnesses. . Mental hygiene as public health education. . Personality disturbances as public health phenomena. . A public health approach to mental illness.1? CU A 00 NO — This, and other efforts toward setting directions to the mental health components of public health programs have barely begun to find their 7Ibid., pp. 58-59. 8 Ibid., p. 60. ® Hiscock, I. V., and Gruenberg, E. M., “Teaching of Mental Hygiene for Graduate Students in Public Health,” American Journal of Public Health, 40: 591, May 1950. 1 Ibid., p. 592. 43 44 way into the public health curriculums. Attempts to expand curricu- lums and to move intensely to provide training in mental health have been characterized by a continued struggle for obtaining both adequate financing and appropriate personnel. Lemkau commented on the bleak financial status of mental health training and research programs in the schools of public health after World War II: The leadership of the schools of public health in the United States in this field (mental health) leaves something to be desired. I wonder if it is generally realized that the schools of public health in the United States actually spend less than $50,000 a year for mental hygiene teach- ing and research; that only one school in our country has a full-time research and teaching staff in mental hygiene. In view of the multiple needs of the schools of public health and the de- mands placed on them, it was apparent that new sources of financial support as well as a new thrust in professional leadership were critically needed to develop and expand mental health training programs. By stimulating the required development, the Federal Government began to assume a major role. PROGRAM DEVELOPMENT AND EXPANSION In July 1946, the Congress made its first major national commitment to mental health developments with passage of the National Mental Health Act (Public Law 79-487) which created the National Institute of Mental Health. Among the charges assigned to the NIMH was “training personnel in matters relating to mental health.” As a result, new resources for mental health training programs became available to schools of public health. In 1948, even before the NIMH was formally organized,’ a program of grants to promote the expansion and development of mental health train- ing in schools of public health had already been initiated. The conceptual framework of this grant program maintained that the schools of public health would assume responsibility for training professional persons for leadership roles in public health who, by virtue of their positions in their communities and States, would affect the implementation of mental health programs and practices. Further, it also posited that these public health leaders should be aware of interpersonal factors in their public health tasks, the variety of services and facilities available for the mentally ill, and the application of public health principles to the detection, prevention, * Lemkau, P. V., “Mental Hygiene in Public Health,” Public Health Reports, 62: 1161, Aug. 8, 1947. 2 "The new national mental health program was initiated in fiscal year 1948 by the existing Division of Mental Hygiene of the Public Health Service. In 1949 the Division was abolished and the National Institute of Mental Health was established as a component of the National Institutes of Health. (See Brand, J. L., “The National Mental Health Act of 1946: A Retrospect,” Bulletin of the History of Medicine, vol. XXXIX, No. 3, May-June 1965, pp. 231-245.) and control of the mental illnesses and the promotion of mental health as well. To implement these programmatic concepts, the NIMH invited ap- plications for grants from the schools of public health to enable them to obtain resources for developing the designs and curricular content for the mental health teaching and training of public health officers.’® Federal funds would also stimulate the schools to recruit mental health faculty members and to develop mental health courses and curriculum for the general student body of the schools. The provision of stipends facilitated the development in some schools of mental health specialty training pro- grams for a variety of professional health personnel either allied to mental health (e.g., public health nurses) or professionally trained in the clinical aspects of mental health (e.g., psychiatrists). Prior to the receipt of NIMH grant funds few of the schools had been able to develop formal mental health training in the curriculum or were only able to conduct incipient training activities in this area. The first school to receive a grant under this program was Yale Univer- sity which in 1948 received a stipend for the public health-mental health training of one psychiatrist. Later on, the program at Yale was expanded to reach M.P.H. degree candidates and to train mental health specialists. In 1949, Hopkins received a grant initially designed for the inclusion of mental health principles and practices in the overall training of public health students. Over time, the scope of the Hopkins program was enlarged to provide mental health workers with specialized training in program planning and administration. Other schools subsequently receiving mental health training grants and the date of initial award include: North Carolina (1950), Harvard (1950), Pittsburgh (1951), Columbia (1953), Minnesota (1954), Michigan (1958), UCLA (1961), Tulane (1962), and Berkeley (1963) .1 During the year 1949-50 when nine schools of public health in the United States were accredited, eight of them combined offered a total of 19 courses in mental health. Three schools—Harvard, Hopkins, and Minne- sota—were already providing enough courses for students to major in mental health. Hopkins, which accepted both physicians and nurses for special training, was the only school with an organized division of mental hygiene.’ During that same academic year, the deans of four schools— Columbia, Michigan, Minnesota, and Yale-—expressed “an urgent need for expanding instruction in mental health,” although at that time none 13 Goldston, S. E. (ed.), Mental Health Considerations in Public Health, Public Health Service Publication No. 1898, Washington, D.C., Government Printing Office, 1969, p. iii. The initial grant to Harvard lapsed in 1964; a second grant program was funded from 1961 to 1966; a third new program began in 1967. The initial UCLA program terminated in 1966; however, a new grant program commenced in 1965. 5 Rosenfeld, L. S., Gooch, M., and Levine, O. H., Report on Schools of Public Health in the United States, Public Health Service Publication No. 276, Washington, D.C., Government Print- ing Office, 1953, p. 35. 45 46 of these schools had a full-time faculty member responsible for teaching mental health. Over the 20-year period, July 1, 1948, to June 30, 1968, the National Institute of Mental Health awarded almost $8.4 million in mental health training grants to the schools of public health. Approximately 62.0 percent of these funds were awarded in the 5-year period 1964-68 during which total grant funds for mental health training at all schools of public health combined averaged slightly over $1.0 million annually. During the aca- demic year 1967-68, 11 schools of public health were awarded a total of 16 NIMH training grants. During the fiscal year 1966-67, 13 NIMH training grants provided support for a total full-time equivalent of 36.1 faculty positions in 10 schools of public health. By discipline, budgeted funds accounted for the full-time equivalent of 12.8 psychiatrists, 10.9 social scientists (primarily sociologists) , 7.1 nurses, 2.3 psychologists, 2.0 social workers, and 1.0 bio- statistician. The full-time equivalent of 4.2 positions remained unfilled during the grant year. Except in two schools which used some other source of funds for mental health faculty salaries, support of mental health faculty positions in schools of public health was solely from NIMH grant funds. The professional disciplines of the training program directors respon- sible for the 13 NIMH grants to the schools of public health in 1966-67 included six psychiatrists, two psychologists, two sociologists, one nurse, one health educator, and one biostatistician. Approximately 75 mental health courses of various lengths and academic credits were listed in school catalogs in connection with the mental health training programs. About one-third of all the mental health courses were offered at Columbia. As mentioned in chapter 3, by that time, three schools—Columbia, Hop- kins, and North Carolina—had organized identifiable mental health ad- ministrative units. Eight programs in seven schools provided NIMH stipends to students pursuing a mental health major: Berkeley, UCLA, Columbia, Hopkins, Michigan, Minnesota, and Yale. The growth of public health-mental health training programs in the schools of public health over the years, both in terms of the increased number of schools receiving NIMH funds as well as the accelerated amount of grant funds awarded, appears to have been the result of several interacting major factors: (1) The increased attention which the Federal Government gave to mental health problems in the Nation was highlighted by the passage of the Mental Health Study Act of 1955 (Public Law 84-182) which led to the formation of the Joint Commission on Mental Illness and Health, and to their subsequent report Action for Mental Health™ This report in turn influenced the 0 Ibid., p. 87. 17 Joint Commission on Mental Illness and Health, Action for Mental Health, New York: Basic Books, Inc., 1961, 338 pp. President’s decision to establish a cabinet level committee to study and recommend a legislative program. In 1962, the President called for the conduct of a comprehensive mental health planning process which would lead to the development of mental health plans by each of the States. These planning activities involving literally hundreds of people in some States lasted from 1963 to 1965. Meanwhile, another nationwide trend in mental health had developed throughout the States stimulated by the New York State Community Mental Health Services Act of 1954 which in- itiated State-local-private partnerships for community-based mental health programs. In 1963, interest in mental health reached a new momentum when President Kennedy became the first Chief Executive to send a Mental Health Message to the Congress outlining the magnitude of both the mental health and mental retardation problems affecting the country and announc- ing the need for major reforms in the care system. He deplored the conditions of the mentally ill in the State hospitals and identified among his major proposals the program for comprehensive community mental health centers. Throughout the decade between the mid-1950’s and 1960s the community mental health movement with its strong philo- sophical and conceptual orientation toward public health princi- ples and approaches gained major thrust. During this period also rising concern developed about the location, organization, and interrelationships between mental health and public health pro- grams. All these trends precipitated the national context in which schools of public health came to be perceived as potential major training centers for equipping the vast array of leadership personnel needed to assume responsibilities in and related to community mental health. (2) The positive acceptance of the conceptual framework which governed the initiation of the grant program by NIMH and its reviewing bodies encouraged any reasonable steps taken by the schools to introduce mental health training. (8) Since schools of public health generally were perceived as regional institutions and as national resources with limited sources of funds, of necessity, the Federal Government was seen as a logical source of support for them. (4) Since virtually no other sources of support were available for public health-mental health training, and this was a period of program initiation and expansion, the scope of the NIMH program was flexible enough to include projects in areas only generally related to mental health such as academic training in the behavioral science disciplines as conducted in schools of public health. 47 48 The historical landscape depicting public health-mental health training in schools of public health over the past two decades is marked by a series of national conferences. In the early 1950s, as mental health developments were beginning to have major implications for both mental health and public health, and thus for the direction and content of public health- mental health training, it became apparent to the schools of public health and to the NIMH that a forum was needed to explore the status of training programs, to discuss common problems, and to plan for the future. On June 2-3, 1952, a conference sponsored by the NIMH was held at the Harvard School of Public Health. Approaching the issues of curriculum content, student personnel, and teaching methods in public health-mental health training, the conferees agreed that “there should be a universal program of mental health for all public health students and that this should be spread diffusely through all divisions of a school of public health at a hori- zontal level as well as specialized courses on a vertical level.” In addition, the participants indicated that mental health should be, in part, required for all students and that it should be brought into the basic content of other course work. The importance of integrating mental health teaching with the rest of the curriculum was stressed, as well as the relevance of convincing other faculty of the need for mental health content in their courses while simultaneously promoting a more favorable disposi- tion toward these objectives among the deans.!® As experience accrued and additional schools launched mental health training programs, near the close of the decade another national confer- ence was called. Accordingly, the Arden House Conference was convened in December 1959 under the sponsorship of the Association of Schools of Public Health and the NIMH. In preparation for this conference, the NIMH staff recognized that over the years considerable progress had been made in the teaching of mental health in schools of public health, but that these teaching programs were still uneven and required further development. The following major impediments faced by the schools in public health-mental health training were identified: (I) An inadequate understanding of an essential body of content dealing with what mental health is and what aspects of mental health should be taught. (2) Some uncertainty among top administrators of the schools regarding how to teach or what to cover in the application of mental health content to public health. (3) The lack of basic teaching materials for core-teaching content for all students. (4) A lack of adequate numbers of effective and stimulating teachers who could communicate or translate content from the psychiatric and mental health fields to other disciplines. % “Conference on Mental Health in Public Health Training,” NIMH staff memorandum, June 5, 1952. (5) A limited utilization of mental health professionals, other than psychiatrists, to provide a broad teaching approach and base. (6) A certain degree of insufficient interest, support, or perhaps, know-how among certain faculty members which has had the effect of isolating and discouraging the integration of mental health training from the rest of the curriculum. (7) Complexities and problems inherent to the schools of public health themselves, such as inadequate financing, the hetero- geneity of the student body and the presence of many foreign students, insufficient curriculum time, and too little study and research regarding basic concepts upon which teaching can be based. Based on those considerations, NIMH formulated benchmarks or criteria to assess the events and activities in public health-mental health training at schools of public health. Furthermore, the Arden House Confer- ence of 1959 made specific recommendations regarding curriculum content and teaching methods directed to both the mental health training of all public health students as well as mental health specialists.? In the mid-1960’s pursuant to an emerging concern in the Federal Government about planning-programing-budgeting systems and the degree to which program intents may be reflected in program results, an NIMH staff study was undertaken to review mental health training grants to the schools of public health. Among the questions raised by this study were: (1) To what extent were graduate students in public health receiving mental health training? (2) What kinds of mental health training were being offered? (3) To what extent were the original objectives for which mental health training grant funds were provided being fulfilled? (4) What contribution was being made by the schools of public health to solve the mental health manpower crisis? (5) What barriers existed to greater program achievement and development? (6) How could the NIMH and the schools of public health continue to work more effectively and cooperatively to achieve their mutual goals? Staff exploration of these issues indicated that many of the barriers to effective training identified over a decade before had not yet been fully overcome. As a result, an overall plan was formulated for further strength- ening the mental health training programs in the schools of public health. The major components of this plan were: 1 NIMH staff memorandum, May 1959. 2 Mental Health Teaching in Schools of Public Health, Association of Schools of Public Health, Columbia University, 1961, pp. 195-321. 49 (I) The development of new program guidelines and ad- ministrative regulations for reviewing applications for support of mental health training programs in the schools of public health. (2) The convening of a national conference on mental health in public health training. (3) The initiation of a research study on the perceptions of graduates of schools of public health to their public health- mental health training and the extent to which mental health concepts are utilized by these public health workers in their professional work. (4) The development of new teaching materials which would promote the integration of mental health concepts within relevant public health subject areas. Subsequently, on May 27-30, 1968, the National Conference on Mental Health in Public Health Training was held at Airlie House. The 88 confer- ence participants included 78 faculty members representing all the ac- credited schools of public health in the United States. The avowed purpose of the conference was “to bring together faculty members from the schools of public health to explore and identify opportunities to include mental health content within the public health curriculum” which would be meaningful “to the general student body enrolled in the schools of public health, as distinguished from the training of mental health specialists.” 2! In addition to the opportunity for the exchange of viewpoints among public health and mental health faculty members, two publications were generated: (1) A volume composed of formal papers on the mental health aspects of each of 12 public health areas, including content and teaching methods; and (2) a monograph of proceedings containing conference com- mittee reports and plenary session presentations.?? 2 These publications record the thinking and appraisals of both mental health and public health experts on the interfaces between mental health and public health and on the avenues and content areas to which public health workers should be exposed in their training. CONTINUING ISSUES Gaps still persist relating to the expectations of public health- mental health training as provided by schools of public health and as to the capacity of the schools to respond both to mental health manpower shortages and to the need for infusing mental health concepts and practices “ Goldston, S. E., “National Conference on Mental Health in Public Health Training,” Public Health Reports, 84: 136, February 1969. #2 Goldston, S. E. (ed), Mental Health Considerations in Public Health, Public Health Service Publication No. 1898, Washington, D.C., Government Printing Office, 1969, 252 pp. # Goldston, S. E. (ed.), Proceedings of the National Conference on Mental Health in Public Health Training, Public Health Service Publication No. 1899, Washington, D.C., Government 50 Printing Office, 1969, 89 pp. into public health work. In this connection, Rosen had observed in 1959 that “* * * too few of the concepts of the mental hygiene movement have found their way into the teaching programs of schools of public health * * * (and that) schools of public health have not yet reached a con- sensus on the question of mental health as a community problem, or with regard to its place in the curriculum.” 2* Almost a decade later, Fry et al. reiterated this assessment by declaring that “the schools of public health have not notably championed the idea of public health involvement in mental illness and health.” > Unquestionably, these issues remain, and only systematic program research and evaluation by the schools themselves can tell the story of accomplishment or lack of it. It is a bias of these writers that the place of mental health in schools of public health and the optimal development of mental health training programs by these schools is inextricably connected with the place of mental health in professional public health work, as well as with the place of public health in mental health work. Therefore, as the research findings are presented in the following chapters the issues of perceptions of train- ing received and work context are considered as interrelated aspects of this larger problem. * Rosen (ed.), op. cit, pp. 4, 25. “Fry, H. G., et al, Education and Manpower for Community Health, Pittsburgh, University of Pittsburgh Press, 1967, p. 36. 51 EIR Rr pad Cesc b e A Se yy ae thr ae deplaiatn a otal 10s ra in gn hc teh ad i Laid anid nti Soi THE PUBLIC HEALTH "*" PROFESSIONAL AS TRAINEE AND WORKER E ; a 3 b v bh E B ht aagrtiye, 1 cate alt an cone FL A STREP LAE SRY Sins ei Sel FE 5 RA ie ev CA iL 2 oi an mies n EDUCATIONAL CHATTER? AND DEMOGRAPHIC PROFILES OF PUBLIC HEALTH WORKERS BACKGROUND CHOOLS of public health mainly award graduate degrees at the master’s S level. As reported in chapter 2, this study focused on American citizens who received master’s degrees from one of 11 accredited schools of public health in the United States anytime between 1961 and 1967. A total of 70 percent of the graduates responded to the mailed questionnaire. School of Public Health Attended Troupin estimates that during the 7-year period covered by this study, 4,680 American citizens received master’s degrees from schools of public health of which 801 (17.2 percent) graduated from Michigan and 165 (3.5 percent) from Yale. Almost one-half of all the respondents (49.4 percent) graduated from three schools. The largest number of respondents, 565 or 18.1 percent, obtained their degrees from Michigan. Second were those who studied at Berkeley, 513 or 16.5 percent, and third were those who studied at North Carolina and who constituted 462 or 14.8 percent of all respondents. Fol- lowing were 315 or 10.1 percent from Minnesota, 257 or 8.3 percent from Columbia, 226 or 7.3 percent from Harvard, 201 or 6.5 percent from UCLA, and 180 or 5.8 percent each from Hopkins and Pittsburgh. The smallest number of respondents were, respectively, 122 or 3.9 percent from Yale and 94 or 3.0 percent from Tulane.? A large majority of respondents, 2,133 or 68.5 percent, received their degrees between the years 1964 and 1967; the remainder, 982 or 31.5 per- cent, received their degrees between the years 1961 and 1963. The smallest number of respondents receiving degrees in any one of the years included in the study was 309 or 9.9 percent which was the case both in 1961 and 1962; and the largest was 613 in 1966 when 19.7 percent of all respondents graduated. Over the 7-year period 1961-67 the number of respondents graduating from each of the schools fluctuated. There was no indication of * Troupin, J. L., American Public Health Association, unpublished estimates prepared for this survey in 1969. The discrepancies in the proportions of graduates reported by Troupin and respondents who answered usable questionnaires by school were less than 1.0 percent for those from eight schools, and 1.4 percent or less for those from three schools (see app. D, table 1, p- 273). *In the Tulane list, 1967 graduates were underreported. 55 56 a consistent process of annual growth or decline among graduating re- spondents although in general, the numbers of respondents from Berkeley, Michigan, Minnesota, North Carolina, Pittsburgh, UCLA, and Yale were considerably greater in 1967 than in 1961. The largest group of respond- ents from any school in any one year was 114 from Michigan in 1966 (see table 5:1). Types of Master’s Degrees Received During the year ending June 1967 the schools of public health in the United States and Canada awarded 27 different graduate degrees and di- plomas; and among these were 15 different types of master’s degrees granted by schools in the United States? Seemingly, there are no clear-cut differences either in the content or training process required among such degrees. Troupin, in directing attention to the problems emerging from such proliferation of master’s degrees, has called for corrective action: Specifically, the problem is that of the existence of several degrees for one curriculum; for example, in Health Education a student may get an M.P.H. or M.S.P.H. or M.P.H. Ed. or M.S. Hyg., depending on which school he attends. This occurs even though the curricula are similar, and differ from each other no more than should be expected in dealing with several institutions. The same problem exists in Hospital Administration, Sanitary Science, and others. If the profession is to be considered as having ‘come of age,” then corrective steps are indicated soon. * McGavran in 1963, also addressed himself to this issue by dramatizing the confusion raised by the overlapping degree programs. He said that: We would be in utter confusion if all schools of medicine, dentistry, and nursing gave different degrees, meaning different things. Public health’s degree structure isn’t just ridiculous, it’s impossible—a strictly cancerous and malignant growth.’ Still in 1967, this situation persisted and Troupin called attention again to the impracticability of the multiplicity of degree programs and advocated a “complete reform of the degree structure.” © In part, the diversity of degrees has emerged from the development of schools by accretion and the diverse educational and experience require- ments for admission, the tendency of each school to maintain its individu- ality, the development of specific degree programs to meet needs of certain primary professions, and also as a product of the variety of interests of 3 Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967), mimeographed, p. 24. *Ibid., year ending June 1962, p. 17. 5 McGavran, E. G., “The Future of Schools of Public Health,” dedication address, School of Public Health, University of North Carolina, 1963, Chapel Hill, N.C,, 4 Pp., mimeographed, p- 4. ® Troupin, op. cit., 1967, p. 10. LS TABLE 5:1—Master’s degrees received by respondents graduating from eleven schools of public health, years 1961-67 1961 1962 1963 1964 1965 1966 1967 Total School Num-| Per- |Num-| Per- |Num-| Per- |Num-| Per- |Num-| Per- |Num-| Per- |Num-| Per- |Num-| Per- ber | cent | ber | cent | ber | cent | ber | cent | ber | cent | ber | cent | ber | cent | ber | cent Berkeley ................... 56 1.7 43 14 59 19 67 2.2 93 3.0 93 3.0 102 3.3 513 | 16.5 Columbia .... .............. 30 1.0 25 0.8 29 0.9 43 14 44 14 54 1.7 32 1.0 257 8.3 Harvard ................... 30 1.0 27 0.9 21 0.7 29 0.9 40 1.3 42 1.3 37 1.2 226 7.3 Hopkins ................... 24 0.8 19 0.6 18 0.6 26 0.8 27 09 32 1.0 34 1.1 180 5.8 Michigan ................... 68 2.2 61 2.0 71 2.3 76 24 89 29 114 3.7 86 2.8 565 | 18.1 Minnesota ................. 24 0.8 28 0.9 39 1.3 51 1.6 48 1.5 61 2.0 64 2.0 315 | 10.1 North Carolina ........... .. 40 1.3 59 1.9 54 1.7 59 1.9 67 22 87 2.8 96 3.1 462 | 14.8 Pittsburgh ........ ...... .. 8 0.3 20 0.6 28 0.9 26 0.8 30 1.0 35 1.1 33 1.1 180 5.8 Tulane .................... 11 0.4 12 0.4 16 0.5 13 0.4 18 0.6 23 0.7 1* - 94 3.0 UCLA .. ................... 6 0.3 9 0.3 15 0.5 37 1.2 29 0.9 52 1.7 53 1.7 201 6.5 Yale ....................... 12 0.4 6 0.3 14 0.4 16 0.5 23 0.7 20 0.6 31 1.0 122 3.9 Total? by year ....... 309 99 | 309 99 | 364 | 11.7 443 | 142 | 508 | 16.3 613 | 19.7 569 | 18.3 [3,115 | 100.0 t All total percents have been rounded. ? Incomplete data. 58 students attending the schools. Basically, however, degree programs have been considered to fall into two major categories: Those which prepare generalists like the master of public health, and other degree programs which prepare specialists like the master of science. Fry et al., nonetheless, have observed in this light that even in this respect there is some confusion concerning the training programs for the academic-specialist degrees and for the professional-generalist degrees awarded by the schools, and claim that often schools seem to be trying to achieve the same objectives through these two types of programs.” Generally, however, as indicated below, a substantial majority of graduates from schools of public health have pursued programs leading to the M.P.H. degree rather than to an academic-specialist degree. Three-fourths of all respondents, 2,346 or 75.3 percent, had obtained an M.P.H.; 198 or 6.4 percent noted an M.S.P.H.; # 196 or 6.3 percent an M.S. Hygiene; 173 or 5.6 percent an M.H.A or M.SSH.A.; and 202 or 6.5 percent had received some other master’s degree such as an M.S. (see table 5:2). Master of Public Health Degree—All American schools of public health award the M.P.H. degree. Among respondents from 10 of the 11 schools covered by this study, the M.P.H. was the degree most frequently obtained; the exception was among Pittsburgh respondents who noted the M.S. Hygiene. Almost all respondents graduating from Yale and Michigan received an M.P.H.; in the Minnesota group was the lowest percent of respondents from any school receiving an M.P.H. degree. Among those with the M.P.H. degree, 51.7 percent earned this degree between 1964 and 1967. A higher percent of the respondents in all schools earned their M.P.H. degrees in 1964-67 than in 1961-63, but the increase was particularly evident in the UCLA group. Although 68.7 percent of the respondents from UCLA earned the M.P.H. degree, of those receiving this degree only 8.0 percent completed their studies prior to 1964 in contrast to 60.7 percent who received their degrees between 1964 and 1967. Better than four out of five of the respondents from the following schools reported earning the M.P.H. degree: Yale (99.2 percent), Michigan (99.1 percent), Berkeley (97.7 percent), Hopkins (90.6 percent), and Tulane (89.4 percent). Less than one-half of the respondents from Co- lumbia (47.5 percent), Pittsburgh (43.9 percent), and Minnesota (39.4 percent) received this degree. Roughly two-thirds of the respondents from UCLA (68.7 percent), Harvard (65.5 percent), and North Carolina (66.2 percent) also received the M.P.H. degree. The greatest number of M.P.H. degrees was received by Michigan graduates, 560 or almost one in four (23.9 percent) of all the M.P.H. de- grees received by all the respondents from the 11 schools. Nearly three out of five respondents received their degrees from three schools—Michigan "Fry, H. G., et al,, Education and Manpower for Community Health, Pittsburgh: University of Pittsburgh Press, 1967, pp. 80-82. See footnote 9. 69 TABLE 5:2.—Types of master’s degrees received by respondents graduating from eleven schools of public health, years 1961-67 North Master's Berkeley | UCLA |Columbia| Harvard | Hopkins (Michigan | Minne- | Caro- Pitts- Tulane Yale Total degrees sota lina burgh M.P.H.: Number ........ 501 138 122 148 163 560 124 306 79 84 121 2,346 Percent ........ 97.7 68.7 47.5 65.5 90.6 99.1 39.4 66.2 43.9 89.4 99.2 75.3 MS.P.H.: Number ........ 1 47 3 0 1 1 33 111 0 1 0 198 Percent ........ 0.2 23.4 1.2 0.0 0.6 0.2 10.5 24.0 0.0 1.1 0.0 6.4 M.S Hygiene: Number ........ 0 1 0 71 8 2 0 0 100 8 0 196 Percent ........ 0.0 0.5 0.0 34.1 44 0.4 0.0 0.0 55.6 8.5 0.0 6.3 M.HA., MSHA. Number ........ 0 0 54 0 0 1 118 0 0 0 0 173 Percent ........ 0.0 0.0 21.0 0.0 0.0 0.2 37.5 0.0 0.0 0.0 0.0 5.6 Other master’s: Number ........ 11 15 78 1 8 1 40 45 1 1 1 202 Percent ........ 2.1 7.5 30.4 0.4 4.4 0.2 12.7 9.7 0.6 1.1 0.8 6.5 Total: ? Number ........ 513 201 257 226 180 565 315 462 180 94 122 3,115 Percent ........ 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 !Due to rounding error, totals may not add to 100.0 percent. 60 (560) , Berkeley (501), and North Carolina (306) —which together ac- counted for a total of 1,367 M.P.H. degrees, or 58.3 percent of all such degrees. Master of Science in Public Health Degree—In fact, North Carolina is the only school of public health which offers the M.S.P.H. degree. None- theless, in addition to 111 respondents from North Carolina reporting that they had received this degree, 87 respondents from seven other schools also claimed to have the M.S.P.H.? Among North Carolina graduates who received this degree 69 or 62.2 percent completed their studies between 1964 and 1967. Almost one-fourth (24.0 percent) of all the degrees received by North Carolina respondents were the M.S.P.H. Master of Science in Hygiene Degree—The M.S. Hygiene degree is awarded by Harvard, Pittsburgh, and Tulane. However, one respondent from UCLA, two from Michigan, and eight from Hopkins also reported receiving the M.S. Hygiene degree. Of the 196 individuals who reported they had received the M.S. Hygiene degree, 100 or 51.0 percent were Pittsburgh graduates and 77 or 39.3 percent were Harvard graduates. Thus, together Pittsburgh and Harvard respondents reported 90.3 percent of these degrees. Over one-half (55.6 percent) of all the degrees noted by Pittsburgh graduates, over one-third (34.1 percent) of all the degrees received by Harvard graduates, and one in 12 (8.5 percent) of all the degrees received by Tulane graduates were the M.S. Hygiene. Between 1964 and 1967, 66.8 percent of the 177 respondents from Harvard and Pittsburgh received their M.S. Hygiene degrees. Master of Hospital Administration or Master of Science in Hospital Administration Degrees—Both Michigan and Minnesota actually offer a master of hospital administration degree, and Columbia offers a master of science in hospital administration degree. With the exception of one Michigan graduate, only Minnesota and Columbia respondents reported receiving M.H.A. or M.S.H.A. degrees. Of the 173 or 5.6 percent of all respondents who earned these degrees, Minnesota was the source of 118 or 68.2 percent. Nearly as many respondents from Minnesota received an M.H.A., 118 or 37.5 percent, as the M.P.H., 124 or 39.4 percent. Some 54 or slightly over one-fifth (21.0 percent) of Columbia respondents received a M.S.H.A. Of all the M.H.A. or M.S.H.A. degrees reported, 59.5 percent were awarded between 1964 and 1967. Other Master's Degrees.—All schools offer some type of “other mas- ter’s” degree in addition to the types of master’s degrees specified above. At least one respondent from each school received some “other master’s” de- gree. In this category may be included specific master’s titles awarded only ? Respondents from schools other than North Carolina who indicated they had received an M.S.P.H. were in error. It is likely that such respondents designated M.S.P.H. when the degree received was an M.S. which would have been appropriately recorded as “other master’s.” by a particular school such as the master of science in administrative medi- cine offered by Columbia, the master of science in sanitary engineering offered by North Carolina, and the master of industrial health offered by Harvard, or degrees which may not be offered by the school of public health itself but through a department of the graduate school of the uni- versity, as for example, degrees other than the M.P.H. from Yale or other than the M.P.H. or M.H.A. from Michigan. “Other master’s” accounted for 6.5 percent of all the degrees reported. The 78 respondents from Columbia, 45 from North Carolina, and 40 from Minnesota together reporting such degrees comprised 80.7 percent of all such titles. Of all the respondents from Columbia, 30.4 percent reported that they had received an “other master’s” degree. Only one respondent from each of the following five schools had been awarded such a degree: Harvard, Michigan, Pittsburgh, Tulane, and Yale. IN suMMARY, since 1961 the annual number of graduating respondents was irregular with increases and declines also being noted although almost twice as many graduated in 1967 as in 1961 and in 1962. During the 7-year period covered by the study, the most frequently earned degree by respondents from all schools, with the exception of Pittsburgh, was the M.P.H. degree. In general, it appears that respondents from individual schools tended to cluster in one or two kinds of master’s degrees. Respondents from Berkeley, Hopkins, Michigan, Tulane, and Yale had received primarily M.P.H. degrees; in addition, almost one-fourth of the North Carolina re- spondents received an M.S.P.H. degree, and one-third of the Harvard respondents the M.S. Hygiene degree. Among graduates from Pittsburgh the M.S. Hygiene degree was the most prevalent, and among Minnesota respondents the M.H.A. degree was almost as common as the M.P.H. Other degrees like the M.S. were received only by small numbers of respondents. DEMOGRAPHIC CHARACTERISTICS Age Since respondents were requested to give their current ages, the fol- lowing observations pertain to the characteristics of public health workers rather than to the characteristics of students entering or completing their training in schools of public health. The age of respondents both within individual schools and between the various schools is influenced by such considerations as admission requirements with respect to previous years of training and experience, types of programs and degrees offered, and the number of years lapsed since graduation. Among graduates from five schools—UCILA, Minnesota, North Caro- lina, Pittsburgh, and Yale—the most frequently reported ages were be- tween 26 and 35 years, and among graduates from the other six schools —Berkeley, Columbia, Harvard, Hopkins, Michigan, and Tulane—the 61 62 most frequently reported ages were between 31 and 40. The largest group of respondents, 828 or 26.6 percent, was between ages 31 and 35 (see app. D, table 2, pp. 274-275) . Almost one-half (48.4 percent) of all respondents were 35 years old or under in the summer and early fall of 1968 when the survey was con- ducted. Conversely, over one-half (51.4 percent) were 36 years old and over. More than two-thirds (68.2 percent) reported being 40 years old or under. Over one-half of the respondents from UCLA (52.3 percent), Min- nesota (63.2 percent), North Carolina (56.4 percent) and Pittsburgh (55.5 percent) were 35 years old or under. One-third of Hopkins respondents (33.3 percent) and 38.3 percent, respectively, from both the Berkeley and the Tulane groups also were 35 years of age or under. Better than three- fourths of the Harvard group (78.3 percent) and of the Minnesota group (78.8 percent) were 40 years old or under. Of the Harvard graduates 90.2 percent were 45 years old and under as were 89.6 percent of the Minnesota graduates, compared to 77.3 percent among the Berkeley and 77.7 percent among the Hopkins groups. The number of respondents in the group 51 years of age and over was more than twice that of respondents 25 years of age and under; 7.9 percent of all respondents were 51 years of age and over compared to 3.1 percent who were 25 years old and under. In the age group 56 and over were 74 or 2.4 percent of all respondents. Over one-fourth (26.0 percent) of all respondents 25 years old and under, and over one-fifth (21.2 percent) of all those between 26 and 30 years old were from North Carolina. In the age group 25 years old and under, none of the respondents was from Hopkins and only 1.0 percent in this age group was from Tulane. In the 31- to 35-year-old group 20.8 per- cent and in the 41- to 45-year-old group 19.6 percent were from Michigan. In the 36-40 age level 19.0 percent were from Berkeley. Also, 22.2 percent of all respondents between ages 51 and 55, and 31.1 percent of all those age 56 and over were from Berkeley. The sharpest distinctions noted in the distributions of age groups by schools were the comparatively high percent (7.5 percent) of UCLA gradu- ates who were 25 years old and under; the comparatively high percent of Minnesota graduates (35.6 percent) who were age 30 and under; the relatively high percent from Minnesota (63.2 percent) who were 35 years old and under; and the relatively high percents within the Harvard group (90.2 percent) and within the Minnesota group (89.6 percent) who were age 45 and under. By contrast, within the Berkeley group, 77.3 percent and within the Hopkins group, 77.7 percent were age 45 and under. IN sumMARY, among the UCLA, Minnesota, North Carolina, Pittsburgh, and Yale respondents the largest groups tended to be between 26 and 35 years old, while among the Berkeley, Columbia, Harvard, Hopkins, Michi- gan, and Tulane respondents the largest groups tended to be between 31 and 40 years old. Among respondents from all schools, the percents of respondents declined steadily starting with the age group 41-45 through ages 56 and over. Thus, the bulk of the respondents were 40 years old and under, although there were relatively smaller numbers of those in the youngest age level 25 years old and under, than in the oldest, 51 years old and over. Sex Better than two-thirds of all respondents (2,104 or 67.5 percent) were men. In all the schools men predominated in numbers over women. A total of 993 women or 31.9 percent were included in the total population. Proportionately there were more men in the Harvard group (84.1 percent) than in any other school, while the highest percents of women were, re- spectively, among the Michigan (38.1 percent) and the North Carolina (37.2 percent) groups. In the Harvard group at least four out of every five graduates were men; and in the Michigan and North Carolina groups where the highest percents of women were found, men also exceeded women since three out of every five graduates were men (see app. D, table 3, p. 275) . There were more men than women within every age group except in the 51- to bb-year-old group and there were as many men as women in the 56 years and over group. Within the age group 51-55, the percent of women was 56.7 percent compared to 40.9 percent among men, and as noted above among respondents 56 years of age and older there was an equal percent of men (50.0 percent) to women (50.0 percent). In the age group 31-35 years old was the most sizable discrepancy in the ratio of men (77.8 percent) to women (21.7 percent). The distribution of respondents by sex among graduates from the various schools appears to be affected both by career opportunities and the types of major programs offered by the schools—chiefly, the offerings of training in Public Health Nursing which attracted women almost exclusive- ly, and of Medical Care/Hospital Administration /Administrative Medicine, Aviation Medicine, and Environmental Health /Public Health Engineering/ Sanitary Science, which attracted mainly men. The extent to which admis- sion policies and programs attract comparatively large numbers of phy- sicians in the student body also results in larger proportions of men than women. The age distribution and the age by sex distributions bear upon the capacity, public health manpower pool, and the career span of gradu- ates. Thus, since proportionately the women respondents tend to be older than the men, a greater proportion of the women than of the men can be expected to retire sooner from the labor force. Among the men the propor- tion of respondents from age 25 and under to age 40 was 73.6 percent; 57.2 percent of the women were in that age range. An additional sex-linked consideration which affects career opportunities and utilization of public health manpower is that among persons obtaining public health training men comprise a much larger group than women. In the age group 25 and under the percent of women (3.6 percent) 63 64 was slightly higher than that among men (2.8 percent). Equal percents of men (19.0 percent) and women (18.6 percent) were in the 26- to 30-year- old group. However, the percent of men in the 31- to 35-year-age group (30.6 percent) was better than one and a half times that of women (18.1 percent), and proportionately also, there were more men (21.2 percent) than women (16.9 percent) in the 36- to 40-year-old age group. The percent of women (17.0 percent) exceeded that of men (13.3 percent) in the 41- to 45-year-age group and continued to be higher than that of men in older age groups. The highest percent of men in any age group was in the 31- to 35-year-old group; after this age level the percents of men declined. The age distribution of women increased in the 26- to 30-year-old group and remained more or less at the same level through age 45 when it started to decline, yet remaining higher than the percents of men in the older age groups. IN summARY, over two-thirds of all the respondents were men, and overall the men were younger than the women. One-half of the respondents were 36 years old or over at the time of the survey; with the number of those 51 years old and over being more than twice those 25 years old and under. Over two-thirds were 40 years old or younger. The highest percent of youngest respondents, age 25 and under, were from North Carolina; none of the respondents from Hopkins was in this age group. Over one- fifth of all respondents between ages 51 and 55, and better than three-tenths of those age 56 and over were from Berkeley. In effect, the oldest popula- tions were in the Hopkins and Berkeley groups. The highest percent of men was among Harvard respondents and the highest percents of women were among the North Carolina and Michigan groups; yet men predomi- nated in the population of all the schools. EDUCATION AND EXPERIENCE BEFORE ENTERING A SCHOOL OF PUBLIC HEALTH Highest Professional or Advanced Degree Bachelor's Degree—For 1,791 or 57.5 percent of all respondents, the highest degree received prior to enrollment in a school of public health was a bachelor’s degree. The second largest group by highest professional or advanced degree was 21.1 percent among those with an M.D. degree. Graduates from all 11 schools included persons whose highest degree was a baccalaureate. At the upper range, 83.2 percent of the respondents graduating from Minnesota and 78.4 percent from North Carolina began their graduate work in public health at that educational level; among the respondents from these two schools also were found relatively large num- bers of nurses. At the lower extreme, only 7.5 percent of the Harvard respondents indicated that their highest degree prior to enrollment was a bachelor’s; among the Harvard graduates better than two-thirds had M.D. degrees. Over one-half of the respondents from seven of the schools reported that their highest degree prior to entering training in a school of public health was a bachelor’s: Minnesota (83.2 percent), North Carolina (78.4 percent), Yale (65.6 percent), Michigan (65.3 percent), Pittsburgh (64.4 percent), UCLA (61.2 percent), and Columbia (51.0 percent). The bache- lor’s degree was the most frequently reported highest degree held prior to enrollment by respondents graduating from nine of the 11 schools: Berkeley, UCLA, Columbia, Michigan, Minnesota, North Carolina, Pittsburgh, Tulane, and Yale. Respondents indicating that a bachelor’s degree was the highest de- gree held were asked to specify the field of study pursued for this degree. The answers given by 1,827 1° respondents who replied to this question fell largely into nine major categories as shown in the following distribution: Major field of undergraduate study reported by respondents with a bachelor’s as highest degree prior to attending a school of public health Number Science (including biology, zoology, chemistry, physics, and bacteriology), mathematics and Statistics ....... LLL 539 NUISING oo 389 Behavioral and social sciences (including psychology, sociology, anthropology, economics, political science, and government) ............. . 192 Business administration and related areas (including marketing, accounting, commerce, and Management) ..... 106 Engineering ...... 105 Education ....... RB 94 NULHition 84 Public health and health ...... 63 All other 255 Thus, although persons entering a school of public health with a bachelor’s degree may have a wide variety of backgrounds, their under- graduate training was in a field either allied or directly related to health. Only small numbers of bachelor’s holders entered training in public health from fields that were neither allied nor directly related to health; e.g, liberal arts and philosophy, music/fine arts, and theology. M.D. Degree.—A total of 657 or 21.1 percent of all respondents had an M.D. degree prior to entering a school of public health. Respondents with M.D. degrees were found among graduates from all 11 schools. The M.D. degree was most frequently reported as the highest earned degree by respondents from two schools: 68.6 percent of the 226 Harvard group and 61.7 percent of the 180 Hopkins respondents. The M.D.’s from these two schools together with those from Berkeley (153) comprised 63.8 percent of all respondents who held this degree. Over one-fifth of the respondents from Berkeley (29.8 percent), Tulane (22.3 percent), Co- lumbia (21.8 percent), and UCLA (20.9 percent) also held M.D.’s. The N=1,827 (100.0 percent), based on hand count of responses. There was a discrepancy of 36 or 1.0 percent between the hand and the automated count. 65 66 lowest percents of M.D.’s were among respondents from Yale (16.4 percent), Pittsburgh (9.4 percent), Michigan (8.0 percent), North Carolina (6.1 per- cent), and Minnesota (2.9 percent). Master's Degree.—A master’s degree was indicated as the highest de- gree held prior to enrollment in a school of public health by 364 or 11.7 percent of all respondents. Respondents with a master’s degree prior to attending a school of public health were also found in all 11 schools. A master’s degree prior to enrollment was more frequently reported among respondents from Pittsburgh (18.3 percent), Columbia (16.3 percent), Michigan (14.5 percent), Berkeley (13.8 percent), and UCLA (12.9 percent) . D.D.S. Degree.—Only 106 or 3.4 percent of all respondents indi- cated that they had a D.D.S. degree prior to entering a school of public health. The highest percent of respondents with a D.D.S. was among the Columbia respondents (6.2 percent). D.D.S. holders were found among graduates from all 11 schools; however, 72.6 percent of all respondents holding such a degree attended four schools: Columbia, Michigan, Berkeley, and North Carolina. D.V.M. Degree.—Eighty-three respondents or 2.7 percent reported having a D.V.M. degree before their enrollment in a school of public health. There were persons with D.V.M. degrees among respondents from all schools. The highest percent of respondents with the D.V.M. degree was found in the Tulane group (12.8 percent); the lowest percents were among Berkeley (1.2 percent), North Carolina (1.1 percent), and UCLA (1.0 percent) graduates. Over one-half of the D.V.M. holders (56.6 percent) had attended Michigan, Tulane, and Minnesota. Ph. D., Sc. D., Ed. D., and Other Doctoral Degrees.— Those with a Ph. D., Sc. D., Ed. D., or other doctorate prior to enrollment comprised only 57 or 1.8 percent of the study population. The respondents in this category, however, were found in all 11 schools. In the Harvard (17 or 29.8 percent) and in the Berkeley (9 or 15.8 percent) groups were, respectively, the largest numbers of respondents having these degrees. Other Degree.—Only 12, or 0.4 percent of all respondents from four schools—Berkeley, Michigan, Minnesota, and North Carolina—indicated they held some “other degree” than as specified above prior to their enrollment in a school of public health. IN summARy, the largest number of respondents (57.5 percent) re- ported that a baccalaureate was the highest degree held prior to attending a school of public health; bachelor’s degree holders were a majority of respondents in seven schools and a plurality in two other schools. The M.D. degree was the next most frequently reported degree held; M.D.’s were in the majority in two schools. In addition, 3.4 percent had a D.D.S. degree, and another 2.7 percent a D.V.M. An even smaller group held a Ph. D., Sc. D., an Ed. D., or other doctorate. Cumulatively, respondents with all types of doctorates totaled 29.0 percent of all respondents, while those with master’s degrees comprised 11.7 percent of the total study population. In total, 40.7 percent of all respondents reported having a higher degree than a bachelor’s degree prior to enrollment. These findings suggest that except for holders of a medical degree, persons with other doctorates do not ap- pear to be attracted or encouraged to pursue a master’s degree in schools of public health, and that a master’s degree in public health is attractive to persons with only a bachelor’s degree and to a lesser extent, to persons already holding a master’s. The findings also confirm both the marked heterogeneity and param- eters which characterize the previous preparation—level, scope, and di- rection—of persons who enroll in a school of public health both for those who enter seeking their first graduate degree and for those for whom public health training is a second career. Primary Professional Discipline As indicated by the data on highest professional or advanced degree received by respondents prior to entering a school of public health, public health workers were drawn into this field from a variety of disciplines, specialty interests, and educational levels. In order to tap their specific backgrounds, respondents were asked to identify their primary professional discipline prior to enrollment in a school of public health. A list of 24 specific professions derived from the American Public Health Association’s Student Census Card filled out at the time of registration in a school of public health was used for this purpose. Those graduates who did not have a primary profession before entering a school of public health were instructed to check the category ‘“nonapplicable.” Better than four out of five respondents, 2,605 or 83.6 percent, desig- nated themselves as having a specific primary professional discipline prior to enrollment in a school of public health; thus, by and large, their public health training was received on an already acquired professional base and identity. The primary professional disciplines of respondents were, on the whole, related to health. A total of 357 or 11.5 percent of the study popu- lation indicated by a nonapplicable response that they had no primary professional identification prior to their enrollment in a school of public health; 112 or 3.6 percent indicated “other,” nonspecified professional disciplines, and 41 or 1.3 percent did not answer. The most frequently reported primary professional discipline was physician; 604 or 19.4 percent designated themselves as such, not including psychiatrists who comprised an additional 35 or 1.1 percent of all the respondents. Nurses, with 467 or 15.0 percent of all respondents, comprised the second largest professional group. Although other major health profes- sions engaged in direct personal care were in very small numbers, such as dentists (106 or 3.4 percent) and physical therapists (45 or 1.4 percent), overall, 40.3 percent of all respondents identified themselves as members of the above five mentioned direct personal health care professions. 67 68 Physicians, excluding psychiatrists, comprised the highest percents of respondents by primary professional discipline from four schools: Harvard (62.4 percent), Hopkins (58.9 percent), Berkeley (29.4 percent), and Columbia (16.7 percent). The lowest percent of physicians was in the Minnesota group (2.5 percent). Nurses comprised the highest percents of respondents by primary professional discipline from four schools: Minne- sota (27.9 percent), Michigan (22.7 percent), Tulane (22.3 percent), and North Carolina (16.9 percent). The lowest percent of nurses (0.9 per- cent) was in the Harvard group. In the remaining three schools, the highest percents of respondents were within the “nonapplicable” category: Yale (22.1 percent), UCLA (20.9 percent), and Pittsburgh (17.8 percent) ; among the respondents from these three schools were also high percentages of persons indicating that their most advanced degree was a baccalaureate. The primary professional disciplines noted by respondents from all schools were: Administrator or hospital administrator, bacteriologist, lab- oratory scientist or parasitologist, dentist, teacher or educator, mathema- tician, statistician or programer, nurse, physician (excluding psychiatrist), and veterinarian. There were primary professional disciplines not noted by any re- spondents from certain schools. Among Berkeley graduates there were no physicists, radiological health specialists, or health physicists; among UCLA graduates there were no engineers or physiologists; and, among Columbia graduates, no industrial hygienists, physiologists, or behavioral scientists (anthropologists, psychologists, sociologists, or other). Neither health educators, physical therapists, nor sanitarians were reported among Harvard graduates. In the Hopkins group, biologists, entomologists or zoologists, dietitians or nutritionists, health educators, industrial hygienists, physical therapists, physiologists, behavioral scientists (other than psychol- ogists) , and social workers were not reported. Physiologists and anthro- pologists were not noted in the Michigan group. Among Minnesota graduates were not found industrial hygienists, physiologists, psychiatrists, or behavioral scientists (anthropologists, sociologists, psychologists, or other) . Among North Carolina graduates, physiologists and anthropologists were not noted; and among Pittsburgh graduates no health educators, phys- ical therapists, physiologists, anthropologists, and sociologists were reported. Chemists or biochemists, dietitians or nutritionists, industrial hygienists, physicists, radiological health specialists or health physicists, physiologists, or social workers were not found in the Tulane group. Among the Yale respondents there were no chemists or biochemists, dietitians or nutri- tionists, engineers, industrial hygienists, physical therapists, anthropolo- gists, or psychologists. The absence of these categories of professional disciplines suggests that although public health workers as a whole came from a variety of professional backgrounds, there was a selectivity factor or concentration of only certain primary professional disciplines within specific schools. Together with the distribution of respondents by primary professional discipline, the findings above connote patterns of recruitment and selection, program emphasis, as well as the attraction that schools themselves exercise for students of certain backgrounds. Thus, most frequently, respondents with a primary professional background in administration or hospital ad- ministration (20.9 percent) and in mathematics, statistics, or programing (16.9 percent) had been to Columbia; and the largest group of bacteriolo- gists, laboratory scientists or parasitologists (24.8 percent), dentists (29.2 percent), health educators (28.2 percent), mathematicians, statisticians, or programers (16.9 percent just as Columbia), nurses (27.4 percent), sani- tarians (30.4 percent), and veterinarians (26.8 percent) had attended Michigan. The largest group of biologists, entomologists, or zoologists (32.0 percent) , chemists or biochemists (22.0 percent), dietitians or nutritionists (27.5 percent), educators or teachers (33.0 percent) and engineers (35.5 percent) had attended North Carolina, while the largest group of physicians, excluding psychiatrists (25.0 percent), and social workers (31.4 percent) had been to Berkeley. Within the total spectrum of the primary professional disciplines of respondents, the mental health and related disciplines appear particularly small in number. Only 149 or 4.7 percent of all the respondents came from a primary professional discipline either usually identified with or allied to mental health. Included in this category were 35 psychiatrists (1.1 percent), 23 psychologists (0.7 percent), 10 sociologists (0.3 percent), six anthropologists (0.2 percent), 70 social workers (2.2 percent), and five other behavioral scientists (0.2 percent) . Of the 35 psychiatrists, 19 had attended Columbia or Harvard, and the largest number of psychologists (nine of 23) attended Harvard. The ma- jority (57.1 percent) of respondents identifying social work as their pri- mary professional discipline attended Berkeley or Michigan. A total of 24 of the 44 behavioral scientists had attended Berkeley or Harvard. IN summary, over four-fifths of all the respondents indicated that they had a primary profession prior to attending a school of public health. The largest professional groups were, respectively, physicians and nurses. There was a clear association between the primary professional disciplines of respondents and the schools of public health attended. Furthermore, although a large majority of respondents had been trained or had experience in a primary professional discipline related to health prior to entering a school of public health, only a very small group was identified with a mental health profession or with an academic dis- cipline related to mental health. Respondents from mental health-related professional or disciplinary backgrounds attended primarily the schools of public health at Harvard and Columbia (psychiatrists); Harvard and Berkeley (psychologists); Berkeley and Harvard (behavioral scientists, excluding psychologists) ; and Berkeley and Michigan (social work) . 69 70 Professional Experience in Public Health Prior to Enrollment in a School of Public Health Almost two-thirds (63.8 percent) of all respondents had professional work experience in the field of public health before their enrollment in a school of public health. Better than one-third (38.0 percent) indicated that their professional work experience had ranged from less than 1 year to 4 years. One of four respondents (25.8 percent) had worked in public health for 5 or more years before they enrolled for a master’s degree; 15.1 percent had from 5 to 9 years and 10.7 percent had 10 or more years of such pre- vious professional experience. The most frequently reported period of experience was between 1 and 4 years, 31.9 percent of respondents having so indicated. Cumulatively, over one-half of all respondents (53.1 percent) reported up to 9 years of work experience prior to entering a school of public health. The highest percents of respondents with any profes- sional experience in public health prior to attending a school of public health were, respectively, from Michigan (77.3 percent) and from Hopkins, (70.5 percent); those with least experience had attended UCLA (43.9 percent). Whereas 34.0 percent of the respondents had no professional experience before entering a school of public health, over one-half (52.7 percent) of the respondents who attended UCLA and more than 40.0 percent of the respondents from Yale (44.3 percent), Harvard (44.2 percent) , and Pittsburgh (43.9 percent) did not have any such experience. For the period 1961-63, 30.8 percent of respondents indicated no professional public health experience prior to enrollment; during the period 1964-67, the percent of respondents without such experience in- creased to 35.4 percent. This increase is consistent with the tendency toward broadening the base of admissions to include students without previous professional work experience in the field, although still at the time of this study the large majority of respondents had worked in the field prior to pursuing their master’s degree. (a.) Age—1In the younger age groups, 79.2 percent of respondents age 25 and under and 52.2 percent of respondents in the ages 26-30, respectively, had no professional public health experience before attending a school of public health. The percent of respondents with no previous professional ex- perience lessened with increasing age. The largest groups of respondents 31-35 years old (45.0 percent) and 36-40 years old (31.7 percent) had from 1 to 4 years of experience. In the age group 41-45 years old, however, the largest group of respondents (28.0 percent) had not had public health experience prior to their enrollment. In the older age groups starting with age 46 the highest percents of respondents were those with 1 or more years of experience. (b.) Sex—Proportionately, larger groups of men than of women reported no prior public health work experience, less than 1 year of such experience prior to entering a school of public health, as well as 1-4 years of experience. However, the percent of women (34.8 percent) with 5 or more years of experience exceeded the percent of men with a similar length of experience (21.3 percent). These differences in length of experience between men and women may be related to age since the women respondents were older than the men. Also, the fact that experienced nurses comprise a relatively large group and concentrate in the female population further account for the relatively greater experience among women. (c.) Primary Professional Discipline—The number of years of experi- ence in public health prior to attending a school of public health is also re- lated to the primary professional disciplines of the respondents. More than one-half of the dietitians and nutritionists (60.4 percent), educators and teachers (55.7 percent), biologists, entomologists, and zoologists (60.0 percent), and chemists and biochemists (64.0 percent) had no such experi- ence prior to entering a school of public health. However, more than one- half of the engineers (54.2 percent) and of the health educators (57.6 per- cent) had between 1 and 4 years such experience. Nurses tended to have had between 1 and 4 (31.0 percent) and 5 and 9 (28.2 percent) years of experience. Among physicians (excluding psychiatrists) almost as many had not had public health experience (35.6 percent) as those who had be- tween 1 and 4 years (37.1 percent) of experience, while psychiatrists generally had not had any public health experience. The amount of experience prior to enrollment is also a reflection of the varied admission requirements and inducements maintained by the individual schools, and specifically of the requirements for the different degree programs that they offer. The opportunities that are currently available for the support of formal training in public health are in- centives for additional training and career development. Furthermore, the admission criteria established by the Committee on Professional Education of the American Public Health Association also bear on this issue. The Committee requires as a minimum a bachelor’s degree and specifies the criteria for admission to two types of master’s degrees in public health." One type of master’s degree is for the public health specialist or scientist, which includes the M.S. Hyg., M.S.P.H., M.S., and M.A., and has the following admission requirements: Admission should be limited to holders of the bachelor’s degree with adequate preparation in the biological, physical, or social sciences, or combinations thereof; they should meet admission standards equivalent to those required of candidates matriculating for an equivalent master of science degree in other parts of the university.!? This criterion does not require any previous professional preparation or previous experience in the field. Admission requirements for the master’s degree for the public health 1 American Public Health Association, Committee on Professional Education, “Criteria and Guidelines for Accrediting Schools of Public Health,” American Journal of Public Health, 56: 1308-1318, August 1966. 21bid, p. 1313. 72 generalist or administrator which includes the M.P.H. or the D.P.H. (diplomate in public health awarded by Canadian schools) state that: An applicant should possess: I. A graduate degree, from an acceptable institution, in a discipline relevant to public health, or 2. A bachelor’s degree, from an acceptable institution, with substantial knowledge in a discipline relevant to public health either through study or experience or a combination of these. Thus, applicants seeking an M.P.H. (or D.P.H.) are expected to have had training relevant to public health and/or experience in order to gain admission for training for this graduate degree. IN sumMmARY, nearly two-thirds of all respondents had professional public health experience before entering a school of public health, with the most frequently reported periods of experience ranging between 1 and 4 years. The highest percent of respondents with professional public health experience prior to attending a school of public health was from Michigan; the lowest from UCLA. Although among younger respondents there were higher percents who had not had professional public health experience prior to attending a school of public health, increasing age was not a con- sistent factor in determining the years of previous experience in the field. Women were more likely than men to have had such experience, possibly both because women were older and within the female popula- tion there was a high percent of professional nurses who went to a school of public health. Respondents from certain primary professions; i.e., die- titians and nutritionists, educators and teachers, biologists, entomologists, and zoologists, and chemists and biochemists, however, tended not to have had public health experience before attending a school of public health. Furthermore, the American Public Health Association Committee on Profes- sional Education criteria and guidelines for admissions to the schools for certain degrees also specify training and/or experience equivalencies required for the entry of candidates. Mental Health Work Experience and Feeling of Need for Mental Health Training Prior to Entering a School of Public Health Mental Health Work Experience Prior to Enrollment.—Relatively few respondents—three out of 10 (963 or 30.9 percent) —indicated that they had experience in mental health work prior to registering in a school of public health. In this regard, there was only a slight difference (2.0 per- cent) in percentage between those who graduated in 1961-63 (29.2 percent) and those who graduated in 1964-67 (31.2 percent). Relative to the number of graduates who had professional public health experience prior to entering a school of public health (63.8 percent), 1 bid, p. 1314. the percent of those who had experience in mental health work was in fact less than one-half. Overall, the highest percent of respondents with any kind of mental health work experience before studying public health, 38.6 percent, was in the Berkeley group and the lowest, 23.6 percent in the North Carolina group, followed by 25.1 percent within the Minnesota and 25.5 percent within the Tulane groups. One-half of all respondents (50.1 percent) who had mental health work experience attended three of the 11 schools: 198 or 20.6 percent went to Berkeley, 175 or 18.2 percent went to Michigan, and 109 or 11.3 percent attended North Carolina. (a.) Age—The percents of respondents with experience in mental health work prior to entering a school of public health increased progressively up to age 51-55 (46.8 percent), and declined in the age group 56 years and over (40.5 percent). The lowest percent with mental health experi- ence before entering a school of public health was among respondents 25 years and under (9.4 percent). (b.) Sex—Proportionately, more respondents among the women (43.9 percent) than among the men (24.5 percent) had done mental health work prior to going to a school of public health. (c.) Primary Professional Discipline—Among nurses (62.1 percent) and among social workers (84.2 percent) were the highest percents of respond- ents who indicated having had mental health experience before entering a school of public health. Among physicians, three out of five (59.4 per- cent) had not had any mental health work experience prior to attending a school of pubic health. Also, most, but not all of the psychiatrists had experience in mental health work prior to attending a school of public health. Feeling of Need for Mental Health Training.—Respondents without experience in mental health work prior to enrollment in a school of public health were asked to indicate if they had felt a need for mental health training before attending a school of public health. Of the 2,139 respond- ents without mental health work experience 651 or 30.4 percent indicated that they had felt a need for mental health training. A large majority of those who lacked mental health experience, 1,469 or 68.7 percent, felt no need for such training at a school of public health. By school, among respondents without experience in mental health work, the highest percent to have felt a need for mental health training before enrollment was 44.3 percent from Tulane in contrast to 19.8 percent in the Yale group. Furthermore, among respondents without mental health work experience, a higher percent of those graduating in 1961-63 (31.9 percent) than among those graduating in 1964-67 (29.7 percent) felt a need for mental health training. (a.) Age—Generally younger respondents without mental health work experience also indicated that they had not felt a need for mental health training prior to entering a school of public health. Among those respond- ents between 46 and 50 years old and among those 51-55 years old 73 74 who had not had mental health work experience 44.4 percent and 49.4 percent, respectively, indicated that they had felt a need for mental health training. Among those age 56 years old and over 41.9 percent indi- cated having felt a need for such training; this was a higher percent than among respondents in each of the age groups up to 45 years of age. (b.) Sex—Among the women, furthermore, a higher percent (39.8 per- cent) than among men (27.2 percent) reported that they had felt a need for mental health training before going to a school of public health. IN sumMmARY, mental health work experience was held by three out of 10 respondents before entering a school of public health; this was less than one-half the number of respondents who had public health experience prior to going to a school of public health. Among the Berkeley respond- ents was the highest percent of those who had done mental health work before studying in a school of public health; the lowest percent was in the North Carolina group. Those who had done mental health work prior to entering public health training increased proportionately with age up to those 55 years old. Proportionately also, more women than men had mental health experience, with the nurse and social worker groups, respectively, containing the highest percents of respondents with mental health experience. Of those who did not have mental health experience, three out of 10 indicated that they had felt a need for mental health training before attending a school of public health. By school, among Tulane respondents was the highest and among Yale respondents the lowest percents who in- dicated feeling a need for mental health training. In the age group be- tween 51 and 55 the highest percent indicated feeling a need for mental health training; also a higher percent of women than men indicated such a need. MAJOR PROGRAMS OF STUDY Respondents were asked to indicate the major program of study pur- sued during their training in a school of public health using a format identical to the 24 category major subject list on the APHA Student Census Card. A 25th category, “Other (specify),” was also included in the questionnaire. Mental Health Program Majors Mental Health was one of the least frequently reported majors. Only 60 or 1.9 percent of the total study population reported Mental Health, Administrative Psychiatry, Community Psychiatry as the major program area which they pursued during their training in a school of public health. (Subsequently these majors are referred to as Mental Health.) Respondents with Mental Health majors came chiefly from five primary professions: 21 were psychiatrists, 13 nurses, nine psychologists, six were physicians (excluding psychiatrists) , and three social workers. Of the 35 psychiatrists in the study population, 14 did not major in Mental Health, nor did 14 of 23 psychologists, and neither did 67 of 70 social workers. Members of mental health professions tended to obtain public health training in areas of emphasis other than Mental Health, such as administration. Also whereas in practice, nonpsychiatric physicians have been tapped for mental health work and in many instances mental health services are administratively within the purview of public health departments and general hospitals, nonpsychiatric physicians tended not to major in Mental Health but in such areas as Administration or Practice of Public Health, Maternal and Child Health, or Epidemiology. The ma- jority of social workers majored either in Medical Care and Hospital Ad- ministration, Administrative Medicine or Social Work in Public Health while only a few majored in Mental Health. The 60 respondents who majored in Mental Health attended nine of the 11 schools; none of these respondents attended North Carolina or Pittsburgh. Some 60 percent (60.0 percent) of those majoring in Mental Health graduated from three schools: Columbia (13), Harvard (12), and Hopkins (11); 30 of the respondents who majored in Mental Health re- ported they had received the M.P.H. degree, two the M.S.P.H., 12 the M.S. Hygiene, two the M.H.A. or M.S.H.A., and 14 an “other master’s” degree. Among 982 respondents graduating between 1961 and 1963, 14 (1.4 percent) reported a major in Mental Health; these respondents had graduated from five schools, eight of them attended Harvard. Respondents majoring in Mental Health constituted 2.2 percent of those who graduated between 1964 and 1967 (46 of 2,133); these respondents had studied in nine schools; 12 of them attended Columbia. Thus, the number of respond- ents reporting a Mental Health major increased by 32 from 14 who graduated in 1961-63 to 46 in 1964-67, and during this period the number of schools where they pursued a Mental Health major increased from five to nine. Other Program Majors The top five major programs pursued by respondents were: (1) Ad- ministration or Practice of Public Health (486 or 15.6 percent); (2) Medi- cal Care and Hospital Administration, Administrative Medicine (415 or 13.3 percent); (3) Environmental Health, Public Health Engineering, Sanitary Science (320 or 10.3 percent); (4) Public Health Nursing (309 or 9.9 percent); and (5) Health Education (255 or 8.2 percent). These five majors were completed by 57.3 percent of the total study population. The least frequently reported major programs were Rehabilitation or Physi- cal Therapy (2 or 0.1 percent), Physiological Hygiene or Environmental Medicine (5 or 0.2 percent), Population Studies, Family Planning, Demog- raphy (8 or 0.3 percent), Behavioral Sciences (9 or 0.3 percent), Interna- 75 76 tional Health (14 or 0.4 percent), Veterinary Public Health (16 or 0.5 percent) , and Chronic Diseases or Gerontology (17 or 0.5 percent) . There were respondents in five major program areas in all the schools: Administration or Practice of Public Health, Biostatistics, Environmental Health /Public Health Engineering/Sanitary Science, Epidemiology, and Medical Care and Hospital Administration /Administrative Medicine. Hopkins graduates reported having taken 19 different kinds of majors, those from Michigan 18, from Berkeley and Harvard 17 each, from UCLA, Columbia, North Carolina, and Tulane 15 each, from Minnesota and Yale 14 each, and from Pittsburgh 12. Administration or Practice of Public Health was most frequently report- ed as their major by respondents from Berkeley (14.4 percent), Columbia (30.4 percent), Hopkins (22.8 percent), North Carolina (18.2 percent), and Tulane (23.4 percent). Medical Care and Hospital Administration, Administrative Medicine was the most frequently cited major by respond- ents from UCLA (25.9 percent), Minnesota (29.5 percent), Pittsburgh (20.6 percent), and Yale (34.4 percent). Thus, in nine of the 11 schools the most frequently reported major was either Administration or Prac- tice of Public Health or Medical Care and Hospital Administration, Ad- ministrative Medicine. Respondents with other majors constituted higher percents at the two other schools: At Harvard, Aviation Medicine (22.1 percent), and at Michigan, Public Health Nursing (17.7 percent). Among respondents from Minnesota only 10.2 percent and Michigan 8.5 per- cent reported Administration or Practice of Public Health as their majors. Only two respondents from North Carolina and two from Tulane, and five each from Harvard and Hopkins had pursued a major in Medical Care and Hospital Administration, Administrative Medicine. Environmental Health, Public Health Engineering, Sanitary Science was the major for 10.3 percent of the total group. The number of respond- ents with majors in Environmental Health, Public Health Engineering, Sanitary Science from North Carolina (17.5 percent), Michigan (15.8 percent), Minnesota (15.2 percent), and Tulane (13.8 percent) com- prised 72.2 percent of all the respondents who majored in this area; although respondents from all the schools reported this major. Public Health Nursing was the major for 9.9 percent of all respondents. A substantial majority of the Public Health Nursing majors (79.9 percent) graduated from three schools: Michigan (17.7 percent), Minnesota (25.7 percent), and North Carolina (14.3 percent). Health Education was the major field of study for 8.2 percent of all respondents. Graduates from North Carolina and Berkeley comprised 57.6 percent of all majors in Health Education; of all the North Caro- lina respondents 16.7 percent and of all the Berkeley respondents 13.6 percent majored in this area. As noted before, certain majors were not reported by any respond- ents from specific schools. Aviation Medicine was not reported by Michi- gan, Minnesota, Pittsburgh, or Yale graduates; Behavioral Sciences majors were not reported by UCLA, Columbia, Hopkins, Michigan, Minnesota, North Carolina, or Pittsburgh graduates. No graduates reported ma- joring in Chronic Diseases or Gerontology from Columbia, Harvard, Min- nesota, North Carolina, Pittsburgh, or Tulane. Dental Public Health was not a reported major among Berkeley, UCLA, Hopkins, Pittsburgh, or Yale graduates. No majors in Health Education were reported by Harvard, Pittsburgh, or Tulane graduates. Majors in International Health were reported only by Hopkins, Michigan, and Tulane graduates. Among Columbia and Minnesota graduates no majors in Maternal and Child Health were reported, and as already mentioned, neither North Caro- lina nor Pittsburgh graduates reported majoring in Mental Health. Mi- crobiology or Laboratory Public Health was not reported by Columbia or Minnesota graduates; and Nutrition or Biochemistry was not reported by Tulane or Yale graduates. There was no major in Occupational Health or Industrial Hygiene among Tulane graduates. Majors in Physiological Hygiene or Environmental Medicine were only reported by Harvard and Hopkins graduates; these also were the only two schools where graduates re- ported majors in Population Studies, Family Planning, Demography. Neither among the Harvard nor Yale graduates were there any majors in Public Health Nursing; neither were there any majors in Radiation Health in the UCLA or Tulane groups. Only in the UCLA and Minnesota groups were there majors, and only one each, in Rehabilitation or Physical Therapy. Social Work in Public Health was not a reported major among UCLA, Harvard, Hopkins, Minnesota, North Carolina, Tulane, or Yale graduates. Among Berkeley, UCLA, Michigan, Minnesota, and Pittsburgh graduates no majors in Tropical Medicine, Entomology, or Parasitology were re- ported, and Veterinary Public Health was only reported among the majors taken by Michigan, Minnesota, and Tulane graduates. Furthermore, major programs reported tended to concentrate within certain schools with the effect that collectively, a majority of respondents with majors in: (I) Administration or Practice of Public Health were graduates from Berkeley 15.2 percent, Columbia 16.0 percent, North Carolina 17.3 percent, and Michigan 9.9 percent— (58.4 percent). (2) Aviation Medicine were graduates from Harvard— (52.1 percent) . (3) Biostatistics were graduates from North Carolina 19.7 per- cent, Michigan 19.0 percent, and Columbia 16.2 percent — (54.9 percent) . (4) Dental Public Health went to Michigan 62.7 percent. (5) Environmental Health, Public Health Engineering, Sanitary Science went to Michigan 27.8 percent and North Caro- lina 25.3 percent— (53.1 percent). (6) Epidemiology attended Berkeley 25.4 percent, Harvard 14.4 percent, and Hopkins 13.3 percent— (53.1 percent). 77 78 (7) Health Education went to North Carolina 30.2 percent and Berkeley 27.5 percent— (57.5 percent). (8) Maternal and Child Health attended Berkeley 41.0 percent and Hopkins 16.5 percent— (57.5 percent) . (9) Medical Care and Hospital Administration, Administrative Medicine went to Minnesota 22.4 percent, Columbia 16.9 percent, and Berkeley 15.9 percent— (55.2 percent). (10) Mental Health went to Columbia 21.7 percent, Harvard 20.0 percent, and Hopkins 18.3 percent— (60.0 percent) . (11) Microbiology, Laboratory Public Health attended Michigan 35.9 percent and Berkeley 21.9 percent— (57.8 percent) . (12) Nutrition, Biochemistry went to Berkeley 22.6 percent, North Carolina 20.0 percent, and Michigan 18.3 percent— (60.9 percent) . (18) Occupational Health, Industrial Hygiene attended Michigan 32.3 percent and Pittsburgh 18.3 percent— (50.6 per- cent) . (14) Public Health Nursing went to Michigan 32.4 percent and Minnesota 26.2 percent— (58.6 percent). (15) Radiation Health went to Michigan 25.7 percent and North Carolina 24.3 percent— (50.0 percent). (16) Tropical Medicine, Entomology, Parasitology went to North Carolina 39.4 percent and Harvard 18.2 percent— (57.6 percent) . Comparisons Between Mental Health and Other Program Majors In this section the 60 respondents who majored in Mental Health are examined as a group and compared to other specific groups of respondents who majored in each of nine other program areas. For purposes of this comparison, only those major program areas identified by 100 or more respondents were considered. These nine major program areas include: Administration or Practice of Public Health, Biostatistics, Environmental Health /Public Health Engineering/Sanitary Science, Epidemiology, Health Education, Maternal and Child Health, Medical Care and Hospital Adminis- tration /Administrative Medicine, Nutrition /Biochemistry, and Public Health Nursing. For purposes of this comparison, 21 variables were selected (see table 5:3). The modal age of respondents with Mental Health majors was 36-40 years old (26.7 percent); this was the same modal age as that of Public Health Nursing majors (19.1 percent). Mental Health majors exceeded the modal age of respondents in seven other major programs: Biostatistics (33.1 percent) , Health Education (29.8 percent), and Nutrition /Biochemis- try (34.8 percent) whose modal age was 26-30 years old, and Administra- tion or Practice of Public Health (23.7 percent), Environmental Health/ Public Health Engineering/Sanitary Science (34.7 percent), Epidemiology (33.1 percent) , and Medical Care and Hospital Administration /Administra- tive Medicine (28.9 percent) whose modal age was 31-35 years old. Maternal and Child Health majors (20.9 percent) were in the oldest modal age, 41-45 years old, in part both because of the large number of physicians and of women majoring in this area. The older modal age of Mental Health majors may be related also to the extended years of professional training and work experience of the 21 psychiatrists and of respondents with other doctoral degrees as well as of the 13 nurses in the group. As noted before, women in the study population were as a whole older than men, and this is related to the very large group of female nurses in the study population. By sex, the percents of men in each of five majors were higher than in the Mental Health major group (63.3 percent): Administration or Practice of Public Health (76.1 percent), Biostatistics (71.7 percent), Environmental Health /Public Health Engineering /Sanitary Science (96.9 percent), Epide- miology (77.3 percent), and Medical Care and Hospital Administration / Administrative Medicine (86.3 percent). The modal highest degree prior to enrollment in a school of public health was the M.D. degree for 43.3 percent of the Mental Health major group. Of the 27 physicians who majored in Mental Health, 21 were psy- chiatrists. The M.D. degree also was the modal degree for respondents with two other majors included in this comparison: For 72.7 percent of the Maternal and Child Health majors, and for 55.2 percent of the Epidemiology majors. For respondents with seven other majors, the bachelor’s degree was the modal highest degree. Similarly, whereas 55.0 percent of the Mental Health majors reported having any kind of doctoral degree (M.D., D.D.S., Ph. D., Sc. D., Ed. D., or other doctorate) , this percent was higher among Epidemiology majors (81.2 percent) and Maternal and Child Health majors (73.4 percent). The relatively high percent of Mental Health majors hold- ing doctoral degrees may be accounted for by a variety of factors among which are: (a) That mental health training programs in schools of public health are designed primarily as postgraduate sequences for persons who already have completed their basic professional training in a mental health discipline, for example, a physician must have completed a 3-year psy- chiatric residency, and (b) that NIMH regulations on stipends awarded for general public health-mental health training grants to the schools of public health require that candidates for support hold an advanced degree in a mental health discipline. Furthermore, the size of the stipends is predicated on the number of years of graduate training that the student has had. The modal number of years of public health work experience prior to enrollment reported by Mental Health majors was none (51.7 percent) ; this percentage was exceeded only by Biostatistics majors (55.6 percent), and Nutrition /Biochemistry majors (69.6 percent). The modal number of years of public health work experience prior to enrollment was also none for Maternal and Child Health (32.4 percent) and for Medical Care and Hospital Administration /Administrative Medicine (48.9 percent) majors. 79 TABLE 5:3.—Summary comparison of mental health majors Major pro Environ- Adminis- mental Health, Mental tration or Public Health Health Practice of Engineering, | Epidemiology Public Health Sanitary Science A. Total number of respondents. 60 ........ 486 ........ 320 ........ 181 ........ Modal present age: Years .......... 36 to 40. ....| 31 to 35..... 31 to 85..... 31 to 35... .. Percent ........ 26.7 ....... 237 347 ........ 33.1 ........ Percent male ....... 633 ....... 76.1 ........ 969 ........ 778 Modal highest ad- vanced degree: Degree ......... M.D Bachelor's Bachelor's MD. ....... Percent ........ 433 ...... 436 ........ 825 ........ 55.2 ........ Percent of all doc- toral degrees. 55.0 ....... 431 ...... 59 ........ 81.2 ........ Modal number of years of public health work prior to enrollment: Years .......... None ...... lto4 ...... lto4 ...... lto4....... Percent ........ 51.7... 356 ........ 434 ........ 39.2 ........ Modal total years of professional work in public health: Years .......... 1to4 Percent ........ 30.0 Years .......... bt09 ..... 509 ...... 5t09 ..... 5t09 ...... Percent ........ 300 ....... 37.0 ........ 39.1 ....... 343 ....... Percent with mental health work ex- perience prior to enrollment. 80.0 ....... 374 ........ 72... 260 ........ Percent currently working in train- ing area pursued. | 850 ....... 710... 781 oo. 59.7 ........ Percent employed (full and part time) | 95.0 ....... 959 ........ 90.6 ....... 90.6 ........ and 9 other majors (N>100), by selected variables * gram areas Medical Care Health Maternal and Hospital Nutrition, Public Health Education and Child Administration, Biochemistry Nursing Health Administrative Medicine 255 LL... 189 ............ 415 115... 309 26 to 30 ........ 41 to 45 ........ 31to35 ........ 26 to 30 ........ 36 to 40 298 ............ 209 ............ 289 ............ 348 ............ 19.1 518 ............ 482 ............ 863 ............ 78 1.6 Bachelor's ...... MD. ........... Bachelor's ..... Bachelor's ..... Bachelor's 769 ............ 727 716 ............ 843 ............ 92.2 20 784 ........... 100 ............ 26 ............ 0.0 lto4 .......... None .......... None .......... None .......... 1to4 41.2 LL 324... 489 ........... 696 ........... 35.3 5t09 .......... 5t09 .......... lto4 .......... lto4 .......... 5t09 358 ............ 288 ............ 318 ............ 318 ............ 28.8 286 ............ 446 ............ 280 ............ 183 ............ 56.6 690 ............ 69.8 ............ 84.1 ............ 765 LL. 78.6 882 ............ 943 ............ 966 ............ 835 ............ 89.7 81 TABLE 5:3.—Summary comparison of mental health majors and Major pro Environ- Adminis- mental Health, Mental tration or Public Health Health Practice of Biostatistics | Engineering, | Epidemiology Public Health Sanitary Science Percent not taking mental health courses. 1.7 oo. 481 ........ 82... 822 ........ 69.6 ........ Percent taking one or more mental health courses. 96.7 ........ 485 ........ 197... 14.1 ........ 27.0 ........ B. Number of re- spondents sub- total. 57 oo... 466 ........ 112 ........ 290 ........ 164 ........ Percent employed, working in health field. 96.5 ........ 959 ........ 893 ........ 91.7 ........ 96.3 ........ Public Modal present health functional profes- engi- sional title: Adminis- neer/ Title .......... Other ...... trator Biostatistician| sanitarian .| Other ...... Percent ........ 404 ........ 356 ........ 786 ........ 55.2 ........ 470 ....... Executive- adminis- Modal major role Executive- Executive- trative, in present job: adminis- adminis- 214; Role .......... trative .... trative ....| Research, consultative, | Research, Percent ........ 421 ........ 51.1 ........ 402 ........ 20.7 ........ 329 ........ Percent engaged in patient care. h44 152 ........ 7.0 3.1... 220 ........ Federal gov- ernment (uniformed Modal principal service) , source of profes- | Voluntary County, city, 21.3; sional income: agency or local gov- | State govern- | State gov- State govern- Source ........ institution, ernment, ment, ernment, ment, Percent ....... 246 ........ 200 ........ 259... 279 ........ 20.7... Percent a govern- mental principal source of profes- sional income. 439 ........ 62.7 ........ 616 ........ 741 LL 645 ........ 82 9 other majors (N>100), by selected variables '—Continued gram areas Medical Care Health Maternal and Hospital Nutrition, Public Health Education and Child Administration, Biochemistry Nursing Health Administrative Medicine 56.1 ............ 403 ............ 549 ............ 722 30.7 408 ............ 590 ............ 419 ............ 234 67.6 225 131 ............ 401 LL 9% ............. 277 924 ............ 97.7 973 ........... 875 ............ 98.2 Public health Public health Health educator physician Administrator Other .......... nurse. 636 ............ 435 738 ........... 698 ............ 72.6 Executive-ad- Executive-ad- Consultative, ministrative, ministrative, Consultative, Instructional, 347 328 623 ........... 344 28.2 76 ............. 466 ............ 127 417 oo 21.3 County, city, County, city, local govern- local govern- Voluntary agency | Federal Govern- ment, ment, or institution, ment (civilian), | State government, 249 29.0 oo... 389 ............ 219 o.oo 30.7 658 ............ 672 ............ 374 LL 57.2 68.9 83 84 TABLE 5:3.—Summary comparison of mental health majors and Major pro Environ- Adminis- mental Health, Mental tration or } oo Public Health Epidemiology Health Practice of Biostatistics | Engineering, Public Health Sanitary Science Modal-principal Mental work setting: health Health—not | Health—not | Health—not | Health—not Setting ........ setting, hospital, hospital, hospital, hospital, Percent ........ 368 ........ 502 ........ 31.2 ........ 50.7 ........ 335 ........ Modal relatedness of present duties to mental health: Strongly re- | Occasionally Occasionally | Occasionally Relatedness . . .. lated, $0, Not related, SO, so, Percent ....... 754 39.1 ........ 393 ........ 369 ........ 348 ........ C. Number of re- spondents subtotal. | 12 ...... ... 303 ........ 119 ........ 297... 134 ........ Needing mental health training prior to enroll ment. N=7 ....... 36.6 percent | 14.3 percent | 19.5 percent | 20.9 percent D. Number currently working in mental health but not majoring in Men- tal Health. |. ............ 4 0 ......... 1... 1 * Discrepancy between N's in this table and other tables is due to inclusion of nonresponses herein. The modal number of years of public health work experience prior to enrollment was 1-4 years for majors in Administration or Practice of Public Health (35.6 percent), Environmental Health /Public Health Engineering/ Sanitary Science (43.4 percent), Epidemiology (39.2 percent), Health Edu- cation (41.2 percent), and Public Health Nursing (35.3 percent). The modal total number of years of professional work experience in public health among Mental Health majors was divided equally with 30.0 percent each reporting 1-4 years and 5-9 years. Majors in Administration or Practice of Public Health (37.0 percent), in Environmental Health /Public Health Engineering/Sanitary Science (39.1 percent), in Epidemiology (34.3 percent) , in Health Education (35.3 percent), in Maternal and Child Health (28.8 percent), and in Public Health Nursing (28.8 percent) had a mode of 5-9 years of total professional experience in public health. Majors in which the highest modal total number of years of professional work experience in public health was 1-4 years included Biostatistics (39.4 percent), Medi- 9 other majors (N>100), by selected variables '—Continued gram areas Medical Care Health Maternal and Hospital Nutrition, Public Health Education and Child Administration, Biochemistry Nursing Health Administrative Medicine Health—not hos- | Health—not Health—hos- Health—not Health—not pital, hospital, pital, hospital, hospital, 524... 519 ............ 489 ............ 344 480 ............ Moderately re- Moderately re- Moderately re- lated, lated, Occasionally so, lated, Strongly related, 320 ...........] 412 429 28.1 LL. 49.1 181 ............ Bo 29%... 92 132 44.8 percent ....| 53.3 percent ....| 24.7 percent ....| 26.1 percent ....| 65.9 percent 5 0 7 0 1 cal Care and Hospital Administration/Administrative Medicine (31.8 per- cent), and Nutrition/Biochemistry (31.3 percent). While 80.0 percent of the Mental Health majors reported mental health work experience prior to enrollment, among other majors the range was from 56.6 percent for Public Health Nursing majors to 7.2 percent for Environmental Health /Public Health Engineering /Sanitary Science majors. Seven of the 12 Mental Health majors with no mental health work experience prior to attending a school of public health affirmed at the time of the study to have felt a need for mental health training prior to enroll- ment. However, four of the Mental Health majors with no mental health work experience prior to attending a school of public health indicated that they had not felt such a need. As many as 65.9 percent of the Public Health Nursing majors and over one-half of the Maternal and Child Health majors (53.3 percent) with no mental health work experience prior to enrollment also expressed a need for mental health training before studying in a school of public health. 85 86 While 51 or 85.0 percent of the Mental Health majors were currently working in the major area of their training, the range of similar responses among majors in the other nine areas was 84.1 percent for Medical Care and Hospital Administration/Administrative Medicine majors to 59.7 percent for Epidemiology majors. Of the 745 respondents in the total study population who were not working in their major program area at the time of the study, 22 (3.0 percent) reported working in mental health although they had not majored in this area. Seven of these had majored in Medical Care and Hospital Administration /Administrative Medicine, five had majored in Health Edu- cation, four had majored in Administration or Practice of Public Health, and each of the remaining six had majored in some other area. Six re- spondents who were mental health professionals prior to enrollment in a school of public health majored in an area other than Mental Health but at the time of the study were doing mental health work; five of these respondents were psychiatrists and one was a social worker. Thus, only 16 respondents, who were not mental health professionals prior to enrollment and who majored in an area other than Mental Health, were engaged in mental health work at the time of this study. The small number of persons subsequently working in mental health although not Mental Health majors suggests that there may be factors within the training in schools of public health, as well as in both the professional practices of public health and mental health work which tend to discourage public health workers from crossing over into doing mental health work. The highest percents of employed majors were 96.6 percent of the Medical Care and Hospital Administration /Administrative Medicine majors and 95.9 percent of the Administration and Practice of Public Health ma- jors, while 95.0 percent of the Mental Health majors also were employed. The lowest percent of employed respondents was among the Biostatistics majors (78.8 percent). Of the 57 employed Mental Health majors, 96.5 percent or 55 were working in the health field, this percent was exceeded by the Public Health Nursing majors (98.2 percent), the Maternal and Child Health majors (97.7 percent), and the Medical Care and Hospital Administration /Administra- tive Medicine majors (97.3 percent). The lowest percent of employed respondents working in the health field was among the Nutrition /Biochem- istry majors (87.5 percent). Among Mental Health majors the modal present functional profes- sional title for 40.4 percent was “other,” while among Biostatistics majors the modal functional title was biostatistician (78.6 percent). The lowest modal percent by functional title was 35.6 percent for Administration and Practice of Public Health majors who noted the title administrator. The modal major role in present job among Mental Health majors was executive-administrative noted by 42.1 percent; this same role also was indicated by 62.3 percent of the Medical Care and Hospital Administration / Administrative Medicine majors and 51.1 percent of the Administration and Practice of Public Health majors. The modal major role among Biostatistics majors (40.2 percent) and Epidemiology majors (32.9 percent) was re- search. Among Health Education majors (34.7 percent) and Nutrition / Biochemistry majors (34.4 percent) the modal major role was consultative. The modal major role among Public Health Nursing majors (28.2 percent) was instructional. Among Environmental Health/Public Health Engineer- ing /Sanitary Science majors 21.4 percent were in executive-administrative roles and 20.7 percent in consultative roles. Of the 57 employed Mental Health majors, 31 or 54.4 percent reported that they were directly engaged in patient care. Among other majors, the percents of respondents engaged in patient care ranged from 46.6 percent for Maternal and Child Health majors and 41.7 percent for Nutrition/ Biochemistry majors to 3.1 percent for Environmental Health/Public Health Engineering/Sanitary Science majors. The modal principal source of professional income among Mental Health majors was voluntary agency or institution for 24.6 percent; the same source was noted by the modal percent of majors in Medical Care and Hospital Administration /Administrative Medicine (38.9 percent). State government was the modal source of professional income for 30.7 percent of Public Health Nursing majors, 27.9 percent of Environmental Health/ Public Health Engineering/Sanitary Science majors, and 25.9 percent of Biostatistics majors. County, city, other local government was noted as the modal source by 29.0 percent of Maternal and Child Health majors, 24.9 percent of Health Education majors, and 20.0 percent of Administration or Practice of Public Health majors. The Federal Government (uniformed service) was the modal source of professional income for Epidemiology majors (21.3 percent) and the Federal Government (civilian) for Nutri- tion /Biochemistry majors (21.9 percent). Whereas 43.9 percent of the Mental Health majors noted a govern- mental body as their principal source of professional income, the lowest percent of respondents noting such a source was 37.4 percent among Medical Care and Hospital Administration/Administrative Medicine majors. The highest percent noting government as a principal source of professional income was 74.1 percent among Environmental Health/Public Health Engineering /Sanitary Science majors. Among Mental Health majors, the modal principal work setting was a mental health setting, hospital, or outside of a hospital, noted by 36.8 percent. The modal principal work setting named by eight other majors was a health agency, other than a hospital; such replies ranged from 52.4 percent among Health Education majors and 51.9 percent among Maternal and Child Health majors to 31.2 percent among Biostatistics majors. Among majors in Medical Care and Hospital Administration /Administrative Medi- cine the modal principal work setting was a health agency, hospital (48.9 percent) . On the relationship of present professional duties to mental health concerns the modal reply among Mental Health majors was strongly related 87 88 (75.4 percent) ; this was also the modal reply among Public Health Nursing majors (49.1 percent). The modal response of moderately related was noted by Maternal and Child Health majors (41.2 percent), Health Educa- tion majors (32.0 percent), and Nutrition/Biochemistry majors (28.1 per- cent) . Among majors in the following four areas the modal response was occasionally related: Medical Care and Hospital Administration /Adminis- trative Medicine (42.9 percent), Administration or Practice of Public Health (39.1 percent), Environmental Health /Public Health Engineering/ Sanitary Science (36.9 percent), and Epidemiology (34.8 percent). The modal response among Biostatistics majors was that their jobs were not related to mental health concerns (39.3 percent). Whereas only one of 60 (1.7 percent) Mental Health majors reported not having taken catalog listed mental health courses, relatively large minorities of the Public Health Nursing majors (30.7 percent), Maternal and Child Health majors (40.3 percent), and Administration or Practice of Public Health majors (48.1 percent) indicated they had not taken any mental health courses. In addition, a majority of the respondents in six other major program areas reported not having taken any mental health courses; this ranged from 82.2 percent of the Environmental Health /Public Health Engineering /Sanitary Science majors to 54.9 percent of the Medical Care and Hospital Administration /Administrative Medicine majors. In the group of Mental Health majors, 96.7 percent reported taking one or more mental health courses. While a majority of majors in Public Health Nursing (67.6 percent) and Maternal and Child Health (59.0 per- cent) took one or more mental health courses, a minority of respondents in seven other major areas had taken one or more mental health courses. This group ranged from 48.5 percent among Administration and Practice of Public Health majors to 14.1 percent among Environmental Health / Public Health Engineering/Sanitary Science majors. Primary Professional Discipline and Choice of Major Program Area Respondents from 22 of the 24 specific primary professional disciplines listed in the questionnaire majored in Medical Care and Hospital Adminis- tration /Administrative Medicine; from 21 different primary professions majored in Administration or Practice of Public Health, and from 18 dif- ferent professions majored in Health Education. By contrast, respondents from only two primary professional disciplines majored in Rehabilitation / Physical Therapy, two majored in Social Work in Public Health, and one majored in Veterinary Public Health. Physicians (excluding psychiatrists) had pursued 19 of 24 different specified major program areas. They were followed by educators/teachers who had majored in 14 different specified program areas. More restricted in the number of programs in which they majored were anthropologists, sociologists, engineers, psychiatrists, and dentists who majored in five areas each; “other” behavioral scientists, health educators, dietitians/nutrition- ists, and physiologists majored in four; and industrial hygienists majored in two (see app. D, table 4, pp. 276-277) . A majority of respondents from 10 of the primary professional disci- plines majored in a single area, usually in the same field or a field closely related to their primary profession: (1) Administrators, hospital administrators tended to major in Medical Care and Hospital Administration/Administrative Medicine (108 of 182). (2) Dietitians, nutritionists tended to major in Nutrition/ Biochemistry (84 of 91). (3) Engineers tended to major in Environmental Health/ Public Health Engineering /Sanitary Science (82 of 107). (4) Health educators tended to major in Health Education (64 of 85). (5) Industrial hygienists tended to major in Occupational Health /Industrial Hygiene (16 of 19). (6) Mathematicians, statisticians, programers tended to major in Biostatistics (62 of 77). (7) Nurses tended to major in Public Health Nursing (294 of 467). (8) Physicists, radiological health specialists, health physi- cists tended to major in Radiation Health (29 of 42). (9) Psychiatrists tended to major in Mental Health (21 of 35). (10) Sanitarians tended to major in Environmental Health/ Public Health Engineering/Sanitary Science (140 of 217). In 10 other specified primary professional disciplines, a majority of re- spondents selected two or more major program areas also related either to their primary professional discipline or to administration: (1) Physicians (excluding psychiatrists) tended to major in either Administration or Practice of Public Health, Maternal and Child Health, or Epidemiology (345 of 604). (2) Bacteriologists, laboratory scientists, parasitologists tended to major in either Microbiology/Laboratory Public Health, or Tropical Medicine/Entomology/Parasitology (66 of 113). (3) Biologists, entomologists, zoologists tended to major in either Environmental Health /Public Health Engineering /Sanitary Science, Tropical Medicine /Entomology/Parasitology, or Occupa- tional Health/Industrial Hygiene (28 of 50). (4) Chemists, biochemists tended to major in either Environ- mental Health /Public Health Engineering/Sanitary Science, or Nutrition / Biochemistry (28 of 50). 89 90 (5) Dentists tended to major in either Public Health Den- tistry, or Administration or Practice of Public Health (83 of 106). (6) Educators, teachers tended to major in either Health Education, or Medical Care and Hospital Administration/Admin- istrative Medicine (66 of 115). (7) Physical therapists tended to major in either Administra- tion or Practice of Public Health, or Medical Care and Hospital Administration /Administrative Medicine (31 of 45). (8) Behavioral scientists collectively tended to major in either Mental Health, Medical Care and Hospital Administration / Administrative Medicine, or Administration or Practice of Public Health (25 of 44). (9) Social workers tended to major in either Medical Care and Hospital Administration/Administrative Medicine, or Social Work in Public Health (44 of 70). (10) Veterinarians tended to major in either Epidemiology, or Veterinary Public Health (50 of 82). A majority of those respondents who indicated an “other” nonspecified primary professional discipline as well as those who considered that a primary professional discipline was not applicable to them tended to major either in Medical Care and Hospital Administration /Administrative Medi- cine, Administration or Practice of Public Health, or Health Education. Conversely, there is congruence between the major program area chosen and the primary professional background. A majority of respondents in the following major program areas came from one primary professional group: (I) Aviation Medicine majors tended to be physicians (92 of 96). (2) Dental Public Health majors tended to be dentists (45 of 51). (3) Epidemiology majors tended to be physicians (101 of 181). (4) International Health majors tended to be physicians (10 of 14). (5) Maternal and Child Health majors tended to be physi- cians (102 of 139). (6) Microbiology, Laboratory Public Health majors tended to be bacteriologists/laboratory scientists/parasitologists (48 of 64). (7) Nutrition, Biochemistry majors tended to be dietitians/ nutritionists (84 of 115). (8) Physiological Hygiene, Environmental Medicine majors tended to be physicians (three of five) . (9) Population Studies, Family Planning, Demography ma- jors tended to be physicians (five of eight). (10) Public Health Nursing majors tended to be nurses (294 of 309). (11) Social Work in Public Health majors tended to be social workers (21 of 22) . (12) Veterinary Public Health majors tended to be veteri- narians (16 of 16). Similarly, a majority of respondents in the following major program areas tended to come from two or more related primary professional groups: (1) Administration or Practice of Public Health majors tended to be either physicians, administrators/hospital adminis- trators, or nurses (253 of 486) . (2) Behavioral Sciences majors tended to be either psychi- atrists or psychologists (six of nine) . (3) Biostatistics majors tended to be either mathematicians statisticians /programers or respondents in the “nonapplicable” category (107 of 142). (4) Chronic Disease, Gerontology majors tended to be either physicians or nurses (10 of 17). (5) Environmental Health, Public Health Engineering, Sani- tary Science majors tended to be either sanitarians or engineers (222 of 320). (6) Health Education majors tended to be either health edu- cators, in the ‘“‘nonapplicable” category, or educators/teachers (173 of 255) . (7) Medical Care and Hospital Administration, Administra- tive Medicine majors tended to be either in the “nonapplicable” category or administrators/hospital administrators (247 of 415). (8) Mental Health majors tended to be either psychiatrists, psychologists, or nurses (43 of 60). (9) Occupational Health, Industrial Hygiene majors tended to be either physicians or industrial hygienists (55 of 93). (10) Radiation Health majors tended to be either physicists/ radiological health specialists/health physicists or in the “non- applicable” category (39 of 74). (11) Tropical Medicine, Entomology, Parasitology majors tended to be either physicians or bacteriologists/laboratory scientists / parasitologists (40 of 66) . IN summary, the largest groups of respondents majored in areas of Administration, Environmental Health, Public Health Nursing, and Health Education. Only a very small group of all respondents, 60 or 1.9 percent, majored in Mental Health. Proportionally, these Mental Health majors came largely from psychiatry and psychology. Those who majored in Mental Health attended nine of the 11 schools, although a majority of Mental Health majors attended Columbia, Harvard, and Hopkins. 91 92 Respondents choosing certain major areas appeared to concentrate in certain schools suggesting either the emphasis and quality of the school in that particular program area, its attractiveness for certain majors, or their criteria of admission. By primary profession, it appeared that physicians (other than psychiatrists) and educators/teachers had the broadest options in choosing major program areas, while respondents drawn from other primary professions either by choice of their own or as a result of other circumstances had majored in a lesser number of areas. PUBLIC HEALTH CHAPTER 6 WORKERS IN THE LABOR FORCE UBLIC health workers are drawn largely from a broad range of primary health and related professions and occupational groups such as medicine, nursing, administration, education, laboratory sciences, and engineering. Their previous training and educational backgrounds are diverse, ranging from baccalaureate to postdoctoral levels. The extent and kind of profes- sional work experiences prior to attending a school of public health also vary considerably. Furthermore, the particular school of public health at- tended imparted unique experiences, styles, and interests to their graduates. Subsequent career patterns and experiences continue to sharpen differences among graduates while also reinforcing common views about the field and its activities. This chapter examines some of the main features of the occupational patterns of public health workers—their geographic location, employment status, professional experience in public health, professional titles and roles, sources of income, and places of work. Of special concern was to identify the extent to which public health workers who did not major in Mental Health were working in the mental health field at the time of the survey. GEOGRAPHIC DISTRIBUTION OF PUBLIC HEALTH WORKERS An overwhelming majority (83.3 percent) of the American public health workers who participated in this study lived or worked in large metropolitan areas of the continental United States. Seven in 10 (71.0 percent) were living or working in a metropolitan area of at least 250,000 population, one in eight (12.3 percent) in a metropolitan area of less than 250,000, and just over one out of six (16.8 percent) was located in a nonmetropolitan area. A majority (71.5 percent) concentrated in four regions: The Pacific (20.6 percent), the south Atlantic (20.3 percent), the middle Atlantic (16.5 percent), and the east-north-central (14.1 percent). Only small num- bers of public health workers have been attracted to the east-south-central, west-south-central, west-north-central, and mountain regions. In metropoli- tan areas with less than 250,000 population, the highest percents of public health workers were located respectively in the east-north-central (32.8 percent) and in the south Atlantic (30.9 percent) regions; the percent of public health workers from those two regions living in metropolitan areas of 250,000 population or more were, respectively, 10.7 and 19.0 percent. 93 The highest concentration of public health workers in the metropolitan areas of 250,000 and over appeared in the Pacific (25.8 percent), the middle Atlantic (20.4 percent), and in the south Atlantic (19.0 percent) regions (see table 6:1) . TABLE 6:1.—Regional distribution of 1961-67 graduates from 11 schools of public health by metropolitan and nonmetropolitan areas, 1968 Metropolitan 250,000 and Metropolitan Nonmetropolitan Regional Regions over under 250,000 distribution Number | Percent | Number | Percent | Number | Percent | Number | Percent New England. 143 6.7 15 4.0 55 10.8 213 7.0 Middle Atlantic .... 439 20.4 5 1.3 55 10.8 499 16.5 East-north- central ..... 230 10.7 122 32.8 76 15.0 428 14.1 West-north- central ..... 128 6.0 18 3.5 55 10.8 196 6.5 South Atlantic .... 409 19.0 115 30.9 91 17.9 615 20.3 East-south- central ..... 47 2.2 20 54 62 12.2 129 4.3 West-south- central ..... 127 59 29 78 13 2.6 169 5.6 Mountain .... 73 34 27 7.3 56 11.0 156 5.1 Pacific ....... 554 25.8 26 7.0 45 8.9 625 20.6 Total .. 2,150 71.0 372 12.3 508 16.8 13,030 100.0 An additional 85 or 2.4 percent were in U.S. possessions, in the Armed Forces, and in foreign countries. EMPLOYMENT STATUS A substantial majority of the respondents, 2,848 or 91.4 percent, were employed on either a full-time or on a part-time basis. As many as 224 or 7.2 percent, however, were unemployed at the time of the survey. Most of those who were working, 2,748 or 88.2 percent of all respondents, were employed full-time; and a small group, 100 or 3.2 percent, was employed only on a part-time basis. By and large, respondents were employed in the health field (86.1 percent) with fewer, but a substantial number (73.5 percent), also working in the area of their major program in a school of public health at the time of the survey. Of all employed respondents, 70 or 2.5 percent were working in the mental health field. Employment was highest in the Tulane group (96.9 percent) and lowest in the UCLA group (87.1 percent). Unemployment was highest in the UCLA (10.9 percent), North Carolina (9.3 percent), and Pittsburgh (8.9 percent) groups, and lowest in the Tulane group (2.1 percent). Part- time employment was highest in the Berkeley group (5.5 percent) and lowest in the Hopkins (1.7 percent) and the Minnesota (1.6 percent) groups. Employment in the Health Field Among the employed respondents, 2,682 or 94.2 percent were working in the health field. An additional 152 or 5.3 percent respondents were working in some other field than health. Employment in the health field was highest in the Minnesota group (98.3 percent), and lowest in the UCLA group (89.7 percent). Of the 152 employed respondents not cur- rently working in the health field, 104 or 68.4 percent gave their occupa- tion as “other,” 12 or 7.9 percent as students, three or 2.0 percent as housewives, and two or 1.3 percent as retired. Within the UCLA, Columbia, Hopkins, and Pittsburgh groups were found neither students, housewives, nor retired respondents. Among those employed but not working in health, 31 or 20.4 percent were nonresponses. Unemployment As already stated, 224 or 7.2 percent of all the respondents were un- employed at the time the survey was conducted in the summer of 1968, a rather high rate for a health field occupation. Among women the unem- ployment rate (11.6 percent) was over twice that of men (5.2 percent). One-third of the unemployed, 75 or 33.5 percent, were looking for work in the health field, while 134 or 59.8 percent were not. Among the unemployed, 18 or 8.0 percent indicated that they were looking for work other than in the health field, but it is not known how many of these nor how many of those working only part time were underemployed and were also looking for work in health. From available data it is not possible to determine either how many of the unemployed were not looking for work at all, nor how many, in effect, were looking for just any kind of work. IN sumMmARY, although 91.4 percent of all respondents were employed at the time of the survey, 3.2 percent were only working on a part-time basis and a relatively sizable group (7.2 percent) was completely out of work. Most respondents indicated that they worked in the health field (86.1 percent), the rest being either unemployed, retired, students, house- wives, or working in other areas and thus, outside the field either permanently or temporarily (see table 6:2). PROFESSIONAL PUBLIC HEALTH WORK EXPERIENCE Among the graduates, from schools of public health who participated in this study, 373 or 12.0 percent had not had any professional work ex- perience in public health. Another 115 or 3.7 percent had less than 1 year of public health work experience. At the other end of the time-experience continuum, 317 or 10.2 percent had accumulated at least 15 years of pro- 95 96 TABLE 6:2.—Employment status of 1961-67 graduates from 11 schools of public health, 1968 Status Number equals 3,115 Percent equals 100.0? Employed .................. 2,848 91.4 Full time ............. .. 2,748 88.2 Part time ............. .. 100 3.2 In health field ........ .. 2,682 86.1 Not in health field ...... 152 49 Unemployed ................ 224 7.2 * Discrepancies in totals are due to rounding error, nonresponses, and respondent error. fessional work experience, and another 442 or 14.2 percent had from 10 to 14 years such experience. A total of 838 or 26.9 percent of all the re- spondents had from 1 to 4 years of professional public health experience, and 943 or 30.3 percent had between 5 and 9 years of such experience. Cumulatively, 2,655 or 85.3 percent of all the respondents had at least some professional public health work experience. By school, 21.4 percent of the UCLA respondents had not had profes- sional public health experience at all at the time of the survey; in contrast, among Michigan respondents 7.6 percent and among Yale respondents 8.2 percent had no experience. The highest percents of respondents from seven schools had 5-9 years of experience: Berkeley (32.7 percent), Columbia (31.1 percent), Hopkins (36.1 percent), Michigan (34.2 percent), Minnesota (29.5 percent), North Carolina (32.3 percent), and Tulane (31.9 percent). Among respondents from UCLA (34.8 percent), Harvard (31.9 percent), Pittsburgh (33.3 per- cent), and Yale (40.2 percent) the highest percents were those who had from 1 to 4 years of experience. The highest percent of respondents from any of the schools with 10 and over years of professional experience in public health was in the Tulane group (35.1 percent), while in the Harvard group was the lowest percent (13.2 percent) to indicate that level of ex- perience. Cumulatively, the most experienced group, those who had worked in public health from less than 1 year to 15 and over years, was among Michigan respondents (91.0 percent) and the least experienced group was among UCLA respondents (74.7 percent). The characteristics of the respondents’ career experiences and their impact on professional styles and commitments were beyond the scope of this inquiry, but are recognized as sufficiently relevant for future research on the sociology of public health as a profession and its contribution to the health field. Some insights for future inquiry along these lines may be obtained from currently available data. The matter of total years of professional experience in the public health field is influenced by a variety of factors; e.g., opportunities avail- able and incentives for further study such as fellowships and scholarships, leave with pay for attending school, admission policies of the school at- tended, respondent’s age at time of entering and at time of graduating, year of graduation, and particularly for men the extent of military service and duties. Also, as indicated earlier, professional experience in public health work per se is not necessarily a requirement for admission made by a school of public health since training in the field or in a related field may be considered as equivalent to experience for admission to certain pro- grams. In fact, 1,058 or 34.0 percent of all the respondents indicated not having had public health work experience prior to entering a school of public health. Among UCLA respondents was the highest percent of re- spondents, 52.7 percent, without such prior experience while the lowest was 21.2 percent in the Michigan group. (a.) Age—In the youngest group, 25 years and under, was the highest percent of respondents (28.1 percent) in any age group without any public health experience. Also in this youngest age group was the highest percent of respondents (22.9 percent) with less than 1 year of experience, and the second highest percent (47.9 percent) with 1-4 years of such experience. Among the 26- to 30-year-old group was the second highest percent (18.7 percent) of respondents without any professional experience, a small per- cent (6.5 percent) with less than 1 year of experience and, the highest percent in any age group—almost one-half (49.3 percent) —who had 1-4 years of public health experience. An additional 24.0 percent in the 26-30 age group had between 5 and 9 years of experience. Although generally the total years of experience in public health was related to the age of the respondents, still in the 31- to 35-year-age group 9.4 percent, in the 36- to 40-year-age group 11.2 percent, in the 41- to 45- year-age group 10.6 percent, and in the 51- to 55-year-age group 9.4 percent, respectively, had not had any public health work experience. Among those between 31 and 35 years old (43.7 percent), in the 36-40 age group (33.9 percent), and in the 41-45 age group (27.5 percent), the highest percents of respondents had, respectively, between 5 and 9 years of total public health experience. In the 46- to 50-year-old group (28.8 per- cent) , in the 51- to 55-year-old group (41.5 percent), and in the 56-and-over- year-old group (43.2 percent) were the highest percents of respondents, respectively, with at least 15 years experience. (b.) Sex—The differences in years of experience in public health work between men and women were sharply drawn at the extremes of the time- continuum but tended to lessen, to level off, and to reverse between 1 and 14 years of experience. Thus, among men 13.5 percent had no public health experience at all compared to 8.8 percent among the women. Among men 2.9 percent, compared to 5.4 percent among women, had less than 1 year of professional experience. The percent of men with 1-4 years experience was 27.5 percent compared to 25.7 percent among women. A higher per- cent among the men (32.5 percent) than among the women (25.6 percent) had from 5 to 9 years of experience. Among men, however, the percent (13.8 percent) with 10-14 years of experience was somewhat lower (15.0 percent) than among women, but among men also (7.6 percent) the per- 97 98 cent with 15 and over years of experience was much smaller than among women (15.5 percent). Cumulatively, however, women were proportion- ately more experienced than the men since as stated before women tended to be older than men. It may also be inferred that men were more likely to go to a school of public health at a younger age and at earlier points in their career development than women. CURRENT WORK AREA AND MAJOR PROGRAM PURSUED IN A SCHOOL OF PUBLIC HEALTH To what extent were public health workers who graduated from a school of public health currently working in the same program area in which they had majored in their graduate studies? Drawing a direct con- nection between major program area in the school of public health and current area of work is not possible since it is not known how many graduates previously had worked in other areas than that of the major area which they identified at the time of the survey. Unfortunately, the career history of respondents since graduation cannot be ascertained from avail- able data; yet, it is plausible to surmise that there is an association between the primary emphasis of the training program pursued and the content area and interest of professional work as indicated by present work. Nearly three out of four respondents, 2,291 or 73.5 percent, were working in the same area as that in which they had majored in a school of public health. A total of 745 or 23.9 percent of all respondents were not working in the area of their major program. The question of whether re- spondents work in their major training area is germane to whether public health workers have capabilities and opportunities as generalists to per- form and engage in work in a variety of areas, or whether there is in fact a tendency for job and task specialization from training throughout their career life space. Admittedly, situational factors, such as career ladders, experience requirements, promotional considerations, demand, oppor- tunity, and rewards for specialization in the field bear on this issue and deserve study in their own right. A main interest of this study was to determine to what extent those who majored in areas other than Mental Health moved into mental health work and conversely, how many of those who majored in Mental Health have been attracted to jobs in other areas as indicated by their current work. Before attempting to answer these questions some observations on the limitations of the data are necessary. Of those who indicated working in some area other than their major in a school of public health, 190 or 25.5 percent did not respond to the question regarding their current field of activity and another 220 or 29.5 percent responded “other” to this question. Thus, although the data pro- vides an indication on the extent to which public health workers were working in the area of their major training program or in some other spe- cific area, the information examined here is based on less than one-half (45.0 percent) of the expected replies, and caution must be exercised in interpreting and generalizing from these findings. As indicated in chapter 5, a relatively high percent of respondents (28.9 percent) majored either in Administration or Practice of Public Health, or in Medical Care and Hospital Administration, Administrative Medicine. Of those not working in the area in which they majored, 111 or 14.9 percent were working either in Administration or Practice of Public Health, or in Medical Care and Hospital Administration, Administrative Medicine. Within the group of respondents working in areas other than their major, the smallest gains were made in the Behavioral Sciences (0.4 percent) , Biostatistics (0.5 percent), Physiological Hygiene /Environmental Medicine (0.1 percent), Radiation Health (0.5 percent), and Social Work in Public Health (0.5 percent). Only 60 or 1.9 percent of the total study group of 3,115 respondents majored in Mental Health, the main interest of this study; nine such re- spondents were employed but not working in mental health at the time of the survey and three were unemployed. Of the Mental Health majors work- ing in mental health, 43 were employed full-time and five were employed on a part-time basis only. Social workers tended to major in areas other than Mental Health and to work in health as distinguished from mental health settings. Similarly, anthropologists, sociologists, and “other” behavioral scientists graduating from schools of public health also tended to work outside of distinct mental health settings. Some 22 or 3.0 percent of those not working in the area in which they majored in a school of public health were working in mental health. At least one, but no more than three respondents from each school was in this group. Thus, 48 Mental Health majors were working in the mental health field, as well as an additional 22 respondents who had majored in some other area, bringing to 70 or 2.5 percent of the employed population of graduates who were working in the mental health field. Those working in the mental health field comprised 2.2 percent of all the respondents. There was, therefore, a very minor gain in mental health workers from among graduates of schools of public health in a 7-year period coinciding with an unprecedented scale of expansion of financing, development of services, of training and research, and in opportunities for employment in the mental health field throughout the Nation. Present evidence indicates that graduates from schools of public health tended to work in the same area as that of their major program in a school of public health. This finding implies a tendency toward continued specialization through work as well as very limited substantive area- mobility within the field of public health itself. It also clearly suggests that the increased demands, opportunities, and needs in the mental health field appear to have had only a minor impact on the occupations and careers of public health workers. 99 100 PUBLIC HEALTH WORKERS AT WORK Functional Professional Titles The title of administrator was held by 609 or 21.4 percent of all the employed respondents. As many as 265 or 9.3 percent had the title of public health nurse, and 219 or 7.7 percent noted their title as public health physician. The title of health educator was indicated by 206 or 7.2 percent, and that of public health engineer or sanitarian by another 205 or 7.2 per- cent. Reporting themselves as laboratory scientists were 141 or 5.0 percent, and as biostatisticians 100 or 3.5 percent. The largest category of respondents, 789 or 27.7 percent, noted their title to be “other” and generally identified as their specific title either their primary professional discipline, primary specialty, role, or university faculty rank; e.g., physician, epidemiologist, planner, teacher, or professor. Another 314 or 11.0 percent did not respond. The highest percents of respondents from Columbia, Minnesota, and Yale reported the title of administrator, while the highest percents of re- spondents from each of the eight other schools noted “other” as their professional title. The highest percent of biostatisticians from any school (7.6 percent) was in the Columbia group and the lowest (0.3 percent) was in the Minnesota group. In the North Carolina group 12.7 percent were health educators; in the Hopkins group 1.8 percent. The highest percent of ad- ministrators from any school (42.9 percent) was in the Yale group and the lowest percents were, respectively, in the North Carolina (10.5 percent) and Michigan (11.0 percent) groups. The highest percents of public health sanitarians or engineers were among North Carolina (12.2 percent) and Michigan (11.8 percent) respondents, while there were none with this title in the Yale group. In the Minnesota group (19.7 percent) was the highest percent of respondents with public health nurse titles, while among Yale graduates none held this job title. In the Hopkins group was the highest percent (24.0 percent) with the title of public health physician, and the lowest percent with this title was among Minnesota graduates (1.7 percent). The highest percent of laboratory scientists was in the Harvard group (8.8 percent) and the lowest among the Minnesota (2.4 percent) graduates. The lowest percent of those noting “other” (15.5 percent) was in the Minnesota group, and the highest (41.2 percent) in the Harvard group. Professional Roles Of those employed, 898 or 31.5 percent reported that they had exec- utive-administrative roles. The second largest group of respondents, 463 or 16.3 percent, described their work role as consultative, and third were, respectively, those in instructional roles, 293 or 10.3 percent, and in re- search roles, 284 or 10.0 percent. Staff roles were identified by 256 or 9.0 percent, and supervisory roles by 222 or 7.8 percent. “Other” roles were ascribed by 141 or 5.0 percent, and another 291 or 10.2 percent either did not answer or indicated more than one major role or combination of roles such as executive-administrator-supervisor, or coordinator-supervisor. Illus- trative of the “other” replies were roles relating directly to clinical and diagnostic work, planning, and coordination. The highest percents of respondents from each of the schools were in executive-administrative roles. In the Columbia group was the highest percent of respondents in executive-administrative roles (48.7 percent), and in the Tulane group (19.8 percent) was the lowest percent from any school in these roles. In the North Carolina group was the highest percent of those in consultative roles (22.1 percent), while in the Harvard group 8.8 percent had such roles. Instructional roles were highest within the Tulane group (18.7 percent) and lowest among the Yale group (4.5 per- cent). The highest percent from any school in a research role was 20.1 percent among Harvard respondents and the lowest 4.1 percent in the Minnesota group. The highest percents noting staff roles were within the UCLA (12.0 percent), Harvard (11.8 percent), and Hopkins (11.7 per- cent) groups, and the lowest percent was in the Tulane group (5.5 per- cent). In the Tulane group also was the highest percent of respondents in supervisory roles (14.3 percent), while the lowest percent in this category was in the UCLA group (3.4 percent). The highest percent to note “other” roles was in the UCLA group (10.3 percent), and the lowest percent was in the Minnesota group (2.4 percent). Other characteristics of the occupational roles of employed respondents were examined in further detail by selected variables: (a.) Age—In every age group, except the 25 year old and under, the highest percents of respondents were in executive-administrative roles. In the 25-year-old-and-under age group were the highest percents of any age group in both research (27.5 percent) and in instructional (15.9 percent) roles. The lowest percents in research jobs were, respectively, in the age 51-55 (4.3 percent) and in the 56-year-old-and-over age groups (4.4 per- cent), while the lowest percent of employed respondents in instructional roles (8.3 percent) was in the age group 36-40. The highest percent in executive-administrative roles (38.6 percent) was among those 46-50 years old, and the lowest percent (20.3 percent) in the 25-year-old-and-under group. The highest percent of respondents in consultative roles was among those age 56 and over (24.6 percent), and the lowest percent among those 25 years old and under (11.6 percent). Among the 26- to 30-year-old group was the highest percent (13.4 percent) in staff roles, while the lowest per- cents in such roles were, respectively, among the 41- to 45-year-old group (6.0 percent) and among those 56 years old and over (5.8 percent). The highest percent in supervisory roles (9.6 percent) was in the 41- to 45-year- old group, and the lowest percent in these roles were (4.3 percent) among those who were 25 years old and under. 101 102 (b.) Sex—Also, higher percents of men than women were in executive- administrative (36.1 to 21.4 percent), in research (10.9 to 7.9 percent), and in staff roles (9.8 to 7.2 percent). The ratios of women to men were higher in consultative (20.0 to 14.5 percent), instructional (20.1 to 6.1 percent), and in supervisory roles (11.2 to 6.4 percent). (c.) Functional Professional Title—Among health educators were the highest percents of respondents in consultative (35.4 percent) and in in- structional roles (25.2 percent). Among laboratory scientists was the highest percent of those in research roles (60.3 percent), and among administrators was the highest percent (78.2 percent) of those in executive-administrative roles. Among public health engineers or sanitarians (12.7 percent) and in the “other” category (12.8 percent) were the highest percents of those in staff roles, and the highest percent of those in supervisory roles (24.5 percent) was among public health nurses. (d.) Principal Source of Professional Income—Within county, city, other local government, the highest percent of respondents had executive- administrative roles (46.8 percent) followed by those in supervisory roles (19.0 percent), and the lowest percent was in research roles (1.4 percent). Of those respondents whose principal source of professional income was the Federal Government (civilian), the highest percents were in research (23.3 percent) and consultative (22.7 percent) roles, while the lowest percents were in supervisory (6.6 percent) and “other” nonspecified roles (5.7 per- cent). A different distribution of the roles of respondents from that of the Federal Government civilian employees obtains in the Federal Government uniformed service where over one-third (35.0 percent) were in executive- administrative roles followed by those in staff roles (18.3 percent), with the instructional role (3.5 percent) being the least frequently reported. Within private profitmaking organizations, the highest percent worked in consultative roles (28.4 percent) followed by those in staff roles (17.0 percent), while the lowest percent was in supervisory roles (5.7 percent). Nearly one-half of the self-employed respondents were in “other” non- specified roles (48.0 percent), and one-fifth in consultative roles (20.0 per- cent) ; none of the self-employed reported being in instructional, research, or supervisory roles. Among respondents in State government the two highest percents were, respectively, in consultative (28.0 percent) and in executive- administrative (26.0 percent) roles, and the lowest percent was in “other” nonspecified roles (3.9 percent). Of those respondents in voluntary agencies or institutions, the highest percent was in executive-administrative roles (58.8 percent) followed by those in instructional roles (9.8 percent), while the lowest percent was in “other” nonspecified roles (3.2 percent). Within the category “other” nonspecified principal source of professional income, the highest percents were, respectively, in executive-administrative (28.4 per- cent) and instructional (23.7 percent) roles, and the lowest percent was in supervisory roles (3.6 percent). Stated differently, the highest percents of respondents in consultative roles were, respectively, within private profitmaking organizations (28.4 percent) and within State government (28.0 percent) while the lowest percent of respondents in these roles was reported by those noting “other” sources (5.2 percent). The highest percent of respondents in executive- administrative roles (58.8 percent) was in voluntary agencies or institutions, and the lowest percent in such roles was among the self-employed (8.0 per- cent) . The highest percent of respondents in research roles (23.3 percent) was in the Federal Government (civilian) and the highest percent of re- spondents in staff roles (18.3 percent) was in the Federal Government (uniformed service) . Among the self-employed none were in instructional, research, or supervisory roles and 2.0 percent were in staff roles. The highest percent of respondents in supervisory roles was within county, city, other local government (19.0 percent), and among those reporting “other” non- specified sources of professional income was the highest percent of re- spondents in instructional roles (23.7 percent). The highest percent of respondents noting “other” principal source of income was (48.0 percent) among the self-employed. (e.) Principal Work Setting—Within college or university settings, the highest percent of respondents had instructional roles (51.7 percent) followed by those in research roles (17.6 percent); the lowest percent was in supervisory roles (1.8 percent). Of those respondents working in a hos- pital, the highest percents were in executive-administrative (63.3 percent) and staff (8.5 percent) roles, and the lowest percent was in instructional roles (3.2 percent). Among respondents working in a health agency, other than hospital, the two highest percents were, respectively, in executive- administrative (37.5 percent) and consultative (25.2 percent) roles, and the lowest percents were in “other” nonspecified roles (3.0 percent) and in instructional roles (2.7 percent). Within the category industry or business, the highest percents were each in consultative (32.6 percent) and staff (20.2 percent) roles; none of the respondents in these settings were in in- structional roles. Among respondents in medical or other health professional schools, the highest percents were, respectively, in instructional (30.2 per- cent) and research (19.7 percent) roles; none were in supervisory roles. Nearly one-half of the respondents working in mental health settings, both in and outside of a hospital, were in executive-administrative roles (48.4 percent) while the next highest percent was in consultative roles (13.3 percent) ; none were in instructional roles. Within school of public health settings, over one-half of the respondents were in research roles (52.0 per- cent) and over one-fourth in instructional roles (28.0 percent); none were in consultative roles. Within the category “other” nonspecified principal work setting, the highest percents of respondents were each in executive- administrative roles (27.8 percent) and in consultative roles (18.7 percent), while the lowest percent was in instructional roles (3.0 percent). Patient Care Functions A relatively small number of employed respondents (559 or 19.6 percent) were engaged in direct patient care, while a large majority 103 104 (2,010 or 70.6 percent) had jobs not requiring such functions. Less than one-half of the physicians (44.5 percent), one-fifth of the nurses (20.9 percent), and just over one-fourth of the dentists (27.7 percent) were engaged in direct patient care. Of the 35 psychiatrists, 20 also indicated that they were engaged in direct patient care. By school, the highest percent of respondents with jobs involving direct patient care was 39.7 percent in the Harvard group, and the lowest was 9.8 percent in the Yale group. Principal Sources of Professional Income All levels of government combined were the principal source of income for 1,723 or 60.4 percent of all employed respondents; the private sector for 567 or 20.0 percent, and “other” sources for 194 or 6.8 percent. A large number of respondents noting “other” specified a college or uni- versity as their principal source of professional income. The principal source of professional income was not reported by 364 or 12.8 percent of the employed respondents (see table 6:3). By school, the highest percent of respondents identifying government as their principal source of income was 69.1 percent in the North Carolina group, and the lowest percent was 42.8 percent in the Yale group. The highest percent of respondents from any school working in the private sector was 36.9 percent within the Columbia group, and the lowest percent was 13.2 percent in the Tulane group. Overall, the Federal Government (uniformed and civilian services combined, 716 or 25.1 percent), was the principal source of income for more of the employed respondents than either State (571 or 20.0 percent) or county, city, other local (436 or 15.3 percent) governments. The Federal Government was the principal source of income for 46.6 percent in the Harvard group but only for 11.5 percent of the Columbia group. Within the Harvard group 31.9 percent while in the Columbia group 4.3 percent were, respectively, in the Federal Government uniformed service. The highest percent of civilians in the Federal Government was 15.8 percent in the Hopkins group, and the lowest 7.2 percent in the Columbia group. The Federal Government (civilian and uniformed services com- bined) was also the principal source of income for higher percents of respondents from Berkeley (24.8 percent), UCLA (21.7 percent), Har- vard (46.6 percent), Hopkins (41.5 percent), Michigan (23.5 percent), Pittsburgh (27.1 percent), Tulane (24.2 percent), and Yale (22.3 percent) than either State government or county, city, other local government taken singly. The highest percent of respondents from any school employed by State government was 31.4 percent in the North Carolina group and the lowest percents were, respectively, 10.7 percent in the Pittsburgh and 10.9 percent in the UCLA groups. The highest percents of employed re- spondents whose principal source of income was county, city, other local S01 TABLE 6:3.—Graduates from 11 schools of public health, 1961-67, by principal sources of professional income Source of income Berke- | UCLA Colum- | Har- | Hop- | Michi- |Minne- Soe Pitts- | Tulane | Yale | Total ley bia vard kins gan sota lina | burgh Number ............. 480 175 236 204 171 519 290 411 159 91 112 | 2,848 Percent .............. 100.0 | 100.0 | 1000 | 100.0 | 100.0 | 100.0 | 1000 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 Government ........................ (65.2)| (52.0) | (46.2)| (66.7) (66.7) (65.5) (55.2) (69.1)| (49.1)| (55.0)| (42.8)| (60.4) Federal ........................ 24.8 21.7 11.5 46.6 41.5 23.5 18.6 24.3 27.1 24.2 22.3 25.1 Civilian .................... 9.2 13.7 7.2 14.7 15.8 11.9 7.6 12.9 10.1 12.1 9.8 11.1 Uniformed service .......... 15.6 8.0 4.3 31.9 25.7 11.6 11.0 11.4 17.0 12.1 12.5 14.0 State ...... o.oo. 20.2 10.9 14.4 15.2 13.5 22.5 24.5 314 10.7 19.8 13.4 20.0 County, city, other local ........ 20.2 19.4 20.3 4.9 11.7 19.5 12.1 13.4 11.3 11.0 7.1 15.3 Private ............................ (14.8) (269) (36.9) (16.2) (14.0) (18.5) (27.2) (13.9) (29.6) (13.2)| (35.8) (20.0) Voluntary agency or institution..| 10.6 10.3 27.5 74 9.9 7.9 22.0 7.5 18.9 12.1 29.5 13.2 Profitmaking organization ....... 3.1 9.7 7.2 44 2.3 4.6 5.2 54 8.2 1.1 3.6 5.0 Self-employed .................. 1.1 6.9 2.2 44 1.8 1.0 0 1.0 2.5 0 2.7 1.8 Other .............................. (7.3) (8.0) (4.2) (11.3) (5.3) (6.4) (5.5) 3.6) (11.9) (11.0) (8.9) (6.8) Nonrespomses Ce (12.7) (13.1) (12.7) (5.8) (14.0)| (146) (12.1) (134) 94) (20.8) (125) (12.8) 106 government were, respectively, 20.2 percent in the Berkeley and 20.3 percent in the Columbia groups, and the lowest was 4.9 percent in the Harvard group. Among graduates from every school, government collectively was the principal source of income for the largest number of employed respond- ents. Although the private sector (20.0 percent) was a poor second to government (60.4 percent) as a principal source of income, there were instances in which voluntary agencies or institutions alone were the prin- cipal source of income for a higher percent of respondents from specific schools than either State, county, city, other local, or Federal Government civilian and uniformed services taken individually. Within the private sec- tor itself, voluntary agencies or institutions were noted by higher percents of respondents from each school as a principal source of income than were self-employment or profitmaking organizations. Voluntary agencies or institutions were the principal source of in- come for 13.2 percent of all employed respondents. Within the Yale group was the highest percent from any school (29.5 percent) to note voluntary agencies or institutions as their principal source of income; this was a higher percent than for Yale respondents whose principal source of income was county, city, other local government (7.1 percent), the Federal Government civilian service (9.8 percent), the Federal Government uniformed serv- ice (12.5 percent), and State government (13.4 percent) as well. Within the Columbia group similarly, the highest percent of respondents (27.5 percent) indicated voluntary agencies or institutions as their principal source of income while State government was noted by 14.4 percent, the Federal uniformed service by 4.3 percent, the Federal Government civilian service by 7.2 percent, and county, city, and other local government by 20.3 percent. Within the Berkeley group, the percent of those whose principal source of income was a voluntary agency or institution (10.6 percent) slightly exceeded those noting the Federal Government civilian service (9.2 percent); within the UCLA group a higher percent had as principal source of income the voluntary sector (10.3 percent) than the Federal Government uniformed service (8.0 percent). Within the Harvard group voluntary agencies or institutions (7.4 percent) as principal source of income surpassed those from county, city, other local government (4.9 percent) . Voluntary agencies or institutions (22.0 percent) ranked second to State agencies (24.5 percent) as source of income among Minnesota graduates, and exceeded the percent for county, city, other local govern- ment (12.1 percent), Federal Government civilian service (7.6 percent), and the Federal Government uniformed service (11.0 percent). Among Pittsburgh graduates, the voluntary agencies or institutions were the prin- cipal source of income for 18.9 percent, which was higher than for those in State government (10.7 percent), or the Federal Government civilian service (10.1 percent), the Federal Government uniformed service (17.0 percent), and county, city, other local government (11.3 percent). In the Hopkins group, each branch of the Federal Government— civilian (15.8 percent), uniformed (25.7 percent) —State (13.5 percent), and county, city, other local government (11.7 percent) contained a higher percent of respondents each than the voluntary agencies or institutions (9.9 percent). Similarly, Michigan and North Carolina respondents tended to note a component of government as their principal source of income. In the Michigan group, 11.9 percent were in the Federal Govern- ment civilian service, 11.6 percent in the Federal Government uniformed service, 22.5 percent in State, 19.5 percent in county, city, other local government, while 7.9 percent noted voluntary agencies or institutions. In the North Carolina group, 12.9 percent were in the Federal Govern- ment civilian service, 11.4 percent in the Federal Government uniformed service, 31.4 percent in the State, 13.4 percent with county, city, other local government, and 7.5 percent with voluntary agencies or institutions. Among Tulane respondents, 19.8 percent indicated State government as principal source of income, 12.1 percent the Federal Government uni- formed service, 12.1 percent the Federal Government civilian service, 11.0 percent county, city, other local government, and 12.1 percent voluntary agencies or institutions. To only a few, 50 or 1.8 percent, self-employment was the principal source of income; in fact, the highest percent from any school so indicating was 6.9 percent in the UCLA group, whereas among Minnesota and Tulane graduates none reported self-employment as a principal source of income. A relatively small number also, 141 or 5.0 percent, indicated as principal source of professional income a private profitmaking organiza- tion. In the UCLA group 9.7 percent derived their income principally from a private profitmaking organization, while among Tulane respond- ents only 1.1 percent indicated such a principal source of income. Overall, respondents from each school except from Columbia and Yale indicated as their principal source of income one of the levels of government; among Columbia and Yale graduates a voluntary organization was noted by a higher percent of respondents than any single level of government as their principal source of income. Work Settings The principal place of work for a majority of employed respondents, 1,483 or 52.1 percent, was a health setting. This was followed by 475 or 16.6 percent whose principal place of work was an academic setting, and third were 454 or 15.9 percent who worked in other settings such as school systems, welfare or social agencies, industry or business, private practice, and other unspecified establishments. Only 60 of the employed respondents or 2.2 percent worked in a mental health setting, whether a hospital or other kind of mental health agency (see table 6:4). The highest percent of respondents from any school working in academic settings was 27.5 percent from the Tulane group, and the lowest 107 801 TABLE 6:4.—Graduates from 11 schools of public health, 1961-67, by principal work setting Principal work setting Berke- | UCLA Colum-| Har- | Hop- | Michi- | Minne- Cro Pitts- | Tulane | Yale | Total ley bia vard kins gan sota lina | burgh Number .............. 480 175 236 204 171 519 290 411 159 91 112 | 2,848 Percent .............. 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 Academic .............. ool. (11.0)| (16.0)| (149) (20.1)| (18.1) (17.7)| (2L.1)| (16.3) (183) (27.5) (11.6)! (166) College or university ............ 7.4 12.0 6.4 7.4 8.8 18.7 18.3 12.7 14.5 20.9 8.0 11.5 Medical or other health professional school ............ 2.3 34 6.8 9.3 6.4 2.7 1.4 1.7 25 22 1.8 3.3 School of public health .......... 1.3 0.6 1.7 34 2.9 1.3 1.4 19 1.3 44 1.8 1.8 Health ............................. (58.1) (41.8) (57.2)| (426) (46.2) (50.5)| (56.9) (55.0) (50.9)| (429) (50.9) (52.1) Hospital ....................... 15.6 189 28.8 13.7 10.5 5.0 25.2 6.3 19.5 6.6 25.0 14.5 Health, not hospital ............. 425 22.9 28.4 28.9 35.7 455 31.7 48.7 31.4 36.3 259 37.6 Mental health ...................... (1.2) (2.8) (4.2) (3.0) (3.6) (0.6) (2.4) 24) (06) (0) (5.4) (2:2) Hospital ....................... 0.8 1.1 2.1 0.5 1.8 0.2 2.1 0.5 0.6 0 4.5 1.1 Not hospital .................... 0.4 1.7 2.1 2.5 1.8 0.4 0.3 1.9 0 0 0.9 1.1 All other .......................... (15.9) (25.1) (106)| (279)| (175) (16.9) (72) (13.4) (20.1) (7.7) (17.0)| (15.9) School system .................. 15 2.3 0.4 0 12 1.7 1.7 1.0 1.3 0 0.9 1.2 Welfare or social agency ........ 1.7 1.1 1.7 2.5 0 16 0.7 0.7 0.6 1.1 2.7 1.3 Industry or business ............ 1.7 74 4.7 49 1.8 48 14 3.6 6.9 1.1 2.7 3.6 Private practice ................. 1.2 5.7 2.1 3.9 1.8 1.3 0.3 0.7 2.5 0 0.9 1.7 Other .......................... 9.8 8.6 1.7 16.6 12.7 75 3.1 74 8.8 5.5 9.8 8.1 Nonresponses ....................... (13.8)| (14.3) (13.1) (6.4) (146) (14.3) (124)| (129) (@10.1)| (21.9) (15.1) (132) percent in those settings was 11.0 percent in the Berkeley group. Of those working in health settings, the highest percents were each in the Berkeley group (58.1 percent) and in the Columbia group (57.2 percent), and the lowest percent was in the UCLA group (41.8 percent). More than one-fourth of both the Harvard (27.9 percent) and UCLA (25.1 percent) groups worked in other than academic, health, or mental health settings, however, the lowest percent from any school working in such other settings was in the Minnesota group (7.2 percent). Respondents working in a mental health setting were divided equally between those who worked in a mental health setting in a hospital (1.1 percent) and those who worked in a mental health setting outside a hospital (1.1 percent). By school, in the Yale group 5.4 percent was the highest percent of respondents working in a mental health setting, while among Tulane graduates none were working in a mental health setting. The largest number of respondents working principally in academic settings was 329 or 11.5 percent who noted a college or university. Only 96 or 3.3 percent of all employed respondents worked principally in a medical or other health professional school, and still less, 50 or 1.8 per- cent, indicated that their place of work was a school of public health. Within the Harvard group a higher percent (9.3 percent) than from any other school indicated working principally in a medical or other health professional school than in a college or university (7.4 percent). Among Columbia respondents, almost as many were working in a college or univer- sity (6.4 percent) as those working in a medical or other health profes- sional school (6.8 percent). Respondents from the other nine schools who worked in academic settings indicated more frequently working in a col- lege or university than in a medical or other health professional school, or in a school of public health. Among Tulane graduates a higher percent of those in academic settings indicated a college or university (20.9 per- cent), but a school of public health (4.4 percent) was noted more fre- quently than a medical or other health professional school (2.2 percent). The lowest percent from any school to note a school of public health as principal work setting was from UCLA (0.6 percent). There is no question that the principal place of work for graduates from a school of public health was a health setting although it was not likely for them to work in a mental health setting. Also, it was unlikely for these graduates to work principally in a private practice setting, in a school system, in a welfare or social agency, or in industry or business. Within health settings, better than 214 times more respondents worked outside a hospital than in a hospital setting. Among Columbia respond- ents the percent of those working in health settings in hospitals (28.8 percent) was almost equal to those working in nonhospital settings (28.4 percent). In the Columbia group was the highest percent of respondents from any school working in a hospital. Among Yale graduates 25.0 per- cent worked in a hospital setting and 25.9 percent worked in a health 109 110 setting other than hospital. Among graduates from the other nine schools, health settings other than hospitals were the principal place of work. In the North Carolina group 48.7 percent worked principally in health set- tings outside hospitals and 6.3 percent worked in hospitals. IN sumMmARY, graduates from schools of public health tended to live or work in the larger metropolitan areas of the country concentrating particularly in the Pacific, the south Atlantic, the middle Atlantic, and the east-north-central regions. Fewer graduates have been attracted to the east-south-central, west-south-central, west-north-central, and moun- tain regions. At the time of the survey, although a very substantial majority of the respondents were employed full time, a relatively high percent was unemployed (7.2 percent), and about half as many (3.2 percent) worked part time only. In effect, one in seven respondents was not working at all in the health field. Although, one in eight respondents had not had professional work experience in the public health field at the time of the survey, generally public health graduates except among those in the youngest age group tended to have between 1 and 9 years of total public health experience. The highest percents of respondents from each of seven schools had from b to 9 years of experience: Berkeley, Columbia, Hopkins, Michigan, Minnesota, North Carolina, and Tulane. Among graduates from four schools, the modal years of experience in the field was from 1 to 4 years: UCLA, Harvard, Pittsburgh, and Yale. Cumulatively, the most experienced group of graduates was from Michigan, and the least experienced from UCLA. Age clearly bears upon the years of experience in the field particu- larly among both the youngest and the oldest respondents although not consistently among respondents in their middle years. In the age groups 31-35, 36-40, and 41-45, however, the highest percents of respondents had from 5 to 9 years experience. Among respondents age 25 and under was the highest percent of any age group without experience, and among the oldest, age 56 and over, was the highest percent of those with the most years of experience. Length of professional experience in the field also varied by sex since as it has been noted before, the men tended to comprise a younger population. Indeed, men were more likely than women not to have had any experience in public health work; while among women the percent of those with 15 or more years of public health experi- ence was higher than among men. Yet, differences started to level off from the first year to 10-14 years of experience to the point that the percent of men was higher than among women who had from 5 to 9 years experi- ence. Thus, it appears also that there may be a tendency among men to at- tend a school of public health at an earlier stage in their career than women. Judging by the present jobs of respondents it may be surmised that a large majority of graduates from a school of public health work in the same area as that in which they majored at school suggesting a tendency toward both continued stability and career specialization. Only very minor gains of mental health workers were made from the respondents both from among those who majored in Mental Health as well as in any other area. The number of employed graduates from the 7-year period covered who had jobs in the mental health field at the time of the survey totaled 70 or 2.2 percent of the total study population. Of the 60 who had majored in Mental Health, 12 were not working in this area. The most frequently reported present functional professional title among employed respondents was the title “other” which was generally specified as the primary profession of training, primary specialty, role, or university rank. The title administrator was reported by over one-fifth of the respondents or better than twice that of public health nurse, or public health physician, or health educator, or public health engineer /sanitarian. The major job role most frequently reported was executive-adminis- trative; this was followed by consultative. The highest percent of re- spondents from each of the schools held executive-administrative roles. In the Berkeley, UCLA, Columbia, Michigan, North Carolina, and Yale groups, the highest percents of respondents were, respectively, in executive- administrative and consultative roles; in the Harvard, Hopkins, and Pitts- burgh groups in executive-administrative and research roles; and in the Minnesota and Tulane groups in executive-administrative and instructional roles. Analyses of work roles by age group suggests that research and teaching appeared to attract younger graduates, executive-administrative and supervisory jobs appeared to attract more mature respondents, while consultant roles appeared to be more prevalent among the oldest workers. Men reported certain roles more frequently than women; namely, executive-administrative, research, and staff; while women reported more often such roles as consultative, instructional, and supervisory. Roles also appear to be associated both with the principal source of professional income and with the principal work setting in which it was performed. In city, county, other local government, in the Federal Govern- ment uniformed service, in voluntary agencies and institutions, and in “other” nonspecified principal sources of professional income, the highest percents of respondents were each in executive-administrative roles. In State government and in private profitmaking organizations the highest percents of respondents were in consultative roles. In the Federal Govern- ment civilian service the highest percent of respondents was in research roles. Among the self-employed the highest percent of respondents was in “other” nonspecified roles. By principal work settings, within hospitals, health agencies other than hospitals, and in mental health settings including hospitals, and “other” settings, the highest percents of respondents were, respectively, in executive-administrative roles. Within colleges and universities and within medical and other health professional schools, not including schools of public health, the highest percents of respondents were in instructional roles; in schools of public health, the highest percent was in research roles. 111 112 Of those in business and industry, the highest percent was in consultative roles. A relatively small group of respondents was engaged in direct pa- tient care activities, including less than one-half of the physicians, one- fifth of the nurses, and one-fourth of the dentists. Government was the principal source of income for three in five of the employed respondents and the private sector for one in five. The Federal Government including both the civilian and uniformed service was the principal source of income for a larger group of employed respondents than either State or county, city, other local governments. Of those in the private sector, the largest group noted a voluntary agency or institution as their principal source of income; very few noted a private profitmaking organization, and even less noted self-employment. For a majority of employed respondents the principal place of work was a health setting. Very few, however, worked in a mental health setting either in a hospital or outside a hospital. Of those working in academic settings, the largest group worked in colleges or universities, and sub- stantially fewer worked in a medical or other health professional school, while the smallest group worked in a school of public health. ASSESSMENT OF PART III MENTAL HEALTH TRAINING pce PUBLIC HEALTH CHAPTER 7 WORKERS APPRAISE THEIR SCHOOL OF PUBLIC HEALTH TRAINING AND PRACTICE IN MENTAL HEALTH VIEWS ON MENTAL HEALTH TRAINING IN PUBLIC HEALTH O clear consensus prevails among professionals in the public health field regarding the extent to which mental health and public health concerns may be brought together within a common sphere of professional work activities, whether in content, administration, organization, or pro- cedure. This state of affairs poses particularly difficult problems in training public health workers within a framework which attempts to integrate or interrelate public health and mental health concepts and methods. Since it has been so difficult in administrative and professional practices to in- stitute integrated or coordinated programs of public health and mental health, how can training be organized and conducted in such a direction? If so, what opportunities will be available to graduates from schools of public health in applying such training in their public health careers or in exer- cising leadership to implement such directions? And, what is the impact of schools of public health on public health-mental health practice? Although the formulation of a body of theory of practice as is re- quired for such purposes is not within the scope of the present work, it was a major concern of the research inquiry itself to contribute toward establishing systematically an empirical base for some of the views and opinions held by professionally trained public health workers regarding their own training, experience, and perceptions of mental health in public health. This body of information was deemed to be a necessary background to such theoretical formulations. This chapter examines the extent of exposure that respondents had to mental health courses and concerns, the perceptions noted by respondents of the mental health training they received in a school of public health, and the scope of their interactions with mental health professionals on the faculty. A portion of the chapter is concerned with responses to sets of questions raised to tap the opinions of graduates as they appraise their past training. When the survey was conducted a timespan ranging between 1 and 7 years had elapsed since their graduation from a school of public health. 115 116 Admittedly, many other factors than those directly and inherently related to the training experience itself may have conditioned their views. Such factors might include career experiences, work roles, self-views as public health workers, as well as those particular personal experiences and per- spectives which might have been developed before, during, or after their training period. Therefore, these questions were intended to identify the saliency of impacts of public health-mental health concerns among re- spondents, and their interrelationships and relevance, rather than to their recall of any actual training experiences. Mental Health Courses Taken at a School of Public Health This section is addressed to whether respondents had taken courses listed as mental health in the catalog of the school attended. This approach was one of several used to establish the kinds of exposures to mental health training that public health workers may have undergone while attending a school of public health. How many mental health courses were taken, if any? Were the courses taken required, elective, or both required and elective? First, a much larger group of respondents, 1,814 or 58.2 percent, indi- cated not having taken a mental health course than those who took such courses while attending a school of public health. Less than two in five, 1,218 or 39.2 percent, reported taking one or more such courses. Second, better than one-half (675 or 55.4 percent) of those who had taken any mental health courses took only one catalog listed mental health course. In other words, slightly over one in five (21.7 percent) of all respondents had taken only one mental health course as part of their training for a master’s degree in a school of public health. An additional 310 or 10.0 percent of all respondents took two mental courses, and 233 or 7.5 percent took three or more such courses. Respondents from Columbia, North Carolina, Tulane, and Yale more frequently than those from the other schools indicated having taken one or more mental health courses. Three-fourths (75.0 percent) of Columbia respondents had taken one or more mental health courses in contrast to less than one-sixth (14.9 percent) among those who had attended Pitts- burgh. Between one-half and four-fifths of the respondents from Pittsburgh (80.6 percent), Berkeley (77.2 percent), UCLA (68.7 percent), Michigan (66.7 percent), Minnesota (63.8 percent), Harvard (62.4 percent), and Hopkins (50.6 percent) did not take any mental health courses. By contrast, 20.2 percent among the Columbia and 24.6 percent among the Yale gradu- ates reported not having taken any mental health labeled course. In detail, by school, the percents of respondents taking one course ranged between 41.0 percent from Yale to 8.3 percent from Pittsburgh. Of those who re- ported two courses, the range by school was 27.2 percent from Columbia to 2.7 percent from Berkeley. Among those who reported three or more courses, the highest percent was 26.8 percent from Columbia and the lowest 1.6 percent from Berkeley. A somewhat higher percent of respondents (59.5 percent) graduating in 1964-67 indicated not having taken any mental health courses than the percentage indicating not taking any such courses among the 1961-63 graduates (55.5 percent). Among respondents who had taken one or more mental health courses, a large minority (45.6 percent) took only required courses; a smaller group (29.2 percent) took only elective mental health courses, and 19.8 percent took both required and elective mental health courses. However, from the data available it is not possible to determine precisely the actual referent to required or elective courses since a given course may be required for all students enrolled in a school, and/or for students enrolled in specific major program areas or degree programs in the same school. Also, a student’s previous training and experience may also influence whether certain courses are designated as elective or required. Furthermore, a school may offer options in the choice of particular courses within a given area although it may establish prerequisities for certain electives. Thus, although the responses to this question would not express students’ pre- ference or lack of preference for mental health course work, they indicate one dimension of their exposure to mental health training within professional education in public health. By school, among those who took mental health courses, required courses were more frequently noted among respondents from Columbia, Minnesota, North Carolina, and Yale; electives were more frequently indi- cated by Berkeley, UCLA, Hopkins, Michigan, Pittsburgh, and Tulane re- spondents; and in the Harvard group, the highest percent noted both required and elective courses. The highest percent of those graduates who took required mental health courses was in the North Carolina group (71.4 percent), in contrast to the lowest percent within the Tulane group (6.6 percent). Of those who reported having taken only elective mental health courses, the highest per- cent (70.5 percent) was in the Berkeley group and the lowest (2.3 percent) within the Yale group. In the Harvard group 34.1 percent indicated having taken both required and elective mental health courses, while in the Berkeley group 10.5 percent took such courses. (a.) Age—Among the youngest group, 25 years old and under, was the highest percent of respondents in any age group (80.2 percent) who did not take any mental health courses. The highest percent taking any such courses was among the 51-to 55-year-old respondents (56.1 percent). Also, the lowest percents of respondents who took either one, two, or three or more mental health courses were in the 25-year-old-and-under group (17.7 percent). Among the 51-to 55-year-old group was the highest percent to have taken two (15.2 percent) and also three or more mental health courses (15.2 percent). In the age group 56 years old and over was the highest percent (28.4 percent) to have taken one mental health course. Within any 117 118 of the age groups, a higher percent of respondents took one mental health course than the percents taking either two or three or more mental health courses. (b.) Sex—There were substantial differences between men and women with respect to having taken mental health course work. Women respond- ents were more likely than men to have taken any such course work. In fact, better than one-half of the women (51.3 percent) took one or more mental health courses compared to one-third among the men (33.3 percent) . (c.) Years of professional experience prior to enrollment—Among the respondents who had worked in the public health field for at least 15 years before they enrolled for a master’s degree was the highest percent (50.4 per- cent) who had taken one or more mental health courses. Among those who had had from 10 to 14 years of such experience was the second highest percent of respondents (48.4 percent) to have taken one or more mental health courses. In the groups which had, respectively, from 1 to 4 and 5 to 9 years of professional public health experience prior to attending a school of public health, similar percents of respondents (40.4 percent and 39.2 per- cent) had taken one or more mental health courses. Among both those who had not had any such experience (35.6 percent), and among those who had had less than 1 year of public health experience (33.9 percent) before entering a school of public health were the lowest percents of re- spondents that had taken one or more mental health courses. Except among respondents with 15 or more years of public health experience prior to enrollment, the ratios of respondents who took any mental health courses were lower than for those who did not take any such courses. Thus, in general, respondents who had had the greatest extent of professional public health experience prior to admission to a school of public health were also more likely than both those with lesser experience and those with no experience at all to have taken any mental health courses during their public health training (see app. E, table 1, p. 278). (d.) Mental health work experience prior to enrollment—Proportion- ately, respondents with experience in mental health work prior to entering a school of public health were more likely to have taken one or more mental health courses while attending a school of public health than those who had not had such mental health experience. Of the 2,139 respondents who had not had mental health work experience 720 or 33.7 percent took one or more mental health courses. Of the 963 respondents who had mental health work experience, 494 or 51.3 percent took one or more mental health courses at a school of public health. Of those who had mental health work experience prior to attending a school of public health 45.7 percent did not take any catalog listed mental health course, while among those who lacked such experience 63.9 percent did not take any such courses either. (e.) Felt need for mental health training—Among the 2,139 respond- ents who had no mental health work experience before enrollment 1,469 or 68.7 percent reported not having felt a need for mental health training at that time, while 651 or 30.4 percent considered that they needed such training. Among those without mental health experience who felt a need for such training 47.5 percent took one or more mental health courses compared to 27.7 percent among those who had not felt such a need. (f.) Primary professional discipline—Among nurses (66.8 percent) was the highest percent of respondents to have taken one or more mental health courses. Among administrators/hospital administrators 54.9 percent took one or more mental health courses. Among health educators 47.1 per- cent, among social workers 44.2 percent, among educators/teachers 40.9 percent, and among dentists 39.6 percent took one or more mental health courses. Mental health course work was least frequently taken among such professional groups as engineers (4.6 percent) and chemists/biochemists (8.0 percent). (g.) Major program area—Almost all Mental Health majors took one or more mental health courses (96.6 percent); but except for majors in Public Health Nursing (67.6 percent) and Maternal and Child Health (59.0 percent), less than one-half of respondents in all other major program areas took any mental health course as shown below: Respondents taking 1 or more mental health courses Selected major programs taken in schools of public health: Number | Percent Mental Health ......... 58 of 60| 96.6 Public Health Nursing .......................................... 209 of 309 67.6 Maternal and Child Health ..................................... 82 of 139| 59.0 Administration or Practice of Public Health ..................... 236 of 486| 48.6 Medical Care, Hospital Administration, Administrative Medicine ...| 174 of 415] 41.9 Health Education .......... 104 of 255| 40.8 Aviation Medicine ............. 38 of 96| 39.6 Dental Public Health ............. ................ .............. 20 of 51| 39.2 Tropical Medicine, Entomology, Parasitology ...................... 22 of 66 33.3 Epidemiology ............... 49 0f181| 27.1 Nutrition, Biochemistry ......................................... 27 of 115| 23.5 BIOStAtiStICS o.oo 28 of 142) 19.7 Occupational Health, Industrial Hygiene ......................... 18 of 93| 19.4 Environmental Health, Public Health Engineering, Sanitary Science .| 45 of 320] 14.1 Microbiology, Laboratory Public Health .......................... 9of 64) 14.1 Radiation Health ............. ........ 8of 74| 10.8 (h.) Public health degree—Among those who obtained a master’s de- gree in hospital administration (M.H.A. or M.S.H.A., 55.5 percent) was the highest percent of respondents who took one or more mental health courses. The second highest percent was among those who received an M.P.H. degree (40.5 percent). The lowest percent of respondents to take any mental health courses was among those who received the M.S. Hygiene degree (20.4 percent). Among the M.S. Hygiene holders also was the highest per- cent of respondents who did not take any mental health courses (76.5 per- cent). The percents of respondents not taking any mental health course work were also considerably large among respondents who received M.S.P.H. degrees (63.7 percent), “other” master’s degrees (61.9 percent), and M.P.H. degrees (57.3 percent). Still large, although smaller than in 119 120 other degree groups, was the percent who did not take any mental health courses among holders of the M.H.A. or M.S.H.A. degree (39.3 percent) (see app. E, table 2, p. 278). (i.) Highest advanced degree—By highest advanced degree held prior to enrollment, a minority of respondents in all categories reported that they had taken one or more mental health courses. While 42.0 percent of re- spondents holding an M.D. degree reported taking one or more mental health courses, a little more than one-third of those holding master’s degrees (35.2 percent) and almost two of five of those with bachelor’s degrees (39.5 percent) and D.D.S. degrees (39.6 percent) replied similarly. IN sumMARY, roughly two-fifths of all respondents took one or more mental health courses. Among those who took such courses, the largest group took only one course. Women were more inclined to have taken mental health courses than men, and the youngest group, age 25 and under, was least likely to have taken any such courses. In the age group 51-55 was the highest percent to have taken mental health courses. The group with the most experience in the public health field prior to enrollment in a school of public health was also more likely to have taken mental health course work. It was also more likely for respondents who had not had mental health work experience not to take mental health course work and to note that they had felt no need for such training. A higher percent of those who noted that they felt a need for mental health training prior to enrollment took mental health course work in comparison to those who felt no such need. Among the primary professional groups, nurses and ad- ministrators / hospital administrators ranked highest in taking mental health courses. Among those who majored in Mental Health, in Public Health Nursing, and in Maternal and Child Health were, respectively, the highest percents who took mental health course work. Among holders of M.H.A. and M.S.H.A. degrees was the highest per- cent of respondents who had taken any mental health courses, while M.S. Hygiene holders were least likely to have taken any such courses. By highest advanced degree held prior to attending a school of public health, the highest percent of respondents who had taken one or more mental health courses were M.D.’s; the second highest percent was among those who had bachelor’s and D.D.S. degrees. Actually a majority of graduates did not take any courses listed in a school catalog as mental health, and of those who took any such courses, the highest percent took only required courses. Concerns of Mental Health Course Work There are still unreconciled tendencies: (a) To equate mental health with psychiatry and psychology, and by extension with individual psycho- pathology; (b) to identify both public health and mental health issues as separate fields and domains; and (c) to consider mental health as a part of public health. In addition, since most mental health faculty members in schools of public health have been trained in and are drawn from clinical, case-oriented, one-to-one treatment practices, respondents who had taken mental health courses were asked their views on the extent that their mental health course work was concerned with psychiatry and psychology as well as the extent to which such course work was concerned with public health issues. Almost one-half of the 1,218 respondents who took one or more mental health courses (592 or 48.6 percent) noted that this course work was highly concerned with psychiatry and psychology. One-half or more of the respondents from six schools! considered their mental health courses as highly concerned with psychiatry and psychology: Tulane (62.3 per- cent) , Columbia (60.6 percent), Berkeley (55.2 percent), UCLA (50.9 per- cent), Harvard (56.1 percent), and Yale (56.8 percent). An almost equal number of respondents (602 or 49.4 percent) indicated that their mental health course work was highly concerned with public health issues. One-half or more of the respondents from Hopkins (68.2 per- cent), Michigan (61.0 percent), Tulane (57.4 percent), Harvard (57.3 percent), Berkeley (52.4 percent), and UCLA (50.9 percent) considered that their mental health courses had been highly concerned with public health issues. In this connection it may be noted that one-half or more of the respondents from Berkeley, UCLA, Harvard, and Tulane also indi- cated that their mental health courses were highly concerned with psy- chiatry and psychology. Among respondents from each Berkeley, Columbia, Minnesota, Tulane, and Yale higher percents considered their mental health courses as highly concerned with psychiatry and psychology than those who considered such courses as highly concerned with public health issues. On the other hand, higher percents of respondents from Hopkins and Michigan, re- spectively, appraised their mental health courses as highly concerned with public health issues than those who considered them to be highly con- cerned with psychiatry and psychology. Also, equal or almost equal percents from each UCLA, North Carolina, and Harvard considered such courses as being highly concerned with psychiatry and psychology as well as with public health issues. Less than one-half of the respondents from Minnesota as well as from North Carolina indicated that their mental health course work was both highly concerned with psychiatry and psychology, and with public health issues. (a.) Number of mental health courses taken—As stated earlier, 1,218 or 39.2 percent of all the respondents took one or more mental health courses with better than one-half of that group (55.4 percent) having taken only one course. A positive association may be observed between the number of mental health courses taken in relation to the degree to which such course work was reportedly concerned both: (1) With psychiatry and psychology, and (2) with public health issues. The greater the number of mental 1 Respondents from Pittsburgh were excluded from this analysis since only 27 graduates had taken any catalog labeled mental health courses. 121 122 health courses taken, the greater the likelihood of respondents to indicate that such course work was highly concerned with psychiatry and psychology as well as highly concerned with public health issues. While 64.8 percent of those who took three or more mental health courses reported these to be highly concerned with psychiatry and psychology, 51.3 percent of those who took two mental health courses and 41.8 percent of respondents taking one mental health course replied similarly. Likewise, 66.1 percent of those taking three or more mental health courses indicated that their mental health course work was highly concerned with public health issues, while 55.8 percent of those who took two mental health courses and 40.7 percent of those taking one mental health course responded similarly. However, the fewer the number of mental health courses taken, the more likely for respondents to indicate that their mental health course work was either moderately concerned or not concerned with psychiatry and psy- chology and moderately concerned or not concerned with public health issues. While 45.2 percent of those who took one mental health course re- ported that this course work was moderately concerned with psychiatry and psychology, 41.9 percent of those who took two mental health courses and 30.9 percent of those taking three or more mental health courses replied in this manner. Of those reporting that their mental health course work was not concerned with psychiatry and psychology, 5.0 percent took one mental health course, 2.6 percent took two mental health courses, and none took three or more mental health courses. Similarly, 45.0 percent of those taking one mental health course reported their course work as moderately concerned with public health issues, while 35.5 percent of those taking two mental health courses and 30.0 percent of those taking three or more mental health courses stated that these were moderately concerned. Of those indicating that their mental health course work was not concerned with public health issues, 9.3 percent took one mental health course, 4.9 percent took two mental health courses, and 1.3 percent took three or more mental health courses (see app. E, tables 3 and 4, pp. 279-280) . Public Health Contexts of Mental Health Course Work Another set of questions was addressed to the 1,218 respondents who had taken one or more mental health courses while attending a school of public health. This set was aimed at a more searching probe as to: (a) The extent to which respondents considered their mental health course work to have been meaningful to public health, (b) their views on the knowledge of the mental health faculty about the problems and approaches of public health work, and (c¢) the relevance of such course work to the present work functions of those respondents. To the largest groups of respondents, course work in mental health was moderately meaningful (45.9 percent) to public health concerns, and the mental health course work had been useful (43.7 percent) to their present functions. According to one-half of the re- spondents (49.9 percent) the mental health faculty was very knowledgeable with regard to public health. Meaningfulness of mental health courses—Stated in detail, although 559 or 45.9 percent of the respondents considered the mental health course work presented by the mental health faculty as moderately meaningful to public health concerns, 473 or 38.8 percent deemed it highly meaningful, and another 132 or 10.8 percent considered it not meaningful to public health concerns. Better than one-half of the respondents from Hopkins (58.8 percent) and Michigan (53.1 percent) regarded their mental health course work as highly meaningful to public health concerns; but in the opinion of one-half or better of respondents from UCLA (50.9 per- cent) , Minnesota (53.3 percent), and North Carolina (52.9 percent) their mental health course work was moderately meaningful to public health concerns. To almost one-fifth of Yale respondents (18.2 percent), their mental health course work was not meaningful in a public health context. (a.) Mental health work experience prior to enrollment—Persons who had had mental health work experience before attending a school of public health were more likely than those without such experience to consider the mental health course work in the school as highly meaningful to public health concerns. Those without such experience were more likely to con- sider such course work as moderately meaningful to public health concerns. While 48.2 percent of respondents with prior mental health experience indicated that their mental health courses were highly meaningful to public health concerns, 32.5 percent of those without prior mental health experience replied similarly. On the other hand, 50.0 percent of respond- ents with no prior mental health experience judged their mental health courses as moderately meaningful to public health concerns; this answer was also given by 39.9 percent of those with prior mental health experience (see app. E, table 5, p. 280). (b.) Number of mental health courses taken—The degree to which mental health courses taken were considered to be meaningful to public health concerns also appears to be related to the number of such courses taken. The greater the number of courses taken the more likely for respondents to indicate that such course work was highly meaningful. Of those respondents taking three or more mental health courses, 60.5 percent reported this course work as highly meaningful to public health concerns; 41.9 percent of those taking two mental health courses, and 29.9 percent of those taking one mental health course replied similarly. However, the fewer the number of mental health courses taken, the more likely for re- spondents to indicate that their mental health course work was moderately meaningful or not meaningful to public health concerns. While 49.9 percent of respondents taking one mental health course reported these as moder- ately meaningful, 45.5 percent of those taking two mental health courses, and 34.7 percent of those taking three or more mental health courses indicated similarly. Furthermore, of those reporting that their mental health course work was not meaningful to public health concerns, 14.4 percent 123 124 took one mental health course, 9.0 percent took two mental health courses, and 3.0 percent took three or more mental health courses (see app. E, table 6, p. 281). Public health knowledge of mental health faculty.—Regarding the competence of the mental health faculty on public health matters, 608 or 49.9 percent of respondents rated this faculty as very knowledgeable, 416 or 34.2 percent as knowledgeable, 115 or 9.4 percent as not very knowl- edgeable, and 66 or 5.4 percent did not express an opinion. Over three- fourths of the Hopkins group (76.5 percent) assessed the mental health faculty as very knowledgeable and so did one-half or more of the respondents from Columbia (53.9 percent), Harvard (50.0 percent), Michigan (60.5 percent), and Minnesota (50.5 percent). Among North Carolina re- spondents, 34.0 percent rated the mental health faculty as very knowledge- able and another 42.4 percent as knowledgeable in public health problems and approaches. The lowest percent to rate the faculty as knowledgeable was 16.5 percent in the Hopkins group. The highest percent of respond- ents holding the opinion that the mental health faculty was not very knowledgeable in public health matters was 19.7 percent in the Tulane group; the lowest percents holding to this view were, respectively, 4.0 percent among Michigan, 3.8 percent among Minnesota, and 3.5 percent among Hopkins respondents. The range of no opinion in this regard was from 9.5 percent among the Minnesota respondents to 1.6 percent among Tulane and 2.3 percent among Yale respondents. (a.) Mental health work experience prior to enrollment—Respondents with experience in mental health work prior to studying in a school of public health were more likely than those who lacked such experience to consider that the mental health faculty at the school was very knowledgeable about public health problems and approaches. While 54.9 percent of re- spondents with prior mental health experience considered this faculty as very knowledgeable about public health problems and issues, 46.7 percent of the respondents with no prior mental health experience replied similarly (see app. E, table 7, p. 281). (b.) Number of mental health courses taken—The greater the number of mental health courses taken, the more likely for respondents to indicate that the mental health faculty was very knowledgeable about public health problems and approaches. Among respondents taking three or more mental health courses 68.2 percent indicated that the mental health faculty was very knowledgeable about public health problems and approaches, while 55.5 percent of respondents taking two mental health courses and 41.0 per- cent of those taking one mental health course so reported. However, the fewer the number of mental health courses taken, the more likely for re- spondents to indicate that the mental health faculty was knowledgeable about public health problems and approaches. While 40.4 percent of re- spondents taking one mental health course reported knowledgeable, 27.7 percent of those taking two mental health courses, and 24.5 percent of those taking three or more mental health courses replied similarly (see app. E, table 8, p. 282). Usefulness in Present Work.—In appraising the level of usefulness of their mental health training to present functions, 532 or 43.7 percent of those respondents who took mental health courses considered such training as useful, 321 or 26.4 percent as highly useful, 272 or 22.3 percent as of little use, and 58 or 4.8 percent as of no use at all. Only 18 or 1.5 percent held no opinion on this issue. Among respondents from all schools except Minne- sota, mental health training was more frequently considered to be useful to present functions than highly useful, of little use, or of no use at all. The highest percent of respondents indicating that the mental health training received was useful was 48.2 percent in the Columbia group and the lowest was 38.1 percent in both the Berkeley and Minnesota groups. Minnesota respondents were almost equally split between the opinions highly useful (39.0 percent) and useful (38.1 percent) regarding their mental health training. One-fourth or more of the graduates from Berkeley (26.7 percent), UCLA (26.3 percent), Columbia (25.4 percent), North Carolina (25.6 percent), and Yale (27.3 percent) were of the opinion that their mental health training was of little use to their present functions. The opinion that mental health training had been of no use at all was highest among Harvard (12.2 percent) and Yale (11.4 percent) and lowest in the UCLA (1.8 percent), Hopkins (1.2 percent), and Michigan (0.6 percent) groups (see also chs. 8 and 9 on “Usefulness in Work”). (a.) Mental health work experience prior to enrollment—Respondents experienced in mental health work prior to attending a school of public health were more likely than those without such experience to consider their mental health course work as highly useful to their present work. While 39.3 percent of the respondents with prior mental health experience reported their mental health course work as highly useful, 17.5 percent of those with no prior mental health experience replied similarly. On the other hand, 27.6 percent of respondents with no prior mental health experi- ence judged their mental health course work as of little use to their present work, and 14.6 percent of those with prior mental health experience also replied similarly (see app. E, table 9, p. 283). (b.) Number of mental health courses taken—The greater the number of mental health courses taken, the more likely for respondents to indicate that their mental health course work was highly useful in their present work. Among respondents taking three or more mental health courses 54.9 percent reported that their mental health course work was highly use- ful in the performance of their present work functions, while 25.2 percent of the respondents taking two mental health courses, and 17.0 per- cent of the respondents taking one mental health course replied similarly. However, the fewer the number of mental health courses taken, the more likely for respondents to indicate that their mental health course work was of little use in their present work. While 27.4 percent of respondents taking one mental health course reported this to be of little use, 20.6 percent 125 126 of those taking two mental health courses, and 9.9 percent of those taking three or more mental health courses replied similarly (see app. E, table 10, p. 284). Mental Health Issues in Public Health Course Work In the opinion of 1,162 or 37.3 percent of all the respondents, mental health issues were occasionally related to their total public health course work, and for 874 or 28.1 percent mental health issues were moderately related to those courses. A smaller group, 658 or 21.1 percent, however, considered that mental health issues were highly related to public health courses, and for another 185 or 5.9 percent they were not related. An ad- ditional 166 or 5.3 percent held no opinion on this question. Among graduates from all schools except Hopkins and Yale, the view that mental health issues were occasionally related to public health courses was more frequently expressed than any other. Among Hopkins and Yale graduates, however, the opinion more frequently reported was that mental health aspects were moderately related in public health course work. The highest percents of respondents indicating that mental health issues were highly related to their public health course work were 25.0 percent in the Berkeley and 25.1 percent in the Minnesota groups; the lowest percent so indicating was 13.9 percent in the Pittsburgh group. Of those who noted that the relationship of mental health issues to public health courses was mod- erate, the highest percent, 36.7 percent, was in the Hopkins group and the lowest, 20.0 percent, in the Pittsburgh group. In the Pittsburgh group also was the highest percent, 46.7 percent, to indicate that there was an oc- casional relationship of mental health issues to public health courses, and the lowest percent to share this opinion was 28.7 percent in the Yale group. In the Pittsburgh group was the highest percent (11.7 percent) noting that mental health issues were not related to their public health courses; the lowest percents with the same view were, respectively, 3.5 percent among the UCLA, 3.8 percent in the Minnesota, and 4.3 percent in the Berkeley groups. The distribution of opinions in this area among Pittsburgh grad- uates is characterized by the relatively higher percent (58.4 percent) who noted that mental health issues were either occasionally or not related to the public health courses taken. (a.) Mental health work experience prior to enrollment—Respondents with mental health work experience prior to entering a school of public health were more likely to consider that mental health issues were highly related to public health concerns in their overall public health course work. Among respondents with prior mental health experience 31.8 percent con- sidered that mental health issues were highly related to public health con- cerns, while 16.3 percent of the respondents with no prior mental health experience also gave the same answer. On the other hand, respondents with no prior mental health experience were more likely to consider that mental health issues were either occasionally related or not related to public health concerns in their total public health course work (see app. E, table 11, p. 285). (b.) Number of mental health courses taken—Likewise, the greater the number of mental health courses taken, the more likely for respondents to indicate that mental health issues were highly related to public health con- cerns in their overall public health course work. Among respondents taking three or more mental health courses 41.6 percent indicated that mental health issues were highly related to public health concerns in their total public health course work; 32.3 percent of the respondents taking two mental health courses, 20.7 percent of the respondents taking one mental health course, while 16.9 percent of the respondents taking no mental health courses reported similarly (see app. E, table 12, p. 286) . Interest of Public Health Faculty in Mental Health A large minority of all respondents, 1,448 or 46.5 percent, considered other public health faculty (exclusive of the mental health faculty) as moderately interested in discussing mental health aspects of public health. According to 574 or 18.4 percent, the public health faculty was very in- terested, and to 456 or 14.6 percent, this faculty was not interested in mental health. As many as 557 or 17.9 percent expressed no opinion in this regard. Among graduates from all the schools, the more frequently reported opinion was that the public health faculty was moderately interested in mental health aspects of public health; the highest percents to express such a judgment were, respectively, 51.8 percent in the Columbia and 52.1 percent in the Tulane groups, and the lowest was 41.7 percent in the Pittsburgh group. Among the Minnesota graduates 23.5 percent and among Yale graduates 23.8 percent indicated that the public health faculty was very interested in mental health, while in the Harvard group only 12.8 per- cent gave the same response. According to 22.1 percent in the Harvard group, the public health faculty was not interested in mental health, and the lowest percent holding that opinion was 7.9 percent in the Minnesota group. Respondents with no opinion ranged from 26.1 percent in the Pittsburgh group to 9.0 percent in the Yale group. IN sunimAry, the largest groups of respondents (46.5 percent) were of the opinion that the public health faculty (exclusive of the mental health faculty) was moderately interested in discussing mental health and that mental health issues were occasionally related to the total public health training program (37.3 percent). Only a minority of the respondents (39.2 percent) took one or more mental health courses. Of these, the largest groups held the views that their mental health course work was highly concerned with psychiatry and psychology (48.6 percent), that it was highly concerned with public health (49.4 percent), and that it was moderately meaningful to public health (45.9 percent). One-half of those who took mental health courses indicated that the mental health faculty 127 128 was very knowledgeable about public health problems (49.9 percent), and a plurality of respondents reported that the mental health training re- ceived had been useful to their present work (43.7 percent). The greater the number of mental health courses taken, the greater the likelihood of respondents to indicate that such course work was highly concerned with psychiatry and psychology as well as highly concerned with public health issues. Similarly, respondents who had taken several mental health courses and those who had mental health experience prior to enter- ing a school of public health were more likely to consider that mental health courses were highly meaningful to public health concerns. These respondents were also more likely to judge the mental health faculty as very knowledgeable about public health, to deem their mental health course work as highly useful to their present work functions, and to regard the discussion of mental health issues as highly related to their overall public health course work. INTERACTION WITH FACULTY MEMBERS FROM THE MENTAL HEALTH PROFESSIONS Respondents were asked to identify what contacts they had during their training with faculty members from the mental health professions— psychiatry, psychology, psychiatric nursing, psychiatric social work, and “other” mental health professions, and to specify any such other professions. They were also asked to identify the roles assumed by such faculty in these contacts, viz, teachers, advisors or supervisors, tutors, or “others.” Multiple replies were allowed. The purpose of this question was to identify the dimensions of exposure to mental health associated with any sort of con- tacts that respondents had had with mental health professionals on the faculty, regardless of course work taken in this area. Nearly two-thirds of all respondents (2,042 or 65.6 percent) reported a combined total of 4,763 contacts with this faculty while an additional 895 respondents or 28.7 percent did not report any contacts with them. A ma- jority of respondents from every school reported contacts with mental health professionals on the faculty. Four-fifths or more of the respondents from Yale (93.4 percent), Columbia (82.9 percent), and Tulane (79.8 percent) had such contacts; the lowest percent of respondents with these contacts was from Berkeley (52.8 percent). Overall, the highest percent of contacts with mental health professionals on the faculty was with psychi- atrists (37.5 percent) who were followed in rank order by psychologists (25.3 percent), psychiatric nurses (14.9 percent), psychiatric social workers (14.3 percent), and last were contacts with “other” mental health profes- sionals (8.0 percent). By faculty role, the highest percent of contacts was with teachers (76.7 percent) . As shown by table 7:1, contacts with teachers ranked highest for all the mental health professions with the remaining types of contacts— TABLE 7:1.—Roles of faculty members, by mental health professions Mental health professions Roles Psychiatric | Psychiatric Psychiatry | Psychology nursing social work | Other Total Teacher: Number ......... 1,476 968 482 465 266 3,657 Percent .......... 82.6 80.3 67.8 68.3 70.1 76.7 Advisor-supervisor: Number ......... 139 100 109 57 56 461 Percent .......... 7.8 8.3 15.4 84 14.8 9.7 Tutor: Number ......... 36 21 10 15 15 97 Percent .......... 2.0 1.7 1.4 2.2 4.0 2.0 Other: Number ......... 136 117 109 144 42 548 Percent .......... 7.6 9.7 15.4 21.1 11.1 11.6 Total: Number ......... 1,787 1,206 710 681 379 4,763 Percent .......... 100.0 100.0 100.0 100.0 100.0 100.0 advisor or supervisor (9.7 percent), tutor (2.0 percent), or “other” (11.6 percent) —being by far much lower. Contacts With Psychiatrists Although, overall, contacts with psychiatrists on the faculty were the most frequently indicated, there was a wide range of variation in the number and kinds of contacts with specific mental health professionals reported by graduates from the various schools of public health. Over one-half of the contacts reported by respondents from Columbia (56.0 percent) and Tulane (52.8 percent) were with psychiatrists; the lowest percents reporting these contacts were from Berkeley (22.2 percent) and from Pittsburgh (22.3 percent). Contacts with psychiatrists ranked highest among respondents from nine schools. Of the 3,657 teacher contacts reported, 1,476 or 40.4 percent were with psychiatrists. Among Columbia graduates was the highest percent of con- tacts with psychiatrists in teaching roles (48.2 percent), and the lowest percents of such contacts were among Pittsburgh (17.3 percent) and Berkeley (17.4 percent) graduates. The highest percent of contacts with psychiatrists was in teaching roles (82.6 percent). Contacts With Psychologists Only among Berkeley (36.4 percent) and Pittsburgh respondents (25.0 percent) did contacts with psychologists rank higher than those with psychiatrists. The lowest percents of contacts with psychologists were re- 129 130 ported by Minnesota (17.0 percent) and Tulane (15.1 percent) graduates. Of all the teacher contacts, 968 or 26.5 percent were with psychologists. The highest percents of contacts with psychologists in a teaching role originated within the Berkeley group (27.8 percent) followed by the North Carolina (25.2 percent) and Harvard (25.1 percent) graduates. Among Pittsburgh graduates the percent of contacts with psychiatrists as teachers (17.3 percent) was roughly as high as with psychologists in the same role (17.7 percent). The lowest percents of contacts with psy- chologists as teachers were among graduates from Minnesota (12.7 per- cent) and from Tulane (11.3 percent). The highest percent of contacts with psychologists was in teaching roles (80.3 percent). Contacts With Psychiatric Nurses Although the highest percent of contacts reported with psychiatric nurses on the faculty was in teaching roles (67.8 percent), yet contacts with psychiatric nurses as advisors or supervisors were proportionately higher (15.4 percent) than those noted for any other specific mental health profession. The highest percent of contacts with psychiatric nurses from any school (23.8 percent) was among Michigan respondents. Overall, contacts with psychiatric nurses (14.9 percent) were propor- tionately lower than with psychiatrists (37.5 percent) and with psycholo- gists (25.3 percent). Contacts with psychiatric nurses, however, were higher than those with psychiatric social workers among Michigan, Minnesota, North Carolina, and Pittsburgh graduates, while proportionately contacts with psychiatric nurses and psychiatric social workers were about the same among Yale graduates. Contacts with psychiatric nurses ranked second to those with psychi- atrists in the Michigan (23.8 percent) and in the Minnesota (22.1 percent) groups and third in the North Carolina (17.1 percent), Pittsburgh (21.9 percent) and Yale (11.1 percent) groups. Such contacts were fourth in rank among Tulane (10.1 percent), Harvard (9.5 percent), and Hopkins (13.6 percent) respondents. The lowest percents of contacts with psychiatric nurses originated with the Berkeley (8.6 percent), UCLA (8.8 percent), and Columbia (6.1 percent) respondents, respectively. Of the 3,657 teacher contacts reported, 482 or 13.2 percent were with psychiatric nurses. The highest percents of contacts with psychiatric nurses as teachers were among Michigan (19.0 percent), Pittsburgh (15.0 per- cent), and Minnesota (14.9 percent) respondents. Over one-fourth (27.8 percent) of all psychiatric nurse-teacher contacts originated among Michigan respondents. Contacts With Psychiatric Social Workers There were as many contacts reported with psychiatric social workers (14.3 percent) as with psychiatric nurses (14.9 percent). The contacts with psychiatric social workers as teachers (68.3 percent) were proportionately as many as those with psychiatric nurses (67.8 percent) in such a role. The highest percent of contacts with psychiatric social workers was from Berke- ley (22.6 percent), and the lowest percent from Columbia (9.9 percent). Of all the teacher contacts, 465 (12.7 percent) were with psychiatric social workers. The highest percents of contacts with psychiatric social workers in teaching roles were from Berkeley (14.0 percent) and from Pittsburgh (14.2 percent) ; the lowest percent of such contacts was among Columbia graduates (5.9 percent). Over one-fifth (21.1 percent) of all contacts with psychiatric social workers were reported as “other,” and another 8.4 percent as advisor or supervisor. The percents of contacts reported with psychiatric social workers were higher than with psychiatric nurses among respondents from six schools: Berkeley (22.6 to 8.6 percent), UCLA (17.0 to 8.8 percent), Columbia (9.9 to 6.1 percent), Harvard (16.7 to 9.5 percent), Hopkins (16.0 to 13.6 percent), and Tulane (14.5 to 10.1 percent). In no instance did respond- ents from any school indicate that the frequency of contacts with psychi- atric social workers was higher than those reported for psychologists; yet among Berkeley respondents the frequency of contacts with psychiatric social workers (22.6 percent) was almost the same as those with psychiatrists (22.2 percent). Contacts With Other Mental Health Professionals Mental health faculty members from other than the specified mental health disciplines and specialties discussed above were noted as “other.” These contacts were less frequently reported (8.0 percent) than with any of the specified mental health professions. The highest percent of contacts with “other” mental health professionals was in teaching roles (70.1 per- cent). Other contacts with these professionals included 14.8 percent as advisor or supervisor, and 11.1 percent “other.” The distribution of types of contacts with these faculty members thus resembles that of psychiatric nurses more than that of psychiatrists or psychologists among whom substantially higher percents of contacts were as teachers. IN suMMARY, a large majority of respondents had contacts with faculty members with a mental health professional identification while attending a school of public health. The number of respondents who reported con- tacts with mental health professionals on the faculty was greater than that of respondents who took mental health course work. The lowest percent of graduates from any one school reporting such contacts was from Berkeley among whom still better than one-half indicated exposure to mental health professionals. Based on the types of contacts reported, the most common role was that of teacher; relatively lower percents reported other role relationships, particularly low, being that of tutor. Contacts with psychiatrists were most frequently reported overall and in teaching roles as well. While contacts with psychiatrists were most frequently reported in nine schools, contacts with psychologists were more frequent among 131 132 Berkeley and Pittsburgh graduates. Combined, contacts with psychiatrists and psychologists, comprised 62.8 percent of all types of contacts reported with mental health professionals. Contacts with psychiatric social workers, psychiatric nurses, and other mental health professionals on the faculty were reported primarily as teachers although within each of these profes- sional groups higher percentages indicated advisory or supervisory roles and “other” roles than were reported for psychiatrists and psychologists. APPRAISALS OF CHAPTER 8 MENTAL HEALTH ASPECTS COVERED IN PUBLIC HEALTH TRAINING N order to identify further the extent and kinds of exposure to mental health considerations in school of public health training and their relevance to professional practice, a list of 74 subject items consisting of 31 public health content topics and 43 mental health content topics was included in the questionnaire. Respondents were asked to indicate: (1) If the mental health aspects of each public health content topic was covered in any class; (2) if yes, whether it was well-presented; and (3) if the mental health aspects of the public health content topic covered had been useful in their work. The same questions were asked regarding each of the mental health topics (see ch. 9). This chapter presents the findings on the mental health aspects of the public health content topics. The public health content topics were subdivided further into two areas, a socioenvironmental area containing 19 topics and a family and child health area with 12 topics. The 43 mental health content topics were categorized into three areas: A basic area containing nine topics, a general area of 26 topics, and a specialized area with eight topics. The focus of concern on the public health content topics was solely with respect to the mental health aspects of the topic, rather than with the topic itself. For example, the questions about coverage, presentation, and usefulness of fluoridation dealt with the mental health aspects of that topic rather than with the entire subject of fluoridation. The following 19 topics were included in the socioenvironmental area of the public health content topics: (1) Accident prevention, (2) air and water pollution, (3) alcoholism control, (4) chest X-ray programs, (5) cigarette smoking, (6) delinquency control, (7) fluoridation, (8) geriatric programs, (9) housing, (10) industrial health, (11) immunization pro- grams, (12) medical quackery, (13) migrant health, (14) narcotic control, (15) noise abatement, (16) nutrition and food fads, (17) radiation con- trol, (18) suicide prevention, and (19) tuberculosis control. The family and child health area included: (1) Abortion, (2) battered child syndrome, (3) birth control and family planning, (4) classes for expectant parents, (5) out-of-wedlock children, (6) postnatal care of mothers, (7) pregnancy and childbirth crises, (8) premature births, (9) school health programs, (10) sex education, (11) venereal disease, and (12) well-child conferences. 133 134 COVERAGE OF MENTAL HEALTH ASPECTS OF PUBLIC HEALTH TOPICS The responses are presented with reference to a set of four questions: (I) How many respondents in the whole study population indicated that a given topic was covered in relation to mental health issues? (2) In the view of majorities of respondents from individual schools, which topics were covered in relation to mental health issues? (3) Which topics were covered in relation to mental health issues according to the highest /lowest percents of respondents and which schools they attended? (4) Which topics were covered in the view of the highest |lowest percents of respondents from each of the 11 schools? Through this fourfold presentation of data it is possible to gage the extent of coverage of mental health aspects of public health topics in schools of public health as viewed by respondents. According to majorities of all respondents, the mental health aspects of two of the 31 topics were covered in their public health training: 1,722 or 55.3 percent for alcoholism control, and 1,684 or 54.1 percent for geriatric programs. The smallest number of all respondents to indicate that the mental health aspects of a public health topic was covered was 790 or 25.4 percent for air and water pollution, and 791 or 25.4 percent also for classes for expectant parents. The topic covered most frequently according to respondents from in- dividual schools was alcoholism control. One-half or more of the respond- ents from each of the following eight schools reported that the mental health aspects of alcoholism control were covered: Berkeley, UCLA, Co- lumbia, Harvard, Hopkins, Michigan, Tulane, and Yale. The second most frequently identified topic was geriatric programs which was reported by a majority of respondents from each of seven schools: UCLA, Columbia, Hopkins, Michigan, Minnesota, Tulane, and Yale. The median percent of all respondents who indicated coverage of the mental health aspects of the 31 public health topics was 36.5 percent. The median of those who indicated coverage of the mental health aspects of the 19 socioenvironmental area topics was 37.8 percent; the median per- cent of respondents noting that the 12 family and child health area topics were covered in relation to mental health was somewhat lower, 34.1 per- cent. The range of all responses indicating that the mental health aspects of the 31 public health topics were covered was from 55.3 to 25.4 percent (see table 8:1). A closer range perspective follows on the coverage of particular topics, their overall respective rank of coverage, and their rank of coverage ac- cording to graduates from each of the 11 schools. Through this type of analysis, groups of respondents from each school of public health have been compared to each other on the dimension of perceived coverage of mental health aspects of topics, and the coverage of topics has been com- pared in the context of the total study population. Caution must be ex- asl TABLE 8:1.—Coverage of mental health aspects of public health topics in school of public health training [Medians and range of percents of respondents] Covered, Not covered, Do not recall, Nonresponse, percent of respondents | percent of respondents | percent of respondents | percent of respondents Number of items Median Range Median Range Median Range Median Range Public health topics ........... 31 36.5 55.3-25.4 34.1 49.1-20.8 20.4 23.6-14.9 8.6 21.4-5.8 Socioenvironmental area ... 19 37.8 55.3-25.4 32.3 49.1-20.8 19.9 23.6-14.9 8.3 10.8-5.8 Family and child health area .................... 12 34.1 49.2-254 34.4 41.8-26.9 20.5 22.6-15.4 10.0 214-84 136 ercised in interpreting these data and in assessing their implications since the views of respondents may be tinged and influenced by a variety of factors extraneous to their public health training which were not controlled for purposes of this study. Among such factors may be included the in- fluence, special interests in research, prominence, and publications of certain faculty members, time lapsed since graduation, varieties of work experi- ences, age, changing professional and personal interests, and other personal, professional, and career considerations. Public Health Topics Most Frequently Covered in Relation to Mental Health in Schools of Public Health Topics Noted as Covered by Majorities of Respondents.—As indicated earlier, one of the main procedures followed in summarizing the large mass of data gathered was to determine if a majority of respondents, 50.0 percent or more, from a given school indicated coverage of the mental health aspects of a specific topic. As may be observed from table 8:2, one-half or more respondents from one or more schools noted that the mental health aspects for 16 of the 31 public health topics listed were covered in their public health training. Of these, 11 were in the socioen- vironmental area and five were in the family and child health area. Also, a majority of respondents from each of the schools, except from Pittsburgh, indicated at least one public health topic as covered in its relationship to mental health. By school, the number of public health topics which in the view of majorities were covered in relation to their mental health aspects were: Yale 12, UCLA nine, Tulane seven, Harvard six, Hopkins six, Minnesota five, Columbia four, Berkeley three, Michigan two, North Carolina one, and Pittsburgh none.! A majority of respondents from eight of the schools noted alcoholism control, from seven of the schools geriatric programs, from six of the schools suicide prevention, and from five schools each accident prevention, ciga- rette smoking, and birth control and family planning. Fluoridation was noted by majorities from four schools, and also majorities from three schools noted school health programs. Housing, industrial health, narcotic control, and venereal disease were noted by majorities from two schools, and majorities from one school each noted nutrition and food fads, tuberculosis control, abortion, and battered child syndrome. Topics Noted by the Highest Percents of Respondents and School Attended.—What are the highest percents of respondents to indicate that the mental health aspects of each of the 31 topics was covered? The fol- lowing list contains the 31 topics and the highest percents of respondents *See app. F, table 1, pp. 287-288, for percent coverage on mental health aspects of all public health topics. LEI TABLE 8:2.—Majorities of 1961-67 graduates from schools of public health indicating coverage of mental health aspects of public health topics North Public health topics * Berke- | UCLA |Colum- | Har- Hop- | Michi- | Minne- | Caro- | Pitts- [Tulane | Yale | Total ley bia vard kins gan sota lina | burgh Number .............| 513 201 257 226 180 565 315 462 180 94 122 3,115 Percent ......... ..... 100.0 | 1000 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 1000 | 100.0 | 100.0 | 100.0 100.0 Socioenvironmental area: Accident prevention ............ ...... 56.2 [...... 602 |. .....|...... 53.0 |... |... 50.0 533 |...... Alcoholism control .............. 54.8 72.1 56.4 50.9 65.0 549 [LLL ooo 75.5 72.1 55.3 Cigarette smoking .............. ...... 54.7 bl4 |...... BLT |. loo 56.4 582 |...... Fluoridation ................... ...... 592 |...... 500 |. ooo B15 |... |... 500 |...... Geriatric programs ............. ...... 66.7 650 |...... 57.2 57.7 610 |......|...... 72.3 69.7 54.1 Housing ...........cooooevi fin BOT [ooo] 55.7 [...... Industrial health ...............[...... B92 |. 55.7 |... Narcotic control ...............[......|...... 590 |. 639 |...... Nutrition and food fads ........[......|......|...... 504 |... Suicide prevention .............. 51.1 652 [...... 54.4 B39 |... 62.8 623 |...... Tuberculosis control ...........0...... |... |... ooo 500 |... Family and child health area: Abortion ...........oiiiiiiide aoe 516 |...... Battered child syndrome .........[...... |... | ooo 553 [......... Birth control and family planning | 56.1 |......|...... 58.4 64.4 |... 54.3 64.8 |...... School health programs .........|......[......[......J...... 600 |...... 500 |... a 500 |...... Venereal disease ................[...... 59.2 |... 546 |... 18 topics in the socioenvironmental area and 7 topics in the family and child health area were not reported as covered by a majority from any of the 11 schools. 138 indicating that the topic was covered. The distribution is presented in rank order and the school attended is identified: Percent from [Respondents Public health topic school total | graduated in rank order! from— Alcoholism control ............ 75.5 | Tulane Geriatric programs ................. 72.3 Do Suicide prevention ................ 65.2 | UCLA Birth control and family planning .............................. 64.8 | Yale Narcotic control .................. iio. 63.9 Do Accident prevention .................. ioe 60.2 | Harvard School health programs ........................................ 60.0 | Hopkins Fluoridation .................... 59.2 | UCLA Industrial health ........................ ...................... 59.2 Do Venereal disease ..................... 59.2 Do Cigarette smoking ........................... 58.2 | Yale Housing ............ 56.7 | UCLA Battered child syndrome ................ oo 55.3 | Tulane Abortion ..... 51.6 | Yale Nutrition and food fads ........................................ 50.4 | Harvard Tuberculosis control ........................ i. 49.8 | Minnesota Migrant health ................... ..................... 48.9 | Berkeley Delinquency control ...................... 0... 489 | Tulane Sex education .......... 47.5 | Yale Immunization programs ........................... 0... 47.3 | Minnesota Postnatal care of mothers ......... ......... 0... 45.4 Do Out-of-wedlock children .......... ............................. 45.1 | Yale Medical quackery .......... 44.8 | UCLA Well-child conferences ......................................... 44.4 | Hopkins Pregnancy and childbirth crises ........................... ..... 43.6 | Tulane Noise abatement .................... 40.8 | UCLA Premature births ........... 40.0 | Hopkins Radiation control ................ 35.0 | Pittsburgh Air and water pollution ................... 34.4 | Yale Chest X-ray programs ................................. 0... 33.0 | Minnesota Classes for expectant parents ................................... 31.9 | Tulane * Total for each school equals 100.0 percent. As noted from the above list, the highest percents of respondents who indicated coverage of any of the public health topics originated with eight of the schools. No such respondents were in the Columbia, Michigan, or North Carolina groups. Respondents from two schools, UCLA and Yale, each noted the largest number of public health topics covered in relation to mental health. Topics Noted by the Highest Percents of Respondents From Each School.—Which topics were most frequently covered in their mental health aspects according to respondents from each of the 11 schools? Except for respondents from Pittsburgh, all other topics reported below by the highest percent of respondents from a school were noted by a majority: Public health topics Percent from Respondents graduated from— most frequently reported school total? Berkeley ........................... Birth control and family planning ..... 56.1 UCLA... Alcoholism control ..................... 72.1 Columbia .......................... Geriatric programs ..................... 65.0 Harvard ........................... Accident prevention .................... 60.2 Hopkins ........................... Alcoholism control ..................... 65.0 Michigan .......................... Geriatric programs ..................... 57.7 Minnesota ........................ |... Do ....... 61.0 North Carolina ..................... Fluoridation ........................... 51.5 Pittsburgh ......................... Alcoholism control ..................... 48.3 Industrial health ....................... 48.3 Tulane ............................ Alcoholism control ..................... 75.5 Yale i] Do... 72.1 ! Total for each school equals 100.0 percent. Public Health Topics Least Frequently Covered in Relation to Mental Health in Schools of Public Health Topics Noted as Covered by Minorities of Respondents.— The 15 topics listed below were not considered as covered in relation to their mental health aspects by a single majority of respondents from any of the schools. In fact, from one-fourth to somewhat over one-third of all re- spondents indicated that these topics had been covered in relation to mental health aspects during their public health training: Public health topics: a als Public health topics: Lb uals Immunization programs ..... 36.5 Noise abatement ........... 31.7 Postnatal care of mothers .... 34.8 Medical quackery ........... 31.0 Sex education .............. 34.5 Premature births ........... 30.0 Well-child conferences ...... 33.6 Delinquency control ........ 29.9 Pregnancy and childbirth Radiation control ........... 27.3 Crises .................... 33.0 Chest X-ray programs ...... 26.5 Migrant health ............. 32.8 Air and water pollution .... 254 Out-of-wedlock children .... 32.3 Classes for expectant parents 25.4 Topics Noted by the Lowest Percents of Respondents and School Attended —What are the lowest percents of respondents to indicate that the mental health aspects of each of the 31 topics was covered? The fol- lowing list contains the 31 topics and the lowest percents of respondents from each school that indicated their coverage. The distribution is presented in rank order and the school attended is identified: 139 Percent from | Respondents Public health topic school total graduated in rank order?’ from— Noise abatement ........................................... 14.9 | Tulane Migrant health ............................................ 15.6 | Pittsburgh Sex education ........... 16.1 Do Chest X-ray programs .............................. 0... 16.4 | Harvard Air and water pollution ............................. ....... 16.8 Do Nutrition and food fads .................................... 18.3 | Hopkins Classes for expectant parents ................................ 20.6 | Pittsburgh Delinquency control ......................... 0... 20.9 | Michigan Abortion... 21.0 | North Carolina Medical quackery ....................... 21.1 | Hopkins Radiation control .................. 22.3 | Tulane Premature births ............. 229 | UCLA Out-of-wedlock children .................................... 23.4 Do Narcotic control ................. io. 25.8 | North Carolina Pregnancy and childbirth crises ................. ............ 27.1 Do Battered child syndrome ............... ....... 0... 27.7 Do Postnatal care of mothers ................................... 27.9 | Harvard Well-child conferences ............ .......................... 28.1 | North Carolina Housing ............ 28.3 | Hopkins Immunization programs .................................... 30.1 | Harvard Tuberculosis control ....................................... 30.1 Do Fluoridation ....................... 31.7 Do Suicide Prevention ......................... 0... 32.2 | Pittsburgh School health programs ..................................... 33.3 Do Venereal disease ......................... oo. 33.3 Do Birth control and family planning .......................... 34.9 | Minnesota Industrial health ........................................... 35.1 | North Carolina Cigarette smoking ........................ 35.6 | Minnesota Geriatric programs .................... oii 37.6 | Harvard Accident prevention ................ 40.5 | Columbia Alcoholism control ................ 45.9 | North Carolina * Total for each school equals 100.0 percent. As noted from the above list, the lowest percents of respondents to indi- cate coverage of any of the 31 public health topics originated with nine schools. No such respondents however were in the Berkeley and Yale groups. Topics Noted by the Lowest Percents of Respondents From Each School.—Which topics were least frequently noted as covered in their men- tal health aspects by respondents from each of the 11 schools? Eight of the 15 topics which were not covered in the view of a single majority of re- spondents from any of the schools fell also among the least frequently noted topics: Public health topics Percent from Respondents graduated from— least frequently reported school total* Berkeley ........................... Radiation control .................... .. 23.2 UCLA ............................. Classes for expectant parents ............ 224 Columbia .......................... Noise abatement ....................... 19.5 Harvard ........................... Chest X-ray programs .................. 16.4 Hopkins ........................... Air and water pollution ................ 17.2 Michigan .......................... Delinquency control .................... 20.9 Minnesota ......................... |... Do... 23.2 North Carolina ..................... Abortion ........... 21.0 Pittsburgh ......................... Migrant health ........................ 15.6 Sex education ........................ .. 16.1 Tulane ............................ Noise abatement ....................... 14.9 Yale ................. Classes for expectant parents ............ 23.0 * Total for each school equals 100.0 percent. IN SUMMARY, in the socioenvironmental area, the topic most frequently indicated as covered in relation to its mental health aspects was alcoholism control (55.3 percent). The range of replies for this topic was from 45.9 percent in the North Carolina group to 75.5 percent in the Tulane group. Next in rank order was geriatric programs (54.1 percent). This topic ranged from 37.6 percent in the Harvard group to 72.3 percent in the Tulane group. The topic in the socioenvironmental area least frequently covered with respect to its mental health aspects was air and water pollu- tion (25.4 percent). In the Harvard group (16.8 percent) was the lowest percent of respondents to indicate that this topic was covered. The highest percent of respondents to indicate such coverage was 34.4 percent in the Yale group. In the family and child health area, the topic most frequently indicated as covered in relation to mental health was birth control and family plan- ning (49.2 percent) . In the Minnesota group (34.9 percent) was the lowest percent of respondents noting such coverage; and in the Yale group (64.8 percent) the highest. The least frequently covered topic in relation to mental health in the family and child health area was classes for expectant parents (25.4 percent). The range of coverage was from 20.6 percent in the Pittsburgh group to 31.9 percent in the Tulane group. The highest percent of respondents who indicated coverage of a topic was 75.5 percent in the Tulane group for alcoholism control. The lowest percent of respondents to report coverage of a topic was 14.9 percent also in the Tulane group for noise abatement. Six of the 31 topics were covered in relation to mental health ac- cording to the highest percents of respondents from each of the schools. These topics were: Birth control and family planning, alcoholism control, geriatric programs, accident prevention, fluoridation, and industrial health. Nine of the 31 topics were covered according to the lowest percents of respondents from each of the schools. These topics were: Radiation con- 141 142 trol, classes for expectant parents, noise abatement, chest X-ray programs, air and water pollution, delinquency control, abortion, sex education, and migrant health. QUALITY OF PRESENTATION As indicated before, only those respondents who noted positively that the mental health aspects of a certain public health topic were covered during their public health training were asked to judge the quality of its presentation. The number of respondents assessing quality of presentation were therefore only a fraction of those who replied that the topic in ques- tion was covered in relation to its mental health aspects. For purposes of discussing the quality of presentation of specific public health topics in relation to mental health only those replies based on at least 50 respondents from individual schools have been considered. Although a relatively small percent of respondents noted that they were exposed to the mental health aspects of the 31 public health topics listed (median: 36.5 percent), the median percent of respondents from that group indicating that these aspects were well-presented was 70.7 per- cent. While a slightly higher percent of respondents indicated coverage of the mental health aspects of topics in the socioenvironmental area (median: 37.8 percent) than of topics in the family and child health area (median: 34.1 percent), the median percent of respondents who indicated that the 19 socioenvironmental area topics were well-presented was 69.7 percent; the median for the 12 family and child health area topics was 72.3 percent. Thus, a somewhat higher percent of the respondents indicated that the topics in the family and child health area rather than the topics in the socioenvironmental area were well-presented. The median percent of respondents indicating that the coverage was not well-presented was 12.6 percent and the median percent noting don’t recall was somewhat higher, 13.8 percent. The median for nonresponse was 2.4 percent (see table 8:3). The highest percents of respondents indicating that the mental health aspects of a public health topic were well-presented were 77.3 percent for fluoridation in the socioenvironmental area and 76.5 percent for pregnancy and childbirth crises in the family and child health area. The lowest per- cents indicating that a topic was well-presented were 62.0 percent for narcotic control in the socioenvironmental area, and 68.4 percent for sex education in the family and child health area. Two distinct but related sets of questions have been used in examining the responses to those topics considered to have been well-presented. The first question is concerned with: Which topics were well-presented ac- cording to the highest/lowest percents of respondents with the schools attended identified? The second question refers to: Which topics were considered well-presented by the highest/lowest percents of respondents gvl TABLE 8:3.—Quality of presentation of mental health aspects of public health topics covered in school of public health training [Medians and range of percents of respondents] Well-presented, Not well-presented, Do not recall, Nonresponse, Rumb percent of respondents | percent of respondents | percent of respondents | percent of respondents umber of items Median Range Median Range Median Range Median Range Public health topics ............. 31 70.7 | 77.3-62.0 12.6 174-92 13.8 | 19.2- 99 24 3.3-09 Socioenvironmental area ...... 19 69.7 | 77.3-62.0 12.7 16.6-9.2 152 | 19.2-10.1 25 3.3-09 Family and child health area .. 12 72.3 | 76.5-68.4 12.2 174-95 12.3 | 14.7- 99 2.2 3.3-15 144 from each of the 11 schools individually? Through this type of presenta- tion, responses have been ranked: (1) In the context of the 31 topics listed, and (2) in the context of the schools themselves. Mental Health Aspects of Public Health Topics Most Frequently Considered Well-Presented in Schools of Public Health Topics Noted by the Highest Percents of Respondents and School At- tended.—The highest percents of respondents to indicate that the 31 covered topics were well-presented are listed below in rank order with the respective school that they attended: Percent from Respondents Public health topic school total graduated in rank order from— Premature births .................. ii 91.7 | Hopkins Birth control and family planning ........................... 84.1 | Harvard Fluoridation ...................... i 83.9 Do Pregnancy and childbirth crises .............................. 83.6 | Hopkins Venereal disease .......................... iii 82.0 | Minnesota Immunization programs ....................c.i iii. 81.9 Do Nutrition and food fads ..................................... 81.9 | Columbia Alcoholism control .................. iii. 81.7 | Tulane Well-child conferences .................c.iiiiiiiieiinnnnnn. 81.2 | Hopkins Radiation control ................ iii 81.0 | Pittsburgh School health programs ..................................... 80.6 | Hopkins Tuberculosis control ...................... 80.3 | Minnesota Battered child syndrome ..................... ooo 80.2 Do Geriatric Programs ................iiiiiiiiii iia 80.0 | Pittsburgh Postnatal care of mothers .............................. 79.5 | Hopkins Industrial health .................................... a. 79.0 | UCLA Cigarette smoking ................. iii 78.7 | Pittsburgh AbDOTtion ........ a 78.3 | Hopkins Medical quackery ................ iii 78.2 | Columbia Suicide prevention .............. iii 78.0 | Tulane Classes for expectant parents ............................... 76.5 | Harvard Migrant health .......................... iii 76.5 | Hopkins Out-of-wedlock children ..................................... 75.8 | North Carolina Air and water pollution ......................... 0 75.6 Do Noise abatement ....................... iii 74.6 | Harvard Chest X-ray programs ...............c.c.oeiiiuieiiineeinnennns 74.3 | Michigan Sex education ........... iii 72.9 Do Accident prevention ................. iii 72.2 | Pittsburgh Narcotic control ............... iii 71.8 | Yale Delinquency control ...................... ieee 71.2 | Michigan Housing ........... iii 70.6 | Hopkins * Total for each school based on responses to covered topics equals 100.0 percent. As noted from the above list, the highest percents of respondents to indicate that the 31 covered public health topics were well-presented origi- nated with 10 of the schools. No such respondents were in the Berkeley group. Respondents from Hopkins noted the largest number of public health topics considered well-presented. Topics Noted by the Highest Percents of Respondents From Each School.—The highest percents of respondents from each school to indicate that the mental health aspects of a public health topic covered in class were well-presented are listed below: Percent from Respondents graduated from— Public health topics school total* Berkeley ................. Fluoridation ........................... 76.3 UCLA ..... Industrial health ...................... 79.0 Columbia .......................... Nutrition and food fads ................ 81.9 Harvard ........................... Birth control and family planning ...... 84.1 Fluoridation ........................... 83.9 Hopkins ........................... Premature births ...................... 91.7 Michigan .......................... Fluoridation ........................... 81.8 Minnesota ......................... Immunization programs ................ 81.9 Venereal disease ....................... 82.0 North Carolina ..................... Premature births ...................... 83.5 Pittsburgh ............... Birth control and family planning ...... 83.1 Tulane ............................ Alcoholism control ..................... 81.7 Yale ........ il Cigarette smoking ...................... 71.5 Abortion... 77.8 * Total for each school based on responses to covered topics equals 100.0 percent. Mental Health Aspects of Public Health Topics Least Frequently Considered Well-Presented in Schools of Public Health Topics Noted by the Lowest Percents of Respondents and School At- tended.—The 31 topics rated by the lowest percents of respondents as well-presented and the schools that they attended follows: 145 146 Percent from Respondents Public health topic school total graduated in rank order? from— Narcotic control ............... iii 52.1 | North Carolina Noise abatement .................. iii 56.0 | Columbia Accident prevention ............ iii 56.6 | Berkeley Suicide prevention ................iiiiii iii 57.5 | Columbia Delinquency control ............... iii 58.1 | UCLA Air and water pollution ...................... i. 58.5 | Columbia Nutrition and food fads ................... ccc. 59.6 | UCLA Radiation control ............... iii 59.7 | Berkeley Alcoholism control .................. iii 60.2 | Yale School health programs ........................... 00.0 604 | UCLA Medical quackery ............... iii 60.7 | Harvard Geriatric Programs ............. coo 61.7 | North Carolina Housing .......... 61.8 | Yale Migrant health ........................... iii 62.5 | Minnesota Battered child syndrome ................... oe 62.6 | Harvard Sex education ............ iii 62.6 | Columbia Chest X-ray Programs ..................cooeiueeaueineannnns 62.7 | UCLA Cigarette smoking ............. iii 62.9 | North Carolina Industrial health ........................................... 63.6 Do Tuberculosis control ................ i iii 64.0 | UCLA Classes for expectant parents ......................oiueeennn 64.3 | Columbia Well-child conferences ................... iii... 64.8 | Harvard Postnatal care of mothers ................................... 65.5 | UCLA Birth control and family planning ........................... 65.7 Do Venereal disease ................ iii 66.0 | North Carolina Premature births ................. ii 66.2 | Columbia ADOTtion ........ 66.3 | Minnesota Out-of-wedlock children ..................................... 66.7 | Berkeley Pregnancy and childbirth crises ........................ 70.7 | UCLA Fluoridation .................... iii 71.1 | Minnesota Immunization programs .................c.uiiiiiiiaiiiaaan. 71.1 | Berkeley * Total for each school based on responses to covered topics equals 100.0 percent. As noted from the above list, the lowest percents of respondents to indicate that the 31 covered public health topics were well-presented originated with seven schools. No such respondents were in the Hopkins, Michigan, Pittsburgh, or Tulane groups. Even the topics rated by the lowest percents of respondents as well-presented were so considered by more than one-half of the respondents from each school. Topics Noted by the Lowest Percents of Respondents From Each School.—The lowest percents of respondents from each school observing that the mental health aspects of a public health topic covered in class had been well-presented were as follows: Percent from Respondents graduated from— Public health topic school total* Berkeley ........................... Accident prevention .................... 56.6 UCLA... Delinquency control .................... 58.1 Columbia .......................... Noise abatement ....................... 56.0 Harvard ........................... Medical quackery ...................... 60.7 Hopkins ........................... Narcotic control ....................... 60.0 Michigan ........................ |. Do... 58.5 Minnesota ......................... | .... Do 60.6 North Carolina ....................|..... Do ...... 52.1 Pittsburgh ............... oo] Do... 62.7 Tulane ............................ Geriatric programs ..................... 72.1 Yale ......... iL Alcoholism control ..................... 60.2 * Total for each school based on responses to covered topics equals 100.0 percent. IN sumMmARY, the coverage of the mental health aspects of public health topics was generally considered to be well-presented. In the socioenviron- mental area, the highest percent of respondents indicating that the mental health aspects of a public health topic were well-presented was 77.3 percent for fluoridation. This distribution ranged from 71.1 percent in the Minne- sota group to 83.9 percent in the Harvard group. The topic in the socio- environmental area whose mental health aspects were least frequently considered to have been well-presented was narcotic control (62.0 per- cent) . The frequency of this reply ranged from 52.1 percent in the North Carolina group to 71.8 percent in the Yale group. In the family and child health area, the highest percent of respondents indicating that the mental health aspects of a public health topic were well-presented was 76.5 percent for pregnancy and childbirth crises. The range for this reply was from 70.7 percent in the UCLA group to 83.6 percent in the Hopkins group. The topic in the family and child health area whose mental health aspects were least frequently considered to have been well-presented was sex education (68.4 percent). The frequency of this reply ranged from 62.6 percent in the Columbia group to 72.9 percent in the Michigan group. The highest percent of respondents who considered the mental health aspects of a topic well-presented was 91.7 percent in the Hopkins group who so rated the presentation on premature births. The lowest percent of re- spondents considering a covered topic well-presented was 52.1 percent from North Carolina who made that indication for narcotic control. The highest percents of respondents from each of the schools indicated as well-presented the mental health aspects of the following public health topics: Fluoridation, industrial health, birth control and family planning, premature births, venereal disease, immunization programs, alcoholism con- trol, nutrition and food fads, abortion, and cigarette smoking. The lowest percents of respondents from each of the schools indicated that the mental health aspects of the following public health topics were well-presented: 147 148 Accident prevention, delinquency control, noise abatement, medical quackery, narcotic control, geriatric programs, and alcoholism control. USEFULNESS IN WORK As with the previous analysis on quality of presentation, only those respondents indicating that the mental health aspects of the public health topics were covered are included in the discussion which follows on the use- fulness of such coverage in current work. Similarly, in those instances in which the size of responses to coverage of a topic was less than 50, the number in the base of the responses to usefulness has been deemed too small for analysis, and excluded from consideration. The median response indicating that the mental health aspects of the 31 public health topics had been of great use in the work of respondents was 20.9 percent; of moderate use was 33.1 percent, and of little use 36.8 per- cent. The median for nonresponses was 7.4 percent. In general, more re- spondents considered topics in the family and child health area (median: 26.6 percent) to be of great use than topics in the socioenvironmental area (median: 15.8 percent) (see table 8:4). Following is an examination of the replies which deemed the covered topics as of great use, of moderate use, and of little use to the current work activities of respondents. The examination is concerned with two distinct questions: (1) To what extent did a plurality or majority of re- spondents indicate that a given topic was of great, of moderate, or of little use? (2) Which topics were considered of great, of moderate, or of little use by respondents from individual schools? Of Great Use Overall, none of the topics covered were considered either by a plural- ity or majority of respondents to be of great use, but rather all topics were assessed to be either of moderate or of little use. The highest percents of respondents rated 22 topics as of little use, seven topics as of moderate use, and equal percents of respondents rated two topics as of little and of moder- ate use. The highest percents of respondents to consider that the mental health aspects of a public health topic was of great use to their work were 28.8 percent who indicated pregnancy and childbirth crises and another 28.6 percent who indicated premature births, both in the family and child health area; in the socioenvironmental area, nutrition and food fads was con- sidered as of great use, by 26.7 percent. The lowest percents of respondents to consider that the mental health aspects of a public health topic was of great use to their work were 12.1 percent who indicated noise abatement in the socioenvironmental area and 21.1 percent abortion in the family and child health area. 6¥1 TABLE 8:4.—Usefulness in work of mental health aspects of public health topics covered in school of public health training [Medians and range of percents of respondents] Of great use, Of moderate use, Of little use, Nonresponse, percent of respondents | percent of respondents | percent of respondents | percent of respondents Number of items Median Range Median Range Median Range Median Range Public health topics ........... 31 20.9 28.8-12.1 33.1 45.7-28.8 36.8 50.2-29.9 74 10.1-3.3 Socioenvironmental area ... 19 15.8 26.7-12.1 34.8 45.7-28.8 41.3 50.2-29.9 7.1 10.1-3.3 Family and child health area .................... 12 26.6 28.8-21.1 323 34.1-29.4 339 | 414-319 7.7 9.1-6.7 150 The highest percents of respondents from each school to consider that the mental health aspects of a covered topic were of great use were as follows: Respondents graduated Percent from from— Public health topic school total * Berkeley .............. Premature births .................. 37.5 UCLA ................ Sex education ............ oo 34.8 Columbia ............. Geriatric Programs ...............ouiiiiiiianiieiiiann.. 23.4 Harvard .............. Industrial health ........................ oie 27.6 Hopkins .............. Pregnancy and childbirth crises ....................... 29.9 Michigan ............. Nutrition and food fads .............................. 39.3 Minnesota ............ Pregnancy and childbirth crises ...................... 32.8 Well-child conferences ............................... 33.0 North Carolina ........ Classes for expectant parents .......................... 34.9 Pittsburgh ............ Premature births ....................... ooo 28.8 Tulane ............... Cigarette Smoking ................... iii. 20.8 Yale .................. Battered child syndrome ..................... oo. 24.6 ! Total from each school based on responses to covered topics equals 100.0 percent. The lowest percents of respondents from each school to consider that the mental health aspects of a topic was of great use were as follows: Respondents graduated Percent from from— Public health topic school total * Berkeley .............. Air and water pollution .......................... 7.4 UCLA ................ Noise abatement .................. iii. 134 Columbia ............. Fluoridation ................................ a 8.3 Harvard .............. Geriatric programs ...............c.iiiiiiiiiiiiiiiaans 94 Hopkins .............. Fluoridation ........................... ci. 8.8 Michigan ............. Noise abatement ......................ciiiiiiiiii.. 10.1 Minnesota ............ Industrial health ..................................... 7.0 North Carolina ........ Noise abatement .................... iii... 25 Pittsburgh ............ Suicide prevention ................... iia 6.9 Tulane ...............|..... Do . 15.3 Yale .................. Alcoholism control ................... iii... 114 * Total from each school based on responses to covered topics equals 100.0 percent. To review, 10 topics were noted as of great use by the highest percents of respondents from each school. Four of these topics were in the socioenvironmental area; i.e., geriatric programs, industrial health, nu- trition and food fads, and cigarette smoking, and six in the family and child health area; i.e., premature births, sex education, pregnancy and childbirth crises, well-child conferences, classes for expectant parents, and battered child syndrome. The highest percent of respondents from any school to consider a topic of great use was 39.3 percent from Michigan who so noted for nutrition and food fads. The seven topics described by the lowest percents of respondents from each school as of great use all were in the socioenvironmental area: Air and water pollution, fluoridation, geriatric programs, noise abatement, in- dustrial health, suicide prevention, and alcoholism control. Of Moderate Use Seven topics were considered by a plurality of respondents to be of moderate use: Accident prevention (45.7 percent), chest X-ray programs (42.8 percent), geriatric programs (35.7 percent), immunization programs (37.0 percent), nutrition and food fads (34.8 percent), pregnancy and childbirth crises (32.5 percent), and well-child conferences (32.5 percent). The highest percents of respondents were equally divided also in designat- ing tuberculosis control as of moderate use (35.9 percent) and as of little use (35.8 percent), and sex education as of moderate use (32.5 percent) and as of little use (32.5 percent). The topics considered as of moderate use by the highest percents of the respondents were accident prevention (45.7 percent) in the socioen- vironmental area and battered child syndrome (34.1 percent) in the family and child health area. However, overall the topic battered child syndrome was considered of little use by the highest percent of respondents (36.8 percent) . Considered to be of moderate use by the lowest percents of the respondents were noise abatement (28.8 percent) in the socioenviron- mental area and abortion (29.4 percent) in the family and child health area. The highest percents of respondents from each school to consider that a public health topic covered in relation to its mental health aspects was of moderate use were as follows: Percent from Respondents graduated from— Public health topic school total * Berkeley ........................... Accident prevention ............... 494 UCLA ...... oo. Chest X-ray programs ............. 49.2 Columbia .......................... School health programs ............ 47.7 Harvard ........................... Accident prevention ............... 48.5 Hopkins ........................... Abortion ......... oo 46.4 Michigan .......................... Accident prevention ............... 40.9 Minnesota ......................... Chest X-ray programs ............. 50.0 Radiation control ................. 49.5 North Carolina ..................... Accident prevention ............... 49.5 Pittsburgh ........ o.oo ooo] Do... 48.1 Tulane ............................ Suicide prevention ................ 39.0 Yale .......... Cigarette smoking ................. 36.6 * Total for each school based on responses to covered topics equals 100.0 percent. The lowest percents of respondents from each school to indicate that the mental health aspects of a topic covered was of moderate use were as follows: 151 152 Percent from Respondents graduated from— Public health topic school total * Berkeley ............... Abortion... 26.1 School health programs ............ 26.0 UCLA... Abortion ....... ooo 22.2 Postnatal care of mothers .......... 224 Columbia .......................... Abortion... 25.6 Harvard ........................... Suicide prevention ................. 22.0 Hopkins ........................... Geriatric programs ................ 26.2 Michigan .......................... Abortion... ooo 21.5 Minnesota ......................... Postnatal care of mothers .......... 28.7 North Carolina ..................... Suicide prevention ................. 27.5 Classes for expectant parents ....... 274 Pittsburgh ................... 0.0... Premature births .............. .... 19.2 Tulane ............................ Geriatric programs ................ 29.4 Yale .............................. Fluoridation ...................... 19.7 * Total for each school based on responses to covered topics equals 100.0 percent. To review, the seven topics which the highest percents of respondents from each school considered of moderate use consisted of five in the socioenvironmental area; i.e., accident prevention, chest X-ray programs, radiation control, suicide prevention, and cigarette smoking, and two in the family and child health area; i.e., school health programs and abortion. The highest percents of respondents from any of the schools to rate a topic of moderate use were 50.0 percent from Minnesota in rating chest X-ray programs, 49.5 percent also from Minnesota with regard to radiation control, and 49.5 percent from North Carolina in relation to accident pre- vention. Of the eight topics described by the lowest percents of respondents from each school as of moderate use, three were in the socioenvironmental area; i.e., suicide prevention, geriatric programs, and fluoridation, and five in the family and child health area; i.e., abortion, school health programs, postnatal care of mothers, classes for expectant parents, and premature births. Of Little Use Of the 31 topics 22 were judged by a plurality or by a majority of the respondents to be of little use: Air and water pollution (45.8 percent), alcoholism control (44.4 percent), cigarette smoking (41.1 percent), de- linquency control (41.5 percent), fluoridation (46.4 percent), housing (40.9 percent), industrial health (43.2 percent), medical quackery (41.9 percent) , migrant health (45.7 percent), narcotic control (41.3 percent), noise abatement (50.2 percent), radiation control (40.7 percent), suicide prevention (45.1 percent), abortion (41.4 percent), battered child syn- drome (36.8 percent), birth control and family planning (33.9 percent), classes for expectant parents (33.5 percent), out-of-wedlock children (34.4 percent) , postnatal care of mothers (35.2 percent), premature births (32.9 percent) school health programs (33.8 percent), and venereal disease (37.8 percent) . The topics considered of little use by the highest percents of respond- ents were noise abatement (50.2 percent) in the socioenvironmental area and abortion (41.4 percent) in the family and child health area. The topics considered as of little use by the lowest percents of respondents were immunization programs (29.9 percent) in the socioenvironmental area, and pregnancy and childbirth crises (31.9 percent) and well-child con- ferences (32.0 percent) in the family and child health area. The mental health aspects of nine of the 31 public health topics were considered of little use by the highest percents of respondents from each school: Percent from Respondents graduated from— Public health topic school total * Berkeley ........................... Noise abatement .................. 50.0 Air and water pollution ............ 50.0 UCLA... Do ... oo... 55.4 Columbia .......................... Fluoridation ...................... 53.3 Sex education ..................... 52.5 Harvard ........................... Medical quackery ................. 57.1 Hopkins ........................... Narcotic control ................... 50.0 Michigan .......................... Noise abatement .................. 52.2 Alcoholism control ................ 51.6 Minnesota ......................... Fluoridation ...................... 474 North Carolina ..................... Noise abatement .................. 65.3 Pittsburgh... ..... 0... School health programs ............ 51.7 Tulane .................... Geriatric programs ................ 39.7 Yale .............. Fluoridation ...................... 60.7 * Total for each school based on responses to covered topics equals 100.0 percent. The mental health aspects of eight of the 31 public health topics were considered of little use by the lowest percents of respondents from each school: Percent from Respondents graduated from— Public health topic school total * Berkeley ........................... Pregnancy and childbirth crises. . . .. 21.0 UCLA ............................. Chest X-ray programs .............. 23.7 Columbia .......................... School health programs ............ 29.5 Harvard ........................... Accident prevention ............... 29.4 Hopkins ........................... School health programs ............ 31.5 Michigan .......................... Nutrition and food fads ............ 23.6 Minnesota ......................... Out-of-wedlock children ............ 23.0 North Carolina ..................... Well-child conferences ............. 26.2 Pittsburgh ................. EE 27.3 Tulane ............................ Birth control and family planning... 314 Yale ...... School health programs ............ 34.4 * Total for each school based on responses to covered topics equals 100.0 percent. 153 154 Thus, the nine topics which the highest percents of respondents from each school considered of little use included seven in the socioenviron- mental area; i.e., air and water pollution, noise abatement, fluoridation, medical quackery, narcotic control, alcoholism control, and geriatric pro- grams, and two in the family and child health area; i.e., sex education and school health programs. The highest percent of respondents from any school to consider a topic of little use was 65.3 percent from North Carolina in noting noise abatement. Of the eight topics described by the lowest percents of respondents as of little use, three were in the socioenvironmental area; i.e., chest X-ray programs, accident prevention, and nutrition and food fads, and five in the family and child health area; i.e., pregnancy and childbirth crises, school health programs, out-of-wedlock children, well-child conferences, and birth control and family planning. OVERVIEW According to better than one-half of all the respondents, only two of the 31 topics, alcoholism control and geriatric programs, were covered in relation to their mental health aspects in a school of public health. Ma- jorities of respondents from eight of the schools noted such coverage for alcoholism control and from seven of the schools for geriatric programs. A total of 11 of the 19 socioenvironmental area topics, and five of 12 family and child health area topics were, respectively, reported as covered by ma- jorities of respondents from at least one school of public health. The highest percents of respondents from each school indicated coverage of the following topics: Birth control and family planning, alcoholism control, geriatric pro- grams, accident prevention, fluoridation, and industrial health. The lowest percents of respondents from each school indicated coverage of the mental health aspects of radiation control, classes for expectant parents, noise abatement, chest X-ray programs, air and water pollution, delinquency control, abortion, migrant health, and sex education. The topics covered in relation to mental health were generally con- sidered to have been well-presented. Fluoridation, and pregnancy and childbirth crises were considered most frequently to have been well- presented. The topic considered well-presented by the lowest percent of respondents was narcotic control. Of those who indicated coverage, the highest percents of respondents from each school rated the following topics as well-presented: Fluorida- tion, industrial health, nutrition and food fads, birth control and family planning, premature births, venereal disease, immunization programs, al- coholism control, abortion, and cigarette smoking. The lowest percents of respondents from each school indicated the following topics as well- presented: Accident prevention, delinquency control, noise abatement, medical quackery, narcotic control, geriatric programs, and alcoholism control. Even among the topics least frequently considered well-presented, only minorities from each school would not make such a positive appraisal. In general, the coverage of the mental health aspects of the public health topics was likely to be considered of little use or of moderate use rather than of great use to current work or practice. According to the highest percents of respondents, 22 of the topics were considered of little use, seven of moderate use, and two were equally divided between those of little use and those of moderate use. The topic noise abatement was con- sidered of great use by the lowest percent of respondents. The highest per- cents of respondents to note that a topic was of great use to their work indicated both pregnancy and childbirth crises and premature births. In no instance, however, in comparing the size of the highest percents of responses from each school to each topic for each of the three levels of usefulness, did the highest percent of respondents from a particular school rate any topic as of great use. The highest percent of respondents from any school to indicate that the mental health aspect of a topic was of great use was 39.3 percent from Michigan who noted nutrition and food fads. The mental health aspects of the following nine public health topics had been of little use according to the highest percents of respondents from each school: Air and water pollution, noise abatement, fluoridation, sex education, medical quackery, narcotic control, alcoholism control, school health pro- grams, and geriatric programs. The highest percent of respondents from each school indicated the following seven topics to be of moderate use: Accident prevention, chest X-ray programs, school health programs, abor- tion, radiation control, suicide prevention, and cigarette smoking. 155 156 APPRAISALS OF CHAPTER 9 MENTAL HEALTH TOPICS COVERED IN PUBLIC HEALTH TRAINING HIS chapter is specifically concerned with appraisals of the coverage of distinctly identifiable mental health content areas, subject matter, and activities in a public health training context. As indicated in the introduc- tory paragraphs to the preceding chapter on mental health aspects of public health topics, respondents were questioned regarding the coverage of 43 mental health topics, the quality of presentation, and level of usefulness of the covered topics. The mental health topics were organized into three areas each broadly reflecting components of the scope of public health- mental health work: (a) A basic area which included nine topics in per- sonality theory, socialization, and interpersonal relations; (b) a general area which included 26 topics related to primary prevention techniques of mental health work, administration, and information or content; and (c¢) a special- ized area which included eight topics concerned with secondary and ter- tiary prevention. COVERAGE OF MENTAL HEALTH CONTENT TOPICS The fourfold approach in presenting the responses on coverage of the mental health topics is identical to that employed in the previous chapter on coverage of the mental health aspects of public health topics: (1) How many respondents in the whole study population indicated that a given mental health topic was covered? (2) In the view of majorities of respond- ents from individual schools, which mental health topics were covered? (3) Which mental health topics were covered according to the highest [lowest percents of respondents and which schools they attended? (4) Which topics were covered in the view of the highest/lowest percents of respondents from each of the 11 schools? According to majorities of all respondents, seven of the 43 mental health topics were covered in their public health training: 1,922 or 61.7 percent for importance of feelings and emotions, 1,871 or 60.1 percent for small-group interaction, 1,819 or 58.4 percent for understanding a client’s attitudes, fears, and prejudices, 1,717 or 55.1 percent for role of the family, 1,695 or 54.4 percent for public attitudes toward the mentally ill, 1,674 or 53.7 percent for individual personality dynamics, and 1,558 or 50.0 percent for role of conscious and unconscious factors. The smallest number of all respondents to indicate that a mental health topic was covered was 324 or 10.4 percent for psychiatric registers. LST TABLE 9:1.—Coverage of mental health topics in school of public health training [Medians and range of percents of respondents] Yes, percent No, percent of Do not recall, percent Nonresponse, percent of respondents respondents of respondents of respondents Number of items Median Range Median Range Median Range Median Range Mental health topics ........ 43 35.2 61.7-10.4 37.3 58.4-19.6 17.8 26.0-12.3 8.1 11.5-6.1 Basic area .............. 9 53.7 61.7-32.3 24.1 35.5-19.6 15.8 25.0-12.6 7.0 8.3-6.1 Personality theory .. 4 51.9 61.7-32.3 24.6 35.5-19.6 16.9 25.0-12.6 6.7 7.2-6.1 Socialization ........ 12 55.1-44.8 |... .. 30.0230 |......... 17.2-185 |. ........ 8.3-7.9 Interpersonal relations ......... 3. 60.1-49.1 |. ..... ... 248-205 |......... 19.1-129 |... .... .. 7.0-6.5 General area ............ 26 34.2 54.4-10.4 39.3 58.4-25.6 18.9 25.5-12.3 8.0 11.3-6.8 Techniques ......... 7 35.2 48.0-26.8 39.0 41.1-28.0 18.9 24.6-15.8 7.5 11.3-7.0 Administration ..... 13 29.2 42.7-17.6 42.7 58.4-31.1 19.1 25.5-14.2 8.2 8.7-6.8 Information ........ 6 38.7 544-104 35.3 55.2-25.6 18.0 25.5-12.3 8.1 8.9-7.7 Specialized area ......... 8 29.9 43.2-16.2 42.1 47.7-31.7 18.7 26.0-16.5 8.4 11.5-8.2 Secondary prevention ........ 5 26.3 43.2-16.2 46.3 47.7-31.7 17.8 26.0-16.5 8.3 11.5-8.2 Tertiary prevention. . 13 35.2-29.1 |. ........ 40.5-36.8 |. ........ 219-179 |. ........ 8.6-8.3 ! Medians are reported only for sections containing 4 or more topics. 158 Except for the topic public attitudes toward the mentally ill which was in the general area, all other topics noted as covered by one-half or more of all the respondents were in the basic area. The largest group of respondents indicating coverage for a topic in the specialized area was 43.2 percent who indicated types of mental health treatment agencies and services. The topics noted by the smallest groups of respondents were 16.2 percent for social breakdown syndrome and 10.4 percent for psychiatric registers; these topics were, respectively, the least frequently noted in the general and specialized areas. The least frequently reported topic in the basic area was survey of personality theories which was indicated by 32.3 percent of all respondents. The two topics covered most frequently according to respondents from individual schools were importance of feelings and emotions and under- standing a client’s attitudes, fears, and prejudices; one-half or more of the respondents from all 11 schools reported that these two topics had been covered. The median percent of all respondents who indicated coverage of the 43 mental health topics was 35.2 percent. Mental health topics in the basic area, which included personality theory, socialization, and interpersonal relations, were noted as covered by more respondents than the topics in any other area; the median percent of respondents who noted coverage of the basic area topics was 53.7 percent. Much smaller percents of respondents indicated coverage of the general area which included techniques, admin- istration, and informational aspects (34.2 percent median) and of the specialized area which included secondary and tertiary prevention aspects in mental health (29.9 percent median). The range of all responses indicating that the 43 mental health topics were covered was from 61.7 to 10.4 percent (see table 9:1). Mental Health Topics Most Frequently Covered in Schools of Public Health Topics Noted as Covered by Majorities of Respondents.—As indicated in table 9:2, one-half or more of all respondents from one or more schools noted coverage of 26 of the 43 mental health topics listed. Nine of these were basic area topics, 14 general area topics, and three specialized area topics. Also, a majority of respondents from each of the 11 schools indicated covereage of at least one mental health topic. By school, the number of mental health topics which in the view of majorities were covered were: Yale 22, Columbia 20, Tulane 14, UCLA 12, Minnesota 10, Harvard eight, North Carolina eight, Berkeley seven, Hopkins six, Michigan five, and Pittsburgh two.! Thus, according to a majority of respondents, by school, all nine of the basic area topics, 14 of the 26 general area topics, and three of the eight specialized area mental health topics were covered. Majorities of re- !See app. G, table 1, pp. 289-293, for percent coverage of all mental health topics. 641 TABLE 9:2.—Majorities of 1961-67 graduates from schools of public health indicating coverage of mental health topics North Mental health topics Berke- | UCLA |Colum-| Har- | Hop- | Michi- |Minne- | Caro- | Pitts- | Tulane | Yale | Total ley bia vard kins gan sota lina | burgh Number ............. 513 201 257 226 180 565 315 462 180 94 122 3,115 Percent .............. 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 100.0 A. Basic Area PERSONALITY THEORY Importance of feelings and emotions. .| 60.4 54.7 712 57.5 55.0 58.9 66.0 68.0 50.0 57.4 74.6 61.7 Individual personality dynamics. ..... 515 |... V2 | 61.0 60.0 | ....... 56.4 69.7 53.7 Role of conscious and unconscious factors ............ LL 50.1 |... ... 60.7 |... 55.9 53.7 |... 54.3 67.2 50.0 Survey of personality theories .......|.......|. ooo 500 |....... SOCIALIZATION Infancy and the preschool period.....|.......[....... 638 |... .. 506 |... [22 1% UN A 52.1 516 |... .... Role of the family .................. 50.7 50.2 63.4 56.6 60.0 51.5 52.7 61.7 | ....... 64.9 66.4 55.1 INTERPERSONAL RELATIONS Sensitivity to behavioral and verbal CUES iii 53.0 | ....... 56.8 |. 57.8 502 | ....... 52.1 525 |... Small-group interaction ............. 62.4 54.7 73.2 580 | ....... 57.3 68.6 63.0 | ....... 50.0 62.3 60.1 Understanding a client’s attitudes, fears, and prejudices ........... ... 64.3 52.2 62.6 57.1 52.2 54.5 62.2 59.3 51.1 59.6 60.7 58.4 B. GENERAL AREA TECHNIQUES OF MENTAL HEALTH WORK Principles of interviewing ...........|..... |... .... 521 [Loo B33 | Other preventive mental health inter- vention techniques; e.g., community organization, mental health educa- tion, parent education, and crisis intervention ......................|....... 52.2 553 |... lo B27 | 50.8 [....... 091 TABLE 9:2.—Majorities of 1961-67 graduates from schools of public health indicating coverage of mental health topics—Continued Mental health topics Berke- ley UCLA Colum- bia Har- vard Hop- kins Michi- gan Minne- sota North Caro- lina Pitts- burgh Tulane Yale Total Referral to special mental health fa- cilities ................... LL ADMINISTRATION OF MENTAL HEALTH WORK Comprehensive community mental health centers .................... Distribution of mental disorders in the general population ........... Mental health functions of basic community services in health, ed- ucation, and welfare .............. Organization and delivery of mental health services .................... Principles of comprehensive mental health planning ................ .. State, local, and Federal mechanisms for financing mental health pro- Grams ....................o..... Etiological factors in mental dis- orders ................. oo... Public attitudes toward the mentally ilo Roles and functions of mental health specialists ........................ Sources of epidemiological data on mental disorders .................. 53.2 52.7 55.7 51.2 52.5 59.5 51.1 59.0 68.0 53.3 62.3 53.3 64.8 77.9 50.0 55.7 191 TABLE 9:2.—Majorities of 1961-67 graduates from schools of public health indicating coverage of mental health topics—Continued North Mental health topics Berke- | UCLA |Colum-| Har- Hop- | Michi- |Minne- | Caro- | Pitts- | Tulane | Yale Total ley bia vard kins gan sota lina | burgh Varieties of mental disorders ........|.......|....... 67.3 | 60.6 63.1 | ....... C. SPECIALIZED AREA SECONDARY PREVENTION Methods for care of patients with mental disorders; e.g., psychological- psychiatric, pharmacological, milieu or social environmental ...........| |... BL8 | 525 |... Types of mental health treatment agencies and services ..............|....... 55.7 56.0 |... 55.3 55.7 |... .. TERTIARY PREVENTION Psychiatric rehabilitation agencies and services ....................o loool 521 | Note.—Not included are 17 topics not reported as covered by a majority from any of the schools. 162 spondents from all 11 schools noted coverage of the importance of feelings and emotions, and understanding a client’s attitudes, fears, and prejudices. The role of the family was covered according to majorities from 10 schools, while small-group interaction was covered according to majorities from nine schools. Majorities from eight schools reported cover- age of public attitudes toward the mentally ill. The topics individual per- sonality dynamics, role of conscious and unconscious factors, infancy and the preschool period, sensitivity to behavioral and verbal cues, other preventive mental health intervention techniques, distribution of mental disorders in the general population, etiological factors in mental disorders, and types of mental health treatment agencies and services were covered according to majorities from between four to six schools. Majorities from two to three of the schools noted coverage of principles of interviewing, comprehensive community mental health centers, mental health functions of basic com- munity services in health, education, and welfare, organization and delivery of mental health services, sources of epidemiological data on mental dis- orders, varieties of mental disorders, and methods for care of patients with mental disorders. Majorities from a single school indicated coverage of survey of personality theories, referral to special mental health facilities, principles of comprehensive mental health planning, State, local, and Federal mechanisms for financing mental health programs, roles and functions of mental health specialists, and psychiatric rehabilitation agencies and services. Topics Noted by the Highest Percents of Respondents and School At- tended.—What are the highest percents of respondents to indicate that each of the 43 mental health topics was covered? The following list contains the 43 topics and the highest percents of respondents indicating that the topic was covered. The distribution is presented in rank order and the school attended is identified: Percent from Respondents Mental health topic school total graduated in rank order? from— Public attitudes toward the mentally ill .......... 779 | Yale Importance of feelings and emotions .............. 74.6 Do Small-group interaction ..................... ..... 73.2 | Columbia Individual personality dynamics ................. 71.2 Do Distribution of mental disorders in the general 68.0 | Yale population. Varieties of mental disorders .................... 67.3 | Columbia Role of conscious and unconscious factors ........ 67.2 | Yale Role of the family .............................. 66.4 Do Etiological factors in mental disorders ............ 64.8 Do Understanding a client's attitudes, fears, and 64.3 | Berkeley prejudices. Infancy and the preschool period ................ 63.8 | Columbia (continued) Percent from Respondents Mental health topic school total graduated in rank order?! from— Organization and delivery of mental health 62.3 | Yale services. Sources of epidemiological data on mental dis- 59.3 | Harvard orders. Comprehensive community mental health centers. .. 59.0 | vale Sensitivity to behavioral and verbal cues ......... 57.8 | Minnesota Types of mental health treatment agencies and 56.0 | Columbia services. Mental health functions of basic community 55.7 | UCLA services in health, education, and welfare. Other preventive mental health intervention tech- 55.3 | Columbia niques. Principles of interviewing ....................... 53.3 | Minnesota Principles of comprehensive mental health plan- 53.3 | Yale ning. Methods for care of patients with mental dis- 52.5 Do orders. Psychiatric rehabilitation agencies and services. . . . 52.1 | Columbia State, local, and Federal mechanisms for financing 51.7 | UCLA mental health programs. Referral to special mental health facilities. ....... 51.1 | Tulane Survey of personality theories .................... 50.0 | Yale Roles and functions of mental health specialists. . . 50.0 Do Adjustment problems of ex-patients and their 49.0 | Columbia families. How to recognize mental disorders ............... 47.9 | Tulane Means of improving the mental health functioning 45.1 | vale of community care givers. Principles of consultation ....................... 40.4 | Tulane and Berkeley Psychiatric rehabilitation functions of public 40.4 | Tulane health workers. Identification and relief of mental hazards ........ 40.4 Do Means of introducing innovation and change in 37.7 | Columbia mental health programs. “Anticipatory guidance” as related to the primary 37.2 | Hopkins prevention of mental disorders. 36.3 | Harvard Mental health medico-legal problems ............ Coordinating interagency relationships in mental 36.2 | Columbia health. Mental disorder casefinding role of public health 35.1 | Tulane workers. How to develop programs for the control of men- 34.6 | Columbia tal disorders. Role of the private sector in mental health pro- 30.8 | UCLA gramming and financing. Utilization of mental health data for program 30.3 | Yale evaluation. Budget planning for mental health programs ..... 30.1 | Harvard Social breakdown syndrome ...................... 30.0 | Columbia Psychiatric registers ............................. 24.4 | Hopkins * Total for each school equals 100.0 percent. 163 164 As noted from the above list, the highest percents of respondents to indicate coverage of any of the 43 mental health topics originated with eight of the schools. No such respondents were in the Michigan, North Carolina, and Pittsburgh groups. Respondents from Yale noted the largest number of mental health topics covered. Topics Noted by the Highest Percents of Respondents From Each School—Which mental health topics were most frequently covered ac- cording to respondents from each of the eleven schools? Each mental health topic listed below had been reported by the highest percents of respondents from a school: Respondents graduated Percent from from— Mental health topics most frequently reported school total * Berkeley .............. Understanding a client's attitudes, fears, and prejudices . . 64.3 UCLA ................ Public attitudes toward the mentally ill ........... ... 62.7 Columbia ............ Small-group interaction .............................. 73.2 Harvard ............. Sources of epidemiological data on mental disorders .... 59.3 Hopkins .............. Role of the family ................................... 60.0 Michigan ............. Importance of feelings and emotions .................. 58.9 Minnesota ............ Small-group interaction .............................. 68.6 North Carolina ....... Importance of feelings and emotions .................. 68.0 Pittsburgh ........ .... Understanding a client’s attitudes, fears, and prejudices . . 51.1 Tulane .............. Role of the family ................................... 64.9 Yale ................. Public attitudes toward the mentally ill ............ .. 71.9 * Total for each school equals 100.0 percent. Mental Health Topics Least Frequently Covered in Schools of Public Health Topics Noted as Covered by Minorities of Respondents.—Of the 43 mental health topics, 17 were not noted by a majority of respondents from any school. In fact, from one-tenth to somewhat over one-third of all respondents indicated that these topics had been covered. These topics are listed below in rank order: Mental health topics: Adjustment problems of ex-pa- tients and their families ...... Principles of consultation ........ Means of improving the mental health functioning of communi- ty care givers; e.g., clergy, police, and teachers ............. ..... Coordinating interagency relation- ships in mental health ......... Psychiatric rehabilitation functions of public health workers ...... Means of introducing innovation and change in mental health programs ..................... “Anticipatory guidance” as re- lated to the primary prevention of mental disorders .......... .. How to recognize mental disorders Number equals 3,115 (100.0 percent) 32.8 30.7 29.1 28.4 26.8 26.3 Mental health topics: Number equals 3,115 (100.0 percent) Identification and relief of mental hazards ..................... 24.9 Mental disorder casefinding role of public health workers ......... 23.9 Mental health medico-legal prob- lems .......................... 21.8 How to develop programs for the control of mental disorders. . ... 21.3 Role of the private sector in men- tal health programing and fi- nancing .................... 20.4 Utilization of mental health data for program evaluation ........ 20.3 Budget planning for mental health programs ..................... 17.6 Social breakdown syndrome ...... 16.2 Psychiatric registers ............. 10.4 Topics Noted by the Lowest Percents of Respondents and School At- tended.—What are the lowest percents of respondents to indicate that each of the 43 mental health topics was covered? The following list con- tains the 43 topics and the lowest percents of respondents that indicated their coverage. The distribution is presented in rank order and the school attended is identified: 165 166 Mental health topic Percent from school total in rank order? Respondents graduated from— Psychiatric registers .............. Social breakdown syndrome ................................ Budget planning for mental health programs .... ............ Mental health medico-legal problems ....................... Role of the private sector in mental health programing and financing. How to develop programs for the control of mental disorders . . Utilization of mental health data for program evaluation. ... How to recognize mental disorders ........................ Mental disorder casefinding role of public health workers .... Means of introducing innovation and change in mental health programs. Identification and relief of mental hazards ................. Principles of comprehensive mental health planning ........ Principles of consultation Psychiatric rehabilitation agencies and services ............. Psychiatric rehabilitation functions of public health workers. . “Anticipatory guidance” as related to the primary prevention of mental disorders. Methods for care of patients with mental disorders .......... Coordinating interagency relationships in mental health ..... Sources of epidemiological data on mental disorders ........ Survey of personality theories .............................. State, local, and Federal mechanisms for financing mental health programs. Comprehensive community mental health centers ............ Means of improving the mental health functioning of com- munity care givers. Organization and delivery of mental health services .......... Adjustment programs of ex-patients and their families ...... Principles of interviewing .................. Roles and functions of mental health specialists ............. Referral to special mental health facilities .................. Infancy and the preschool period ........................... Varieties of mental disorders .............................. Types of mental health treatment agencies and services ...... Mental health functions of basic community services in health, education, and welfare. Etiological factors in mental disorders ...................... Distribution of mental disorders in the general population .... Other preventive mental health intervention techniques ...... Sensitivity to behavioral and verbal cues .................... Role of conscious and unconscious factors .................. Individual personality dynamics ............................ Role of the family ................................. Small-group interaction ............... 0 Public attitudes toward the mentally ill .................... Importance of feelings and emotions ........................ Understanding a client’s attitudes, fears, and prejudices ...... 48 9.4 10.2 10.4 10.6 11.9 12.2 15.8 16.1 18.2 19.5 19.7 19.7 20.1 20.3 20.6 20.9 21.4 21.6 21.9 22.1 22.5 22.8 24.0 25.7 26.2 26.6 27.5 284 28.7 29.9 30.3 31.4 32.1 32.2 40.0 40.3 40.6 40.6 45.0 45.2 50.0 51.1 North Carolina Pittsburgh North Carolina Do Do Do Pittsburgh Berkeley Pittsburgh North Carolina Berkeley North Carolina Yale North Carolina Berkeley Pittsburgh Berkeley North Carolina Minnesota UCLA North Carolina Do Pittsburgh North Carolina Berkeley Yale North Carolina Do UCLA Berkeley North Carolina Do Berkeley Minnesota Pittsburgh Do UCLA Pittsburgh Do Do Berkeley Pittsburgh Do * Total for each school equals 100.0 percent. As noted from the above list, the lowest percents of respondents to report coverage of any of the 43 mental health topics originated with six of the schools. No such respondents were in the Columbia, Harvard, Hopkins, Michigan, and Tulane groups. Topics Noted by the Lowest Percents of Respondents From Each School—Which mental health topics were least frequently covered ac- cording to respondents from each of the 11 schools? Three of the 17 topics which were not covered in the view of a single majority of respondents from any of the schools fell also among the least frequently noted topics: Respondents graduated Percent from from— Mental health topics least frequently reported school total * Berkeley ............. Psychiatric registers .................. 8.8 UCLA ................|....... Do 10.9 Columbia ............[....... Do 18.7 Harvard ..............| ...... Do 18.6 Hopkins .............. Social breakdown syndrome .......................... 21.1 Michigan ............. Psychiatric registers ................ 5.1 Minnesota ............| ..... DO 5.4 North Carolina ........[ ... ... Do 4.8 Pittsburgh ............ Social breakdown syndrome .......................... 9.4 Tulane ............... Psychiatric registers .................... 16.0 Yale ................ |... Do 16.4 Budget planning for mental health programs .......... 16.4 * Total for each school equals 100.0 percent. IN SUMMARY, in the basic area, the most frequently indicated covered topic was importance of feelings and emotions (61.7 percent). The replies indicating its coverage ranged from 50.0 percent in the Pittsburgh group to 74.6 percent in the Yale group. The smallest group of respondents noting coverage of a mental health topic in the basic area was for survey of personality theories (32.3 percent). The lowest percent of respondents to indicate coverage of this topic was 21.9 percent in the UCLA group, and the highest, 50.0 percent of the Yale group. In the general area, the topic public attitudes toward the mentally ill (54.4 percent) was most frequently indicated as covered. The lowest per- cent to note this topic was 45.2 percent in the Berkeley group; the highest, 77.9 percent in the Yale group. The smallest group of respondents noting coverage of a mental health topic in the general area was for psychiatric registers (10.4 percent). The replies noting coverage of this topic ranged from 4.8 percent in the North Carolina group to 24.4 percent in the Hopkins group. In the specialized area, the most frequently indicated mental health topic covered was types of mental health treatment agencies and services (43.2 percent). The responses to this topic ranged from 29.9 percent in the North Carolina group to 56.0 percent in the Columbia group. Social break- down syndrome (16.2 percent) was the topic least noted as covered in the 167 168 specialized area. In the Pittsburgh group was the lowest percent (9.4 percent) who indicated its coverage; the highest percent was 30.0 percent in the Columbia group. The highest percent of respondents who indicated coverage of a men- tal health topic was 77.9 percent in the Yale group for public attitudes toward the mentally ill. The lowest percent of respondents to report cover- age of a topic was 4.8 percent in the North Carolina group for psychiatric registers. Six of the 43 mental health topics were covered according to the highest percents of respondents from each of the schools: Understanding a client’s attitudes, fears, and prejudices, public attitudes toward the men- tally ill, small group interaction, sources of epidemiological data on mental disorders, role of the family, and importance of feelings and emotions. Three of the 43 topics were covered according to the lowest percents of respondents from each of the schools: Psychiatric registers, social breakdown syndrome, and budget planning for mental health programs. QUALITY OF PRESENTATION * A large number of the respondents who indicated coverage of mental health topics considered them to have been well-presented. The median percent for well-presented mental health topics was 70.0 percent; this median percent was similar to that for well-presented coverage of the mental health aspects of the 31 public health topics (70.7 percent). The median percent for those who indicated well-presented for the nine basic area topics was 75.7 percent, for the 26 general area topics 69.3 percent, and for the eight specialized area topics 68.0 percent. The median percent for mental health topics not well-presented was 13.9 percent, or slightly higher than for those public health topics judged as not well-presented (12.6 percent). The median percents for do not recall were 13.7 percent and for nonresponse 1.9 percent (see table 9:3). Of the 43 mental health topics, the highest percents of respondents considered both small-group interaction (80.0 percent) and understanding a client's attitudes, fears, and prejudices (80.3 percent) well-presented; these topics were within the basic area. In the general area, the highest percents of respondents rated principles of interviewing (79.0 percent) and principles of consultation (78.6 percent) well-presented; in the specialized area, social breakdown syndrome which was covered only in accordance to 16.2 percent of all respondents was well-presented in the view of the highest percent of respondents (71.3 percent). The topic in the basic area considered to be well-presented by the lowest percent of respondents was survey of personality theories reported by 69.3 percent, a substantial group of those who indicated its coverage. The mental health topic in the general area which the lowest percent of re- ? Responses based only on positive responses to coverage, not on total number of respondents. 691 TABLE 9:3.—Quality of presentation of mental health topics covered in school of public health training [Medians and range of percents of respondents] Well-presented, Not well presented, Do not recall, Nonresponses, percent of percent of percent of percent of respondents respondents respondents respondents Number of items Median Range Median Range Median Range Median Range Mental health topics 43 70.0 | 80.3-63.7 139 | 19.3- 94 13.7 | 194-59 1.9 3.0-1.0 Basicarea .......................... 9 75.7 | 80.3-69.3 12.8 | 18.8-10.1 88 | 103-59 2.0 3.0-1.3 Personality theory .............. 4 742 | 77.4-69.3 146 | 18.8-12.7 94 | 10.3- 8.6 15 2.1-1.3 Socialization .................. .. 120 757-739 |... 139-128 |......... 103-95 |......... 2.0-1.9 Interpersonal relations .......... 3 80.3-76.9 |. ........ 122-10.1 |... ... 82-59 |......... 3.0-24 Generalarea ........................ 26 69.3 | 79.0-63.7 145 | 193-94 13.8 | 19.3- 6.2 2.1 29-14 Techniques ..................... 7 72.2 | 79.0-70.1 13.3 | 151-129 12.0 | 13.7- 6.2 1.9 29-17 Administration .................. 13 66.2 | 70.1-63.7 153 | 19.3-12.3 16.5 | 19.3-12.6 2.1 2.7-14 Information ..................... 6 70.5 | 74.3-68.5 132 | 164-94 13.8 | 15.6-12.5 22 2.5-1.6 Specialized area ..................... 8 68.0 | 71.3-65.9 13.4 | 164-115 16.6 | 19.4-13.9 1.6 2.0-1.0 Secondary prevention ............ 5 68.1 | 71.3-65.9 143 | 164-115 154 | 194-139 1.6 2.0-1.0 Tertiary prevention ............. 3 69.5-66.9 |......... 135-119 |. ........ 182-17.0 |......... 1.8-1.3 * Medians are reported only for sections containing 4 or more topics. 170 spondents considered well-presented was organization and delivery of men- tal health services; yet, this topic was noted by 63.7 percent of those who indicated its coverage. In the specialized area, the topic considered by the lowest percent as well-presented was types of mental health treatment agencies and services noted also by a relatively large group, 65.9 percent of those who reported its coverage. The twofold approach in examining the responses to quality of pres- entation of the mental health topics was identical to that employed in the previous chapter on the mental health aspects of the public health topics: (1) Which topics were well-presented according to the highest / lowest percents of respondents with the schools attended identified? (2) Which topics were considered well-presented by the highest lowest percents of respondents from each of the eleven schools individually? Mental Health Topics Most Frequently Considered Well-Presented in Schools of Public Health Topics Noted by the Highest Percents of Respondents and School Attended.—The highest percents of respondents who considered that the 43 mental health topics were well-presented are reported below in rank order with the school attended identified: Percent from Respondents Mental health topic school total graduated in rank order!’ from— Importance of feelings and emotions ........................ 90.7 | Tulane Principles of interviewing ..................... 000. 88.1 | Minnesota Public attitudes toward the mentally ill .................... 87.9 | Tulane Small-group interaction ..................... 87.8 | Columbia Understanding a client’s attitudes, fears, and prejudices ...... 85.7 | Minnesota Sensitivity to behavioral and verbal cues .................... 85.7 Do Means of introducing innovation and change in mental health 85.5 | Harvard programs. Role of conscious and unconscious factors .................. 84.7 | Minnesota Principles of consultation .................................. 84.5 | Harvard Individual personality dynamics ........................... 84.4 | Minnesota Infancy and the preschool period .......................... 83.9 Do Distribution of mental disorders in the general population ... 83.3 | Tulane Types of mental health treatment agencies and services ...... 82.7 Do Role of the family ........................................ 82.0 Do Identification and relief of mental hazards .................. 81.9 | Columbia How to recognize mental disorders ......................... 81.7 | Harvard Adjustment problems of ex-patients and their families ...... 81.4 | Yale “Anticipatory guidance” as related to the primary prevention 80.9 | Minnesota of mental disorders. Varieties of mental disorders ............................... 80.7 | Tulane Mental health medico-legal problems ...................... 80.5 | Columbia Social breakdown syndrome ............................... 80.0 | Harvard Budget planning for mental health programs ................ 80.0 | Columbia Mental health casefinding role of public health workers ...... 79.7 Do Psychiatric rehabilitation agencies and services .............. 79.3 | Yale Comprehensive community mental health centers ............ 79.2 Do Survey of personality theories .............................. 78.1 | Minnesota Means of improving the mental health functioning of com- 78.1 | Hopkins munity care givers. Roles and functions of mental health specialists ............. 78.0 | Minnesota Principles of comprehensive mental health planning ......... 77.9 | Columbia Etiological factors in mental disorders ...................... 77.6 Do How to develop programs for the control of mental disorders . . 71.5 Do Coordinating interagency relationships in mental health ..... 774 Do Methods for care of patients with mental disorders ......... 77.4 Do Other preventive mental health intervention techniques... ... 77.0 | Hopkins State, local, and Federal mechanisms for financing mental 76.4 | Columbia health programs. Sources of epidemiological data on mental disorders ........ 76.4 | Hopkins Referral to special mental health facilities .................. 76.3 | Columbia Utilization of mental health data for program evaluation .... 76.1 | Minnesota Mental health functions of basic community services in health, 75.9 | Columbia education, and welfare. Organization and delivery of mental health services .......... 78.7 Do Psychiatric rehabilitation functions of public health workers .. 72.5 Do Role of the private sector in mental health programing and 71.4 | Minnesota financing. Psychiatric registers (The total number of respond- ents reporting coverage of this topic in any school was less than 50.) * Total for each school based on responses to covered topics equals 100.0 percent. 171 172 As may be observed from the above list, the highest percents of respondents to note that the 43 covered mental health topics were well-presented originated with six of the schools. No such respondents were in the Berkeley, UCLA, Michigan, North Carolina, or Pittsburgh groups. Respondents from Columbia noted the largest number of mental health topics considered well-presented. Topics Noted by the Highest Percents of Respondents From Each School.—Following is a list of the highest percents of respondents from each school to indicate that a mental health topic covered in class was well-presented.: Respondents graduated Percent from from— Mental health topic school total * Berkeley .............. Principles of consultation ......................... ... 79.2 UCLA ................ Role of conscious and unconscious factors ............. 82.7 Columbia ............ Small-group interaction .............................. 87.8 Harvard .............. Means of introducing innovation and change in mental 85.5 health programs. Hopkins .............. Infancy and the preschool period ................... .. 82.4 Michigan ............. Understanding a client’s attitudes, fears, and prejudices 83.1 Minnesota ............ Principles of interviewing .......................... .. 88.1 Importance of feelings and emotions ................. 87.5 North Carolina ........| Principles of consultation ............................ 83.9 Pittsburgh ....... .. ... Principles of interviewing ........ ................ .. .. 79.4 Understanding a client’s attitudes, fears, and prejudices 79.3 Tulane ............... Importance of feelings and emotions .................. 90.7 Yale .................. Understanding a client's attitudes, fears, and prejudices 82.4 Public attitudes toward the mentally ill ............ .. 82.1 * Total for each school based on responses to covered topics equals 100.0 percent. Mental Health Topics Least Frequently Considered Well-Presented in Schools of Public Health Topics Noted by the Lowest Percents of Respondents and School Attended.—The 43 mental health topics judged by the lowest percents of respondents as well-presented and the schools that they attended follows: Mental health topic Percent from school total in rank order’ Respondents graduated from— Organization and delivery of mental health services How to recognize mental disorders Psychiatric rehabilitation agencies and services Principles of comprehensive mental health planning Types of mental health treatment agencies and services How to develop programs for the control of mental disorders Distribution of mental disorders in the general population ... Mental health medico-legal problems Psychiatric rehabilitation functions of public health workers . . Utilization of mental health data for program evaluation .... Coordinating interagency relationships in mental health Identification and relief of mental hazards State, local, and Federal mechanisms for financing mental health programs. Budget planning for mental health programs Mental health functions of basic community services in health, education, and welfare. Methods for care of patients with mental disorders Comprehensive community mental health centers Adjustment problems of ex-patients and their families Role of the private sector in mental health programing and financing. Etiological factors in mental disorders Sources of epidemiological data on mental disorders Survey of personality theories Means of introducing innovation and change in mental health programs. Roles and functions of mental health specialists Social breakdown syndrome Principles of interviewing Other preventive mental health intervention techniques Varieties of mental disorders Mental disorder casefinding role of public health workers .... Means of improving the mental health functioning of com- munity care givers. Role of conscious and unconscious factors Infancy and the preschool period Individual personality dynamics Role of the family Referral to special mental health facilities Public attitudes toward the mentally ill .................. .. Principles of consultation Sensitivity to behavioral and verbal cues “Anticipatory guidance” as related to the primary prevention of mental disorders. Importance of feelings and emotions Small-group interaction Understanding a client's attitudes, fears, and prejudices .... Psychiatric registers 49.5 51.9 52.3 53.9 54.7 54.9 55.4 55.6 55.6 56.0 58.0 58.1 58.5 58.8 58.9 59.5 60.5 60.6 61.0 61.7 61.8 62.0 62.5 62.9 63.4 63.8 63.8 64.0 64.0 64.2 64.5 65.1 66.8 67.7 67.9 68.5 69.2 70.3 70.5 72.0 72.4 75.2 North Carolina Berkeley Do UCLA Berkeley UCLA Minnesota Michigan UCLA Do Do Michigan Berkeley Do UCLA Do Minnesota Berkeley Do North Carolina Michigan Columbia Berkeley Do Do Hopkins Pittsburgh North Carolina Berkeley Do North Carolina Yale North Carolina Berkeley Michigan and Yale Berkeley and Pittsburgh Hopkins Yale Berkeley North Carolina Yale Berkeley (The total number of respond- ents reporting coverage of this topic in any school was less than 50.) * Total for each school based on responses to covered topics equals 100.0 percent. 173 174 As noted from the above list, the lowest percents of respondents to indicate that the 43 covered mental health topics were well-presented originated with nine of the schools. No such respondents were in the Harvard or Tulane groups. Topics Noted by the Lowest Percents of Respondents From Each School.—The lowest percents of respondents from each school to indicate that the mental health topics covered in class had been well-presented were as follows: Respondents graduated Percent from from— Mental health topic school total? Berkeley .............. Psychiatric rehabilitation agencies and services ........ 52.3 How to recognize mental disorders .................... 51.9 UCLA ............... Principles of comprehensive mental health planning .... 53.9 Columbia ............ Survey of personality theories ........................ 62.0 Harvard .............. How to develop programs for the control of mental 59.4 disorders. Hopkins .............. Principles of comprehensive mental health planning .... 62.7 Michigan ............. Mental health medico-legal problems .................. 55.6 Minnesota ............ Distribution of mental disorders in the general popu- 55.4 lation. North Carolina ........ Organization and delivery of mental health services .... 49.5 Pittsburgh ............ Mental health functions of basic community services in 61.3 health, education, and welfare. Tulane .............. Etiological factors in mental disorders ................ 77.2 Yale .................. Survey of personality theories ........................ 62.3 Organization and delivery of mental health services .... 61.8 * Total for each school based on responses to covered topics equals 100.0 percent. IN suMMARY, the covered mental health topics like the covered mental health aspects of public health topics were generally considered to be well- presented. The highest percent of respondents indicating that a mental health topic was well-presented was understanding a client’s attitudes, fears, and prejudices (80.3 percent). Respondents so appraising this topic ranged from 75.2 percent in the Berkeley group to 85.7 percent in the Minnesota group. Next highest was the topic small-group interaction (80.0 percent) . This distribution ranged from 72.4 percent in the Yale group to 87.8 percent in the Columbia group. The lowest percent of respondents indicating that a mental health topic was well-presented was 63.7 percent for organization and delivery of mental health services. The frequency of this reply ranged from 49.5 percent in the North Carolina group to 73.7 percent in the Columbia group. The highest percent of respondents who considered a mental health topic well-presented was 90.7 percent in the Tulane group who so rated the presentation on importance of feelings and emotions. The lowest per- cent of respondents considering a covered topic well-presented was 49.5 percent in the North Carolina group who made that indication for organization and delivery of mental health services. The highest percents of respondents from each of the schools indi- cated as well-presented the following mental health topics: Importance of feelings and emotions, role of conscious and unconscious factors, infancy and the preschool period, small-group interaction, understanding a client’s attitudes, fears, and prejudices, means of introducing innovation and change in mental health programs, principles of interviewing, principles of con- sultation, and public attitudes toward the mentally ill. The lowest percents of respondents from each of the schools indicated that the following mental health topics were well-presented: Principles of comprehensive mental health planning, how to develop programs for the control of mental dis- orders, mental health medico-legal problems, distribution of mental dis- orders in the general population, organization and delivery of mental health services, mental health functions of basic community services in health, education, and welfare, etiological factors in mental disorders, how to recognize mental disorders, survey of personality theories, and psychiatric rehabilitation agencies and services. USEFULNESS IN WORK?* Overall, the mental health topics covered were considered of great use by relatively small numbers of respondents as indicated by a median re- sponse of 20.8 percent. A much larger group rated these topics as of moderate use as indicated by the median response of 34.0 percent. A somewhat smaller group rated the topics of little use to their work as suggested by the median of 32.6 percent. This median was lower than the median response of little use for mental health aspects of public health topics (36.8 percent). As indicated by the medians also, more than twice as many respondents considered topics in the basic area (46.5 percent) to be of great use than topics in the general area (19.1 percent) or in the specialized area (20.2 percent). The median distribution of responses suggests that the coverage of mental health topics in the basic area was more likely to be considered of great use, topics in the general area to be of little use, and topics in the specialized area in the directions of moderate use (35.9 percent) and of little use (35.2 percent) (see table 9:4). The twofold approach in examining the responses on usefulness in work of the mental health topics is identical to the procedure employed in the previous chapter on usefulness in work of the mental health aspects of the public health topics: (1) To what extent did a plurality or majority of respondents indicate that a given topic was of great, of moderate, or of little use? (2) Which topics were considered of great, of moderate, or of little use by respondents from individual schools? Of Great Use Ten of the topics covered were considered by a plurality or majority of respondents to be of great use rather than of moderate or of little use: * Responses based only on positive responses to coverage, not on total number of respondents. 175 9LI TABLE 9:4.—Usefulness in work of mental health topics covered in school of public health training [Medians and range of percents of respondents] Of great use, Of moderate use, Of little use, Nonresponses, percent of percent of percent of percent of Number respondents respondents respondents respondents of items Median Range Median Range Median Range Median Range Mental health topics 43 20.8 | 54.0-14.7 34.0 | 41.3-23.3 32.6 | 50.8-10.3 8.9 11.1-4.7 Basic area .......................... 9 46.5 | 54.0-30.9 35.2 | 36.3-30.1 13.3 | 28.1-10.3 5.7 7.44.7 Personality theory ............... 4 43.6 | 47.0-34.7 35.8 | 36.3-35.4 15.1 | 23.6-12.9 5.2 6.14.7 Socialization .................... 12 0... 349-309 |... ...... 352-336 |......... 281-228 |......... 74-17.0 Interpersonal relations .......... 13 54.0498 |. ........ 31.7-80.1 |......... 128-103 |... ...... 6.6-5.2 General area ........................ 26 19.1 | 49.5-14.7 32.0 | 41.3-23.3 348 | 50.8-15.0 9.5 10.9-5.5 Techniques ..................... 7 34.5 | 49.5-25.2 31.6 | 329-295 24.7 | 33.2-15.0 7.8 9.2-5.5 Administration .................. 13 184 | 20.9-14.7 315 | 41.3-23.3 39.6 | 50.8-29.7 9.5 10.8-7.5 Information ..................... 6 18.3 | 219-154 37.0 | 38.9-25.3 34.3 | 49.7-31.5 9.7 10.9-9.3 Specialized area ..................... 8 20.2 | 26.3-15.4 35.9 | 40.1-34.0 35.2 | 36.8-28.0 9.2 11.1-7.7 Secondary prevention ............ 5 21.7 | 263-154 37.3 | 40.1-34.0 31.9 | 36.3-28.0 8.38 11.1-7.7 Tertiary prevention .............. 3 196-182 |. ........ 36.2-35.1 |......... 36.8-35.1 |......... 9.9-9.5 * Medians are reported only for sections containing 4 or more topics. Understanding a client’s attitudes, fears, and prejudices (54.0 percent), importance of feelings and emotions (47.0 percent), individual personality dynamics (46.5 percent), role of conscious and unconscious factors (40.7 percent), sensitivity to behavioral and verbal cues (49.8 percent), small- group interaction (50.2 percent), anticipatory guidance (39.6 percent), principles of consultation (49.5 percent), principles of interviewing (48.9 percent), and other preventive mental health intervention techniques; e.g., community organization, mental health education, parent education, and crisis intervention (34.5 percent). The mental health topics considered by the lowest percents of respond- ents as of great use to their work were as follows: Distribution of mental disorders in the general population (14.7 percent), role of the private sector in mental health programing and financing (14.7 percent), State, local, and Federal mechanisms for financing mental health programs (14.8 percent), psychiatric registers (15.4 percent), and types of mental health treatment agencies and services (15.4 percent). The highest percents of respondents from each school to consider that the mental health topics covered were of great use were as follows: Respondents graduated Percent from from— Mental health topic school total * Berkeley ............. Principles of consultation ............................ 59.4 UCLA ............... Sensitivity to behavioral and verbal cues .............. 51.6 Columbia ............ Small-group interaction .............................. 55.3 Harvard ............. Principles of consultation ............................ 40.8 Hopkins .............. Understanding a client’s attitudes, fears, and prejudices 51.1 Michigan .............| ..... Do 60.4 Minnesota ............ Importance of feelings and emotions .................. 65.9 North Carolina ....... Understanding a client's attitudes, fears, and prejudices 51.5 Principles of consultation ............................ 52.2 Pittsburgh ............ Principles of interviewing ............................ 47.6 Tulane ............... Understanding a client’s attitudes, fears, and prejudices 58.9 Yale ................. Do 55.4 * Total from each school based on responses to covered topics equals 100.0 percent. The lowest percents of respondents from each school to consider that a topic was of great use were as follows: 177 178 Respondents graduated Mental health topic Percent from from— school total! Berkeley .............. State, local, and Federal mechanisms for financing men- 14.5 tal health programs. Role of the private sector in mental health programing 15.0 and financing. UCLA ................ State, local, and Federal mechanisms for financing men- 9.6 tal health programs. Columbia ............. Adjustment problems of ex-patients and their families .. 15.9 Harvard .............. Psychiatric rehabilitation functions of public health 8.3 workers. Hopkins .............. Distribution of mental disorders in the general popu- 12.0 lation. How to develop programs for the control of mental 12.1 disorders. Michigan ............. Role of the private sector in mental health programing 12.0 and financing. Minnesota ............ How to develop programs for the control of mental 6.0 disorders. North Carolina ....... Types of mental health treatment agencies and services 10.9 State, local, and Federal mechanisms for financing men- 10.8 tal health programs. Varieties of mental disorders .......................... 10.7 Pittsburgh ........... |... .. Do 9.0 Tulane ............... Types of mental health treatment agencies and services 9.6 Yale .................. Varieties of mental disorders ......................... 10.4 * Total from each school based on responses to covered topics equals 100.0 percent. To review, the six topics which the highest percents of respondents from each school considered of great use consisted of four in the basic area; i.e., sensitivity to behavioral and verbal cues, small-group interaction, understanding a client’s attitudes, fears, and prejudices, and the importance of feelings and emotions, and two topics in the general area; i.e., principles of consultation and principles of interviewing. None of the specialized area topics covered were considered of great use by the highest percents of respondents from any school. The highest percent of respondents from any school to consider a topic of great use was 65.9 percent from Minnesota in noting the importance of feelings and emotions. Of the eight topics described by the lowest percents of respondents from each school as of great use, five were in the general area; i.e., role of the private sector in mental health programing and financing, State, local, and Federal mechanisms for financing mental health programs, distribu- tion of mental disorders in the general population, how to develop pro- grams for the control of mental disorders, and varieties of mental disorders. The remaining three topics—adjustment problems of ex-patients and their families, types of mental health treatment agencies and services, and psy- chiatric rehabilitation functions of public health workers—were within the specialized area. Not one of the basic area topics covered was considered by the lowest percents of respondents from any school to be of great use to their work. Of Moderate Use Eighteen of the topics were considered by a plurality of respondents to be of moderate rather than of great or of little use: Identification and relief of mental hazards (41.3 percent), survey of personality theories (86.1 percent), infancy and the preschool period (33.6 percent), means of improving the mental health functioning of community care givers (32.9 percent), referral to special mental health facilities (32.3 percent), coor- dinating interagency relationships in mental health (36.5 percent), mental health functions of basic community services in health, education, and welfare (37.4 percent), mental health medico-legal problems (37.9 percent), etiological factors in mental disorders (38.9 percent), public attitudes toward the mentally ill (37.3 percent), roles and functions of mental health specialists (36.6 percent), varieties of mental disorders (38.1 percent), how to recognize mental disorders (38.1 percent), men- tal disorder casefinding role of public health workers (34.0 percent), social breakdown syndrome (40.1 percent), types of mental health treatment agencies and services (37.3 percent), adjustment problems of ex-patients and their families (36.2 percent), and psychiatric rehabilitation functions of public health workers (35.5 percent). The role of the family was considered by the highest percents of respondents either as of moderate use (35.2 percent) or of great use (34.9 percent) . Budget planning for mental health programs (23.3 percent) was considered as of moderate use by the lowest percent of respondents. The highest percents of respondents from each school to consider that a covered mental health topic was of moderate use were as follows: Respondents graduated Percent from from— Mental health topic school total * Berkeley .............. Adjustment problems of ex-patients and their families. . 424 Identification and relief of mental hazards ............ 42.0 UCLA ................ Etiological factors in mental disorders ................ 43.2 Mental disorder casefinding role of public health workers. 429 Columbia ............ Identification and relief of mental hazards ............ 46.8 Harvard .............. Social breakdown syndrome .......................... 54.0 Hopkins .............. Psychiatric rehabilitation functions of public health 44.6 workers. Michigan ............. Social breakdown syndrome .......................... 49.1 Minnesota ............ Identification and relief of mental hazards ............. 51.2 North Carolina ....... Mental health functions of basic community services in 43.6 health, education, and welfare. Coordinating interagency relationships in mental health. 44.4 Pittsburgh ............ Etiological factors in mental disorders ................ 50.0 Tulane ............... Types of mental health treatment agencies and services. . 55.8 Yale ................. Adjustment problems of ex-patients and their families. . 44.1 ! Total from each school based on responses to covered topics equals 100.0 percent. 179 180 The lowest percents of respondents from each school considered that the following topics were of moderate use: Respondents graduated Percent from from— Mental health topic school total * Berkeley .............. Principles of consultation ............................ 24.6 UCLA .......... ...... Understanding a client's attitudes, fears, and prejudices. . 23.8 Columbia ...... ..... .. State, local, and Federal mechanisms for financing mental 27.3 health programs. Harvard ........... ... Comprehensive community mental health centers. ...... 11.0 Hopkins .............. Principles of comprehensive mental health planning... . 18.6 Michigan ............. Budget planning for mental health programs. .......... 21.0 Minnesota ............ Principles of interviewing. ............ 0 00.. 22.6 North Carolina ....... How to develop programs for the control of mental 21.8 disorders. Pittsburgh ......... ... Adjustment problems of ex-patients and their families. . 20.0 Tulane ............... Understanding a client's attitudes, fears, and prejudices. . 25.0 Yale .................. Other preventive mental health intervention techniques. . 11.3 * Total from each school based on responses to covered topics equals 100.0 percent. In other words, the nine topics which the highest percents of respond- ents from each school considered of moderate use consisted of five special- ized area topics; i.e., adjustment problems of ex-patients and their families, mental disorder casefinding role of public health workers, social breakdown syndrome, psychiatric rehabilitation functions of public health workers, and types of mental health treatment agencies and services, and four topics in the general area; i.e., identification and relief of mental hazards, etiological factors in mental disorders, coordinating interagency relation- ships in mental health, and mental health functions of basic community services in health, education, and welfare. None of the basic area topics covered were considered of moderate use by the highest percents of re- spondents from any school. The highest percent of respondents from any school to consider a topic of moderate use was 55.8 percent from Tulane who so designated types of mental health treatment agencies and services. Of the 10 topics described by the lowest percents of respondents from each school as of moderate use, eight were in the general area; i.e., principles of consultation, State, local, and Federal mechanisms for financing mental health programs, comprehensive community mental health centers, prin- ciples of comprehensive mental health planning, budget planning for men- tal health programs, principles of interviewing, how to develop programs for the control of mental disorders, and other preventive mental health intervention techniques. The remaining two topics considered by the lowest percents of respondents to be of moderate use were: Understanding a client’s attitudes, fears, and prejudices in the basic area, and adjustment problems of ex-patients and their families in the specialized area. Of Little Use Of the 43 topics, 14 were considered by a plurality or majority of respondents to be of little use rather than of great or of moderate use: Budget planning for mental health programs (50.8 percent), means of introducing innovation and change in mental health programs (33.2 per- cent) , comprehensive community mental health centers (44.5 percent), dis- tribution of mental disorders in the general population (38.8 percent), how to develop programs for the control of mental disorders (44.1 percent), or- ganization and delivery of mental health services (39.6 percent), principles of comprehensive mental health planning (39.1 percent), role of the private sector in mental health programing and financing (45.4 percent), State, local, and Federal mechanisms for financing mental health programs (47.2 percent), utilization of mental health data for program evaluation (40.2 percent), psychiatric registers (49.7 percent), sources of epidemiological data on mental disorders (40.9 percent), methods for care of patients with mental disorders (35.6 percent), and psychiatric rehabilitation agencies and services (36.8 percent). Understanding a client’s attitudes, fears, and prejudices (10.3 percent) was considered of little use by the lowest percent of respondents. The mental health topics considered by the highest percents of respondents from each school to be of little use were as follows: Respondents graduated Percent from from— Mental health topic school total * Berkeley .............. Role of the private sector in mental health programing 43.0 and financing. UCLA ................ State, local, and Federal mechanisms for financing mental 52.9 health programs. Columbia ............. Psychiatric rehabilitation agencies and services. ........ 39.6 Harvard .............. Budget planning for mental health programs.......... 67.6 Hopkins .............. State, local, and Federal mechanisms for financing men- 57.7 tal health programs. Michigan ............. Budget planning for mental health programs.......... 53.2 Minnesota ............ How to develop programs for the control of mental 56.0 disorder. North Carolina ....... State, local, and Federal mechanisms for financing men- 53.9 tal health programs. Pittsburgh ............ Adjustment problems of ex-patients and their families. . 50.0 Tulane ............... Etiological factors in mental disorders. ................. 36.8 Yale .................. Distribution of mental disorders in the general popula- 49.4 tion. * Total from each school based on responses to covered topics equals 100.0 percent. The topics considered by the lowest percents of respondents from each school to be of little use were as follows: 181 182 Respondents graduated Percent from from— Mental health topic school total! Berkeley .............. Individual personality dynamics. ...................... 9.5 Importance of feelings and emotions. .................. 9.4 UCLA ................ Sensitivity to behavioral and verbal cues... ........ .... 11.6 Columbia ......... .... Understanding a client’s attitudes, fears, and prejudices. . 9.9 Harvard .............. Individual personality dynamics. ...................... 18.2 Importance of feelings and emotions. .................. 17.7 Hopkins .............. Understanding a client's attitudes, fears, and prejudices. . 9.6 Michigan .............| ..... Do... 6.2 Minnesota ............|. ..... Do 6.6 North Carolina ....... Principles of consultation... ................ ..... .. 9.1 Pittsburgh ...... ..... Understanding a client's attitudes, fears, and prejudices 12.0 Tulane ............... Importance of feelings and emotions. .................. 13.0 Understanding a client’s attitudes, fears, and prejudices. . 12.5 Yale ........ ooo Do 12.2 Small-group interaction .............................. 11.8 * Total from each school based on responses to covered topics equals 100.0 percent. In other words, two of the eight specialized area topics appeared among those which the highest percents of respondents from each school considered to be of little use in their work: Psychiatric rehabilitation agencies and services, and adjustment problems of ex-patients and their families. The remaining six topics, all in the general area, which the highest percents of respondents from each school considered of little use included: Role of the private sector in mental health programing and financing, State, local, and Federal mechanisms for financing mental health programs, budget planning for mental health programs, how to develop programs for the control of mental disorders, etiological factors in mental disorders, and distribution of mental disorders in the general population. None of the basic area topics appeared among those which the highest percents of respondents from each school considered to be of little use. The highest percent of respondents from any school to consider a topic of little use was 67.6 percent from Harvard who did so in regard to budget planning for mental health programs. Of the six topics described by the lowest percents of respondents from each school as of little use, five were in the basic area; i.e., importance of feelings and emotions, individual personality dynamics, sensitivity to be- havioral and verbal cues, understanding a client's attitudes, fears, and prejudices, and small-group interaction. The remaining topic, principles of consultation, was within the general area. None of the specialized area topics covered was considered of little use by the lowest percents of respondents from each school. OVERVIEW One-half or more respondents from one or more of the schools indi- cated that 26 of the 43 mental health topics listed were covered during their training in a school of public health. A majority of respondents from each of the I1 schools indicated coverage of at least one of the mental health topics listed. The number of mental health topics covered by schools according to the majorities of respondents were: Yale 22, Columbia 20, Tulane 14, UCLA 12, Minnesota 10, Harvard eight, North Carolina eight, Berkeley seven, Hopkins six, Michigan five, and Pittsburgh two. Majorities of respondents from each of the schools noted that both the importance of feelings and emotions and understanding a client's attitudes, fears, and prejudices had been covered. The highest percents of respondents from each school indicated that the following mental health topics were covered: Understanding a client’s attitudes, fears, and prejudices, public attitudes toward the mentally ill, small-group interaction, sources of epidemiological data on mental disorders, role of the family, and importance of feelings and emotions. Generally, coverage of mental health topics in the basic area was noted by more respondents than for topics in the general area; least noted were topics in the specialized area. As with the mental health aspects of public health topics, in general, the mental health topics were considered well-presented by roughly two- thirds of those who reported their coverage. The topics considered well- presented by the highest percents of respondents were small-group interaction and understanding a client’s attitudes, fears, and prejudices, while the lowest percents indicated organization and delivery of mental health services to have been well-presented. Of those who indicated coverage, the highest percents of respondents from each school considered the following topics well-presented: Impor- tance of feelings and emotions, principles of interviewing, small-group interaction, means of introducing innovation and change in mental health programs, principles of consultation, role of conscious and unconscious factors, infancy and the preschool period, understanding a client’s attitudes, fears, and prejudices, and public attitudes toward the mentally ill. The lowest percents of respondents from each school indicated the following topics as well-presented: Principles of comprehensive mental health plan- ning, how to develop programs for the control of mental disorders, mental health medico-legal problems, distribution of mental disorders in the gen- eral population, organization and delivery of mental health services, mental health functions of basic community services in health, education, and welfare, etiological factors in mental disorders, how to recognize mental disorders, survey of personality theories, and psychiatric rehabilitation agencies and services. Mental health topics covered were considered of great use by relatively few respondents. Furthermore, respondents were more likely to consider more often topics in the basic area as of great use than topics either in the general area or in the specialized area. A total of 10 of the mental health topics were considered by a majority or by a plurality of respondents to be of great use, 18 of moderate use, and 14 of little use. 183 184 The mental health topic which the highest percent of respondents considered to be of great use was understanding a client's attitudes, fears, and prejudices. Five topics were deemed of great use by the lowest percents of respondents: Distribution of mental disorders in the general population, role of the private sector in mental health programing and financing, State, local, and Federal mechanisms for financing mental health programs, psychiatric registers, and types of mental health treatment agencies and services. The highest percent of respondents from any school to consider a topic covered as of great use was 65.9 percent from Minnesota with respect to the importance of feelings and emotions. The highest percent of re- spondents from any one school to indicate that a topic was of moderate use was 55.8 percent from Tulane who noted types of mental health treatment agencies and services. The highest percent of respondents from any one school to indicate a topic of little use was 67.6 percent from Harvard for the topic budget planning for mental health programs. MENTAL HEALTH PE IN PUBLIC HEALTH PRACTICE RELATIONSHIPS CHATTER 1 OF MENTAL HEALTH TO PUBLIC HEALTH TRAINING AND PRACTICE INTEREST IN MENTAL HEALTH PROMPTED BY TRAINING IN A SCHOOL OF PUBLIC HEALTH S indicated earlier, over two-thirds of the respondents had not had A any experience in mental health work prior to the time they registered in a school of public health. Furthermore, slightly more than two-thirds of those who had no experience in mental health work indicated that they felt no need for training in this field. Almost two-thirds of all respondents, however, were exposed to contacts with mental health professionals on the faculty during their public health training, although slightly less than two-fifths took one or more courses listed as mental health in the catalog of the school. To what extent do respondents credit training experiences in a school of public health—through course work, interactions with faculty, or discussion in different contexts—as having prompted their own interest in mental health? This chapter explores how public health workers per- ceive the level of interest in mental health which was prompted in them by their public health training, the importance of mental health training to public health practice, and the usefulness of their total public health training to their present work functions. According to 1,145 or 36.8 percent of the respondents their public health training prompted little interest in mental health, to 1,119 or 35.9 percent moderate interest, and to another 515 or 16.5 percent high interest. A total of 252 or 8.1 percent held no opinion on this matter; 84 or 2.7 per- cent did not answer. Moderate interest was more frequently indicated among UCLA, Columbia, Tulane, and Yale graduates, and little interest was more fre- quently indicated among Berkeley, Harvard, and Pittsburgh graduates. Among graduates from Hopkins, Michigan, Minnesota, and North Carolina almost as many or as many held the opinions that their schools had prompted in them either moderate or little interest in mental health. Although high interest in mental health was prompted by their school of public health training for 26.0 percent of the Minnesota group, 12.8 percent in the Pittsburgh group and 13.1 percent in the Berkeley group re- ported similarly. Among Columbia graduates 40.1 percent and among Yale graduates 40.2 percent indicated that moderate interest in mental health was prompted by their public health training, while among Pittsburgh 187 188 graduates 30.0 percent also indicated the same reply. Little interest in mental health was prompted for 43.4 percent of Harvard and for 28.9 per- cent of UCLA and 29.5 percent of Yale graduates. (a.) Age—The reported level of interest in mental health prompted by public health training appears to be partially associated with age, particu- larly among the youngest and the oldest respondents. Within the 25-year- old-and-under age group, only 8.3 percent indicated that high interest in mental health was prompted by their school of public health training while 41.7 percent indicated that little interest was prompted. Among those be- tween 51 and 55 years old 24.6 percent, and among those in the 56-year-old- and-over age group 25.7 percent indicated that high interest in mental health was prompted by their public health training. On the other hand, 27.5 percent in the 5l-to bb-year-old group and 25.7 percent in the b6-year-old age group and over indicated that little interest in mental health was prompted by their public health training. (b.) Sex-—There were differences between the sexes regarding the level of mental health interest prompted by school of public health training both for high interest and little interest. A higher percent of women (26.3 per- cent) than of men (11.8 percent) noted that high interest was prompted; nonetheless, equal size percents among both men (35.9 percent) and women (36.0 percent) noted moderate interest. Among men was a higher percent (40.8 percent) than among women (28.3 percent) noting little interest. (c.) Mental health work experience prior to enrollment—Respondents who had experience in mental health work prior to attending a school of public health were quite similar to those without such experience in their judgment that schools of public health prompted moderate interest in mental health; 35.4 percent among those with such experience and 36.2 percent among those without mental health experience expressed that view. A much higher percent among those with mental health experience, 26.6 percent, than those without such experience, 12.0 percent, noted that high interest in mental health was prompted by their school of public health training. On the other hand, 40.5 percent of those without mental health experience and 28.7 percent of those with such experience considered that little interest in mental health had been prompted. (d.) Felt need for mental health training—Among those respondents with no prior mental health experience who felt a need for mental health training before attending a school of public health 20.1 percent reported that high interest in mental health was prompted; 8.3 percent of those with no prior mental health experience who did not feel a need for mental health training indicated high interest. On the other hand, 46.7 percent of re- spondents with no prior mental health experience who did not feel a need for mental health training reported that little interest was prompted, while 26.7 percent of those with no prior mental health experience who did feel a need for mental health training noted little interest. (e.) Primary professional discipline—Among nurses was the highest percent (39.8 percent) reporting that high interest in mental health was prompted by their school of public health training. (f.) Major program pursued—The only group in which a majority of the respondents indicated that training in a school of public health prompted high interest in mental health was among Mental Health majors (56.6 per- cent) . The second highest percent of respondents, by major program, who reported high interest was among the Public Health Nursing majors (42.4 percent) . (g.) Number of mental health courses taken—Among a majority of the respondents who took three or more mental health courses, the view was held that training in a school of public health prompted high interest in mental health. In fact, the greater the number of mental health courses taken, the more likely that respondents would report that high interest in mental health was prompted; 53.2 percent of those taking three or more mental health courses noted high interest, while 29.4 percent taking two mental health courses, 17.2 percent taking one mental health course, and 9.5 percent of those taking no mental health courses noted this same level of interest. On the other hand, the fewer the number of mental health courses taken, the more likely for respondents to have reported that little interest in mental health was prompted. Among those taking no mental health courses 46.2 percent noted little interest, while the same reply was forthcoming from 29.9 percent taking one mental health course, 21.6 per- cent taking two mental health courses, and 7.7 percent taking three or more mental health courses (see app. H, table 1, p. 294). IMPORTANCE OF MENTAL HEALTH TRAINING TO PUBLIC HEALTH PRACTICE Mental health training was considered very important for the per- formance of public health work by 1,083 or 34.8 percent of all respondents, extremely important by 992 or 31.8 percent, and of some importance by 798 or 25.6 percent. In the opinion of a very small group, 37 or 1.2 percent, such training was not important at all. The highest percent of respondents indicating that mental health training was extremely important to public health work was 38.1 percent in the Minnesota group and the lowest was 24.4 percent in the Hopkins group. Within both the Hopkins group 41.7 percent and the Columbia group 41.6 percent indicated that mental health training was very important; the lowest percent concurring with this posi- tion was 27.0 percent in the Minnesota group. The percents of respondents considering that mental health training was only of some importance to public health work ranged from 29.8 percent in the Tulane group to 20.2 percent in the Columbia group, and the opinion that it was not im- portant at all was 1.7 percent or less among respondents from every school. In general, the tendency among respondents was to consider mental health training to be either very important or extremely important to public health performance. An examination of selected characteristics of re- 189 190 spondents by their appraisal of the importance of mental health training to public health work follows: (a.) Age—Generally, older respondents were more likely than younger ones to consider mental health training as extremely important to public health work. The percents of respondents favoring this point of view, however, did not consistently continue to increase with age, but declined in the oldest age group; yet, these latter percents were not as low as among younger respondents. Thus, although nearly one-half (49.1 percent) of the respondents in the 51-55 age group held the view that mental health train- ing is extremely important to public health work, 39.2 percent in the 56- year-old-and-over group and 38.9 percent among those between 46 and 50 years old also held the same view. By comparison, among the younger age groups, 26.0 percent among those 25 years old and under, 25.0 percent in the 26- to 30-year-old age group, and 27.8 percent among the 31- to 35-year- old age group, also held this view. Thus, among the younger as among the older ones, there was no clear-cut consistent increase or decline in the size of the percents of respondents that held the view that mental health training is extremely important to public health work. The lowest percent of respondents who considered mental health train- ing as very important, 31.0 percent, was in the 26- to 30-year-old group; and the highest percent to express this view, 40.5 percent, was in the 56- year-old-and-over group. In the 26- to 30-year-old group was the highest percent of respondents, 33.6 percent, indicating that mental health training was of some importance to public health work. (b.) Sex—Sharper and clearer differences, however, may be observed between men and women regarding the importance of mental health train- ing to public health work. Better than one-half (53.2 percent) of the women considered mental health training as extremely important to public health compared to 21.7 percent among the men who held the same opinion. Among men 36.5 percent considered mental health training to be very important and among women 30.9 percent also held this view. However, among men 32.2 percent considered such training to be of some importance, an opinion which was expressed by only 12.0 percent of the women. (c.) Mental health work experience prior to enrollment—Among re- spondents who had done mental health work prior to attending a school of public health, 48.4 percent judged that mental health training was extremely important to public health work compared with 24.4 percent of the re- spondents who had not had such experience. The opinion that mental health training was very important to public health performance was nearly the same, roughly, one-third, in both groups of respondents. Mental health training was considered of some importance, however, by 30.5 percent among those who had not had mental health experience before entering a school of public health compared to 14.8 percent among those who had had such experience. (d.) Felt need for mental health training—Respondents without mental health experience before going to a school of public health but who indicated that they felt a need for mental health training differed sharply in their opinions regarding the importance attached to mental health train- ing in public health work from those who did not feel such a need. As many as 40.7 percent of those who indicated that they had felt a need for mental health training noted that mental health training was extremely important to public health in comparison to 17.2 percent of those who felt that they did not need such training prior to entering a school of public health. Among those who felt a need for mental health training 17.7 percent and, by contrast, among those who did not feel such a need, 36.2 percent deemed that mental health training was of some importance to public health. (e.) Primary professional discipline—A majority of respondents in two professional groups considered mental health training to be extremely im- portant to public health work—nurses (70.0 percent) and health educators (50.6 percent). (f.) Major program pursued—The highest percents of respondents considering that mental health training was extremely important to public health work were among those who majored in Public Health Nursing (74.4 percent), in Mental Health (60.0 percent), and in Health Education (53.3 percent) . (g.) Number of mental health courses taken—An association was also noted between the number of mental health courses taken and the opinion that mental health training is extremely important to public health work. Among those who had not taken any mental health courses 23.8 percent considered mental health training as extremely important, while among those who had taken one mental health course 38.5 percent held that opin- ion. A higher percent, 46.8 percent of those who had taken two mental health courses also considered mental health training as extremely im- portant, but actually the highest percent holding this opinion, 57.1 percent was among those who had taken three or more mental health courses. USEFULNESS OF TOTAL PUBLIC HEALTH TRAINING TO PRESENT WORK FUNCTIONS Over one-half of all respondents, 1,760 or 56.5 percent noted that their public health training was highly useful to their present functions; less than one-third, 997 or 32.0 percent deemed it useful, 216 or 6.9 percent of little use, and 35 or 1.1 percent of no use at all. A majority of graduates from all schools except Berkeley and UCLA—from 66.7 percent in the Minnesota group to 51.1 percent in the Tulane group—considered their public health training was highly useful to their present functions. A plurality from UCLA (45.8 percent) and from Berkeley (48.0 percent) considered their public health training was highly useful to their present functions. Those reporting that their public health training was useful to their present functions ranged from 38.2 percent in the Berkeley group to 23.5 percent in the Minnesota group. The highest percent indicating that their overall public health training was of little use to their present functions 191 192 was 12.8 percent in the Tulane group and the lowest, 3.2 percent in the North Carolina group. None in the Yale group indicated that their public health training was of no use at all to present functions but 2.5 percent in the UCLA group so noted. Thus, generally respondents considered their public health training was highly useful or useful rather than of little use or no use at all to their present work functions. IN sumMMARY, over one-third of all the respondents indicated that schools of public health prompted little interest in mental health; another group of nearly the same size noted that the schools had prompted moderate interest in mental health. According to one-sixth of the respondents, how- ever, the schools prompted high interest in this area. The highest percent of respondents also considered that mental health training was very impor- tant and the second highest percent considered it extremely important to public health work. A majority of all the respondents also rated their public health training as highly useful to their present functions. By selected variables, the views of respondents were briefly that: within the youngest age group, 25 years old and under, was the lowest percent within any age group to consider that schools of public health had prompted in them high interest in mental health. Higher percents of respondents between 51 and 55 years old and 56 years old and over gave that same reply. Among men and among women, equal percents considered that schools had prompted in them moderate interest in mental health, and similarly the highest percents of those with mental health work experience prior to attending a school of public health and of those without it indicated that the schools prompted moderate interest in mental health. Those with no prior experience in mental health but who had not felt a need for mental health training were more likely to note that schools had prompted little interest in mental health for them than those who had reported such a need. Among those who had taken one or more mental health courses, the percents of respondents indicating that high interest in mental health was prompted increased progressively with the number of mental health courses taken. Mental health training was also considered to be extremely im- portant to public health work by nearly one-half of all the respondents be- tween 51 and 55 years old. Generally, older rather than younger respondents considered mental health training to be extremely important or very im- portant to public health work, although the percents of respondents holding these views did not increase consistently with age. Also, a much higher percent of the women than of the men considered mental health training to be extremely important to public health work. Respondents who had mental health work experience before they entered a school of public health were also more likely to hold the above view than those who had not had such experience. However, those who had not had experience in mental health work but who had indicated that they felt a need for such training were more likely to indicate that mental health training was extremely important to public health than those who did not report that they felt a need for such training. By primary professional discipline, among nurses and health educators were the highest percents to consider mental health training to be extremely important to public health. Among those who had taken one or more mental health courses, the percents of respondents who considered mental health as extremely important to public health increased progressively with the number of mental health courses taken. 193 194 THE PLACE OF CHAPTER 11 MENTAL HEALTH IN PUBLIC HEALTH REVIOUS chapters have noted that there is no consensus on the place of mental health in public health work nor on what kinds of mental health responsibilities or activities can be or ought to be conducted by public health workers. Neither is there general agreement as to the place of public health in mental health work. These issues require clarification both for purposes of training and practice since they are crucial to planning and improving the organization and the delivery of health services. To gage current opinions about these dimensions of public health and mental health work, respondents were asked three interrelated questions. One question was addressed to their views on the acceptance of mental health aspects of public health by public health administrators; the second, to their views on public expectations of mental health knowledge among public health workers; and the third, to their views on whether the public expects public health workers to assume mental health roles. Stated differently, do public health workers see themselves having responsibilities in mental health as a re- flection of public expectations, and do they consider mental health factors to be compatible with administrative requirements of the organizations in which they are employed? In addition, respondents were asked to indicate the extent to which they believe that their present professional duties were related to mental health concerns. ACCEPTANCE OF MENTAL HEALTH ASPECTS BY PUBLIC HEALTH ADMINISTRATORS More than one-half of all respondents (1,616 or 51.9 percent) indicated that mental health aspects of public health had limited acceptance among public health administrators.! According to better than one-fifth (657 or 21.1 percent) mental health aspects were tolerated. Another 449 or 14.4 percent indicated that mental health aspects were strongly accepted by public health administrators, and an additional 125 or 4.0 percent indicated that they were resisted or strongly resisted. A group of 268 respondents or 8.6 percent gave no response. The highest percents of respondents from each school reported limited acceptance of mental health aspects among public health administrators. Together, at least two out of three respondents from each school held the opinions that mental health aspects had either limited acceptance or were 1 For convenience of the reader, the term “mental health aspects” as used in this subsection refers specifically to the mental health aspects of public health. tolerated by public health administrators. The highest percent from any school noting that mental health aspects had limited acceptance among public health administrators was 57.6 percent in the Columbia group, while the lowest percent holding this same opinion was 43.8 percent of the Harvard graduates. The highest percent of respondents from any school to indicate that mental health aspects were tolerated was 29.2 percent among Harvard graduates, and the lowest percent was 15.2 percent in the Columbia group. The range of the percents of respondents indicating that mental health aspects were strongly accepted by public health administrators was from 18.1 percent in the Michigan group to 10.6 percent, respectively, in both the Hopkins and Pittsburgh groups. Those who held the opinion that mental health aspects were resisted or were strongly resisted by public health ad- ministrators ranged from 6.0 percent within the UCLA group to 2.1 per- cent within the Tulane group. Similar directions in findings were obtained when respondents’ replies were analyzed by their functional professional titles, major professional roles, principal sources of professional income, and principal work settings. (a.) Functional professional title—The highest percents of respondents in each category of functional professional title indicated limited acceptance of mental health aspects by public health administrators. Among public health nurses (21.9 percent) was the highest percent of respondents to in- dicate that mental health aspects were strongly accepted by public health administrators, while the lowest percent to hold this view was among public health engineers or sanitarians (7.8 percent). Limited acceptance of mental health aspects was indicated by 60.3 percent of the administrators, and the lowest percent who noted this reply was among the biostatisticians (39.0 percent) . The highest percent of respondents to indicate that mental health aspects were tolerated by public health administrators was among public health engineers or sanitarians (26.8 percent), and the lowest percent was among administrators (17.6 percent). The highest percent of respondents to indicate that mental health aspects were resisted by public health ad- ministrators was among health educators (7.3 percent), and the lowest percent to give this reply was among administrators (2.1 percent). Strongly resisted was indicated by 1.3 percent or less of the respondents in each of the functional professional titles. (b.) Major role—The highest percents of respondents in each major role reported limited acceptance of mental health aspects by public health ad- ministrators. Among the respondents in each major professional role who indicated that mental health aspects were strongly accepted by public health administrators, the highest percent was reported by respondents in super- visory roles (20.7 percent). The lowest percents indicating that mental health aspects were strongly accepted by public health administrators were in consultative roles (12.3 percent) and in “other” roles (11.3 percent). Among respondents in executive-administrative roles was the highest percent (57.0 percent) indicating that mental health aspects had limited acceptance among public health administrators; the lowest percent of re- 195 196 spondents to give this reply was among those in research roles (45.4 per- cent) . The range of percents for those indicating that mental health aspects were tolerated by public health administrators was from 25.1 percent among those in consultative roles to 18.4 percent among those in instruc- tional roles. The highest percent indicating that mental health aspects were resisted by public health administrators was 6.6 percent among those in staff roles and the lowest was 1.9 percent among those in executive-administrative roles. Those who indicated that mental health aspects were strongly resisted by public health administrators comprised generally less than 1 percent among each of the above cited major professional roles of public health workers. (c.) Principal source of professional income—The highest percent of respondents in each category of principal source of professional income indi- cated limited acceptance of mental health aspects by public health admin- istrators. Among respondents working for county, city, other local government was the highest percent indicating that mental health aspects were strongly accepted (19.0 percent) by public health administrators, while the lowest percent holding that view was among State government employees (12.1 percent) . The highest percent of respondents to indicate limited acceptance (58.0 percent) originated within the group working in voluntary agencies or institutions, and the lowest percent, among the self-employed (40.0 per- cent) . Among the self-employed also was the highest percent (30.0 percent) to indicate that mental health aspects were tolerated; the lowest percent giving this appraisal was among those working in voluntary agencies or institutions (16.8 percent). The range of percents indicating that mental health aspects were resisted was rather low and narrow—from 4.0 percent among respondents in the self-employed group to 2.5 percent among those in the Federal Government uniformed service. The reply that mental health aspects were strongly resisted ranged from 4.0 percent among the self- employed to 0.0 percent among those in voluntary agencies or institutions. (d.) Principal work setting-—The highest percent of respondents in each principal work setting indicated that mental health aspects had limited ac- ceptance among public health administrators. Among those working in hos- pitals (17.0 percent) was the highest percent considering mental health aspects as strongly accepted by public health administrators; and the lowest percent giving this reply was among respondents working in mental health settings, both in and outside of a hospital (10.0 percent). The highest percent of respondents who considered mental health aspects to have limited acceptance among public health administrators worked in medical or other health professional schools (60.4 percent); the lowest percent to give this reply was among respondents in industry or business (46.2 percent). The highest percent indicating that mental health aspects were tolerated origi- nated among those working in “other” settings (23.5 percent), while the lowest percent replying similarly worked in medical or other health pro- fessional schools (8.3 percent). The highest percent of respondents who noted that mental health aspects were resisted or strongly resisted by public health administrators worked in schools of public health (8.0 percent) ; the lowest percent with those opinions worked in hospitals (2.0 percent). Among respondents working in a school of public health, 14.0 percent reported that mental health aspects were strongly accepted, 48.0 percent in- dicated limited acceptance, 12.0 percent tolerated, and 8.0 percent either resisted or strongly resisted. PUBLIC EXPECTATION OF PUBLIC HEALTH WORKERS’ KNOWLEDGE OF MENTAL HEALTH Theoretically, a profession is responsive to its members—peers or practitioners—to its clientele, and to the expectations and demands of the public for its services. Public expectations as perceived by the members of a profession also shape the manner and scope in which professional missions, activities, and needs are defined. A plurality of all respondents, 1,277 or 41.0 percent, held the opinion that the public had a moderate expectation as to public health workers’ knowledge of mental health. This view was held by the highest percent of respondents from each school. In the Minnesota group (48.6 percent) was the highest percent of respondents expressing this view and the lowest percent was in the UCLA group (35.3 percent). Somewhat more than one out of five of the total study population, 674 or 21.6 percent reported that the public had a high expectation of public health personnel being knowledgeable about mental health. More than one out of four of the respondents from Columbia (26.5 percent) and Berkeley (26.3 percent) reported a high expectation; the lowest percent replying this way was from Harvard (13.3 percent). A group of 468 or 15.0 percent of all respondents, notwithstanding, held the view that the public had no expectation about public health workers being knowledgeable about mental health. The highest percents of respondents from any school to indicate that the public had no expectation in this regard were in the Tulane (19.1 percent), Yale (18.9 percent), and Harvard (18.6 percent) groups, while the lowest percent to give this reply was in the Minnesota group (10.2 percent). An additional 696 respondents or 22.3 percent either held no opinion on this matter or gave no response. The percents of re- spondents indicating either no opinion or no response ranged from 28.3 percent in the Harvard group to 16.0 percent in the Tulane group. (a.) Functional professional title—Among all categories of public health workers, except biostatisticians and laboratory scientists, the highest per- cents of respondents indicated that public expectations in this area were moderate. Public health nurses were more likely than respondents in any other category of functional professional title to indicate that the public expected public health workers to be knowledgeable about mental health; least likely to hold this view were biostatisticians, public health engineers 197 198 or sanitarians, and laboratory scientists. In the public health nurse group were the highest percents of respondents to indicate both that the public had a high expectation (37.0 percent) and a moderate expectation (50.9 percent) about public health workers being knowledgeable about mental health. Within the public health engineer or sanitarian group was the highest percent (26.8 percent) to indicate that there was no expectation in the public as to public health workers being knowledgeable about mental health; in this group also, another 20.5 percent held no opinion. The high- est percents of respondents reporting no opinion in this area were among both laboratory scientists (43.2 percent) and biostatisticians (33.0 percent) . (b.) Major role—Regardless of major role in present job also, the high- est percents of respondents noted that there was a moderate expectation in the public regarding mental health knowledge among public health work- ers. The highest percent to note that such expectation was moderate was by those holding supervisory roles (45.5 percent), while the lowest percent to so indicate was among those in staff roles (33.2 percent). The highest percent to indicate high expectation was 25.6 percent among those in in- structional roles, and the lowest percent noting this reply was 15.1 percent among those in research roles. No expectation was highest among those in staff roles (23.4 percent) and lowest among those in instructional roles (11.6 percent). The percent expressing no opinion was highest among those in research roles (31.3 percent) and lowest among those in executive-administrative roles (14.5 percent). (c.) Principal source of professional income—The highest percents of respondents in each category of principal source of professional income indicated that the public had a moderate expectation as to public health workers’ knowledge about mental health; the range of percents for this reply was from 46.3 percent among those in county, city, other local govern- ment to 36.0 percent among the self-employed. Among respondents em- ployed by county, city, other local government was the highest percent (27.5 percent) to indicate that the public had a high expectation as to public health workers’ knowledge about mental health, and in the Federal Government uniformed service was the lowest percent (16.0 percent) ex- pressing that same view. The highest percent noting that the public had no expectation regarding public health workers’ knowledge of mental health was among State government employees (19.1 percent) and the lowest percent holding this view was among those who were working for private profitmaking organizations (9.9 percent). Among the self-employed (28.0 percent) was the highest percent to express no opinion, while the lowest percent to hold no opinion in this area was among those working in county, city, other local government (9.6 percent). (d.) Principal work setting—The highest percent of respondents in each principal work setting tended to judge that the public expectation of mental health knowledge by public health workers was moderate. The highest percent of respondents from any work setting to indicate a moderate ex- pectation was among respondents working in hospital settings (44.7 per- cent) ; the lowest percent of respondents with the same view were working in mental health settings, both in a hospital and outside of a hospital (30.0 percent), and in industry or business (29.8 percent). The highest percent of respondents within a work setting to hold the opinion that the public had a high expectation as to public health workers’ knowledge about mental health was among respondents working in mental health settings, both in a hospital and outside of a hospital (26.6 percent), and the lowest percent to hold this opinion was among those working in medical and other health professional schools (13.5 percent). Among respondents work- ing in medical and other health professional schools was the highest per- cent noting that there was no expectation (22.9 percent) among the public regarding the mental health knowledge of public health workers; the low- est percents to share in this view were among those working in colleges and universities (12.2 percent), those working in hospitals (12.1 percent) and those working in “other” settings (12.2 percent). Among respondents working in mental health settings, both in a hospital and outside of a hospital, over one-fifth (21.7 percent) also reported no expectation. No opinion in this area was highest among those working in “other” settings (28.7 percent), and lowest among those working in health agencies, other than hospitals (16.2 percent). Among those working in mental health settings, both in a hospital and outside of a hospital, one out of six (16.7 percent) held no opinion on this issue. Among respondents working in schools of public health, 18.0 percent indicated that there was a high expectation in the public as to knowledge of mental health among public health workers, 34.0 percent noted that there was a moderate public expectation, 20.0 percent that there was no expectation, and 26.0 percent registered no opinion on the subject. PUBLIC EXPECTATION OF PUBLIC HEALTH WORKERS ASSUMING MENTAL HEALTH ROLES A plurality of all respondents, 1,202 or 38.6 percent, also assessed that the public had a moderate expectation of public health workers assuming mental health roles. The highest percents of respondents from each school indicated that the public had a moderate expectation of public health workers assuming mental health roles; the highest percent of respondents from any school holding this view was 43.5 percent in the Minnesota group, and the lowest percent (30.4 percent) was in the Columbia group. As many as 581 or 18.7 percent considered that the public had no expectation of public health workers assuming mental health roles; the highest percent from any school holding this view was 23.0 percent in the Yale group and the lowest 12.8 percent in the Pittsburgh group. Within the total study population, 532 or 17.1 percent of all the re- spondents indicated that the public had a high expectation that public health workers will assume mental health roles. While 21.8 percent of the 199 200 respondents from Columbia noted high expectation, 10.2 percent of the re- spondents from Harvard replied similarly. An additional 800 respondents or 25.6 percent either held no opinion on this matter or gave no response. The percent of respondents indicating no opinion or no response ranged from 33.2 percent in the Harvard group to 19.2 percent in the Tulane group. (a.) Functional professional title—The highest percents of respondents in each category of functional professional title, except biostatistician, public health engineer or sanitarian, and laboratory scientist, indicated that the public had a moderate expectation of public health workers performing mental health roles. Among public health nurses were the highest percents of respondents indicating that the public had both high (33.6 percent) and moderate expectations (50.9 percent) of public health workers performing mental health roles. In the public health nurse category also was the lowest percent to note that there was no expectation (10.2 percent) in the public as to the performance of mental health roles by public health workers. Among public health engineers or sanitarians was the lowest percent (7.3 percent) to indicate that there was a high expectation as well as the highest percent (33.1 percent) to note that there was no expectation in the public regarding the performance of mental health roles by public health workers. Among laboratory scientists were both the lowest percent (25.5 percent) to indicate moderate expectation and the highest percent to note no opinion (44.0 percent) as well. (b.) Major role—The highest percents of respondents in each major work role noted that the public had a moderate expectation of public health workers performing mental health roles. Among respondents in instruc- tional roles was the highest percent of those who considered that there was a high expectation (21.5 percent) in the public that public health workers assume mental health roles. The lowest percent noting that the public had a high expectation of public health workers in mental health roles was among research workers (9.9 percent); in this group also were both the lowest percent noting a moderate expectation (33.1 percent) and the high- est percent expressing no opinion in this area (32.0 percent). Among those in consultative (42.3 percent) and those in executive-administrative (41.9 percent) roles were, respectively, the highest percents to note that there was a moderate expectation in the public with regard to the performance of mental health roles by public health workers. The opinion that the public had no expectation of public health workers performing mental health roles was highest among both those in consultative (21.6 percent) and in staff (22.2 percent) roles, and lowest among those in “other” roles (14.9 percent). The lowest percents to note no opinion were in executive-administrative (17.8 percent) and in instructional (17.7 percent) roles. (c.) Principal source of professional income—The highest percents of respondents in each category of principal source of professional income in- dicated that the public had a moderate expectation about public health workers performing mental health roles. Among respondents who worked for county, city, other local government was the highest percent (44.7 percent) with the opinion that there was a moderate expectation in the public about public health workers performing mental health roles; the lowest percent to share this opinion were respondents whose principal source of professional income was a private profitmaking organization (33.3 percent). Among those who were self-employed (24.0 percent) was the highest percent with a high expectation as well as the lowest percent (12.0 percent) which considered that the public had no expectation in this area. The lowest percent to indicate a high expectation was among those in the Federal Government uniformed service (12.8 percent). No expectation by the public regarding the performance of mental health roles by public health workers was highest among State government employees (22.7 per- cent). The highest percent to hold no opinion was among those in the Federal Government uniformed service (32.3 percent), and the lowest percent was among those working for county, city, other local government (11.7 percent). (d.) Principal work setting—The highest percent of respondents in each principal work setting, except business and industry, indicated that there was a moderate expectation in the public of public health workers per- forming mental health roles. Among the respondents working in mental health settings, hospital and outside of a hospital, was the highest percent (41.7 percent) to note that there was a moderate expectation of public health workers performing mental health roles. The highest percent who indicated that there was a high expectation in this area was among re- spondents working in hospitals (19.4 percent). The highest percent to indicate that there was no expectation was among those working in schools of public health (26.0 percent). Among respondents working in industry and business was the highest percent to hold no opinion in this area (31.7 percent) . The lowest percent of respondents to indicate that there was a high expectation in the public related to the performance of mental health roles by public health workers was among those working in medical and other health professional schools (8.3 percent), and the lowest percent to note a moderate expectation was in industry and business (24.0 percent). For no expectation the lowest percent was among those working in “other” settings (14.4 percent), and for no opinion the lowest percent was among those working in mental health settings, hospitals and nonhospitals (13.3 percent) . Among those respondents working in schools of public health, nearly one-third (32.0 percent) held the opinion that the public had a moderate expectation of public health workers assuming mental health roles; over one-fourth (26.0 percent) noted that there was no expectation, and another group of over one-fourth (26.0 percent) expressed no opinion. However, among those working in schools of public health 14.0 percent held the opinion that the public had high expectation of public health workers assuming mental health roles. 201 202 RELATIONSHIPS OF CURRENT PROFESSIONAL WORK TO MENTAL HEALTH CONCERNS To probe further the views held by respondents about the relation of mental health to public health practice, employed respondents (N=2,848) were asked to indicate the extent to which they regarded that their present professional duties were related to what they would consider to be mental health concerns. These mental health concerns were not defined or illus- trated in the questionnaire so that the respondents might not feel constrained by any imposed limits except their own in appraising the relationships of their work to mental health. Among employed respondents, three out of 10 (862 or 30.3 percent) in- dicated that their present professional duties were occasionally related to mental health concerns; 658 or 23.1 percent noted that they were moder- ately related, while 537 or 18.9 percent reported that they were strongly related. An additional 412 or 14.5 percent stated that mental health concerns were not related to their present professional duties, and 379 or 13.3 percent gave no response. Thus, a majority of employed respondents regarded their jobs as either moderately or occasionally related to mental health concerns. Although 23.4 percent of the UCLA and 23.1 percent of the Minnesota groups indicated that their duties were strongly related to mental health, only 13.4 percent of the Yale respondents replied similarly. The highest percent from any school to note moderately related was 28.4 percent of the Columbia group, while the lowest percent so indicating was 18.2 percent in the Pittsburgh group. Among respondents noting occasionally related, the highest percents, 34.8 percent, were in both the Harvard and Yale groups; the lowest percent was 24.2 percent in the Tulane group. Replies indicating that mental health concerns were not related to present professional duties ranged from 23.3 percent in the Pittsburgh group to 9.0 percent in the Berkeley group. The most frequently expressed opinion among respondents from all 11 schools was that their duties were occasionally related to mental health concerns. In no instance did the sum of respondents from any single school reach 50.0 percent for those answering either strongly and/or moderately related; the range for such combined replies was 46.3 percent in the UCLA group, 45.8 percent in the Columbia group, and 45.6 percent in the Berkeley group to 36.3 percent in the Tulane group. The replies given were also examined by age, sex, present functional professional title, major work role, principal source of professional income, and principal work setting of employed respondents. (a.) Age—Generally, differences in opinion regarding the degree of re- lationship between current work duties and mental health varied with age, although such differences were neither consistent nor sharply defined when they occurred. Among those in younger age groups, for instance, higher percents of respondents tended to describe their jobs as either occasionally and/or not related to mental health concerns; however, the opinions among those in older age groups were divided among strongly related, moderately related, or occasionally related to mental health. By specific age group, among those 51-55 years old, 27.8 percent described their jobs as strongly related in contrast to 13.4 percent among those 26-30 years old. In the 56-year-old-and-over age group 36.2 percent considered their jobs as moderately related, while among those 25 years old and under 18.8 percent, and in the 26- to 30-year-old group 19.1 percent held the same opinion. In the 26- to 30-year-old group 35.4 percent and in the 31- to 35- year-old group 35.1 percent noted their jobs as occasionally related; this opinion was also held by 19.1 percent among those 51-55 years old and by 18.8 percent in the 56-year-old-and-over group. One-fourth of those who were 25 years old and under (24.6 percent) considered their jobs not related to mental health, but in the 56 years old and over group only 3.0 percent held this opinion. (b.) Sex—Women were more likely than men to consider their jobs as either strongly related or moderately related to mental health; while men were more likely to consider their jobs as occasionally related or not re- lated to mental health. Slightly over one-third (34.1 percent) of the women described their jobs as strongly related to mental health compared to one-eighth among the men (12.1 percent). Among the women, three out of 10 (30.4 percent) deemed that their jobs were moderately related to mental health while among the men one-fifth (19.9 percent) held this view. Among men, however, 35.9 percent described their jobs as occasion- ally related to mental health; this opinion was held by 17.8 percent of the women. While 7.6 percent among the women regarded their jobs as not related to mental health, 17.5 percent among the men held this view. (c.) Functional professional title—Among all categories of public health workers, except biostatisticians, health educators, public health nurses, and laboratory scientists, the highest percents of respondents indicated their work was occasionally related to mental health. More than one-half of all the public health nurses (51.7 percent) considered their work as strongly related and another 38.5 percent as moderately related to mental health concerns. On the other hand, among the public health nurses was the lowest percent of respondents to consider their work to be both occasion- ally related (6.0 percent) and not related (0.8 percent) to mental health concerns. Among laboratory scientists were, respectively, the lowest per- cents considering their work as strongly related (2.8 percent) and as mod- erately related (5.0 percent) to mental health concerns; in addition, the highest percent of those who considered their work not related to mental health (60.3 percent) was also in this group. Among public health engi- neers or sanitarians was the highest percent describing their jobs as occasionally related to mental health concerns (47.8 percent). (d.) Major role—The highest percents of public health workers except those in instructional and research roles regarded their jobs as occasionally 203 204 related to mental health. Among public health workers in research roles was the lowest percent to regard their jobs as strongly related (8.1 percent) and as moderately related (10.9 percent) to mental health concerns, as well as the highest percent to consider their work as not related (40.5 percent) to mental health. Among those with instructional roles was the highest percent seeing their jobs as strongly related (39.6 percent) and the lowest percent to regard their jobs as occasionally related (21.2 percent) to mental health. The highest percent of respondents to indicate that their jobs were moderately related to mental health (30.0 percent) were among those in executive-administrative roles and in this group also was the highest percent to describe their jobs as occasionally related (38.0 percent) to mental health. Among respondents in instructional roles (8.2 percent) and those in executive-administrative roles (7.9 percent) were the lowest percents to judge their jobs as not related to mental health. In only one instance were those answering either strongly and/or moderately related in excess of one-half of the respondents within a role category; namely, 63.8 percent of the respondents in instructional roles. Among those in research roles less than one out of five respondents (19.0 percent) noted strongly and moderately related. Except for respondents in instructional roles, in all other major work roles a majority held the view that mental health concerns were neither strongly nor moderately related to present professional duties. (e.) Principal source of professional income—The highest percents of respondents in each of the following categories indicated that their work was occasionally related to mental health: Federal Government uniformed service, private profitmaking organizations, State government, voluntary agencies and institutions, and “other” sources. A plurality of respondents whose principal source of professional income was either a county, city, other local government or self-employment reported moderately related, while the highest percents of those in the Federal Government civilian service were almost equally divided between occasionally related and not related. Among those whose principal source of professional income was county, city, other local government were the highest percents to regard their work both as strongly related (27.5 percent) and moderately related (36.5 per- cent) to mental health; also in this group was the lowest percent (4.8 percent) to indicate that their work was not related to mental health. In the Federal Government uniformed service were both the lowest percent to consider their jobs as strongly related (8.0 percent) to mental health and the highest percent to consider them as occasionally related (42.3 per- cent) . In private profitmaking organizations were both the lowest percent to consider their jobs as moderately related (17.7 percent) and the high- est percent to consider their jobs as not related (29.8 percent) to mental health. In the self-employed group was the lowest percent (26.0 percent) to consider their jobs as occasionally related to mental health. Proportionately, employees of county, city, other local government and of State government were more likely to perceive their present jobs as strongly related to mental health than were Federal Government employees. Among public employees, the following percents indicated that their work was strongly related to mental health: Respondents reporting their jobs as strongly related Principal source of professional income: lo mental health Number Percent County, city, other local government... ..... ........ ... 120 of 436. ....... 27.5 State GOVEIrNMMENt ....................ooiiiiiiiiiii.. 150 of 571........ 26.3 Federal Government: Civilian 58 of 317........ 18.3 Uniformed ........................................ 32 of 399. ....... 8.0 (£.) Principal work setting—The highest percent of respondents to indi- cate that their work was strongly related to mental health was among those working in mental health settings, both in a hospital and outside of a hospital (83.3 percent); the lowest percents with this view were among those in industry and business (10.6 percent) and in “other” settings (10.9 percent) . The lowest percent to indicate that their jobs were moderately related to mental health (13.5 percent) were in industry and business, as well as the highest percent to indicate that their work was not related to mental health concerns (41.3 percent). None of those working in mental health settings, both in a hospital and outside of a hospital, replied not related. The highest percents to indicate that their work was moderately related to mental health concerns worked in medical and other health professional schools (31.2 percent) and in health agencies, other than hospitals (30.9 percent). The highest percent to indicate that their job duties were occasionally related to mental health (49.0 percent) worked in hospitals, and the lowest percent with this view worked in mental health settings (1.7 percent). Among those who worked in schools of public health, 30.0 percent described their jobs as strongly related, 28.0 percent as occasionally related, and 26.0 percent as not related to mental health concerns. An additional 14.0 percent described their jobs as moderately related to mental health. IN sumMmARY, the findings reported in this chapter suggest that public health administrators although not resisting the mental health aspects of public health work do not seem to be very enthusiastic about these con- cerns. Respondents’ views also tended to confirm generally that the public had a moderate expectation regarding the extent of knowledge about men- tal health held by public health workers, and a moderate expectation with regard to their assuming mental health roles. Furthermore, respondents tended to consider their jobs to be occasionally related to mental health concerns. Over one-half of all respondents indicated that there was limited ac- ceptance of mental health aspects of public health by public health admin- istrators; the highest percent from any school to indicate this reply was among respondents from Columbia where well over one-half held this 205 206 opinion. Among each—those with the title of administrator, those with executive-administrative roles, those whose principal source of professional income was a voluntary agency or institution, and among those whose principal work setting was a medical or other health professional school— better than one-half indicated that mental health aspects had limited ac- ceptance among public health administrators. Replies indicating that men- tal health was resisted or strongly resisted by public health administrators, however, were generally given by the lowest percents of respondents. Since respondents have also indicated that mental health training is useful or highly useful to public health work (ch. 7) and have noted in- terest in additional training in mental health (ch. 12), the adjudged levels of acceptance of mental health aspects by public health administrators sug- gest that there is a gap between professional needs and judgments on one hand, and the perceptions of administrative behavior on the other. These findings also suggest that mental health although not resisted would have little priority and recognition within public health work as currently con- ceived. Further confirmation of these views are provided by the replies given by respondents working in schools of public health. A plurality of respondents indicated that the public had a moderate expectation of mental health knowledge among public health workers; this view was held by the highest percent of respondents from each school; the highest percent to indicate this reply was among respondents from Minne- sota. The same view was shared by the highest percents of respondents in all functional professional titles except among biostatisticians and laboratory scientists. Among laboratory scientists and biostatisticians the highest per- cents of respondents expressed no opinion. Among public health nurses were the highest percent of respondents to indicate that there was both a high and a moderate expectation of knowledge of mental health by public health workers. The highest percents of respondents regardless of major professional role also noted that the public had a moderate expectation of mental health knowledge by public health workers. Among personnel in supervisory roles was the highest percent to consider that there was a moderate expectation in the public regarding mental health knowledge among public health workers. In all categories of principal source of professional income as well as principal work setting, the highest percents of respondents, respectively, noted the public had a moderate expectation of mental health knowledge by public health workers. In the view of a plurality of respondents the public had a moderate expectation for public health workers to assume mental health roles; the highest percents of respondents from each school shared this opinion; and this reply was highest among respondents from Minnesota. The highest percents of respondents from each category of functional professional title, except biostatistician, public health engineer or sanitarian, and laboratory scientist, indicated a moderate expectation from public health workers re- garding mental health roles. Among public health nurses were the highest percents in a functional professional title which considered that the public had both high and moderate expectations regarding mental health roles by public health workers. The highest percents of respondents in each major work role reported that the public had a moderate expectation of public health workers performing mental health roles. Among respondents in consultative roles and in executive-administrative roles were the highest percents to consider that the public had moderate expectations regarding public health workers assuming mental health roles. In all categories of principal source of professional income, the highest percents of respondents indicated the public had moderate expectations regarding public health workers performing mental health roles. The same view was held by the highest percents of respondents in each principal work setting except business and industry. The highest percents of employed respondents considered their jobs to be occasionally related to mental health concerns. The second and third highest percents considered their jobs to be, respectively, moderately and strongly related to mental health concerns; and lowest were those who considered their jobs not related to mental health concerns. In the Harvard and Yale groups were the highest percents of employed respondents who considered their jobs as occasionally related to mental health concerns; in the Columbia group was the highest percent considering their jobs as moderately related to mental health, while in the UCLA and Minnesota groups were the highest percents considering their jobs to be strongly related to mental health. The highest percent of respondents to consider their jobs as not related to mental health was in the Pittsburgh group. Analyses of employed respondents by six selected variables indicated that those who considered their jobs as strongly related to mental health concerns were likely to be characterized as follows: (1) Between 51 and 55 years old; (2) women; (3) held the functional professional title of public health nurse; (4) held instructional roles; (5) county, city, other local government was their principal source of professional income; and (6) their principal work setting was a mental health setting, in a hospital and outside of a hospital. Those likely to consider their jobs as moderately related to mental health were: (1) 56 years old and over; (2) women; (3) held the functional professional title of public health nurse; (4) held executive-administrative roles, (5) county, city, other local government was their principal source of professional income; and (6) their principal work settings were medical and other health professional schools and health agencies, other than hospitals. Those likely to consider their jobs occasion- ally related to mental health were: (1) Between 26 and 30 and 31 and 35 years old, (2) men, (3) held the professional title of public health engineer or sanitarian, (4) held executive-administrative roles, (5) their principal source of professional income was the Federal Government uniformed service, and (6) their principal work setting was in hospitals. Lastly, those who considered their jobs mot related to mental health concerns were likely to be: (1) 25 years old and under, (2) men, (3) held a professional 207 title of laboratory scientist, (4) held research roles, (5) their principal source of professional income was a private profitmaking organization, and (6) their principal work setting was in industry or business. 208 MENTAL PART HEALTH TRAINING NEEDS AND SUGGESTIONS FOR CURRICULUM MODIFICATIONS NEEDS FOR CHAPTER 12 FURTHER TRAINING AND IMPROVEMENT OF MENTAL HEALTH INSTRUCTION IN SCHOOLS OF PUBLIC HEALTH ESPONDENTS were asked three questions related to needs for further R veining in mental health in addition to two corollary questions about their views on improvements needed in mental health instruction provided in schools of public health. These questions were addressed to probe further respondents’ views regarding the relevance of mental health in public health work, the interest of public health workers in applying mental health con- cepts and tools to public health work, and to tap some of their expectations and opinions about mental health training as provided by schools of public health. Admittedly, from the views as expressed by respondents in this study, it is not possible to determine which specific educational experiences in public health, or in their careers in public health, or what other particular factors, if any, have given form, and contributed to the overall content of the opinions expressed regarding public health-mental health interrelations and division of labor. Yet, regardless of the specific factors which gave direction and intensity to the expressed views, such information is pertinent to train- ing efforts in mental health in schools of public health as well as to continua- tion education programs in public health and mental health. Undoubtedly, graduates from schools of public health, both by virtue of their past training and career involvement in the front lines of health work, can offer views nurtured and supported by experience about the changing requirements and needs of the field. FELT NEED FOR FURTHER TRAINING IN MENTAL HEALTH Slightly more than one-half of all the respondents (1,652 or 53.0 percent) held the opinion that further training in mental health aspects of public health would be helpful in their work. This opinion was held by the highest percent of respondents from every school except Harvard. By school, 211 212 the range of replies was from 59.3 percent in the Berkeley group to 39.4 percent in the Harvard group. A majority of the respondents from each of seven schools considered that further mental health training would be help- ful to them: Berkeley (59.3 percent), UCLA (55.2 percent), Michigan (54.5 percent), Minnesota (57.1 percent), North Carolina (53.7 percent), Pittsburgh (51.7 percent), and Tulane (52.1 percent). A total of 892 or 28.6 percent of all respondents held the view that further training in mental health aspects would not be helpful in their work. While 23.2 percent of the Berkeley respondents gave such a response, 42.9 percent of the Harvard respondents replied similarly. An additional 527 or 16.9 percent of all the respondents indicated uncertain/don’t know as to whether further training in mental health might be helpful to their work. In the Michigan group (19.6 percent) was the highest percent from any school holding the opinion uncertain/don’t know and the lowest percent giving the same reply was in the Tulane group (10.6 percent). (a.) Age—In general, the percents of respondents indicating that fur- ther training in mental health would be helpful increased progressively with age up to 51-55 years old (64.3 percent) and leveled off with those 56 years old and over (63.5 percent). (b.) Sex—Proportionately more women (66.5 percent) than men (46.5 percent) indicated that additional mental health training would be helpful to them in doing their work. Among the men (33.8 percent) the percent indicating that additional mental health training would not be helpful to their work was much higher than among the women (17.8 percent). (c.) Primary professional discipline—Four out of five health educators (80.0 percent) considered that it would be helpful for them to receive ad- ditional mental health training; among nurses (78.8 percent) almost as high a percent held the same view. Within each of the following professional groups were, respectively, the lowest percents of respondents who indicated that additional mental health training would be helpful to their work: Biologists /entomologists /zoologists (30.0 percent), chemists/biochemists (16.0 percent), bacteriologists/laboratory scientists/parasitologists (29.2 percent) , mathematicians /statisticians/programers (31.2 percent), vet erinarians (14.6 percent), and engineers (22.4 percent). (d.) Functional professional title—Among public health nurses was the highest percent of respondents (84.5 percent) who noted that additional mental health training would be helpful, while among laboratory scientists (15.6 percent) was the lowest percent in any professional title so indicating. (e.) Major role—Among those in instructional roles (66.2 percent) was the highest percent of respondents in any major role to indicate that addi- tional mental health training would be helpful to their jobs; the lowest per- cent giving this reply was among those doing research work (28.5 percent). One-half or more of the respondents in each of the following roles noted that additional mental health training would be helpful: Consultative (57.9 percent), executive-administrative (54.7 percent), staff (50.0 percent), and supervisory (58.1 percent). (f.) Principal source of professional income—The highest percent of respondents indicating that additional mental health training would be helpful to their work was among those whose principal source of profes- sional income was county, city, other local government (70.4 percent) ; the lowest percent holding this viewpoint was among those in the Federal Government uniformed service (38.8 percent). Among workers in private profitmaking organizations was the highest percent (43.3 percent) to in- dicate that further mental health training would not be helpful to their work. (g.) Principal work setting—Almost three-fourths of the respondents working in mental health settings, both in and outside of a hospital, (73.3 percent) observed that additional mental health training would be helpful to their work; the lowest percents holding this view were among those working in industry or business (34.6 percent) and in “other” nonspecified work settings (34.8 percent). Among respondents working in schools of public health 42.0 percent indicated that additional mental health training would be helpful to their work. (h.) Relationship of present work to mental health concerns—The ex- tent to which respondents perceived their present work as related to mental health concerns appears to be associated positively with a recognition that additional mental health training would be helpful to their work. Of the respondents who indicated that their work was strongly related to mental health 83.4 percent stated that they would consider additional mental health training to be helpful to their work, compared respectively to 67.9 percent among those who believed their work was moderately related, 41.9 percent occasionally related, and 13.6 percent not related to mental health. VIEWS ON IMPROVEMENT OF MENTAL HEALTH INSTRUCTION BY SCHOOLS OF PUBLIC HEALTH Almost two-thirds of all the respondents (2,009 or 64.5 percent) were of the opinion that schools of public health should improve their instruc- tion about mental health concerns. As many as 914 or 29.3 percent replied uncertain /don’t know, and an additional 131 or 4.2 percent gave a negative response to the question: “Do you believe that schools of public health should improve instruction about mental health concerns?” The highest percent of respondents from any of the schools to indicate that schools of public health should improve instruction about mental health was in the Tulane group (70.2 percent) and the lowest percent in the Pitts- burgh group (60.0 percent). Among the Pittsburgh graduates also was the highest percent of respondents (35.6 percent) who noted uncertain/don’t know regarding the need for such improvement, while in the Tulane group was the lowest percent (22.3 percent) replying similarly. Of those who be- lieved that instruction about mental health by schools of public health did not need improvement, the highest percent was in the Yale group (7.4 per- 213 214 cent), and the lowest percents were in both the Pittsburgh (2.2 percent) and Columbia (2.3 percent) groups. (a.) Age—A majority of the respondents in every age group, except for those 25 years old and younger (46.9 percent) agreed that schools of public health should improve training about mental health concerns. In the 25- year-old-and-younger group also was the highest percent (45.8 percent) of any age group who indicated uncertain /don’t know regarding such improve- ments. The highest percent of respondents to report that schools of public health should improve instruction in mental health concerns was in the 51- to bb-year-old age group (70.8 percent). (b.) Sex—Among the women a higher percent (72.9 percent) than among the men (60.5 percent) believed that instruction about mental health concerns should be improved, and among the men a higher percent (32.8 percent) than among the women (22.1 percent) replied uncertain/don’t know. (c.) Primary professional discipline—Among health educators (80.0 percent) was the highest percent of respondents in any primary professional discipline to hold the opinion that training about mental health concerns needed improvement, and an almost equally high percent among the nurses (79.4 percent) also shared this view. Among chemists/biochemists was the lowest percent (32.0 percent) to note that such instruction needed im- provement. Also among engineers (35.5 percent) and veterinarians (36.6 percent) relatively low percents expressed a need for improving mental health training. (d.) Functional professional title—Four-fifths of the public health nurses (79.6 percent) considered that instruction about mental health con- cerns should be improved. More than three-fourths of the health educators (76.7 percent) held the same opinion, while the lowest percent to also hold that opinion was among laboratory scientists (44.0 percent). Less than one- half of the biostatisticians (48.0 percent) and of the public health engineers or sanitarians (48.8 percent) also believed that instruction about mental health concerns should be improved. Among biostatisticians (48.0 percent) and among laboratory scientists (47.5 percent) were, respectively, the high- est percents of respondents from any professional title who replied uncer- tain/don’t know. (e.) Major role—Among respondents in instructional roles (72.4 per- cent) was the highest percent who believed that instruction about mental health should be improved, and among respondents in supervisory roles was the lowest percent (55.8 percent) who held that view. The highest percents of respondents who indicated uncertain/don’t know were among those in staff (37.5 percent) and in supervisory (37.4 percent) roles. (f.) Principal source of professional income—Among respondents work- ing for a county, city, other local government (71.5 percent) and among those having “other,” nonspecified sources of income (72.7 percent) were the highest percents of respondents to indicate that instruction about mental health concerns should be improved; among those in the Federal Govern- ment uniformed service (53.1 percent) was the lowest percent sharing that opinion. The highest percent of respondents replying uncertain /don’t know (40.4 percent) was in the Federal Government uniformed service, while among the self-employed was the highest percent noting no (10.0 percent). (g.) Principal work setting—Among respondents working in mental health settings, both in and outside of a hospital, was the highest percent to indicate that schools of public health should improve mental health instruc- tion (81.7 percent), and among respondents working in industry or business (52.9 percent) was the lowest percent to believe that mental health instruc- tion in schools of public health should be improved. Among those in in- dustry or business also was the highest percent to indicate uncertain/don’t know (42.3 percent). Of those who believed that schools of public health should not improve mental health instruction, the highest percents were among those working in industry or business (4.8 percent) and among those working in hospitals (4.9 percent). (h.) Relationship of present work to mental health concerns—Re- spondents who described their job duties as strongly related to mental health (85.5 percent) were, respectively, more likely to believe that schools of pub- lic health should improve mental health instruction than respondents who considered their jobs to be moderately related (71.0 percent), occasionally related (58.7 percent), or not related (40.8 percent) to mental health. INTEREST IN FURTHER TRAINING IF OPPORTUNITIES WERE MADE AVAILABLE All respondents were also asked if they would be interested in addi- tional training in mental health aspects of their work if opportunities for such training were made available to them. More respondents (1,745 or 56.0 percent) indicated that they would be interested in such training than those who indicated that further mental health training would be helpful to their jobs (1,652 or 53.0 percent). While 62.2 percent of the UCLA and 61.7 percent of the Tulane re- spondents indicated interest in further training if opportunities were made available, 46.1 percent of the Hopkins and 42.0 percent of the Harvard re- spondents replied similarly. A majority of respondents from each of nine schools expressed interest in obtaining more mental health training if op- portunities were made available: Berkeley (59.6 percent), UCLA (62.2 percent), Columbia (55.6 percent), Michigan (59.3 percent), Minnesota (56.5 percent), North Carolina (56.1 percent), Pittsburgh (55.6 percent), Tulane (61.7 percent), and Yale (51.6 percent). On the other hand, 683 or 21.9 percent of all respondents expressed no interest in such further training, and an additional 640 or 20.5 percent in- dicated uncertain/don’t know. Among the UCLA respondents (14.4 per- 215 216 cent) was the lowest percent of respondents from any school to indicate no interest in further training; in the Harvard group was the highest percent (35.4 percent) to hold that opinion. The highest percent expressing un- certain /don’t know as to whether to pursue additional mental health train- ing if opportunities were made available was 25.4 percent in the Yale group, and the lowest percent was 12.8 percent in the Tulane group. (a.) Age—A majority of respondents within each age category expressed an interest in further mental health training. The highest percent of re- spondents to note such interest was in the 51- to 55-year-old age group (65.5 percent), while the lowest percent was in the 31- to 35-year-old age group (52.2 percent). (b.) Sex—A higher percent of the women (68.0 percent) than the men (50.3 percent) was interested in additional mental health training. The per- cent of the men (26.4 percent) not interested in such further training was more than twice that among the women (12.5 percent). Likewise, a higher percent among the men (21.9 percent) than among the women (17.9 per- cent) replied uncertain/don’t know. (c.) Primary professional discipline—Among health educators (85.9 percent) was the highest percent of respondents to indicate an interest in further mental health training; the lowest percent (23.2 percent) was among veterinarians. Higher percents of respondents from each of the fol- lowing primary professional disciplines expressed interest in further men- tal health training than the percents of respondents from those very same disciplines who had indicated that further mental health training would be helpful: Bacteriologists/laboratory scientists/parasitologists, biologists/en- tomologists/zoologists, dietitians /nutritionists, educators/teachers, engi- neers, chemists/biochemists, dentists, health educators, mathematicians/ statisticians /programers, psychiatrists, sanitarians, social workers, and veterinarians. (d.) Functional professional title—Among public health nurses (83.0 percent) was the highest percent of respondents interested in further mental health training if such training would be available, and the lowest percent showing such an interest was among laboratory scientists (30.5 percent). Among laboratory scientists also was the highest percent (42.6 percent) not interested in additional training, while among biostatisticians was the highest percent (31.0 percent) of those who noted uncertain/don’t know. Among public health nurses were both the lowest percents of those not in- terested (6.4 percent) and of those who replied uncertain/don’t know (10.2 percent). (e.) Major role—Among respondents in instructional roles was the highest percent (65.9 percent) to indicate an interest in further mental health training as well as the lowest percents to indicate no interest (17.1 percent) and to indicate uncertain/don’t know (16.0 percent). The percent of respondents in supervisory roles reporting uncertain/don’t know was similarly low (16.2 percent). Among respondents in research roles was the lowest percent (35.9 percent) of those with an interest in further mental health training as well as the highest percents who reported no interest (32.7 percent) and uncertain/don’t know (29.6 percent). (£) Principal source of professional income—Among those working for a county, city, other local government was the highest percent of respondents to indicate an interest in further mental health training if opportunities were available (71.5 percent), and the lowest percents, respectively, to in- dicate no interest (9.9 percent) and uncertain/don’t know (17.7 percent). The lowest percent of respondents with interest in further mental health training was among those working in a private profitmaking organization (43.3 percent) and in this group also was the highest percent with no in- terest (34.0 percent). Among Federal Government civilian employees was the highest percent noting uncertain /don’t know (22.7 percent). (g.) Principal work setting—The highest percent of respondents from any work setting to indicate interest in more mental health training if oppor- tunities were available was among workers in mental health settings, both in and outside of a hospital (78.4 percent); while in industry or business (40.4 percent) and among those working in “other,” nonspecified settings (39.6 percent) were, respectively, found the lowest percents expressing such an interest. Among respondents working in schools of public health nearly two out of three (58.0 percent) expressed interest in further mental health training; this was followed by three out of 10 (30.0 percent) who indicated uncertain /don’t know, and one out of eight (12.0 percent) who were not interested. Among those working in schools of public health also the percent of respondents indicating that further mental health train- ing would be helpful to their work was lower (42.0 percent) than the percent (58.0 percent) expressing interest in such training if opportunities were made available. (h.) Relationship of present work to mental health concerns—Re- spondents acknowledging that their work was strongly related to mental health (80.8 percent) were more likely to indicate that they would pursue further mental health training if available than respondents who deemed their work moderately related to mental health (67.7 percent), occasionally related (47.1 percent), or not related (24.8 percent) to mental health. PREFERENCE FOR AUSPICES OF FURTHER MENTAL HEALTH TRAINING Respondents who indicated interest in further training in the mental health aspects of public health if opportunities were made available were also asked to indicate the preferred auspices for such training. Four options were presented with a single reply requested: On-the-job training, a school of public health, university or college, other (specify). Of the 1,745 respondents who indicated an interest in further mental health training 656 or 37.6 percent expressed preference for such training to be carried out under auspices of a school of public health. A school of 217 218 public health was the chosen auspice by the highest percents of respondents from every school; with the highest percent making that choice being from the Tulane group (53.4 percent). The percents of respondents from each of the other 10 schools stating a preference for further mental health training to be under auspice of a school of public health were: Berkeley (32.4 per- cent), UCLA (37.6 percent), Columbia (87.8 percent), Harvard (33.7 percent), Hopkins (37.3 percent), Michigan (37.3 percent), Minnesota (32.6 percent), North Carolina (45.6 percent), Pittsburgh (38.0 percent), and Yale (36.5 percent). A total of 429, one in four respondents (24.6 percent), favored an on- the-job training auspice, while 405 or 23.2 percent favored a university or college auspice. By school, the highest percents of respondents favoring on- the-job training were from Berkeley (29.4 percent) and from Hopkins (28.9 percent), while the lowest percents choosing on-the-job training originated in the UCLA (17.6 percent) and in the Yale (17.5 percent) groups. Of those who preferred such training under auspice of a university or college, the highest percent was among Yale respondents (33.3 percent), and the lowest percents were among Tulane (17.2 percent) and North Carolina (17.0 percent) respondents. Of those choosing “other” auspices, the highest percent was in the Harvard group (13.7 percent) and the lowest percent in the Tulane group (1.7 percent). (a.) Age—In the 25-year-old-and-under group, a university or college was the preferred auspice for further mental health training by the highest percent of respondents (35.3 percent) ; this was followed closely by those who preferred a school of public health (33.3 percent). In this youngest age group, the lowest percent (19.6 percent) preferred on-the-job training. The lowest percent to prefer a university or college was in the 51- to 55-year-old age group (17.9 percent). In all other age groups, except the youngest 25 years old and under and the oldest, age 56 and over, the highest percents of respondents preferred such training under auspice of a school of public health. In the 56-year-old-and-over age group, the highest percent of re- spondents (35.9 percent) preferred on-the-job training; this was the highest percent of respondents in any age group to state this preference. The highest percent to prefer a school of public health (40.9 percent) was in the 36- to 40-year-old age group, while the lowest percent was in the b6-and-over-year-old group (30.8 percent). In every age group, the lowest percents of respondents chose some “other” auspice than those mentioned above; the highest percents making such a choice were in the 31- to 35-year- old age group (11.3 percent), in the 36- to 40-year-old age group (10.6 percent) , and in the 51- to 55-year-old age group (10.7 percent) while the lowest percent was in the 25-year-old-and-under age group (2.0 percent). (b.) Sex—There were no differences in the direction of responses given by men and women regarding the choice of auspice for further mental health training. Among both men (39.5 percent) and women (34.2 percent) the highest percents, respectively, preferred a school of public health; on-the-job training was the second preference among both men (23.5 percent) and women (26.2 percent). There was also a small difference in the size of the respective percents of respondents among the men (22.5 percent) and among women (24.6 percent) who preferred a university or college for such training and in the percent of men (9.9 percent) and of women (8.7 per- cent) who favored some “other” auspice as well. (c.) Primary professional discipline—Among administrators /hospital administrators (34.0 percent), dentists (55.4 percent), dietitians/nutrition- ists (39.4 percent), educators/teachers (40.2 percent), health educators (35.6 percent), nurses (35.5 percent), sanitarians (50.0 percent), and “others” (47.7 percent) a school of public health was the preferred auspice for further mental health training. Among physicians, however, the highest per- cent preferred on-the-job training (33.4 percent). Among nurses almost as many preferred on-the-job training (23.5 percent) as a university or college (24.1 percent), while a higher percent among the physicians preferred a school of public health (29.9 percent) to a university or college (18.0 per- cent). In the sanitarian group, those preferring on-the-job training (24.2 percent) exceeded those preferring a university or college (16.2 percent). (d.) Functional professional title—A school of public health was the preferred auspice for further mental health training by the following: Health educators (38.2 percent), administrators (38.6 percent), public health engi- neers or sanitarians (41.2 percent), public health nurses (35.0 percent), and “others” (40.0 percent). Among public health physicians, however, the highest percent of respondents (32.2 percent) preferred on-the-job training. (e.) Major role—Preference for a school of public health was expressed by the highest percents of respondents in all professional roles except among those in supervisory roles (33.1 percent) where a slightly higher percent (33.8 percent) preferred on-the-job training. The lowest percents of re- spondents choosing on-the-job training were, respectively, among those in research (13.7 percent) and among those in instructional (13.5 percent) roles. Among those in research roles (48.0 percent) was the highest percent of respondents who preferred a school of public health, while the lowest percent with that preference was among those in “other” roles (29.3 per- cent). Among respondents in instructional roles was the highest percent choosing a university or college (31.1 percent), while the lowest percent stating that same preference was among those in staff roles (18.4 percent). The lowest percents to prefer some “other” auspices were among those in instructional (7.8 percent) and among those in research (7.8 percent) roles, and the highest percent was among those who considered their roles as “other” nonspecified (14.7 percent). (f.) Principal source of professional income—A school of public health was the preferred auspice among respondents whose principal source of in- come was: County, city, other local government (36.5 percent), Federal Government civilian service (46.6 percent), Federal Government uniformed service (41.8 percent), State government (40.2 percent), and a voluntary agency or institution (35.7 percent). A university or college was preferred by the highest percent (36.0 percent) of those working in private profit- 219 220 making organizations; the lowest percent preferring a university or college (15.7 percent) was among workers in a county, city, other local government. As noted above, the highest percent choosing a school of public health for such training (46.6 percent) was in the Federal Government civilian service, and the lowest percent stating that same preference was among those in “other” nonspecified (30.2 percent) settings. Among those working for State government was the lowest percent (7.2 percent) which chose “other” nonspecified auspices for such training. The highest percent of respondents who preferred further mental health training to be on-the-job was in county, city, other local government (33.7 percent), and the lowest percent making such a choice was among those working in private profitmaking organizations (16.4 percent). (g.) Relationship of present work to mental health concerns—The highest percents of respondents chose a school of public health regardless of whether their work was described as strongly related, moderately related, oc- casionally related, or not related to mental health concerns. However, among respondents who reported their work as not related to mental health a higher percent chose a school of public health (46.1 percent) than among re- spondents whose work was, respectively, noted as strongly related (36.6 per- cent), moderately related (37.6 percent), or occasionally related (38.2 percent) to mental health concerns. SUGGESTIONS FOR IMPROVING MENTAL HEALTH INSTRUCTION BY SCHOOLS OF PUBLIC HEALTH Respondents who had indicated that schools of public health should improve their mental health instruction were asked to suggest how such instruction could be improved. The question was open-ended to allow for maximal latitude in the scope of responses. A qualitative analysis of re- sponses illustrated by replies follows. Suggestions for the improvement of instruction in or about mental health were classified into the following seven general areas or aspects: (I) Philosophy, (2) overall curriculum design, (3) integration and/or incor- poration of mental health subject matter in the curriculum, (4) content and manner of presentation of mental health concerns, (5) teaching faculty, (6) teaching techniques, and (7) availability of and access to mental health course work. Occasional overlapping of areas occurred, with suggestions tending to relate to pragmatic issues of professional practice. (1) Philosophy.—In general, the philosophy expressed supported the view that mental health and public health training should be interrelated in concept, attitude and experience. A physician described this concern as transcending mere instruction and involving the development of an attitude of active interest in optimum mental health patterns for the students, the faculty and their assistants . . . through well-directed school programs and activities under skilled leadership. With such a sensitized awareness to the importance of individual and group mental health, the mental health components of each public health study pro- gram could be introduced and discussed with much greater interest and more workable understanding. A psychiatrist recommended “broadening the concept of public health to a wider range of health-social, economic, legal, and other aspects of living, including behavior and population dynamics.” An educator suggested that greater attention be given “to the sociological analyses of societies which apparently foster the environment in which such problems of mental health arise.” Also suggested by an educator was an emphasis on “the mental health and human relations aspects of public health practices and services.” (2) Overall curriculum design.—This area included concrete sugges- tions dealing primarily with expanding and improving the curriculum by directing course work toward (a) More emphases on techniques and methods of planning, programing, and operation of mental health services; (b) increased development of courses which present and amplify the theoretical bases and practical skills for effective interviewing, group guidance, and consultation; and (c) greater emphases on placement and fieldwork particularly to provide an environment where the students may acquire first hand, practical experience in planning, organization, and opera- tions of community mental health centers and other psychiatric services as well. (8) Integration and/or incorporation of mental health subject matter in the curriculum.—The need for integration and/or incorporation of mental health subject matter within the entire public health curriculum was related to the suggestion that mental health principles, concepts, and concerns ought to be integral parts of public health instruction and relevant to both the delivery of health services and implementation of public health programs. A dietitian /nutritionist expressed the view that “faculties should be made aware of incorporating mental health principles into their disci- plines through seminars.” The following statement by a physician elaborates further on this same point: “Many seminars are given in schools of public health, and during these seminars mental health aspects of the public health subjects involved should be stressed, particularly problems that may affect utilization of health care services.” A dentist commented that “mental health concerns should be related to the implementation of specific public health programs; e.g., fluoridation.” A sanitarian indicated a similar viewpoint when he wrote that: “Mental health aspects of public health work should receive attention in nonmental health courses.” (4) Content and manner of presentation of mental health concerns.— Regarding specific mental health courses, three types of suggestions were made: (a) That mental health courses be identified or designated explicitly as such and be presented as a distinctly identifiable part of the public health curriculum, (b) that a greater number of mental health courses be made available and accessible to students, and (c¢) that students be required to take one and preferably more mental health courses as a precondition for be- ing granted a graduate degree by a school of public health. In discussing the 221 222 requirement for identifying content areas in mental health course work a nurse indicated that: “There should be a course on the organization and ad- ministration of mental health services which includes ways of developing programs emphasizing continuity of care and creative means of stretching the preventive mental health dollar.” A sanitarian observed that the need was for “more pragmatic instruc- tion for individuals working in environmental health, especially public health workers employed by local and State government agencies.” A psy- chiatrist who considered that “radical change” was needed made a range of recommendations encompassing a variety of contents and methods: Fieldwork should be increased in consultation and other areas . . . need for more concrete exposure to administrative problems . . . work with epidemiological techniques should focus on practical problems . . . need course work in program planning and evaluation . . . need greater basis in understanding community and legislative support . . . greater em- phasis on mental health education techniques . . . comparative studies of models for delivery of mental health services . . . better understanding of relation of political community to the service community. (5) Teaching faculty.—Another area of concern involved the qualifica- tions of and types of faculty teaching mental health. One recommendation focused on the need for teaching faculty with specific knowledge and com- petencies based on actual work experience in such areas as implementing mental health programs at the community level, and with mental health of school-age children. A second type of recommendation was that an active effort be made to attract teaching faculty from a variety of disciplines, in- cluding psychology, sociology, and anthropology, as well as psychiatry. In this respect also, respondents commented frequently on the desirability of multidisciplinary approaches in training and practice of mental health work. Lastly, suggestions were made for improving the quality of instruction pre- sented by inviting people prominent in the field of mental health to present guest lectures in their respective areas of expertise. A further suggestion was to bring about “more involvement of ‘working’ mental health personnel in the teaching program and more coordinated training programs between schools of public health and psychiatric facilities.” (6) Teaching techniques.— Teaching methods by which mental health subject matter and concerns could be more effectively communicated were also suggested. Recommended teaching methods included: A greater use of discussion groups in the form of interdisciplinary small-group seminars, work-study programs, means to enhance self-understanding and a greater awareness of one’s impact on others, and a more widespread use of audio- visual training aids and fieldwork. (7) Availability of and access to mental health course work.—It was recommended that it be made easier for students to take mental health courses by eliminating scheduling barriers and restrictions imposed on students who wish to take additional mental health courses, that a more active and fruitful liaison between public health and mental health pro- grams and personnel be established, and that programs related to mental health research be improved. IN SUMMARY, a majority of respondents indicated that further mental health training would be helpful to them in their jobs, that schools of public health should improve their instruction about mental health, and that they would be interested in pursuing further mental health training if such op- portunities were made available. Of those interested in further training, over one-third preferred that such training be conducted under auspice of a school of public health. The respondents who recognized that additional mental health training would be helpful were likely to be women, to be in the 51- to 55-year-old age group or older, to have as a primary professional discipline health educa- tion or nursing, to have the functional professional title of public health nurse, to have instructional roles, to have a principal source of professional income from a county, city, other local government, to work in a mental health setting, and to describe their jobs as strongly related to mental health concerns. Those who believed that schools of public health should improve their instruction about mental health were likely to be women, 51-55 years of age, health educators and nurses by primary professional discipline, have functional professional titles of public health nurses and health educators, have instructional roles, have as principal source of professional income a county, city, other local government or from some “other,” nonspecified source, work in a mental health setting, and see their jobs as strongly related to mental health concerns. Those who would be interested in further training if the opportunities were available were likely to be women, to be 51-55 years of age, health educators by primary professional discipline, public health nurses by func- tional professional title, have instructional roles, have as principal source of professional income a county, city, other local government, work in a mental health setting, and consider their jobs strongly related to mental health. Preference for a school of public health as the auspice for further training was supported by the highest percents of respondents in all age groups except the youngest, 25 years old and under, and the oldest, 56 years old and over. Among the youngest age group preference was for a university or college while for the oldest it was on-the-job training. Men and women showed no major differences in their choice of a school of public health as the auspice for further mental health training. Administrators/ hospital administrators, dentists, dietitians /nutritionists, educators/teachers, health educators, nurses, sanitarians and “others” by primary profession were likely to prefer a school of public health, but physicians were likely to prefer on-the-job training. The functional professional titles of those pre- ferring training under auspice of a school of public health were likely to be health educators, administrators, public health engineers or sanitarians, public health nurses and “others”; public health physicians also were likely 223 224 to prefer on-the-job training. A school of public health was preferred by the highest percents of respondents in all professional roles except among those in supervisory roles who were likely to prefer on-the-job training. By principal source of professional income, respondents working for county, city, other local government, Federal Government civilian and uniformed services, State government, and a voluntary agency or institution were likely to prefer a school of public health. Respondents who considered their work not related to mental health concerns were more likely to choose a school of public health for further training than those who considered their work strongly related, moderately related, or occasionally related to mental health concerns. The views expressed on how to improve mental health instruction in schools of public health included issues related to philosophy, overall cur- riculum design, integration and/or incorporation of mental health subject matter in the curriculum, content and manner of presentation, teaching faculty, teaching techniques, and availability of and access to mental health courses. REVIEW OF PARE FINDINGS Tm mm E P Eas Seen Lf tr de shan RR LAA a FE Ken nh etd cm ima ee on orn ni eeaitog il RE VIEW OF CHAPTER 13 FINDINGS OR more than a century the public health field has had an interest in assuming responsibilities related to mental health. This interest has been recognized by American schools of public health since their earliest begin- nings. Historically, however, both the fields of public health and mental health have followed different directions and foci in terms of manpower training and professionalization, program organization, control and admin- istration, and problem approaches. Such divergencies have been mainly produced by accretion rather than by design in response to the more precise recognition of health and mental health problems and to the capacities and limitations in the application of rapidly developing technical skills. Tradi- tionally, public health workers centered their efforts on the prevention and control of infectious diseases in communities and populations and on the promotion, maintenance, and protection of health. Over time, their efforts have been extended to the prevention and control of early deaths and dis- abilities produced by chronic disorders. The foci of activities of mental health workers have been on mentally and behaviorally disordered individ- uals, and mental health skills have been primarily addressed to their clinical care, treatment, and custody. The increased complexity of scientific knowl- edge, and of the technologies for managing the above-mentioned general problem areas have also tended to reinforce the specialization of institu- tional arrangements and of professional activities with resulting gaps and fragmentation in concepts, in the administration of agencies, and in the training and utilization of personnel in both fields. Political and social forces have also operated to channel separately, and in effect to divide, re- sources and efforts. Attempts at collaboration and viable integration of both fields in dealing with common or complementary problem areas have thus been delayed and often thwarted. After the end of World War II, the Federal Government gave new impetus to both public health and mental health efforts, and opportunities for reform which stimulated the development of locally organized programs became increasingly available. Theoretically, this development called for a closer relationship between mental health and public health including a greater involvement of the public health field in mental health work and a greater recognition of mental health considerations in overall public health practice. One effort in this direction was the establishment by the NIMH of a grants program to support mental health training in schools of public health. The study reported in this volume is concerned with issues related to the impacts of mental health training on public health and conversely, of public health on mental health as reflected in the perceptions and opinions 227 228 of American public health workers who graduated from 11 accredited schools of public health in the United States during 1961-67. All these schools had participated in the above-mentioned NIMH training grants program. A survey questionnaire was conducted by mail among the graduates to obtain data on their demographic, educational, and occupational character- istics as well as on their public health training and its mental health com- ponents. In this context, the extent to which these public health graduates were involved in mental health work and considered mental health training of value to public health was also the object of inquiry. In general, the graduates who participated in the survey lived or worked in the larger metropolitan areas. They concentrated in the Pacific, the south Atlantic, the middle Atlantic, and in the east-north-central regions of the United States. Respondents came from a diversity of professional backgrounds into public health training, but primarily from health and re- lated occupations. Although over four-fifths of the study population had already acquired a primary profession before entering a school of public health, only a few came from a mental health or related profession, viz, psychiatry, psychology, other behavioral sciences, psychiatric nursing, and psychiatric social work. Physicians and nurses comprised the largest primary professional groups. The majority of graduates from Harvard and Hopkins were physicians; while the largest concentrations of nurses had attended either Minnesota or Michigan. A bachelor’s was most frequently the highest degree held before enter- ing a school of public health. Indeed, a majority of graduates from seven schools and a plurality from two other schools entered into public health training at this educational level. One-fifth of the graduates had M.D. de- grees. Few respondents had either a D.D.S., D.V.M., or Ph. D., Sc. D., Ed. D. degree, while one in nine graduates reported a master’s as their highest or most advanced degree before entering a school of public health. One-half of all the respondents graduated from three of the schools: Michigan, Berkeley, and North Carolina. Three-fourths of the respondents worked toward an M.P.H., the generalist degree, with the rest being almost equally divided among those who received specialist degrees such as the M.S.P.H., M.S. Hygiene, M.H.A./M.S.H.A., and “other” master’s degrees. The largest number of respondents from all the schools except from Pitts- burgh received an M.P.H.; the most frequently reported degree among Pittsburgh graduates was the M.S. Hygiene. Thus, although a variety of de- grees were received by graduates only one or two types of master’s titles pre- vailed among the graduates from each school. During the 7-year period covered by this study, the number of graduating respondents fluctuated be- tween 613 and 309 although nearly twice as many graduated in 1967 than in 1961 and in 1962. Two-thirds of the respondents were men and on the whole they were younger than the women. There were more men among Harvard graduates than in any other school group. The highest percents of women were from North Carolina and Michigan; yet men predominated in numbers among all the schools. Slightly over one-half of the respondents were 36 years old and over at the time of the survey; with two-thirds of all being 40 years old or under. Among those who went to North Carolina was the highest percent of respondents 25 years old and under. Over one-fifth of all the respondents between ages 51 and 55 and better than three-tenths of those 56 years old and over were from Berkeley. Nearly two-thirds of all the respondents already had professional public health experience before attending a school of public health, most frequently from 1 to 4 years. Cumulatively, Michigan graduates had the most extensive total number of years of public health experience; the least was among UCLA graduates. At the time of the survey, the most frequently reported total length of public health experience was from 5 to 9 years. Substantially fewer respondents had had mental health experience than those with public health experience before attending a school of public health. Seven in ten respondents did not have any experience in mental health work. The highest percent of respondents with prior mental health experience was in the Berkeley group; the lowest percent was in the North Carolina group. Less than one-third of respondents without mental health experience indi- cated that they had felt a need for mental health training before attending a school of public health. Tulane respondents without such mental health experience indicated more frequently than any others that they had felt a need for mental health training; the least frequently to so report were in the Yale group. At schools of public health, respondents had mostly taken their major programs in: (a) Administration or Practice of Public Health, (b) Medical Care and Hospital Administration/Administrative Medicine, (¢) Environ- mental Health/Public Health Engineering/Sanitary Science, (d) Public Health Nursing, and (e) Health Education. Hopkins graduates took majors in 19 different areas; Pittsburgh graduates in 12. By school attended, the most frequently reported majors were: Administration or Practice of Public Health among respondents from Berkeley, Columbia, Hopkins, North Carolina, and Tulane; Medical Care and Hospital Administration /Admin- istrative Medicine among respondents from UCLA, Minnesota, Pittsburgh, and Yale; Aviation Medicine among respondents from Harvard, and Public Health Nursing among respondents from Michigan. Majors in Public Health Nursing were mainly pursued by women while Medical Care and Hospital Administration /Administrative Medicine, Aviation Medicine, and Environ- mental Health /Public Health Engineering/Sanitary Science were mainly pursued by men. Physicians, excluding psychiatrists, and educators /teachers pursued more different kinds of majors than other respondents. Very few respondents, 60 or 1.9 percent, pursued a Mental Health major. Those who majored in Mental Health were mainly nurses, physicians includ- ing psychiatrists, and psychologists. Although a majority of those who took Mental Health majors attended Columbia, Hopkins, and Harvard, Mental 229 230 Health majors were also reported in smaller number by graduates from six other schools. One-half of those who majored in Mental Health received an M.P.H. degree, and almost one-fourth each received either an M.S. Hygiene or some “other” master’s degree. In general, respondents tended to select a major program in the same or in a closely related field to their primary profession, for example, health educators tended to major in Health Education, nurses in Public Health Nursing, and dentists either in Public Health Dentistry, or Administration or Practice of Public Health. A majority of the respondents who did not identify themselves with a primary profession tended to major either in Medical Care and Hospital Administration/Administrative Medicine, in Administration or Practice of Public Health, or in Health Education. Three different avenues were employed to tap information on the ex- posures of respondents to mental health in their overall public health train- ing: (a) Interaction or contacts with mental health professionals on the faculty, (b) mental health courses taken, and (c) mental health aspects in public health content and mental health content—their coverage, quality of presentation, and usefulness. Nearly two-thirds of all the respondents had experienced contacts with mental health professionals on the faculty and at least one-half of the respondents from each school reported such contacts. More frequently, these contacts were with psychiatrists followed by those with psychologists, psy- chiatric nurses, psychiatric social workers, and “other” mental health pro- fessionals. The most frequently reported contacts by role were with teachers with the highest percent of such contacts being with psychiatrists. A much larger number of respondents had contacts with mental health professionals than those who had taken mental health courses. Two-fifths of the re- spondents had taken one or more mental health courses. One-half or more of the respondents from Berkeley, UCLA, Harvard, Hopkins, Michigan, Minnesota, and Pittsburgh did not take any mental health courses. Only one mental health course was taken by the majority of those who had taken any such courses. The highest percents of those who took mental health courses considered these to be: (a) Highly concerned with psychiatry and psychol- ogy, and (b) highly concerned with public health issues. Among those who took mental health courses also, the highest percents deemed the mental health faculty to be very knowledgeable in public health, and they judged these courses as moderately meaningful to public health, and as useful to their current work. The public health faculty was judged by a plurality of all the respondents as moderately interested in mental health issues. Over one-third of the respondents indicated that mental health issues were oc- casionally related to their total public health course work. The mental health aspects of two from a list of 31 public health topics —geriatric programs and alcoholism control—were covered in their public health training according to majorities of all respondents. A majority of re- spondents from eight schools indicated such coverage for alcoholism control, and from seven schools for geriatric programs. Of the 31 public health topics listed, 16 were covered in relation to their mental health aspects according to majorities from at least one school. According to the highest per- cents of respondents from each school the mental health aspects of the fol- lowing topics were covered: Birth control and family planning, alcoholism control, geriatric programs, accident prevention, fluoridation, and industrial health. The lowest percents of respondents from each school indicated coverage of the mental health aspects of radiation control, classes for ex- pectant parents, noise abatement, chest X-ray programs, air and water pollu- tion, delinquency control, abortion, migrant health, and sex education. The topics covered were generally considered to have been well-presented. Fluoridation, and pregnancy and childbirth crises were considered most frequently to have been well-presented. Narcotic control was considered well-presented by the lowest percent of respondents. The coverage of the mental health aspects of the topics, however, was likely to be considered of little use or of moderate use to current work. The highest percents of re- spondents to rate a topic of great use did so for pregnancy and childbirth crises and premature births. Noise abatement was considered of great use by the least respondents. In no instance did the highest percent of respondents from any of the schools consider any topic to have been of great use to their work or practice. According to majorities of all respondents, seven of the 43 mental health topics were covered in their public health training: importance of feelings and emotions, small-group interaction, understanding a client’s attitudes, fears, and prejudices, role of the family, public attitudes toward the mentally ill, individual personality dynamics, and role of conscious and unconscious factors. Of the 43 mental health topics listed, 26 were covered during their training according to a majority of respondents from one or more of the schools of public health. Majorities of respondents from each school noted that both the topics importance of feelings and emotions, and understanding a client’s attitudes, fears, and prejudices had been covered. The highest per- cents of respondents from each school indicated coverage of: Understanding a client’s attitudes, fears, and prejudices, public attitudes toward the men- tally ill, small-group interaction, sources of epidemiological data on mental disorders, role of the family, and importance of feelings and emotions. The lowest percents of respondents from each school indicated coverage of the topics psychiatric registers, social breakdown syndrome, and budget plan- ning for mental health programs. In general, the mental health topics were considered to have been well-presented. The topics rated as well-presented by the highest percents of respondents were: Small-group interaction, and un- derstanding a client’s attitudes, fears, and prejudices; the lowest percent of respondents considered the topic organization and delivery of mental health services as well-presented. Relatively few respondents considered the mental health topics covered as of great use to their work. The topic which the high- est percent of respondents considered to have been of great use was under- standing a client’s attitudes, fears, and prejudices. The lowest percents of 231 232 respondents to consider a topic of great use did so for the distribution of mental disorders in the general population, the role of the private sector in mental health programing and financing, State, local, and Federal mecha- nisms for financing mental health programs, psychiatric registers, and types of mental health treatment agencies and services. A majority of the respondents considered that further mental health training would be helpful to them in their jobs, and that they would be interested in pursuing further mental health training if such opportunities would become available. One-third preferred that such training be con- ducted under the auspice of a school of public health. A majority shared the view that schools of public health should improve mental health instruction. The areas mentioned as needing improvement were concerned with issues of philosophy, curriculum, integration of mental health content, teaching faculty and techniques, and the availability of and access to mental health courses. At the time of the survey, 91.4 percent of all the respondents were em- ployed, including 3.2 percent who were employed only part time. A group of 7.2 percent was unemployed. Employment in the health field was reported by 86.1 percent of the total respondent population. Thus, one in seven was not working at all in the health field. Employed respondents most frequently identified their functional pro- fessional title as “other” which they generally specified either as their primary profession, specialty, role, or university rank. The next most fre- quently reported title was administrator. Executive-administrative was the most frequently reported major job role; this was followed by consultative. Executive-administrative roles were the most frequently performed accord- ing to respondents from every school. Relatively few of the employed respondents performed direct patient care duties; in fact, four out of five were not engaged in direct patient care. Government was by far the principal source of income for employed respondents. The Federal Government including both the civilian and uni- formed services was the principal source of income for more respondents than State government or than county, city, other local government. Volun- tary agencies or institutions were the principal source of income for most of those employed in the private sector; only a few worked for a profitmaking organization and even less were self-employed. The principal work setting for the highest percent of employed respondents was a health agency outside of a hospital. Less than one-half as many worked either in an academic or in a hospital setting. Those working in academic settings were largely in uni- versities or colleges with very few working in medical or other health pro- fessional schools or in schools of public health. Very few, 60 or 2.2 percent, of the employed respondents worked in a mental health setting, either in a hospital or outside a hospital. Three-fourths of the respondents were working in the program area in which they had majored at a school of public health. Of the 60 respondents who had majored in Mental Health, 48 were working in this area. An addi- tional 22 worked in mental health although they had majored in other program areas, but six of these came from a primary mental health profes- sion. In other words, a total of 70 (or 2.2 percent) mental health workers was generated from all the respondents who participated in the survey. Respondents most frequently considered their jobs to be occasionally related to mental health concerns, a view which was also most frequently expressed by respondents from every school. A plurality of respondents each held the opinion that the public has a moderate expectation of mental health knowedge by public health workers and a moderate expectation about public health workers assuming mental health roles. One-half of all the respondents, furthermore, expressed the view that public health admin- istrators have a limited acceptance of the mental health aspects of public health work. A majority of respondents considered that their public health training had been highly useful to their present functions; and mental health train- ing in schools of public health was considered to be very important to public health work by more than one-third of all the respondents with nearly as many considering it as extremely important. Respondents were likely to judge that schools of public health had prompted in them either a little interest or a moderate interest in mental health. Furthermore, a majority shared the view that schools of public health should improve their instruction about mental health. Consistently throughout the study, awareness of and interest in mental health, and participation in mental health training and in work activities involving mental health were found to be related to the age and sex of respondents, and to mental health work experience prior to enrollment in a school of public health. This was particularly so for older rather than for younger respondents, among women rather than among men, and among nurses more than among members of any other primary profession. Similarly, among those groups, was most often noted an indication of hav- ing felt a need for mental health training prior to enrolling in a school of public health. These findings, thus, have program implications for the public health profession, the mental health professions, the schools of public health, and the public at large. From these findings it may be ex- trapolated that the programmatic implications are perhaps more crucial now than they had been in the past since now there is enough experience and knowledge for constructively challenging the present into more fruitful futures. If there is validity to the claim that there are mental health aspects to all public health problems which involve the community as a whole, it is necessary for schools of public health to suitably prepare their graduates, regardless of professional background, special interests, age, or sex, to deal with this dimension of their work. It would also be incumbent for the mental health field to recognize the public health dimensions of mental health work. Thus, if schools of public health are to be principal training 233 234 centers for health planners and health administrators, it is essential that training for these students include thorough knowledge of the mental health field, as well as the availability of opportunities for them to work in the mental health field. How individual schools might approach these issues can only be re- solved with their assessment of their specific character and mission. A school, for instance, might find it appropriate for all students to enroll for a re- quired course in the mental health aspects of public health practice. An- other might plan for utilizing mental health faculty in new ways by encour- aging tandem teaching by mental health experts and public health faculty in each of the specific public health subspecialty areas. Suitable practicum could be evolved for students to test out mental health techniques as applied to their area of interest or expertise. If mental health instruction in schools of public health would em- phasize utilitarian and practical issues in the context of practice theory, the overall pragmatic oriented public health training could become clearer. For mental health instruction to serve such ends, a school might well involve all faculty members in reviewing the extent of existing instruction in mental health as related to public health issues and pursue the construction of new approaches. For those public health workers in the field, schools of public health might consider increasing their continuation education programs in mental health focusing on the specific concerns of the practitioners. One initial approach which might be fruitful would be for the schools to bring together groups of alumni and faculty to discuss the elements of mental health instruction, the barriers to effective public health-mental health practice, and the effects of these barriers on instruction. Moreover, there is an urgent need to educate mental health specialists on the many and valued contributions which public health workers can assume both directly and indirectly to the mental health field. The findings of this study attest to the apparent lack of opportunities presently available to public health workers for employment in the mental health field. The reasons for this condition must be openly explored and barriers removed so that public health expertise and techniques can be brought to bear on mental health programs. The contributions of mental health professionals to this issue must be sought. Where public health and mental health remain isolated from each other both programs fail to achieve optimal ends and it is the public which suffers in terms of human agony, wasted tax dollars, and misspent energies. In working toward rational health programing, political, economic, and social factors as well as vested interests which have served to discourage the development of operational interrelations between both public health and mental health ought to be dissolved and conflicting professional values resolved. Leadership for evolving a new public health with greater humanistic concerns and with an interchange between public health and mental health rests with the schools of public health and all health and mental health workers in the field. Surely, as mental health moves from the familiarity of the clinical into the community, and as public health embraces the therapeutic while firmly committed to community approaches, some new meeting ground must be found for more effective utilization of personnel and implementation of new as well as tested concepts. 235 Pr ALi. ETT ian Nice RN lS terete i SE Cl niin iit tia atl ak APPENDIXES TREE § E APPENDIX A TABLE 1.—Estimated employment in the medical and health service industry by selected occupation, 1966 and 1975 projections 1966 1975 Percent Occupation change, Number Percent | Number Percent | 1966-75 Total ............. 3,672,000 100.00 5,350,000 100.00 45.7 Professional and technical. .............. 1,487,100 40.50 2,076,500 38.81 39.6 Engineers and natural scientists. . . . .. 23,200 63 36,400 68 56.9 Dentists ..............iii 94,900 2.58 121,900 2.28 28.5 Dieticians and nutritionists. ........ 18,200 50 25,100 47 37.9 Registered nurses .................. 584,100 15.91 799,200 14.94 36.8 Optometrists ...................... 13,900 38 19,800 37 42.4 Pharmacists ....................... 10,600 29 11,300 21 6.6 Physicians (M.D. and D.O.,) ........ 254,500 6.93 371,900 6.95 46.1 Chiropractors and therapists. ....... 54,900 1.50 86,700 1.62 57.9 Medical and dental technicians... . .. 203,600 5.54 376,400 7.04 849 Social and welfare workers. ......... 15,800 43 25,000 47 58.2 Other professional and technical. . . .. 213,400 5.81 202,800 3.79 -5.0 Managers, officials, proprietors .......... 94,400 2.57 143,900 2.69 52.4 Clerical workers ....................... 596,700 16.25 901,200 16.85 51.0 Stenographers, typists, secretaries . . .. 195,000 5.31 295,500 5.52 51.5 Bookkeeping workers ............... 32,100 87 43,400 81 35.2 Office machine operators ........... 5,100 14 10,600 20 107.8 Other clerical workers ............. 364,500 9.93 551,700 10.31 51.4 Sales workers ............. i. 1,300 .04 800 .02 —385 Craftsmen ............................. 87,900 2.39 121,600 2.27 38.3 Operatives ................ coo. 79,600 2.17 95,300 1.78 19.7 Laundry and drycleaning........... 44,400 1.21 64,400 1.20 45.0 Other .............. iii. 35,200 96 30,900 58 —-122 Service workers ........................ 1,310,200 35.68 1,998,700 37.36 52.5 Aids, orderlies, attendants .......... 637,900 17.837 1,023,900 19.14 60.5 COOKS oie 50,700 1.38 55,000 1.03 8.5 Practical nurses .................... 254,800 6.94 398,200 7.44 56.3 Janitors and cleaners. ............... 79,400 2.16 98,100 1.83 23.6 Other service workers. .......... ’eo 287,400 7.83 423,500 7.92 47.4 Laborers .................eii 14,800 40 12,000 22 —189 Source: U.S. Department of Labor, Bureau of Labor Statistics, Health Manpower 1966-75, Report No. 323. 239 APPENDIX B TABLE 1.—Graduates from schools of public health by citizenship, 1961-67 Year ending United States Canada Other countries Total June Number | Percent | Number | Percent | Number | Percent | Number | Percent 1961 ......... 502 65.2 98 12.7 170 22.1 770 100.0 1962 ......... 559 69.7 70 8.7 173 21.6 802 100.0 1963 ......... 584 68.6 58 6.8 209 24.6 851 100.0 1964 ......... 698 70.0 90 9.0 210 21.0 998 100.0 1965 ......... 801 70.1 106 9.3 235 20.6 1,142 100.0 1966 ......... 859 71.1 90 7.5 259 21.4 1,208 100.0 1967 ......... 851 72.8 95 8.1 223 19.1 1,169 100.0 Total .. 4,854 69.9 607 8.8 1,479 21.3 6,940 100.0 Source: Troupin, J. L.; American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967), mimeographed, p. 11. | 84 TABLE 2.—Graduate degrees awarded by United States and Canadian schools of public health, 1961-67 Year MS.P.H./ Total ending M.P.H./ M.S. MHA./ Other Masters Dr. P.H. Sc.D. Ph.D. Doctorate || graduate June D.P.H. Hygiene D.HA. masters subtotal subtotal degrees 1961. ....... 562 93 23 58 736 20 11 3 34 7170 1962. ....... 562 135 47 28 772 14 10 6 30 802 1963. ....... 592 157 47 25 821 12 14 4 30 851 1964... .... 640 181 67 48 936 22 23 17 62 998 1965. ....... 766 194 70 57 1,087 18 19 18 55 1,142 1966. ....... 790 201 79 57 1,127 32 23 26 81 1,208 1967. ....... 729 215 72 78 1,094 33 22 20 75 1,169 Totals. . 4,641 1,176 405 351 6,573 151 122 94 367 6,940 Percent... .. 66.9 16.9 5.8 5.1 94.7 2.2 1.6 1.4 5.3 100.0 Source: Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967); mimeographed, p. 10. Questionnaire Survey of Public Health—Mental Health Training DEPARTMENT OF HEALTH, EBUCATION, AND WELFARE PUBLIC HEALTH SERVICE HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION FORM APPROVED NATIONAL INSTITUTE OF MENTAL HEALTH SURVEY OF PUBLIC HEALTH-MENTAL HEALTH TRAINING CODE NO. BUDGET BUREAU NO. 68-568060 INSTRUCT IONS 2 PLEASE RETURN THIS FORM WITHIN ONE WEEK TO THE AMERICAN PUBLIC HEALTH ASSOCIATION IN THE ENCLOSED ENVELOPE. CARD 1§ 5. Highest professional or advanced degree Col. c Col held PRIOR TO ENROLLMENT in the school Check (27) 1. Citizenship: heck | Co checked in item 4: One one [(10) M.D. 1 USA 1 D.D.S. 2 Other (Specify): 2 Dvn. 3 Ph.D., Sc.D., Ed.D. 4 2. Present Age: Check 1) Other doctorate (Specify): 5 25 and under 1 26 - 30 2 Master's (Specify field): 6 31-35 3 36 - 40 4 Bachelor's (Specify field): 7 41 - 45 5 46 - 50 6 ( ) Other Degree (Specify field): 8 51 - 55 7 56 and over 8 Check 6. Full-time or part-time professional 3. Sex One 12) experience in public health: Male 1 (Do not include wolunteer work) Female 2 A. Number of years of professional work T - i i blic health PRIOR to Check 4A. School from which MOST RECENT public Check Bxperience in itu ! (28) health degree was received: One (13) enrollment in a school of public health | One California (Berkeley) 1 None 1 UCLA 2 Less than one year 2 Columbia 3 1 - 4 years 3 Harvard 4 5-9 years 4 Johns Hopkins 5 10 - 14 years 5 Michigan 6 15 years and over 6 (14) B. TOTAL number of years of professional Check (29) Minnesota 1 work experience in public health One North Carolina 2 None 1 Pittsburgh 3 Less than one year 2 Tulane 4 1-4 years 3 Yale 5 5-9 years 4 Other (Specify): 6 10 - 14 years 5 15 years and over 6 5. PUBLIC HEALTH [Check YEAR TA. Did you have any experience in mental DEGREE RECEIVED One) RECE VED ealth work prior to enrollment in a Check | (39) school of public health? One LJ Mepah. (15-16) = Yes 1 [J M.s.Ph. (17-18) . ; m- o LJ mas. Hygiene (19-20) B. If NO, would you say that you felt a need Check U MHA, (21-22) for some mental health training prior to ec = enrollment in a school of public health? One (31) [J Other Master's (23-24) p [J other Degree (Specify): (25-26) Yes 1 No 2 MH-T24 (8-68) 242 CARD 1 CARD 1 BA. PRIMARY PROFESSIONAL DISCIPLINES Col.| B. Continued (3) No. : - Check your PRIMARY professional discipline 08 Epidemiology 8 PRIOR to enrollment in a school of public 09 Health Education 9 health. Check only one professional dis- cipline. (36) IF NO PROFESSIONAL TRAINING HAD YET BEEN . RECEIVED PRIOR TO ENROLLMENT IN A SCHOOL OF| Check 10 International Health ! PUBLIC HEALTH, CHECK "NON-APPL ICABLE ," one |(32) 11 Maternal and Child Health 2 Administrator, Hospital Administrator 1 12 Medical Care and Hospital 3 Bacteriologist, Laboratory Scientist, ) Administration, Administrative Medicine Parasitologist 19 Mental Health, Administrative 4 Biologist, Entomologist, Zoologist 3 Psychiatry, Community Psychiatry 14 Microbiology, Laboratory Public Chemist, Biochemist 4 Health 5 Dentist 5 15 Nutrition, Biochemistry 6 Dietitian, Nutritionist 6 16 Occupational Health, Industrial 7 Educator, Teacher 7 Hygiene Engineer 8 17 Physiological Hygiene, Environmental 8 Health Educator 9 18 Population Studies, Family Planning, 9 D h (33) emography Industrial Hygienist 1 (37) Mathematician Statistician, Programmer 2 19 Public Health Nursing 1 Nurse 3 20 Radiation Health 2 Physical Therapist 4 21 Rehabilitation, Physical Therapy 3 Physicist, Radiological Health 5 22 Social Work in Public Health 4 Specialist, Health Physicist - — - - 23 Tropical Medicine, Entomology, 5 Physiologist 6 Parasitology Physician (Other than psychiatrist) 7 24 Veterinary Public Health 6 Psychiatrist 8 25 Other (Specify): 7 Behavioral Scientist, Anthropologist 9 (34) == Ce. Are you currently working in the Check] Behavioral Scientist, Psychologist 1 area you checked in item 887 one | (38) Behavioral Scientist, Sociologist 2 Yes 1 Behavioral Scientist, other 3 No 2 Sanitarian 4 If NO, specify the area in which you are S Work currently working, Enter the appropriate ocial Worker 5 two digit number (01 to 25 inclusive) from Veterinarian 6 item 8B Other (Specify): 7 Number — (39-40) 9A. Are you currently employed? Check (41) Non-applicable 8 Full-time 1 B. MAJOR PROGRAM IN SCHOOL OF PUBLIC HEALTH TRAINING: Part-time 2 . Unemployed 3 Check the category representing the MAJOR program which you PURSUED IN YOUR SCHOOL Check B. IF currently employed, are you working Check OF PUBLIC HEALTH TRAINING one (35) in the health field? one | (42) 01 Administration or Practice, Public 1 Yes 1 Health No 2 02 Aviation Medicine 2 - C. If NOT currently employed in the health Check 03 Behavioral Sciences 3 field are you a: One (43) 04 Biostatistics 4 Student 1 05 Chronic Diseases, Gerontology 5 Housewife 2 06 Dental Public Health 6 Retired 3 07 Environmental Health, Public Health 7 Other 4 Engineering, Sanitary Science H- -68) Page 2 243 CARD 1 CARD 1 D. If not currently employed, are you looking| Check |Col.} 4 NC IP : : Check for work in the health field? one | (44) 0. PRINCIPAL source of professional income re (49) Yes 1 County, City, Other Local Government 1 No 2 Federal Government (Civilian) 2 E. If not currently employed, are you looking Federal Government (Uniformed Service) 3 for work OTHER THAN in the health field? (45) Private Organization (Profii-making) 7 Y 1 es Self-employed 5 No 2 State Government 6 IF YOU ARE NOT CURRENTLY EMPLOYED, SKIP TO ITEM 13 Voluntary Agency or Institution 7 F. Check the one item which best describes Check - 3 your present FUNCTIONAL professional One |(46) Other (Specify) titles Biostatistician 1 Health Educator 2 11. PRINCIPAL setting where you work heck (50) N ” ne Medical Care Administrator 3 College or University 7 Public H . ublic Health Engineer or Sanitarian 4 Health Agency, Hospital 2 Public Health Nurse 5 - Health Agency, Other than Hospital 3 Public Health Physician 6 - - - Industry or Business 4 Scientist (Laboratory) ! Medical or Other Health Professional 5 Other (Specify): 8 School Mental Health Service, Hospital 6 (51) G. Check the one item which best describes Check (47) Mental Health Service, Other than Hospital 1 the MAJOR role in your present jobs: One Private Practice 2 Consultative ! School of Public Health 3 Executive-administrative 2 School System 7 Ansiructionsl 3 Welfare or Social Agency 5 R h 4 eseare Other (Specify)s 6 Staff 5 Supervisory 6 Other (Specify): 7 12. To what extent do you believe your present |n, . . professional duties are related to what one | (52) you would define as mental health concernsi Strongly Related 1 He i i i Check |(48 Are you directly engaged in patient care? oo (4 ) Moderately Related 2 Yes 1 Occasionally Related 3 No 2 Not Related 4 13. Below is a list of public health topics which may If your reply to question 1 is ®NO™ or ®DON'T have been discussed during your training in a RECALL," SKIP QUESTIONS 2 and 3 FOR THAT TOPIC. school of public health. We are interested in your comments about the mental health aspects of If your reply to question 1 is Myes", please check these topics WHETHER YOU TOOK SPECIAL COURSES IN in column 2 (question 2) whether the mental health ANY OF THEM OR NOT. aspect was "well=-presented", In column 1 (question 1) please check whether the In column 3 (question 3) please check its useful- mental health aspect was covered in any class. ness in your work. A. SOCIOENVIRONMENTAL 1. Was the mental health | 2. If yes, was it 3. Has the MENTAL HEALTH CARD 1 aspect covered in any well-presented? aspect been useful in PUBLIC class? your work? HEALTH TOPIC YES NO DON'T YES NO DON'T OF LITTLE |OF MODER- [OF GREAT RECALL RECALL USE ATE USE y 1 2 3 1 2 3 1 2 3 ACCIDENT PREVENTION (53-55) AIR & WATER POLLUT ION (56-58) MH-T24 (8-68) Page 3 A. SOCIOENVIRONMENTAL - Continued 1. Was the mental health] 2. If yes, was it 9. Has the MENTAL HEALTH CARD 1 aspect covered in any well-presented? aspect been useful in PUBLIC class? your work? HEALTH ~ DON'T DON'T | OF LITTLE | OF MODER-| OF GREAT TOPIC Yes No recat | TES no RECALL USE ATE USE| USE Col. 1 2 3 1 2 3 1 2 3 No. ALCOHOLISM CONTROL (59-61) CHEST X-RAY PROGRAMS (62-64) CIGARETTE SMOKING (65-67) DELINQUENCY CONTROL (68-70) FLUORIDATION (71-73) GERIATRIC PROGRAMS (74-76) HOUS ING (77-79) INDUSTRIAL HEALTH (mg 3320 ee IMMUNIZATION PROGRAMS (13-15) MEDICAL QUACKERY (16-18) MIGRANT HEALTH (19-21) NARCOTIC CONTROL (22-24) NOISE ABATEMENT (25-27) NUTRITION & FOOD FADS (28-30) RADIATION CONTROL (31-33) SUICIDE PREVENTION (34-36) TUBERCULOSIS CONTROL (37-39) B. FAMILY AND CHILD HEALTH YES NO DON'T YES NO DON'T OF LITTLE | OF MODER-| OF GREAT CARD 2 RECALL RECALL USE ATE USE USE BE 2 3 1 2 3 1 2 3 ABORTION (40-42) "BATTERED CHILD SYNDROME™ (43-45) BIRTH CONTROL AND (46-48) FAMILY PLANNING CLASSES FOR EXPECTANT (49-51) PARENTS OUT-O0F -WEDLOCK (52-54) CHILDREN POSTNATAL CARE ~ OF MOTHERS (55-57) PREGNANCY & (58-60) CHILDBIRTH CRISES PREMATURE BIRTHS (61-63) SCHOOL HEALTH (64-66) PROGRAMS SEX EDUCATION (67-69) VENEREAL DISEASE (70-72) WELL-CH ILD _ CONFERENCES (13-75) MH-T2% (8-68) Page 4 245 14. Now please comment on the more specific MENTAL HEALTH content of your public health training and its usefulness in your subsequent work. Comment on each topic by checking the appropriate answer to each question the same as in Item 13. BASIC MENTAL 1. Was the mental health aspect cov- ered in any class? 2, If yes, was it well=presented? 3. Has the content been useful in your work? HEALTH TOPIC YES NO DON'T RECALL YES NO DON'T RECALL OF LITTLE USE OF MODER=- ATE USE OF GREAT USE 1 2 3 1 2 3 1 2 3 CARD 3 Col. No. |. PERSONALITY THEORY Importance of feelings and emotions (10-12) Individual personality dynamics (13-15) Role of conscious and unconscious factors (16-18) Survey of personality theories (19-21) 11.S0C IAL IZATION Infancy and the preschool period (22-24) Role of the family (25-27) 111. INTERPERSONAL RELATIONS Sensitivity to behavioral and verbal cues (28-30) Small group interaction (31-33) Understanding a client's attitudes, fears and prejudices (34-36) GENERAL |e TECHNIQUES OF MENTAL HEALTH WORK "Anticipatory guidance" as related to the primary pre vention of mental disorders (37-39) Means of improving the mental health functioning of community care givers, e.g., clergy, police, teachers (40-42) Means of introducing inno- vation and change in mental health programs (43-45) Principles of consultation (46-48) Principles of interviewing (49-51) Other preventive mental health intervention tech- niques: e.g., community organization, mental health education, parent educa- tion, crisis intervention (52-54) Referral to special mental health facilities (55-57) Ile ADMINISTRATION OF MENTAL HEALTH WORK Budget planning for mental health programs (58-60) Comprehensive community mental health centers (61-63) MH-T24 (8-68) 246 Page 5 MENTAL 1. Was the mental 2. If yes, was it 3. Has the content been CARD 3 HEALTH health aspect cov- well-presented? useful in your work? TOP IC ered in any class? GREAT] Col £ DON'T N DON'T [| OF LITTLE[ UF WODER-TUF . 11, ADMINISTRATION OF MENTAL ‘es No RECALL ‘ES 0 RECALL USE ATE USE USE No. HEALTH WORK -Continued 1 2 3 1 2 3 1 2 3 Coordinating interagency relationships in mental (64-66) health Distribution of mental disorders in the general (67-69) population How to develop programs for the control of mental (70-72) disorders Identification and relief (73-75) of mental hazards Mental health functions of basic community services (76-78) in health, education and welfare Mental health medico-legal | CARD 4 problems (10-12) Organization and delivery (13-15) of mental health services Principles of comprehen- (16-18) sive mental health planning Role of the private sector in mental health program- (19-21) ming and financing State, local and federal mechanisms for financing (22-24) mental health programs Utilization of mental health data for program (25-27) evaluation 111. INFORMAT IONAL 1 2 3 1 2 3 1 2 3 Etiological factors in (28-30) mental disorders Psychiatric registers 31-33) Public attitudes towards (34-36) the mentally ill Roles and functions of - mental health specialists (57 39) Sources of epidemiological (40-42) data on mental disorders Varieties of mental 43-4 disorders (43 5) C. SPECIALIZED I. SECONDARY PREVENT ION 1 2 3 1 2 3 1 2 3 How to recognize mental (46-48) disorders Mental disorder case- finding role of public (49-51) health workers Methods for care of patients with mental dis- orders, e.g., psychologi=- (52-54) cal-psychiatric, pharma- cological, milieu or social environmental WH-T24 (8-68) Page 6 247 248 MENTAL 1. Was the mental 2. If yes, was it 3. Has the content been CARD 4 HEALTH health aspect cov- well-presented? useful in your work? TOPIC ered in any class? VES NO DON'T | veg no | DON'T JOF LITTLE | OF MODER-| OF GREAT |. SECONDARY PREVENTION - RECALL RECALL] USE ATE USE USE Col. Continued 1 2 3 1 2 3 1 2 3 No. "Social Breakdown Syndrome| (55-57) Types of mental health treatment agencies and (58-60) services I'l. TERTIARY PREVENTION Adjustment problems of ex-patients and their (61-63) families Psychiatric rehabilitation (64-66) agencies and services Psychiatric rehabilitation functions of public health (67-69) workers 15. The following questions are about your mental health training experience in a school of public health. A. How many CATALOG LISTED COURSES labeled Check B. If you responded in 15A that you took any Check as "Mental Health" did you take? one |(70) such course(s), indicate if these were: one | (71) None 1 Required 1 One 2 Elective 2 Two 3 Both required and elective 3 Three or more 4 Don't recall 4 16. The following table lists faculty members by profession and role. Check, if any, the types of contacts you had with the faculty members listed. IF YOU HAD NO CONTACTS WITH SUCH FACULTY MEMBERS, Mn 1 (72) PLACE A CHECK IN THE BOX AND SKIP TO ITEM 17 2 CARD PROFESSION TEACHER ohovisoR/ TUTOR OTHER 5 Psychiatry (10) (11) (12) (13) Psychology (14) (15 (16) (17) Psychiatric Nursing (18) (19) (20) (21) Psychiatric Social Work (22) (23) (28) (25) Other Mental Health Profession (26) (27) (28) (29) (Specify) IF YOU INDICATED IN ITEM 15A THAT YOU DID NOT TAKE A CATALOG LISTED COURSE LABELED AS "MENTAL HEALTH," SKIP ITEMS 17 and 18, AND CONTINUE WITH ITEM 19. 17a. If you indicated in item 15A that you CARD 178. If you indicated in item 15A that you took a catalog listed course(s) labeled 5 took a catalog listed course(s) labeled as "Mental Health," in general, to what as "Mental Health," in general, to what extent would you say that such mental Check extent would you say that such mental Check health course work was concerned with one |(30) health course work was concerned with one |(31) psychiatry and psychology? public health issues? Highly concerned with psychiatry and 1 Highly concerned with public health 1 psychology issues Moderately concerned with psychiatry 2 Moderately concerned with public health 2 and psychology issues Not concerned with psychiatry and Not concerned with public health psychology 3 issues 3 No opinion 4 No opinion 4 WH-T24 (8-68) Page 7 CARD 5 CARD 5 18A. To what extent would you say that the 20. What level of interest in mental health mental health faculty was KNOWLEDGEABLE was prompted by your school of public Check about public health problems and Check health training? One (37) approaches? one |(32) High interest 1 Very knowledgeable 1 Moderate interest 2 Knowledgeable 2 Little interest 3 Not very knowledgeable 3 No opinion 4 No opinion 4 21A. In your experience to what extent are B. To what extent would you say that the the mental health aspects of public course work offered by the mental health health ACCEPTED by public health admin- [Check faculty was MEANINGFUL in the context of | Check istrators? one | (38) public health concerns? one {(33) Accepted strongly 1 Highly meaningful 1 Accepted but limited 2 Moderately meaningful 2 Tolerated 3 Not meaningful 3 Resisted 4 No opinion 4 Strongly resisted 5 C. To what extent would you say that your Nn school of public health training in the B. In your experience to what extent does area of mental health is USEFUL in the the public EXPECT public health performance of your present work Check personnel to be knowledgeable about Check functions? one | (34) mental health? one | (39) High expectation 1 Highly useful 1 Moderate expectation 2 Useful 2 No expectation 3 Of little use 3 No opinion 4 No use at all 4 C. In your experience to what extent does No opinion 5 the public EXPECT public health workers |Check to assume a mental health role? One | (40) 19A. To what extent would you say that other . . public health faculty was INTERESTED in High expectation ! discussing mental health aspects of Check Moderate expectation 2 public health? one [(35) P Very interested 1 No expectation 3 Moderately interested 2 No opinion 4 Not interested 3 22. To what extent was your TOTAL school of — public health training USEFUL to your Check No opinion 4 present functions? One | (41) B. To what extent would you say that mental Highly useful ! health issues were RELATED to public Useful 2 health concerns in your total public Check health course work? One | (36) Of little use 3 Highly related 1 No use at all 4 Moderately related 2 No opinion 5 Occasionally related 3 23. In your opinion, how IMPORTANT would you say that mental health training is to the [Check Not related 4 performance of public health work? One | (42) No opinion 5 Extremely important Very important 2 Of some importance 3 Not important at all 4 No opinion 5 MH-T24 (8-68) Page 8 249 250 [ caro 5 Check (a One 3) 24A. Do you feel that further training in mental health aspects would be helpful in your work? Yes 1 No 2 Uncertain/don*t know 3 k TE B. Were opportunities made available for you to obtain ; some further training in the mental health aspects Tes of your professional work, would you be interested No 2 in participating? P P ¢ Uncertain/don't know 3 Check One (45) j 1 C. If your response in 24B was YES, under whose On the job auspices would you prefer that such training A school of public health 2 be held? University or college 3 Other (Specify): 4 Check (46) One 25A. Do you believe that schools of public health should Yes 1 improve instruction about mental health concerns? \ 2 o Uncertain/don't know 3 B. If YES, in what ways would you say that schools of public health could improve such instruction. Be specific. (47-48) (49-50) (51-52) (53-5¢) (55-56) (57-58) (59-60) (61-62) THANK YOU FOR YOUR COOPERATION WH-T24 (8-68) Page 9 U.S. GOVERNMENT PRINTING OFFICE : 1968 O - 315-944 TABLE 8.—Primary professional discipline of all graduates from schools of public health in the United States, 1961-67,' and of respondents to survey of public health-mental health training All graduates * All survey respondents ? Primary professional discipline Number Percent Number Percent Physicians .................... 1,118 23.0 639 20.5 Nurses ...........coovieinn... 675 13.9 467 15.0 Educators, health educators. . .. 406 8.4 200 6.4 Statisticians .................. 248 5.1 77 2.5 Engineers .................... 235 4.8 107 34 Sanitarians ................... 364 7.5 217 7.0 Dentists ...................... 176 3.6 106 3.4 Veterinarians ................. 142 3.0 82 2.6 All other .................... 1,490 30.7 1,220 39.2 Total .................. 4,854 100.0 3,115 100.0 t Source: Adapted trom Troupin, J. L.: American Public Health Association, Schools of Public Health in the United States and Canada, for the years ending June 1961-67, mimeo- graphed annual reports. 4 Includes all graduates who were permanent residents of the United States at the time of enrollment, master’s and doctoral levels, from all schools of public health in the United States; data compiled by J. L. Troupin. 3 Includes only American citizen, master’s degree recipients from 11 schools of public health in the United States. 251 252 TABLE 4.—Graduates from schools of public health, by mental health and all majors, 1961-67," and of respondents to survey of public health- mental health training All graduates All survey respondents * Ratio of Ratio of Mental Mental ai ea Year Health mimtors mages h Mental All majors majors all majors maior respondents to all (percent) J respondents (percent) 1961 .......... 17 886 1.9 6 309 1.9 1962 .......... 13 802 1.6 3 309 1.0 1963 .......... 13 851 15 5 364 14 1964 .......... 25 998 25 13 443 2.9 1965 .......... 16 1,142 1.4 9 508 1.8 1966 .......... 23 1,208 1.9 10 613 1.6 1967 .......... 23 1,169 2.0 14 569 2.5 Total 130 7,056 1.8 60 3,115 1.9 'Source: Adapted from Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada, for the years ending June 1961-67, mimeo- graphed annual reports. Includes all graduates, regardless of citizenship, from all schools of public health in the United States and Canada who received master’s degrees and doctoral degrees. * Includes only American citizen, master’s degree recipients from 11 schools of public health in the United States. CRITERIA AND GUIDELINES FOR ACCREDITING SCHOOLS OF PUBLIC HEALTH* INTRODUCTION Tee OBJECTIVE of any profession must be that of public service, and ac- creditation must above all serve the pub- lic interest. Its goal must be to stimu- late educational quality and to identify those educational institutions that are adequate for the demands of the times and the needs of the public in the fu- ture. Unless it accomplishes this goal, accreditation cannot be justified. Like any regulatory device, accredi- tation can have the effect either of re- stricting education into conformity and subsequent obsolescence or of aiding its responsiveness and improvement. To be beneficial, those who conduct accredita- tion must foresee the direction that pro- fessional service should take in the next decades, and must help professional edu- cation move in this direction. As Wil- liam K. Selden has said, ‘“‘Accreditation improperly conducted could support professional conservatism, rigidity, and selfishness. It could prevent the intro- duction of new methods and it could indirectly place limits on enrollments. In contrast, accreditation properly con- ducted can and does provide, even with all its limitations and inadequacies, a protection for the public and an assur- ance to the profession. It can and does offer stimulation for continued educa- tional improvements and it can and does indicate, sometimes after too much of a social lag, the proper direction for the education of the future members of the profession.” In the spirit of this current concept * Revised by the APHA’s Committee on Professional Education and approved by the Executive Board, June, 1966. of accreditation, the intent of the Com- mittee on Professional Education is that the accrediting process for schools of public health produce a maximum bene- fit and thus serve the best interests of our rapidly changing society. To this end, the CPE will endeavor to keep the following broad objectives constantly before it for all schools of public health. Each school should: (1) maintain high standards of public health teaching, research, and service; (2) seek .the opportunity and take the respon- sibility for individuality and flexibility; admit students regardless of race, creed, or national origin; (4) point curriculum content toward the future needs of society; (5) make more use of field training and re- lationships; (6) improve and extend continuing education; (7) evaluate the productivity of its faculty (through their teaching, research, and service roles), and the performance of its alumni—in terms of its own stated mission and objectives. (3 ~ In their role of intellectual leader- ship in public health, schools of public health should endeavor to meet the ex- pectations of society by preparing com- petent, imaginative workers for careers in preventing disease and disability, and in analyzing, improving, promoting, and maintaining the health of the public. By continually or periodically evalu- ating their activities, individual schools should maintain sufficient flexibility to conduct. educational experiments, to in- troduce periodic innovations in educa- tional policy and methodology, and to make changes in curriculum content and emphasis when indicated. In carrying out a complex and ex- panding program of teaching, research, and service, each school of public health Reprinted with permission from AMERICAN JOURNAL oF PusLic HEALTH, vol. 56, No. 8, August 1966. Copyright by the American Public Health Association, Inc., 1790 Broadway, New York, N. Y. 10019. 253 254 must be an integral part of a university and also must have access to field serv- ice and community laboratories, as well as to a wide range of physical facili- ties and technical equipment. It should have a faculty and staff of sufficient numbers and stature with diversity of professional ‘training and with knowl- edge of the physical, biological, and so- cial ‘sciences, including humanities. A school of public health should establish relationships with relevant schools and disciplines in the university so as to enable it to participate appro- priately in influencing curriculum de- velopment throughout the university, especially as such participation may con- tribute to meeting manpower needs in the total health field. The APHA Committee on Profes- sional Education, as the accrediting body for schools of public health, is interested in such characteristics of a school as: organization, administration, and financing; competence and balance of the faculty; adequacy of the cur- riculum; appropriateness and consist- ency of admissions requirements; su- pervised student field practice or labora- tory experience in teaching, research, and community service; and provision for self-evaluation in terms of specific objectives of the school. It must be clearly understood, however, that the committee will evaluate these and re- lated factors in the light of the stated purposes of each school and in relation to its expectations of accomplishment. Allowing for wide latitude in sub- ject emphasis and specific course con- tent from one institution to another, the CPE expects that schools of public health will focus their attention at least on the following areas: (a) Special health problems of the general population, e.g., environmental hazards, accidents, infectious diseases, mental ill- ness and retardation, chronic diseases and long-term illness, disease ‘and disability related to stress and deprivation; (b) General health problems of special popu- lation groups, e.g., the aged, mothers and children, occupational groups; Special services for general or special populations, e.g., availability of compre- hensive medical and hospital care, family life education and family planning, health education, nursing, categorical disease control, prevention of accidental injury, occupational health services, etc. General health problems of the general population, e.g., provision of comprehen- sive health care services, when, where, and how needed. (e) Health resources, manpower, and eco- nomics, e.g., analyses of health facilities, means of financial support, and future estimates; assessments of health manpower characteristics and projected require- ments; evaluations of the organization, de- livery, and quality of health services, and systems of financing such services and their utilization. ~~ (c (d - Schools of public health should apply present knowledge about health prob- lems by focusing on concepts, princi- ples, and skills pertinent to: (a) effec- tive planning; (b) organization; (c) administration; (d) evaluation; and (e) improvement of community health services. This will include full use of comprehensive medical and hospital care resources for all members of the popu- lation. The effective accomplishment of this type of community diagnosis and treatment can be greatly enhanced by using multidiscipline community health teams, particularly if all members of such teams have been well grounded in these concepts, principles, and skills. The director of a program should be an administrator prepared to conduct the program effectively with personnel of different skills and abilities. Likewise, schools of public health should make the most of their opportu- nities to increase our knowledge through research. Even more than in the past, epidemiological, behavioral, and opera- tions research should establish hypoth- eses, provide more precise planning of health services, and develop method- ology for evaluating health care services. Schools of public health also should be concerned with the relative perti- nence and applicability of organized community health service programs in all parts of the world. The Committee on Professional Edu- cation recognizes that the admission of students from other countries is an op- portunity and a special problem. Such students should be competent in the teaching language, and in major areas of basic knowledge. Students from abroad should be ad- mitted only when a school is prepared to meet a candidate’s needs for assum- ing substantial responsibility in his home country. I. ORGANIZATION AND ADMINISTRATION A. University Affiliation and Accredi- tation CRITERION:* Any school of public health ac- credited by the American Public Health Association must be an integral part of a university which is a member of one of the regional} associations of colleges and schools. B. Autonomy of Organization and Operation CRITERION: A school, faculty, or council admin- istering courses in public health should have such practical autonomy that re- quirements for public health degrees are effectively determined by the pub- lic health faculty. In support of this position a descriptive statement includ- ing the following points should be pre- pared by the school: I. Identity of the school of public health within the university. * Note: Required standards for accreditation are presented in bold type under “cRITERIA,” while general trends, suggestions, recommen- dations, and explanations offered as helpful comments are included under “Guidelines.” t Applies to U.S.A. only. 2. Relationship of the school of public health to the central administrative authority of the university. 3. Relationship with other schools or units within the university and with outside agencies. 4. Representation on central committees or councils that are advisory or making policy for the university. 5. Organization and administration of the school of public health with reference to faculty appointment, status, and organization related to the general policies of the uni- versity. 6. Process of preparation and administration of the budget within the school of public health. Listing of resources and facilities. 8. Internal organization and administration of the school of public health. N C. Physical Facilities CRITERION: Appropriate and sufficient class- rooms, laboratories, libraries, and other facilities should be available to carry out both the required and elec- tive course work. Guidelines: This means, for example, not only sufficient classrooms, seminar rooms, laboratories, and offices, but also acces- sible auditoria, libraries, reading and study rooms, data-processing equipment and services, and conveniently located administrative units of community health services available to faculty and students for observation, study, anal- ysis, criticism, and field experience of high quality. The availability and convenient ac- cess to adequate library facilities can- not be overemphasized as a fundamental and necessary resource for a school of public health. D. Financing CRITERION: A school of public health should have an assured minimum basic income adequate for its teaching, research, and service functions, and for meeting the various criteria and its own objectives. 255 256 Il. SCHOOL MISSION, FACULTY, AND INTERRELATIONSHIPS A. Definition of the School's Mission, Functions, and Purposes CRITERION: The faculty of each school of pub- lic health should define its individual mission and formulate its statement of philosophy, objectives, and functions. Each school also should describe its own approaches to the major areas of knowledge and professional activity relevant to the health needs of com- munities of people. Each school will prepare a written statement which rep- resents the consensus of its faculty, ex- pressing its concept or philosophy of public health. Such a statement should incorporate the broad, as well as spe- cific or unique, mission of that school, and the intermediate purposes and ob- jectives it proposes to attain its mission. Guidelines: While emphases may differ from one school to another, the Committee on Professional Education expects that, in carrying out its individual self-deter- mined mission, each school of public health will gear its program to the fol- lowing purposes: (1) to provide the broad professional educa- tion required by community health leaders who need: (a) the essential knowledge basic to the field, found in the biologic, physical, and social sciences; and (b) the mastery of skills in educational method- ology necessary to apply scientific and technical health knowledge in the chang- ing economic and political contexts of modern society; (2) to prepare specialists in several academic and professional disciplines for service in community health agencies, and for careers in related teaching and research; (3) to contribute to public health knowledge through the conduct of community-based health research, particularly epidemiologi- cal, behavioral, and operations research, to include an emphasis on the growing num- ber of new health hazards, and the com- plex area of multiple etiology of dis- eases, and methods in use or proposed for their alleviation; (4) to provide, in so far as feasible, con- tinuing education for personnel serving in community health agencies and edu- cational institutions, for community plan- ners, for health leaders (at all community levels—local, state, regional, national, and international), and to the public; (5) to provide community service, especially in the form of professional and technical consultation to individuals, groups, and communities, and through direct partici- pation in community health diagnosis, field investigations, and planning improved comprehensive health services. B. Stature and Number of Faculty 1. CRITERION: The teaching of public health should be under the direction of a full-time faculty which should include, in addi- tion to part-time appointees, at least one member of professorial grade as dean or director of the school, and at least seven other members of profes- sorial or associate professorial grade —all being primarily responsible to the administrative authorities of the school, and carrying specific responsi- bilities. Guidelines: The relatively high faculty-student ratio thus imposed upon a small or re- cently established school does not neces- sarily need to be maintained at the same level as the school grows and student enrollment increases. 2. CRITERION: For each’ subject area in which a school offers a specialty major, there should be at least one full-time faculty member, fully qualified in that particu- lar field or specialization (for example, dental public health, health education, maternal and child health, mental health, occupational health, public health nursing, etc.). Guidelines: The CPE expects each school to dif- ferentiate in personnel rosters its full- time and part-time faculty members and to distinguish them from other em- ployees of the school. The qualifications for each member of the faculty should be determined by his education and his experience in teaching, practice, and research. C. Faculty, University, and Agency In- terrelationships CRITERION: A school of public health should de- velop and maintain appropriate co- operative and joint relationships, not only within the school and university, but also with outside educational in- stitutions and service agencies. Guidelines: A school of public health will ordi- narily foster extensive cooperative rela- tionships internally among its faculty and externally with other schools and organizations, especially with local, state, and regional service agencies. There- fore, the Committee on Professional Education is interested in the extent of the following relationships as an indi- cation of the interdisciplinary and inter- agency concerns of the school. Internal (1) Administrative, e.g., policy determination with regard to programing of admissions, instruction, research, and services; selec- tion and promotion of faculty; etc. (2) Intradepartmental, e.g., departmental fac- ulty and/or staff information, planning, activities. (3) Interdepartmental, e.g., joint planning and teaching of multidiscipline classes, joint committee memberships, etc. (4) Interprofessional, e.g., joint research de- sign, exchange of professional viewpoints, faculty colloquia, etc. (5) Intrauniversity, e.g., joint teaching pro- grams, joint research projects, etc., be- tween the school of public health and other departments, colleges, or professional schools of the university. External (1) Interuniversity, e.g., joint arrangements and programs of study, teaching, or re- search between the school of public health and appropriate academic or pro- fessional segments of other universities, within limits of opportunity and feasibility. (2) Community health service agencies—local, state, regional, national, international Type, range, and depth of participation. Ill. EDUCATIONAL PROGRAM A. Degree Structure CRITERION: A school of public health must have a reasonable degree structure, which will represent and describe the broad content areas for which its faculty is responsible and which will comply with the degree standards and requirements of its parent university and graduate school. Guidelines: Approximately two dozen different degrees and diplomas currently are awarded by the schools of public health in the United States and Canada. Each new degree added to the list brings more confusion to the field. While sim- plicity is desirable, the Committee on Professional Education recognizes that a given degree may represent different admission and course requirements from school to school. A single specific degree may not be appropriate for the technological or scientific specialist on the one hand, and the broadly-based generalist (administrator) on the other. The CPE believes that these two differ- ent areas of interest should reflect: (1) a student’s career goals; (2) admission requirements; (3) course of study; and (4) degree or diploma designation. Al- lowing for some minor differences among the universities, the committee proposes five groupings, according to these four points. This will consist of a master’s level and a doctor’s level in each of the two areas (technological or scientific and general or administra- tive), plus a fifth category to contain, 257 258 until they can be dropped, those desig- nations which do not fit into the first four. (1) Master’s level (a) Public Health Specialist (or Tech- nologist or Scientist or Specialty Consultant) examples — M.S.Hyg., M.S.P.H., M.S., MA. (b) Public Health Generalist (or Admin- istrator or Program Director) examples—M.P.H., D.P.H. (2) Doctor’s level (a) Teaching or Research Specialist or Consultant examples—Sc.D., Dr.Sc.Hyg., Ph.D. (b) Public Health Generalist (Community Planner, Coordinator, Administrator, Specialized Program Director, Teacher, Researcher) example—Dr.P.H. (3) Other (degrees, diplomas, and certifi- cates not readily grouped into the above. Should be eliminated as soon as the changes can be made.) B. Curriculum CRITERION: A school of public health should have curricula differentiated for various types of professional responsibilities. Guidelines: The building and revision of a school of public health curriculum is a con- stantly changing and never-ending task. It should represent the best efforts of the faculty to define and describe— from time to time—the school’s best possible combination of total course offerings, based on the changing needs of the field and the anticipated constitu- ency of its student body. A school’s curriculum so conceived and described should be divided into general cate- gories of courses, according to their major emphases or purposes, and the career objectives of the graduate stu- dents for whom they are designed. In this sort of categorization the total course offerings may be listed in the following groups (although these al- ternative groups are not mutually ex- clusive) : required versus electives; practice versus research; multidisci- plinary versus specialized; etc. In addi- tion to the required courses, certain of the other courses may be designated as “required majors” (i.e, required specialty courses differing according to departmental or degree curriculum in which the student is majoring). C. Admission ments and Degree Require- CRITERION: Each school of public health will en- force admission and degree require- ments that are appropriate to insure the realization of its own stated mis- sion, purposes, and objectives, and that conform to the standards of the parent university and its graduate school. (1) Master's level (Public Health Specialist or Scientist) —M.S.Hyg., M.S.P.H., M.S., M.A. a. Admission Requirements CRITERION: Admission should be limited to hold- ers of the bachelor's degree with ade- quate preparation in the biological, physical, or social sciences, or com- binations thereof; they should meet ad- mission standards equivalent to those required of candidates matriculating for an equivalent master of science degree in other parts of the university. b. Degree Requirements Guidelines: Course content for master’s degrees in this category varies widely, accord- ing to the particular specialty or aca- demic emphasis involved in each in- stance. In spite of this wide range of actual course material, the CPE recom- mends that any master’s degree pro- gram offered by a school of public health would include one or more sub- stantial courses concerned with the ori- entation of the student to community health concepts and practices in general and introduction to the public health sciences in particular. The CPE also ex- pects that a student would fulfill other requirements equivalent to those re- quired of candidates for similar mas- ter’s degree programs in other parts of the university. c. Time Requirements CRITERION: In no case should the length of total courses required for these master's de- grees be less than one academic year of full-time attendance. Guidelines: A school may require that candidates for this category of master’s degrees spend two academic years for the com- pletion of didactic, laboratory, and field studies—if such requirement is consist- ent with: (1) the needs of an indi- vidual student; (2) the mission and ob- jectives of the school and the degree in question; (3) sound academic and pedagogic practice; and (4) the gen- eral pattern of practice found in other parts of the university. (2) Master’s level (Public Health Generalist or Administrator) —M.P.H., D.P.H. a. Admission Requirements CRITERIA: An applicant should possess: I. A graduate degree, from an acceptable in- stitution, in a discipline relevant to public health, or 2. A bachelor's degree, from an acceptable institution, with substantial knowledge in a discipline relevant to public health either through study or experience or a combination of these. Guidelines: Matriculation for the M.P.H. degree should be based upon an applicant’s professional competence in one of the basic disciplines relevant to public health practice. His study should be de- voted to orienting his knowledge and skill to those subjects required in the comprehensive provision of community health services, as well as to appropriate advanced study in his basic profes- sional area. b. Degree Requirements The APHA Committee on Profes- sional Education is convinced it should not require any particular courses of instruction by schools of public health. This responsibility should be left to the individual schools to develop in accord- ance with the broad CPE criteria and guidelines and with the stated objec- tives and purposes of the school. CRITERIA: In the instance of the M.P.H. (or, in Canada, D.P.H.), however, it is appropriate that instruction in certain fields basic to public health be in- cluded as required content for every candidate for this degree. These fields of instruction to be required or com- petence to be demonstrated, before the M.P.H. degree is awarded, are out- lined in the following fundamental areas of knowledge: I. The nature of man, his physical and social environment, and his personal and social interaction—as they affect his health. 2. The basic technics of investigation, measure- ment, and evaluation, including biostatistics and epidemiology. 3. The basic technics of administration (organ- ization and management), particularly as applicable to comprehensive health care programs. 4. The economic and political setting relevant to health services. 5. The application of these knowledges in the promotion of community health. This comprehensive content may be contained within various subject area courses such as administration, biosta- tistics, environmental health, epidemi- ology, social foundations of community health, or in other required offerings 259 260 suited to the program of a particular school. Guidelines: In addition to subjects listed above (under CRITERIA), schools of public health also teach in many other areas, such as accident prevention, the aging population, health economics, health education and communication, health manpower, infectious diseases, interna- national health, long-term illness, ma- ternal and child health, medical care administration, mental retardation and mental illness, population dynamics, and research methodology. As a general context into which these, and other, emerging subjects may be re- lated and fitted, several schools of pub- lic health have grouped these subjects in three broad categories: (1) funda- mental knowledge and concepts about man and his interaction with environ- ment; (2) specific public health skills required for the scientific study and analysis of community health status, needs, and resources (community health “diagnosis”) ; and (3) principles and methodology necessary for applying and relating knowledge, concepts, and skills in solving community health problems (comprehensive health services). Schools of public health have a major obligation to provide students with an understanding of the economic, social, and cultural bases of differences among ethnic and national groups, which affect the provision of health services. Such understanding is necessary to assist stu- dents to overcome prejudices which may prevent them from making their full contribution to the community in which they work, whether on a local, national, or international level. c. Time Requirements CRITERION: In no case should the length of total courses required for the master of pub- lic health degree be less than one aca- demic year of full-time attendance. Guidelines: Some schools of public health are ex- tending the time for covering the M.P.H. program beyond a single aca- demic year. Some include part or all of summer school; some, a third semes- ter; and one has gone to two full aca- demic years. (3) Doctor’s level (Teaching or Research Specialist or Consultant) * Ph.D., Sec.D., etc. a. Admission Requirements CRITERION: A candidate must possess a master's degree in a field related to that in which he seeks admission, and must meet the requirements (if applicable in the particular university) of the graduate school. If it is within the policy of the uni- versity to admit a baccalaureate grad- uate directly to a doctoral program (in this category), the school of pub- lic health may follow this pattern. In this instance the basic preparation usually included in the corresponding master's curriculum should be included in such a doctoral program. b. Degree Requirements Guidelines: In general, the degree requirements should correspond to those set down by the university for the same, or similar, degrees in other schools, including orig- inal investigation plus a dissertation, * The Criteria and Guidelines listed here must necessarily be both general and flexible because of the variation among university regulations for these degrees. In the case of the Ph.D. (and often the Sc.D.), this is almost always administered by the graduate school, though the actual work is done in a school of public health, so that the standards set down by the graduate school must be observed. In some universities, the Dr.Sc.Hyg. is admin- istered by the school of public health, with nominal supervision by the graduate school, whereas in yet other institutions the latter is responsible for all degrees issued beyond the baccalaureate. The APHA does not undertake to promulgate Criteria for the degrees in- cluded in this category (No. 3). certain academic studies, and (for cer- tain degrees) language requirements. c. Time Requirements Guidelines: In general, the time required for completion of the degree requirements should correspond to that set down by the university for the same, or similar, degrees in other schools. This will usu- ally include full-time attendance for at least one year beyond the completion of the work for the master’s degree. Some universities permit selected doc- toral degree candidates to complete their requirements in interrupted “install- ments”’—spread out over several years. If a school of public health adopts this practice, within the regulations of the university, it should be assured that all the degree requirements are fully met before the candidate is presented for the degree. (4) Doctor’s level (Community Planner, Co- ordinator, Administrator, Teacher, Re- searcher) —Dr.P.H. a. Admission Requirements CRITERIA: A candidate for admission to the Dr.P.H. program: I. Must hold the M.P.H. degree (or Diploma in Public Health). or 2. Must fulfill admission requirements for the M.PH. (or D.P.H.) and must also have completed the basic academic requirements therefor. 3. He must also demonstrate (or have previ- ously demonstrated) ability for leadership in his field, as well as for advancement of scientific knowledge. b. Degree Requirements CRITERIA: I. Actual course studies, seminar participation, tutorial work, field assignments, and other individually planned learning experiences may differ considerably from one doctoral candidate to another. The Committee on Professional Education will expect, however, that all doctoral candidates will submit a dissertation or thesis—based on original in- vestigation representing a contribution to knowledge in the art and science of public health—which will be acceptable to the authorities of the university. 2. Candidates for this degree also will com- plete any additional work equivalent to that required of similar doctoral candidates in other parts of the university, consistent with the school's stated objectives and purposes for such candidates. c. Time Requirements CRITERION: A candidate for this degree will complete at least one academic year of work in residence at the university— beyond the appropriate master's de- gree work—including advanced spe- cialization in his particular area of aca- demic or professional work. Guidelines: A school should require of a student such time for completion of his doc- toral studies as is consistent with his needs and: (a) the mission and objec- tives of the school; (b) sound academic and pedagogical practice; and (c) the general pattern in other parts of the university. The same conditions regarding in- terrupted studies are applicable as are mentioned under Ph.D., and Sc.D. D. Exemption from Specific Courses Guidelines: Since the educational programs of schools of public health are designed primarily for graduate students, those entering students with previous grad- uate education rould—in some in- stances—be given the opportunity to take oral or written examinations, or to use previous course transcript evidence, for their advanced placement or exemp- tion from specific courses. E. Jointly Planned and Operated Edu- cational Programs CRITERION: Each school of public health—as consistent with its stated mission and 261 262 objectives—should develop a pattern of joint participation with other insti- tutions and agencies in providing the kinds of teaching and learning experi- ences it deems appropriate for its de- gree candidates, faculty, and staff. 1. Supervised Field Experience Guidelines: The CPE considers supervised field experience, as part of certain degree requirements, to be generally desirable and in some cases a necessity, particu- larly for those students without previ- ous public health experience. This may mean extending the school term for certain categories of students and em- ploying more faculty to carry out the increased amount of individual “tailor- made” planning and personal super- vision required to provide such field experiences effectively. The purpose of such experience is to provide opportunity for supervised field analysis, application, and evaluation of theoretical foundations of community health practice. The time required may vary according to the experience of each candidate and the subject matter. When supervised field training ex- perience is established, the specific re- lationships of the school of public health to the field agency should be clearly defined (preferably in writing) and understood by all parties concerned. 2. Continuing Education Guidelines: The Committee on Professional Edu- cation recommends that the schools be active (jointly with field agencies) in continuing education of: (a) academi- cians and practitioners who hold degrees in public health; and (b) those full- time career public health professionals who do not hold graduate public health degrees, but who look to schools of public health for leadership in prepar- ing teachers, course content, and learn- ing experiences. It is appropriate, de- sirable, and realistic that operating agencies and professional associations participate with schools of pubiic health in developing and operating continuing education activities. 3. Residency Training in Com:nunity Health Guidelines: What may become a trend of col- laboration among schools of public health, schools of medicine, and operat- ing agencies now is beginning in ap- proved medical residency training pro- grams of the various specialties of pre- ventive medicine. Similar patterns of jointly planned and operated programs are being ex- plored among some schools of public health, schools of dentistry, and operat- ing health agencies in developing ac- credited residencies in dental public health. This approach to public health residency training in other specialties of community health may be close at hand (e.g., veterinary public health, community mental health). 4. Teacher Training in Public Health Guidelines: In a few instances, schools of public health and related health professional schools (e.g., schools of medicine, schools of nursing) have developed joint educational programs to prepare teachers of community medicine for medical schools and teachers of public health nursing for baccalaureate nursing degree programs. As the demand grows for more teachers of community medi- cine, dentistry, nursing, etc., in the basic health professional schools, it would be desirable for those schools of public health that have the interest, compe- tence, and opportunity to participate jointly in planning, organizing, and conducting such teacher-training pro- grams in these and other aspects of community health. Demands also are growing for schools of public health to collaborate with lead- ing public and voluntary health agen- cies to develop training programs. Training directors are needed to organ- ize and direct programs of on-the-job training and continuing education in certain central health agencies in each state. F. Research CRITERION: A school of public health should promote appropriate faculty research, and should be able to identify the ex- tent and scope of its faculty's involve- ment in research in terms of: titles of research projects; names and categories of investigators; duration, amount, and sources of grants; and resulting publications. The CPE will expect that all doctor's degree candidates would individually become appropriately in- volved in the school's (or related) re- search activities. Guidelines: Much of the curriculum taught, and most of the health activities carried on in communities, are or will be based on the results and effects of research and organized demonstrations. Many innovating services in the areas of local health, welfare, medical care, and urban and regional planning and de- velopment are being made through re- search projects or planned project ef- forts. Therefore, research and designed demonstrations (with built-in evalua- tion) should be the principal method of developing and advancing the content and practice of public health. IV. EVALUATION Objective Self-Evaluation CRITERION: Schools of public health should de- velop various approaches to self evaluation. Guidelines: Attempts at self-evaluation of a school’s progress and success should be undertaken with as much objectivity as possible, keeping in mind its stated mis- sion, objectives, and purposes. Success should be reckoned not only by the ac- complishments of its faculty through research, publications, and service, but also by the fruitfulness of the careers of its graduates. Since perhaps the general objectives and specific purposes of the schools for improved health services to people will be realized through their graduates, the CPE encourages schools to develop meth- ods of evaluating their performance as students and attainments as alumni. Any realistic assessment of the effective- ness of their careers, over a period of time, should be considered as one step toward the development of valid and practicable methodologies in this type of evaluation. 263 264 TABLE 1.—Areas and number of major organizational units in the 15 accredited schools of public health in the United States and Canada, year ending June 1967 Number of units Administration, community health, community health services, health administration, health services administration, public health administration, public health practice. ... 17 Biometry, biostatistics ................ 13 Environmental health, environmental health sciences, environmental hygiene, environ- mental sanitation, environmental sciences and engineering, public health engineering, sanitary engineering ............... LL... Epidemiology ......... Nutrition, nutritional sciences, public health nutrition .............................. .. Health education, public health education ............................................ Infectious and tropical diseases, parasitology, pathobiology, tropical public health ...... Maternal and child health ........................... Environmental medicine, physiological hygiene, physiology ............................ Hospital administration ......................... Industrial health, industrial hygiene, occupational health, occupational medicine ........ Microbiology, public health laboratory ............................................... Nursing, public health nursing ..................................... Behavioral sciences, social sciences ................. oi Community psychiatry, mental health, mental hygiene ................................. Population and family health, population planning, population unit .................. Chronic diseases ................ Continuation education, continued education ............................... 0... Individual and community health, personal health ................................... Medical care administration, medical care organization ................................ Biochemistry ........... Biochemistry and nutrition ............. Demography ........... Demography and human ecology ............................ Epidemiology and biometrics ................... Epidemiology and microbiology ................... Health development ................ Library Maternal and child and population studies ..................................... Medical care and hospital administration ........................... Medical records ......... LL Nutrition and biochemistry .................. Physical education ................ Public health and medical administration ............................................ Public health economics ................... iii Radiological science ................. Tropical medicine and international health ........................................... srt Ut wo Go Pt fd fd fd Dd fd bd pd pd pd pd pt bd ht bet bt ND OND ND OND WO 00 QO MA a A WA A DY IN © Source: Compiled from Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967), mimeographed, p. 14. TABLE 2.—Applications and acceptances to all accredited schools of public health in the United States and Canada, years ending June 1961-67 for all professional categories Year ending Number of Number of Number of Percent Number of June schools applications acceptances acceptances admissions * 1961. ...... h.. 12 1,594 1,050 659 [............... 1962. ......... 12 2,274 1,465 644 |... ........... 1963. ......... 12 2,376 1,545 65.0 |............... 1964. ......... 13 2,884 1,827 634... .......... 1965. ......... 14 3,591 2,194 61.1 |............... 1966. ......... 15 4,026 2,543 63.2 1,797 1967. ......... 15 4,109 2,371 57.7 1,802 Total... |.............. 20,854 12,995 62.3 3,599 * Includes potential master’s and doctoral candidates. ? Information not available for 1961-65. Source: Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967), mimeographed, p. 9. TABLE 3.—Cumulative number of applications, acceptances, and percent accepted to all accredited schools of public health in the United States and Canada, years ending June 1961 through 1967, by profession 1 Number of Number of Percent Profession applications acceptances accepted Physicians .......................... 4,002 3,289 82.2 Mathematicians/statisticians ......... 757 607 80.2 Engineers .......................... 668 500 74.9 Social workers ...................... 100 61 61.0 Dentists ............................ 676 458 67.8 Biologists .......................... 131 102 77.9 Nutritionists/dietitians .............. 717 520 72.5 Veterinarians ....................... 428 314 73.4 Nurses ............ccoiiiiiiiiiia.. 2,026 1,318 65.1 Educators/health educators .......... 2,584 1,663 64.4 Bacteriologists/laboratory scientists .. 604 400 66.2 Pharmacists ........................ 27 15 55.6 Sanitarians ......................... 1,566 983 62.8 Chemists/biochemists ............... 266 152 57.1 Administrators/hospital and medical care administrators ............... 3,927 1,351 34.4 Physicists .......................... 74 51 68.9 Physical educators .................. 620 214 34.5 Industrial hygienists ................ 26 14 53.8 Others ............................. 1,655 983 59.4 Total ........................ 20,854 12,995 62.3 ! Includes potential master’s and doctoral candidates. Source: Compiled from Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (years ending June 1961 through 1967), mimeographed. 265 266 TABLE 4.—Master’s degree graduates from all accredited schools of public health in the United States and Canada, years ending June 1961 through 1967, by major program pursued Major Program 1961 1962 1963 1964 1965 1966 1967 | Total Administration or Practice of Public Health ........ 149 139 128 150 150 186 181 1,033 Aviation Medicine ........ 15 22 18 19 24 29 34 161 Behavioral and Social Sciences ................ 3 3 10 |....... 9 3 5 33 Biostatistics .............. 38 33 42 44 51 56 47 311 Chronic Diseases .......... 2 9 7 4 8 7 8 45 Dental Public Health ..... 17 22 21 21 17 32 20 150 Environmental Health . .... 68 79 87 104 121 96 97 652 Epidemiology ............ 46 43 54 62 59 52 50 366 Health Education ........ 87 73 65 109 155 136 123 748 International Health ......[.......|.......|.......|....... 3 10 15 28 Maternal and Child Health. 20 38 29 50 51 62 78 328 Medical Care and Hospital Administration ......... 85 100 111 132 143 138 155 864 Mental Health ........... 17 12 13 25 15 21 20 123 Microbiology and Labora- tory Public Health ...... 24 32 40 28 34 33 44 235 Nutrition/Biochemistry ... 39 26 49 43 68 65 70 360 Occupational Health ...... 26 26 33 28 32 28 29 202 Physiological Hygiene ....|.......[.......|.......[....... 6 5 12 23 Public Health Nursing .... 56 49 54 56 67 99 74 455 Radiological Science ...... 15 23 20 21 21 18 21 139 Rehabilitation and Physi- cal Therapy ............[...... |...) 4 5 3 12 Social Work in Public Health ............... |... fii] 3 4 9 16 Tropical Medicine/Ento- mology/Parasitology .... 17 30 27 22 32 30 41 199 Veterinary Public Health .. 5 5 12 15 14 12 70 Other .................... 7 8 1 S|... 1 20 Total .............. 736 772 821 936 | 1,087 | 1,127 | 1,094 6,573 Includes persons reporting as their place of permanent residence prior to enrollment either the United States, Canada, or another country. Source: Compiled from Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (years ending June 1961 through 1967), mimeographed. TABLE 5.—AIl graduates (residing in the United States at the time of enrollment) from all accredited schools of public health in the United States, 1961-67, by profession prior to enrollment 1 Profession 1961 1962 1963 1964 1965 1966 1967 Total Physicians ............... 143 145 127 166 157 173 207 1,118 Nurses ................... 123 62 70 74 95 140 111 675 Educators, health educators .............. 54 49 39 46 64 76 78 406 Administrators ...........|....... 76 78 79 92 88 98 511 Bacteriologists ............|....... 25 28 23 46 45 38 205 Statisticians .............. 22 24 31 40 47 41 43 248 Engineers ................ 30 29 27 44 35 32 38 235 Nutritionists .............|....... 10 18 22 32 28 33 143 Sanitarians ............... 43 49 47 53 64 68 40 364 Dentists .................. 24 22 21 22 26 36 25 176 Biologists, entomologists ..|....... 4 6 15 15 26 24 90 Chemists .................|....... 7 12 15 15 14 17 80 Pharmacists ..............|.......]....... 4 8 6 5 12 35 Social Workers ...........[....... 9 10 17 20 15 19 90 Veterinarians ............. 14 12 21 30 29 20 16 142 Physicists ............... |... .... 11 16 9 15 13 18 82 Behavioral scientists ......[....... 7 10 10 8 10 10 55 Industrial hygienists ......|....... 7 6 7 6 4 7 37 Physical therapists ........|.......[....... 6 10 10 12 6 44 Others ................... 49 11 7 8 19 13 11 118 Total .............. 502 559 584 698 801 859 851 4,854 * Includes doctoral graduates. Source: Compiled from Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (years ending June 1961 through 1967), mimeo- graphed. 267 268 TABLE 6.—Faculty and staff members in all accredited schools of public health in the United States and Canada, for the years ending June 1961 through 1967 * Part-time Year Number Part-time employed ending of Full-time | Full-time | employed in outside Total June schools faculty staff university university 1961. ............. 12 689 | .......... 229 526 1,444 1962. ............. 12 785 | .......... 258 594 1,637 1963. ............. 12 839 | .......... 263 599 1,701 1964... .......... 13 882 |.......... 268 658 1,808 1965. ............. 14 603 313 60.3 91.1 1,067.4 1966. ............. 15 663 354 64.6 100.8 1,182.4 1967. ............. 15 735 420 74.1 112.0 1,341.1 * The number of faculty and staff members are expressed as full-time equivalents for the years ending June 1965-67, but for previous years as a gross count. Included in this count are professors, associate professors, and assistant professors who serve full time in the school of public health, and other persons holding academic appointments prorated on the basis of the approxi- mate proportion of time spent in instruction and related activities specifically for the graduate students enrolled in the school of public health. Source: Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967), mimeographed, p. 6. TABLE 7.—Subject areas taught by equivalent full-time faculty and staff in all accredited schools of public health in the United States and Canada, for the years ending June 19.°5 through 1967 Subject areas Equivalent number of faculty and staff, year ending June 1965 1966 1967 Administration or Practice of Public Health ........... 78.7 91.4 103.5 Behavioral and Social Sciences ....................... 29.0 41.8 38.6 Biostatistics ................. 100.9 102.5 101.9 Chronic Diseases .................................... 18.7 24.8 23.5 Dental Public Health ............................... 7.0 9.9 12.2 Environmental Health ............................... 80.6 87.4 87.4 Epidemiology ............. i. 110.3 142.6 150.9 Health Education ................................... 41.2 47.0 52.6 International Health ................................ 18.8 27.0 31.1 Maternal and Child Health .......................... 66.4 58.0 59.9 Medical Care and Hospital Administration ............ 97.9 110.1 158.1 Mental Health ...................................... 34.6 37.6 37.0 Microbiology and Laboratory Public Health ........ .. 48.6 50.0 51.1 Nutrition/Biochemistry .............................. 64.5 65.9 79.2 Occupational Health ................................ 50.4 44.2 55.2 Physiological Hygiene ............................... 32.7 35.2 38.4 Population Studies/Demography .................... |... ...... 21.0 49.8 Public Health Nursing .............................. 41.8 38.3 41.0 Radiological Science ................................. 36.2 33.3 41.9 Social Work in Public Health ........................ 6.3 74 5.7 Tropical Medicine/Entomology/Parasitology .......... 77.2 70.5 83.1 Other subjects ...................................... 25.6 36.5 39.0 Total ............... 1,067.4 1,182.4 1,341.1 Source: Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967); mimeographed, p. 7. 269 270 TABLE 8.—Subject areas taught and profession of all full-time faculty and staff in all accredited schools of public health in the United States and Canada, year ending June 1967 Subject Areas eo 328 110 103 87 58 55 54 51 23 22 18 spalqng YO 18 ASojorisereq /A3ojoworuy /2up1popy eardoxy, 23 24 |..... 25 |... $30UaDDG [ed130[01pEY Susann yrs orqng AydeiSowa(q /sa1pnig uonendog 17... 14 2ud134H reo1Bojorskyg 12 11 yI[eaH euonedninQ 16 uonIINN 14 ASoo1qomIN 12 Ie [BID Uo BNSIUIWpPY reidsoH pue axe) [edIpI 31 QI[EIH PIIYD PUE [EUINEW 25 [I[e9H [BUOTIRUIdIUY 18 uonednpy YIedH ASororwaprdy 72 28 |... YI[eIH [BIUIWUOIIAUY — $OSBISI(] DTUOIYD) 12 sonsneIsorg UIIIG [RIOIARYIYG 35 I[e’H 21qnd jo 20108IJ I0 UOTIBIISIUTWIPY 42 Profession Physicians ...... Mathematicians/ statisticians ... Behavioral scientists Bacteriologists Educators Chemists/ biochemists ...|.....|.....[....[....] Nurses Engineers Biologists .......[.....|..... Administrators/ Hospital administrators . Dietitians/ nutritionists. |... |... fll Social workers .. Physiologists . ... 148 Sanitarians .... Economists .... Veterinarians ... Physicists ...... Dentists ....... Lawyers ....... Medical record librarians Industrial hygienists Accountants .... Physical therapists Others ........ Total .... 20 Bh be be ee 15 1... Too ei fees 12 | fee eee fe fe 14 ee ee 2 Slob phe 3 Joon cee 2 1 13 ee ee Toop ce ee fee eee 9|.... 2 12 2 ee 2 Loo 1... 5 11 Lio Looe fens ooo 4 7 2h... Lio 2 5 Loo Doo fn Looe eee eee 3 ce ee 2 ee ee 2 eb fe ef ee 2 2 Too]... 1... 9. ff Sf 1 hoof eens 2| 18 8 | 37| 91 | 20| 73 | 136 | 47| 28 | 48 |127| 24 | 45 | 73 | 44 | 35 | 46 | 36 | 36| 77 | 47|L155 ! The number of full-time faculty and staff is expressed in full-time equivalents. Source: Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967), mimeographed, p. 21. 272 TABLE 9.—Income statement for 17 accredited schools of public health United States and Canada for the year ending June 1967 in the A. Basic institutional support: $12,749,602 1. Allocated by university ........................... iii. 6,893,743 2. Endowments to school of public health ............................... 2,270,301 3. Tuition and fees ............. 829,256 4. Indirect contribution (maintenance, etc.) ............................. 2,756,302 B. Teaching and training grants and contracts: ! 13,737,357 1. Formula grants .................... 3,654,848 2. Others from National Government ................................... 9,475,010 8. From other SOUTXCES ............. oi 607,499 C. Research grants and contracts: 27,661,132 1. From National Government .......................c.ouuieeiinneen.n.. 22,055,812 2. From other SOUrces ..........................oiiiiiiiiii 5,605,320 D. Other grants and contracts: 2,197,118 1. From National Government .....................c..euiuniranamnann... 1,823,354 2. From other SOUrCes ....................... iii 373,764 E. Traineeships and fellowships: 6,176,527 1. From National Government ...........................ouiuiiiii... 5,995,927 2. From other sources ...................... iii. 180,600 F. Other budgetary items ...................... iii 589,342 Total 63,111,078 * Not including traineeships and fellowships. Source: Troupin, J. L., American Public Health Association, Schools of Public Health in the United States and Canada (year ending June 1967), mimeographed, p. 15. APPENDIX D TABLE 1.—Master’s degrees granted to United States citizens by 11 schools of public health, 1961-67 1 School Number | Percent Berkeley .... 708 15.1 Columbia ........ 393 8.4 Harvard oe 325 6.9 Hopkins ......... 299 6.4 Michigan ........ 801 17.2 MINNESOtA oo... 544 11.6 North Carolina ................ 659 14.1 Pittsburgh .... 264 5.6 Tulane o.oo 199 4.3 UCLA 323 6.9 Yale 165 35 Total 4,680 100.0 * Source: J. L. Troupin, unpublished estimates, 1969. bla TABLE 2.—Age of respondents graduating from 11 schools of public health, years 1961-67 * Minne- | North Pitts- Age Berkeley | UCLA |Columbia| Harvard | Hopkins |Michigan| sota Carolina | burgh | Tulane Yale Total 25 and under: Number ..... 8 15 6 4 0 9 11 25 11 6 96 Percent ...... 1.6 7.5 23 18 0.0 1.6 3.5 5.4 6.1 1.1 49 3.1 26 to 30: Number ..... 63 50 37 29 16 84 101 124 42 8 30 584 Percent ...... 12.3 24.9 14.4 12.8 8.9 14.9 32.1 26.8 23.3 85 24.6 18.7 31 to 35: Number ..... 125 40 72 78 44 172 87 112 47 27 24 828 Percent ...... 24.4 19.9 28.0 34.5 24.4 30.4 27.6 24.2 26.1 28.7 19.7 26.6 36 to 40: Number ..... 117 26 49 66 45 109 49 81 32 21 21 616 Percent ...... 22.8 129 19.1 29.2 25.0 19.3 15.6 17.5 17.8 22.3 17.2 19.8 41 to 45: Number ..... 83 31 44 27 35 89 34 49 24 21 17 454 Percent ...... 16.2 15.4 17.1 11.9 19.4 15.8 10.8 10.6 13.3 22.3 13.9 14.6 46 to 50: Number ..... 53 19 27 15 22 52 26 36 14 7 14 285 Percent ...... 10.3 9.5 10.5 6.6 12.2 9.2 8.3 7.8 7.8 74 11.5 9.1 51 to 55: Number ..... 38 12 20 5 16 34 5 22 7 7 171 Percent ...... 74 6.0 7.8 2.2 89 6.0 1.6 4.8 3.9 74 4.1 5.5 56 and over: Number ..... 23 8 1 2 16 2 11 2 5 74 Percent ...... 45 4.0 0.4 0.9 1.1 2.8 0.6 24 1.1 2.1 4.1 24 Nonresponses: Number ..... 3 0 1 0 0 0 0 2 1 0 0 7 Percent ...... 0.6 0.0 0.4 0.0 0.0 0.0 0.0 0.4 0.6 0.0 0.0 0.2 Total: * Number ..... 513 201 257 226 180 565 315 462 180 94 122 3,115 Percent ...... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1 Age at time of survey, August-October 1968. 2 Due to rounding error, totals may not add to 100.0 percent. TABLE 3.—Sex of respondents graduating from 11 schools of public health, years 1961-67 Colum- Michi- | Minne- | North Pitts- Sex Berkeley | UCLA bia Harvard | Hopkins gan sota [Carolina | burgh | Tulane Yale Total Male: Number ...... 340 129 186 190 133 345 212 288 126 67 88 2,104 Percent ...... 66.3 64.2 72.4 84.1 73.9 61.1 67.3 62.3 70.0 71.3 72.1 67.5 Female: Number ...... 167 72 71 35 45 215 103 172 54 26 33 993 Percent ...... 32.6 35.8 27.6 15.5 25.0 38.1 32.7 37.2 30.0 27.7 27.0 31.9 Nonresponses: Number ...... 6 0 0 1 2 5 0 2 0 1 1 18 Percent ...... 1.2 0.0 0.0 0.4 1.1 0.9 0.0 04 0.0 1.1 0.8 0.6 Total: * Number ...... 513 201 257 226 180 565 315 462 180 94 122 3,115 Percent ...... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 ! Due to rounding error, tables may not add to 100.0 percent. GLS TABLE 4.—Primary professional discipline prior to enrollment by major [Major pro = £ £8 g = s | 8 | OF |g%8 | 2 |= ££ | 5 § | = |Eu El 2|8 Primary professional 5 g s 3 3 & 2 S=E E 8 jo 3 iscipline Sz = 5 2 AS 3 Erg 2 2 § Sa — = © = — = 8< | | £ | 2 |Z | § |z28| & | E | £ | EF & < ® A | © a |W = x g |= Administrator/hospital administrator ........ 60 2 0 0 0 0 3 1 1 0 1 Bacteriologist/laboratory scientist/parasitologist .| 7 1 0 2 0 0 8 11 2 2 0 Biologist /entomologist/ zoologist ............. 2 0 0 3 0 0 13 2 4 0 0 Chemist/biochemist .... 3 0 0 3 0 1 19 0 2 0 0 Dentist ................ 38 0 0 0 0 45 0 11 0 0 0 Dietician/nutritionist . .. 1 0 0 0 0 0 0 0 3 0 0 Educator/teacher ....... 5 1 0 8 0 3 7 1 54 0 0 Engineer .............. 4 0 0 0 0 0 82 0 0 0 0 Health educator ........ 9 0 0 0 0 0 1 0 64 0 0 Industrial hygienist .... 0 0 0 0 0 0 0 0 0 0 0 Mathematician /statisti- cian/programer ...... 4 0 0| 62 0 0 1 0 2 0 0 Nurse ................. 51 0 0 3 4 0 0 8 15 21 30 Physical therapist ...... 22 0 0 0 3 0 0 1 6 0 2 Physicist/radiological health specialist/ health physicist ...... 1 0 0 0 0 0 2 1 0 0 0 Physiologist ............ 0 0 0 0 0 0 1 0 1 0 0 Physician .............. 142 | 92 1 9 6 0 8 | 101 2 10 | 102 Psychiatrist ............ 6 0 3 1 0 0 0 0 0 0 Behavioral scientist/ anthropologist ........ 1 0 1 0 0 0 0 1 1 0 0 Behavioral scientist/ psychologist .......... 3 0 3 0 0 0 0 3 1 0 1 Behavioral scientist/ sociologist ........... 3 0 1 0 0 0 0 0 1 0 0 Behavioral scientist/ Other ............... 0 0 0 0 0 0 1 0 1 0 0 Sanitarian ............. 41 0 0 1 2 0 | 140 2 17 0 0 Social worker .......... 12 0 0 0 0 0 0 0 3 0 2 Veterinarian ........... 5 0 0 1 0 0 8 34 0 0 0 Other ................. 18 0 0 4 2 1 3 1 17 0 1 Nonapplicable .......... 46 0 0| 45 0 1 19 3 55 0 0 Nonresponse ........... 2 0 0 0 0 0 4 0 3 0 0 Total respondents | 486 96 9 | 142 17 51 | 320 | 181 | 255 14 | 139 * Nonrespondents are excluded from total. program areas pursued in formal training in schools of public health, 1961-67 gram area] 1180 181 110 49 49 100 90 110 104 81 18 75 448 45 42 588 33 22 212 65 78 106 347 21 LYI0 1 2 5 0 39 | 2,998 I[BIH 21[qNg AIBULIIIIA 16 16 A3o[olisereq ‘A3ojow0iuy ‘QuIpa]y [eaidoay, 18 10 22 66 WIEIH 21qnd ul JI0M [e108 21 22 Aderayy, [edsdyq ‘uoneNIqeyY Mes uonerpey 29 10 74 BuisainN YI[edH 21qnd 294 309 Aydeidouwdq ‘Buruuelg Apwe ‘sa1pni§ uonendod 8 UDIPIN [eIUWUOIIAUY ‘QuIIBAH [ed130[01SAYq 5 Qu213AH [eLISnpuj ‘qQI[edy [euonednddQ 16 39 93 Ansrwaydorg ‘uoninnN 84 10 115 YI[e2H 2liqnd A10jR10qRT ‘AB0[0IqOIIN 48 WEIH [AWW 13 21 60 SUDIPIN dA BIISIUIW PY ‘Uuonensiuiupy [el -1dsOH PUE 21eD) [EdIPIN 108 12 17 24 23 38 139 415 277 APPENDIX E TABLE 1.—Number of mental health courses taken at a school of public health, by number of years of professional public health experience prior to enrollment in a school of public health Years of professional public health experience prior to enrollment Mental health Less courses than 1to4 5t09 |10to14 | 15 plus taken None 1 year years years years years Total None: Number .............. 649 121 568 270 110 54 1,772 Percent ............... 61.4 64.0 57.2 57.6 49.8 47.8 58.2 1 or more: Number .............. 377 64 401 184 107 57 1,190 Percent ............... 35.6 33.9 40.4 39.2 48.4 50.4 39.1 Nonresponses: Number .............. 32 4 24 15 4 2 81 Percent ............... 3.0 2.1 24 3.2 1.8 1.8 2.7 Total responses: Number ........ 1,058 189 993 469 221 113 3,043 Percent ......... 100.0 100.0 100.0 100.0 100.0 100.0 100.0 TABLE 2.—Number of mental health courses taken at a school of public health, by types of master’s degrees received from schools of public health Master’s degrees received Mental health courses M.S. M.H.A/ Other taken M.P.H. | MSP.H. | Hygiene | M.SSH.A. | master’s Total None Number .............. 1,345 126 150 68 125 1,814 Percent ............... 57.3 63.7 76.5 39.3 61.9 58.2 1 or more: Number. .............. 949 67 40 96 66 1,218 Percent ............... 40.5 33.8 20.4 55.5 32.7 39.1 Nonresponses: Number .............. 52 5 6 9 11 83 Percent ............... 22 2.5 3.1 5.2 5.4 2.7 Total responses: Number ........ 2,346 198 196 173 202 3,115 Percent ......... 100.0 100.0 100.0 100.0 100.0 100.0 278 TABLE 3.—Views on extent to which mental health course work was concerned with psychiatry and psychology, by number of mental health courses taken at a school of public health Degree of concern Number of mental health courses taken at a school of public health with psychiatry and psychology 1 2 3 or more Total Highly concerned: Number ................. 282 159 151 592 Percent .................. 41.8 51.3 64.8 48.6 Moderately concerned: Number ................. 305 130 72 507 Percent .................. 45.2 41.9 30.9 41.6 Not concerned: Number ................. 34 8 0 42 Percent .................. 5.0 2.6 0.0 3.4 No opinion: Number ................. 38 8 4 50 Percent .................. 5.6 2.6 1.7 4.1 Nonresponses: Number ................. 16 5 6 27 Percent .................. 24 1.6 2.6 23 Total responses: Number ........... 675 310 233 1,218 Percent ............ 100.0 100.0 100.0 100.0 279 TABLE 4.—Views on extent to which mental health course work was concerned with public health issues, by number of mental health courses taken at a school of public health Number of mental health courses taken at a school of public health Degree of concern with public health issues 1 2 3 or more Total Highly concerned: Number ................. 275 173 154 602 Percent .................. 40.7 55.8 66.1 49.4 Moderately concerned: Number ................. 304 110 70 484 Percent .................. 45.0 35.5 30.0 39.7 Not concerned: Number ................. 63 15 3 81 Percent .................. 9.3 4.9 1.3 6.7 No opinion: Number ................. 19 6 2 27 Percent .................. 2.8 1.9 0.9 2.2 Nonresponses: Number ................. 14 6 4 24 Percent .................. 2.2 1.9 1.7 2.0 Total responses: Number ........... 675 310 233 1,218 Percent ............ 100.0 100.0 100.0 100.0 TABLE b.—Views on extent to which mental health courses were meaningful to public health concerns, by mental health work experience prior to enrollment in a school of public health Mental health work experience prior to enrollment Degree of meaningfulness Yes No Total Highly meaningful: Number ....................... 238 234 472 Percent ........................ 48.2 32.5 38.9 Moderately meaningful: Number ....................... 197 360 557 Percent ........................ 39.9 50.0 45.9 Not meaningful: Number ....................... 45 87 132 Percent ........................ 9.1 12.1 10.9 No opinion: Number ....................... 10 30 40 Percent ........................ 2.0 4.2 3.3 Nonresponses: Number ....................... 4 9 13 Percent ........................ 0.8 1.2 1.0 ‘Total responses: Number ................. 494 720 1,214 280 Percent .................. 100.0 100.0 100.0 TABLE 6.—Views on extent to which mental health courses were meaningful to public health concerns, by number of mental health courses taken in a school of public health Degree of meaningfulness public health Number of mental health courses taken at a school of 2 3 or more Total Highly meaningful: Number ................. 202 130 141 473 Percent .................. 29.9 41.9 60.5 38.8 Moderately meaningful: Number ................. 337 141 81 559 Percent .................. 49.9 455 34.7 45.9 Not meaningful: Number ................. 97 28 7 132 Percent .................. 14.4 9.0 3.0 10.8 No opinion: Number ................. 31 7 2 40 Percent .................. 4.6 2.3 0.9 3.3 Nonresponses: Number ................. 8 4 2 14 Percent .................. 1.2 1.3 0.9 1.2 Total responses: Number ........... 675 310 233 1,218 Percent ............ 100.0 100.0 100.0 100.0 TABLE 7.—Views on mental health faculty's knowledge of public health problems and approaches, by mental health work experience prior to enrollment in a school of public health Degree of knowledge of mental health faculty Mental health work experience prior to enrollment Very knowledgeable: Number Percent Knowledgeable: Number Percent Not knowledgeable: Number Percent No opinion: Number Percent Nonresponses: Number Percent Total responses: Number Percent Yes No Total 271 336 607 54.9 46.7 50.0 157 257 414 31.8 35.7 34.1 50 65 115 10.1 9.0 9.5 11 55 66 2.2 7.6 54 5 7 12 1.0 1.0 1.0 494 720 1,214 100.0 100.0 100.0 281 282 TABLE 8.—Views on mental health faculty’s knowledge of public health problems and approaches, by number of mental health courses taken at a school of public health Degree of knowledge of Number of mental health courses taken at a school of public health mental health faculty 1 9 3 or more Total Very knowledgeable: Number ................. 277 172 159 608 Percent .................. 41.0 55.5 68.2 49.9 Knowledgeable: Number ................. 273 86 57 416 Percent .................. 40.4 27.7 24.5 34.2 Not knowledgeable: Number ................. 70 33 12 115 Percent .................. 10.4 10.6 5.2 9.4 No opinion: Number ................. 46 16 4 66 Percent .................. 6.8 5.2 1.7 5.4 Nonresponses: Number ................. 9 3 1 13 Percent .................. 14 1.0 0.4 1.1 Total responses: Number ........... 675 310 233 1,218 Percent ............ 100.0 100.0 100.0 100.0 TABLE 9.—Views on usefulness of mental health course work in present work, by mental health work experience prior to enrollment in a school of public health Degree of usefulness Mental health work experience prior to enrollment Yes No Total Highly useful: Number ....................... Percent ........................ Useful: Number ....................... Percent ........................ Of little use: Number ....................... Percent ........................ No use at all: Number ....................... Percent ........................ No opinion: Number ....................... Percent ........................ Nofiresponses: Number ....................... Percent ........................ Total responses: Number ................. Percent .................. 194 126 320 39.3 17.5 26.4 199 332 531 40.3 46.1 43.7 72 199 271 14.6 27.6 22.3 14 44 58 2.8 6.1 4.8 7 11 18 14 15 15 8 8 16 1.6 1.2 1.3 494 720 1,214 100.0 100.0 100.0 283 284 TABLE 10.—Views on usefulness of mental health course work in present work, by number of mental health courses taken at a school of public health Degree of usefulness Number of mental health courses taken at a school of public health 1 3 or more Total Highly useful: Number ................. 115 78 128 321 Percent .................. 17.0 25.2 54.9 26.4 Useful: Number ................. 313 145 74 532 Percent .................. 46.4 46.8 31.8 43.7 Of little use: Number ................. 185 64 23 272 Percent .................. 27.4 20.6 9.9 22.3 No use at all: Number ................. 43 13 2 58 Percent .................. 6.4 4.2 0.8 4.8 No opinion: Number ................. 12 3 3 18 Percent .................. 1.8 1.0 1.3 1.5 Nonresponses: Number ................. 7 7 3 17 Percent .................. 1.0 2.2 1.3 1.3 Total responses: Number ........... 675 310 233 1,218 Percent ............ 100.0 100.0 100.0 100.0 TABLE 11.—Views on relationships of mental health issues to public health course work, by mental health work experience prior to enrollment in a school of public health Degree of relationship Mental health work experience prior to enrollment Yes No Total Highly related: Number ....................... 306 349 655 Percent ........................ 31.8 16.3 21.1 Moderately related: Number ....................... 299 572 871 Percent ........................ 31.0 26.7 28.1 Occasionally related: Number ....................... 288 870 1,158 Percent ........................ 29.9 40.7 37.3 Not related: Number ....... ............... 33 152 185 Percent ........................ 3.4 7.1 6.0 No opinion: Number ....................... 18 146 164 Percent ........................ 1.9 6.8 5.3 Nonresponses: Number ....................... 19 50 69 Percent ........................ 2.0 24 2.2 Total responses: Number ................. 963 2,139 3,102 Percent .................. 100.0 100.0 100.0 285 TABLE 12.—Views on relationships of mental health issues to public health course work, by number of mental health courses taken at a school of public health Degree of relationship Number of mental health courses taken at a school of public health None 2 3 or more Total Highly related: Number ................. 306 140 100 97 643 Percent .................. 16.9 20.7 32.3 41.6 21.2 Moderately related: Number ................. 422 240 107 86 855 Percent .................. 23.3 35.6 34.5 36.9 28.2 Occasionally related: Number ................. 751 257 90 43 1,141 Percent .................. 41.4 38.1 29.0 185 37.6 Not related: Number ................. 145 24 10 3 182 Percent .................. 8.0 3.6 32 1.3 6.0 No opinion: Number ................. 141 13 3 4 161 Percent .................. 7.8 19 1.0 1.7 53 Nonresponses: Number ................. 49 0 0 50 Percent .................. 2.6 0.1 0.0 0.0 1.7 Total responses: Number ........... 1,814 675 310 233 3,032 Percent ............ 100.0 100.0 100.0 100.0 100.0 L8¢2 TABLE 1.—Coverage of mental health aspects of public health topics, by school of public health attended, 1961-67 1 Berke- | UCLA | Colum- [Harvard |Hopkins | Michi- | Minne- | North | Pitts- | Tulane | Yale Total Public health topics ley bia gan sota |Carolina| burgh Number ....... 513 201 257 226 180 565 315 462 180 94 122 3,115 Percent ........ 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 SOCIOENVIRONMENTAL AREA: Accident prevention . . . 45.8 56.2 40.5 60.2 46.7 48.8 53.0 48.1 439 50.0 53.3 49.1 Air and water pollu- tion ............... 26.5 32.3 20.6 16.8 17.2 25.7 29.8 26.6 22.2 24.5 34.4 25.4 Alcoholism control . ... 54.8 72.1 56.4 50.9 65.0 54.9 47.9 45.9 48.3 75.5 72.1 55.3 Chest X-ray programs. . 32.4 29.4 28.4 16.4 23.9 24.8 33.0 24.0 22.2 22.3 24.6 26.5 Cigarette smoking . .... 48.0 54.7 51.4 45.6 51.7 434 35.6 40.3 444 56.4 58.2 45.9 Delinquency control . . . 32.0 30.8 35.8 38.5 46.7 20.9 23.2 25.5 21.1 489 39.3 29.9 Fluoridation ......... 43.7 59.2 46.7 49.6 31.7 45.7 48.3 51.5 38.9 33.0 50.0 46.3 Geriatric programs . ... 46.4 66.7 65.0 37.6 57.2 57.7 61.0 435 47.2 72.3 69.7 54.1 Housing ............. 43.3 56.7 374 29.2 28.3 41.2 40.3 374 28.9 30.9 55.7 39.5 Industrial health. ..... 39.0 59.2 49.0 43.4 41.7 36.5 45.4 35.1 48.3 4.7 55.7 42.6 Immunization pro- grams ............. 35.1 45.8 37.0 30.1 32.2 32.0 47.3 38.3 33.9 34.0 35.2 36.5 Medical quackery... ... 31.6 44.8 33.9 24.8 21.1 35.0 34.0 23.2 25.6 27.7 40.2 31.0 Migrant health........ 48.9 31.3 24.1 21.7 28.3 37.0 25.4 36.6 15.6 20.2 34.4 32.8 Narcotic control. ...... 39.2 46.8 59.1 35.8 44.4 28.1 33.0 25.3 28.3 43.6 63.9 37.2 Noise abatement. ..... 32.4 40.8 19.5 31.4 31.7 36.6 39.0 26.2 28.3 14.9 36.1 31.7 Nutrition and food fads ............... 38.4 44.3 45.1 50.4 18.3 40.5 36.8 35.5 26.1 29.8 35.2 37.8 Radiation control . .... 23.2 31.8 28.4 22.6 25.6 24.2 32.7 29.7 35.0 22.3 30.3 27.3 Suicide prevention... .. 51.1 65.2 44.0 54.4 53.9 42.1 47.0 37.0 32.2 62.8 62.3 47.4 Tuberculosis control . . 41.7 42.8 33.9 30.1 43.3 40.7 49.8 39.2 37.2 46.8 41.8 40.5 Jd XIANAddV 888 TABLE 1.—Coverage of mental health aspects of public health topics, by school of public health attended, 1961-67 * (continued) Berke- | UCLA | Colum- |Harvard | Hopkins | Michi- | Minne- | North | Pitts- | Tulane | Yale Total Public health topics ley bia gan sota [Carolina | burgh Number ....... 513 201 257 226 180 565 315 462 180 94 122 3,115 Percent ........ 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 FAMILY AND CHILD HEALTH AREA: Abortion ............. 31.4 26.9 35.0 30.5 38.3 23.0 27.3 21.0 22.2 30.9 51.6 28.5 Battered child syn- drome ............. 36.8 29.9 49.0 43.8 489 30.4 41.6 27.7 30.6 55.3 46.7 37.1 Birth control and fam- ily planning ........ 56.1 49.3 48.2 58.4 64.4 42.1 349 46.3 46.1 54.3 64.8 49.2 Classes for expectant parents ............ 25.1 224 27.2 22.6 28.3 25.8 31.1 22.9 20.6 31.9 23.0 25.4 Out-of-wedlock chil- dren ............... 33.9 23.4 35.0 34.1 38.9 28.7 38.7 26.8 25.6 40.4 45.1 32.3 Postnatal care of moth- eS ................ 329 28.9 36.6 27.9 43.3 34.9 454 30.3 36.1 37.2 35.2 34.8 Pregnancy and child- birth crises ......... 32.6 28.9 31.9 32.3 37.2 32.6 425 27.1 31.7 43.6 32.0 33.0 Premature births ..... 29.6 229 26.5 27.9 40.0 31.2 35.2 27.5 28.9 35.1 29.5 30.0 School health pro- grams .............. 48.0 45.3 34.2 39.8 60.0 42.7 495 41.3 33.3 415 50.0 44.0 Sex education......... 37.4 34.3 38.5 30.1 41.7 31.3 32.7 35.5 16.1 42.6 475 345 Venereal disease. . ..... 48.0 59.2 49.4 41.2 39.4 45.3 54.6 35.1 33.3 394 48.4 45.0 Well-child conferences. 36.6 30.3 36.6 31.4 44 315 33.7 28.1 30.6 39.4 38.5 33.6 1 All percents are rounded. 682 TABLE 1.—Coverage of mental health topics by school of public health attended, 1961-67 Berke- | UCLA |Colum- [Harvard Hopkins | Michi- | Minne- | North | Pitts- [Tulane | Yale Total Mental health topics ley bia gan sota |Carolina | burgh Number ....... 513 201 257 226 180 565 315 462 180 94 122 3,115 Percent ........ 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 A. Basic AREA PERSONALITY THEORY Importance of feelings and emotions ......... 60.4 54.7 712 57.5 55.0 58.9 66.0 68.0 50.0 57.4 74.6 61.7 Individual personality dynamics ............. 51.5 43.8 71.2 48.7 46.1 47.1 61.0 60.0 40.6 56.4 69.7 53.7 Role of conscious and unconscious factors. . . . 50.1 40.3 60.7 48.7 489 41.8 55.9 53.7 40.6 54.3 67.2 50.0 Survey of personality theories .............. 31.8 21.9 42.0 31.0 30.6 22.1 40.6 36.1 26.7 39.4 50.0 32.3 SOCIALIZATION Infancy and the preschool period ............... 41.3 28.4 63.8 40.7 50.6 40.5 47.3 51.1 30.6 52.1 51.6 44.8 Role of the family. .... .. 50.7 50.2 63.4 56.6 60.0 51.5 52.7 61.7 40.6 64.9 66.4 55.1 INTERPERSONAL RELATIONS Sensitivity to behavioral and verbal cues ....... 53.0 47.3 56.8 45.1 42.2 42.3 57.8 50.2 40.0 52.1 52.5 49.1 Small-group interaction. . 62.4 54.7 73.2 58.0 48.3 57.3 68.6 63.0 45.0 50.0 62.3 60.1 Understanding a client’s attitudes, fears, and prejudices ............ 64.3 52.2 62.6 57.1 52.2 54.5 62.2 59.3 51.1 59.6 60.7 58.4 D XIANHddV TABLE 1.—Coverage of mental health topics by school of public health attended, 1961-67 (continued)! Berke- | UCLA |Colum- |Harvard {Hopkins | Michi- | Minne- | North | Pitts- |Tulane | Yale Total Mental health topics ley bia gan sota [Carolina | burgh Number ....... 513 201 257 226 180 565 315 462 180 94 122 3,115 Percent ........ 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 B. GENERAL AREA TECHNIQUES OF MENTAL HEALTH WORK “Anticipatory guidance” as related to the pri- mary prevention of mental disorders ...... 25.1 24.4 28.0 32.3 37.2 28.0 29.8 21.2 20.6 33.0 23.0 26.8 Means of improving the mental health func- tioning of community care givers; e.g., clergy, police, teachers ....... 31.6 39.8 38.1 38.1 40.6 29.7 33.3 24.7 22.8 42.6 45.1 32.8 Means of introducing in- novation and change in mental health pro- grams ................ 29.6 32.8 37.7 36.7 33.3 25.5 24.8 18.2 244 34.0 36.9 28.4 Principles of consulta- tion ................. 40.4 25.4 31.1 314 28.9 38.8 34.3 40.3 344 404 19.7 35.2 Principles of interview- ing .................. 31.8 28.4 52.1 28.8 322 39.6 53.3 47.8 35.0 489 26.2 39.5 Other preventive mental health intervention techniques; e.g., com- munity organization, mental health educa- tion, parent education, crisis intervention .... 48.0 52.2 55.3 46.5 48.3 47.6 52.7 45.5 32.2 47.9 50.8 48.0 163 Referral to special men- tal health facilities .... ADMINISTRATION OF MENTAL HEALTH WORK Budget planning for mental health pro- grams ................ Comprehensive commu- nity mental health centers ............... Coordinating interagency relationships in men- tal health ............ Distribution of mental disorders in the gen- eral population ...... How to develop pro- grams for the control of mental disorders . .. Identification and relief of mental hazards .... Mental health functions of basic community services in health, edu- cation, and welfare ... Mental health medico- legal problems ....... Organization and de- livery of mental health services .............. Principles of comprehen- sive mental health planning ............. 29.2 16.6 41.9 18.9 36.3 23.0 41.3 29.9 53.2 34.3 52.7 25.4 31.3 55.7 29.9 51.2 37.8 45.9 19.5 52.5 36.2 59.5 34.6 36.6 53.3 31.9 59.1 475 35.4 30.1 40.3 33.2 57.5 30.5 30.1 42.0 36.3 42.0 32.7 47.2 24.4 40.6 33.9 51.1 32.2 24.4 444 22.8 45.0 32.8 37.0 11.0 32.6 315 38.1 16.3 20.7 41.2 12.7 33.8 24.8 419 20.3 41.0 35.6 32.1 15.9 26.0 43.5 27.6 41.6 28.3 27.5 10.2 22.5 21.4 35.5 11.9 20.6 30.3 10.4 24.0 19.7 28.9 15.0 26.7 27.2 33.3 14.4 20.6 34.4 24.4 32.2 23.9 51.1 23.4 42.6 31.9 57.4 33.0 40.4 44.7 28.7 34.0 45.9 16.4 59.0 35.2 68.0 344 30.3 53.3 62.3 53.3 36.6 17.6 36.8 30.7 42.7 21.3 24.9 42.3 21.8 39.4 29.2 364 TABLE 1.—Coverage of mental health topics by school of public health attended, 1961-67 (continued)? Berke- | UCLA |Colum- |Harvard [Hopkins | Michi- | Minne- | North Pitts- | Tulane | Yale Total Mental health topics ley bia gan sota [Carolina | burgh Number ....... 513 201 257 226 180 565 315 462 180 94 122 3,115 Percent ........ 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Role of the private sec- tor in mental health programing and finan- cng ................ 19.5 30.8 30.4 23.9 18.9 17.7 22.2 10.6 16.1 24.5 28.7 20.4 State, local, and Federal mechanisms for finan- cing mental health programs ............ 404 51.7 42.8 37.6 39.4 37.5 39.0 22.1 24.4 44.7 49.2 37.2 Utilization of mental health data for pro- gram evaluation ...... 18.9 24.9 29.2 25.7 25.6 17.0 14.6 18.2 12.2 22.3 30.3 20.3 INFORMATIONAL Etiological factors in mental disorders ...... 31.4 40.3 60.7 56.2 489 33.8 36.5 39.0 33.3 60.6 64.8 41.6 Psychiatric registers .... 8.8 10.9 18.7 18.6 24.4 5.1 5.4 48 11.1 16.0 16.4 104 Public attitudes toward the mentally ill ...... 45.2 62.7 67.7 57.5 50.6 52.6 57.8 47.8 49.4 61.7 779 54.4 Roles and functions of mental health special- ists... 29.4 47.3 48.6 37.2 35.6 33.1 40.3 26.6 31.7 479 50.0 35.9 Sources of epidemiologi- cal data on mental disorders ............. 26.3 38.8 45.9 59.3 40.0 23.2 21.6 28.4 33.3 42.6 55.7 33.2 Varieties of mental dis- orders ................ 28.7 44.3 67.3 48.7 41.7 34.0 40.6 38.5 37.2 60.6 63.1 41.5 £68 C. SPECIALIZED AREA SECONDARY PREVENTION How to recognize men- tal disorders .......... Mental disorder case- finding role of public health workers ....... Methods for care of pa- tients with mental dis- orders; e.g., psychologi- cal-psychiatric, phar- macological, milieu, or social environmental .. Social breakdown syn- drome ............... Types of mental health treatment agencies and services .............. TERTIARY PREVENTION Adjustment problems of ex-patients and their families .............. Psychiatric rehabilitation agencies and services . . Psychiatric rehabilitation functions of public health workers ....... 15.8 17.3 20.9 13.8 41.3 25.7 29.0 20.3 25.4 17.4 36.8 17.4 55.7 40.3 43.8 26.9 26.8 51.8 30.0 56.0 49.0 52.1 35.4 26.5 23.5 27.9 22.1 40.7 33.6 32.3 26.5 27.8 30.6 32.8 21.1 37.2 43.9 36.1 25.0 28.1 25.3 9.7 40.7 37.9 34.9 34.3 349 32.7 39.7 12.1 489 37.8 39.7 33.7 22.7 18.8 21.9 15.8 29.9 27.7 20.1 23.2 18.3 16.1 25.0 9.4 33.9 27.8 31.1 25.6 479 35.1 44.7 25.5 55.3 47.9 489 32.8 27.0 52.5 23.0 55.7 484 47.5 35.2 26.3 23.9 30.7 16.2 43.2 35.2 35.2 29.1 * All percents are rounded. APPENDIX H TABLE 1.—Views on level of interest in mental health prompted by training in a school of public health, by number of mental health courses taken at a school of public health Number of mental health courses taken at a school i of public health Level of interest None 1 2 3 ormore | Total High interest: Number ............................ 178 116 91 124 504 Percent ............................ 9.5 17.2 29.4 53.2 16.6 Moderate interest: Number ............................ 556 324 135 77 1,092 Percent ............................ 30.7 48.0 43.5 33.0 36.0 Little interest: Number ............................ 838 202 67 18 1,125 Percent ............................ 46.2 29.9 21.6 7.7 37.1 No opinion: Number ............................ 207 23 8 9 247 Percent ............................ 11.4 3.4 2.6 39 8.1 Nonresponses: Number ............................ 40 10 9 5 64 Percent ............................ 22 15 29 22 2.2 Total responses: . Number ...................... 1,814 675 310 233 3,032 Percent ...................... 100.0 100.0 100.0 100.0 100.0 294 w U.S. GOVERNMENT PRINTING OFFICE: 1972 O—440-100 029319828