Pusric HEaLts Monocgraru No. 49 ! A () /1 1 SD AANA, Py NAN ————————— Characteristics and Professional Staff Of Outpatient Psychiatric Clinics U. S. DEPARTMENT of HEALTH, EDUCATION, and WELFARE PuBrLic HEALTH SERVICE PusLic HEALTH MONOGRAPHS Public Health Monographs, edited and issued by Public Health Reports under the general direction of the Board of Editors, present contributions to knowledge in the fields of public health, particularly material that is extensive, detailed, or specialized. All manuscripts considered for publication as monographs receive the same technical and scientific review as papers submitted to Public Health Reports. The opinions expressed are those of the authors and do not neces- sarily reflect the views of Public Health Reports or the Public Health Service. Trade names are used for identification only and do not represent an endorsement by the Public Health Service. 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Stamps are not acceptable. BOARD OF EDITOR! Epwarp G. McGavran, M.D., M.P Chairman MAarGARET G. ArnsTEIN, R.N., M.P. Manper E. Counen, M.D. Harorp D. Cuore, M.D., Dr.P.H. Carr. C. Daver, M.D. H. TrenpLEY DEAN, D.D.S. J. StEwarT HUNTER, M.A. Cuarres V. Kipp, Pu.D. ALExaNDER D. Lanemuir, M.D., M.F Vernon G. MacKenzie Leo W. Simmons, Pu.D. WiLson T. Sowper, M.D., M.P.H. MARY SWITZER Frankriy H. Toe, M.D., M.P.H. & Managing Director G. St.]. PERROTT Chief, Division of Public Health Meth: Executive Editor: Marcus Rosenbl Winona Car. Janet V. Easd Managing Editor: Monograph Editor: U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Marion B. FoLsom, Secretary PUBLIC HEALTH SERVICE Leroy EF. Burney, Surgeon General Outpatient Psychiatric Clinics In the United States 1954-55 Characteristics and Professional Staff Anita K. Bahn, B.A. Vivian B. Norman, B.S. PusrLic Heart MonNoGrarH No. 49 The Authors The authors are with the Biometrics Branch, National Institute of Mental Health, Nationa' Institutes of Health, Public Health Service. Mrs. Bahn is chief of the Outpatient Studies Section, and Miss Norman 18 an analytical statistician in that section. The statistical program is under the direction of Dr. Morton Kramer, chief of the Biometrics Branch. PUBLIC HEALTH LIB. E ® ac, ru 5 Pls ‘ 2, > “tauas “1708” Public Health Service Publication No. 538 (Issued concurrently with the December 1957 issue of Public Health Reports, Vol. 72, No. 12) Library of Congress Catalog Card No. 57-60064 Received for publication May 1957 UNITED STATES GOVERNMENT PRINTING OFFICE, WASHINGTON, D. C. - 1957 For sale by the Superintendent of Documents, U. S. Government Printing Office Washington 25, D. C. — Price 60 cents Contents List of illustrations. _ __________ ToIEE OF TODIRE.. cc sommes rier in Se A Sve mien meh ts REE Te TODO ce mie siren diimimosieEsbummmsibsmsifiimsmismsion sof ims iSesarios ha II. Scope, methodolory, and limitations of data_ ~ § Facilities included. _ __ _____ __ _____________________________ Reporting period _ _ ______ Methodology and limitations________________________ _________ III. Characteristics of elinies____ __ __ __ __ __ __ _______________________ State operation or support___________________________________ AUSpICes._ _ _ CFGIILRL . ics ion Bit ei SF HRB ARES EEE SRE Ea AE See HARE Age groups served _ __ _______________________________________ Special groups served _ _ __ ___________________________________ Geographic radius of service. _ __ _____________________________ IV. Professional staff and man-hours of clinies_ .___________ __________ Distribution, by population__._______________________________ Clinic resources needed____ __ ____ ____________________________ V. Geographic distribution of clinic resources. ______________________ Professional INAN-NONER. «o.com mm 55 wm sms aim Simms =i mw wm 5m Metropolitan and nonmetropolitan areas_____ VI. Clinic variation in professional staff and man-hours___ = ___ Psychiatrist vs. total man-hours_______ _________ _ __ _ _______ VII. Summary and diseussion_ _ ______________________ _____________ Principa’ findings____ __ ______ __ _______________ Need for research and planning ____________ — < NOOO WIS UtUR WWNNMF== 24 — Ut ND DN = = CN IJ ND DD BN ON Wo © © © Ct Ut Ot 30 References. __ __ __ __ L Appendix. ___ ll Annual statistical report of outpatient psychiatric clinics: Section I. General information_________________________________ Section V. Professional staff members____________________ _______ Tables. _ » a a a n n ~ oo i oo = Fa oo oo mmm B Ie rr - | oo . . =" i . f = - = | . & - i , a i E oo ma - co. Lt - a N o . il - - = : = a iol . 1 £0. a . Co EN r . : SN hy 2 CI J - il il ® r - 3 i gl a N = - I . . h . - p ) a - . Hl “a ln n . hm = * n n os = Ys a - } } . “a - B ah n & I - : - a nN MN. " A - a = i . aN . FE x i oy - | l=, . - " FC . - N - ("= = w= I s M NH B . bn "i i IF i i [ \ i i . | 8 » % -a N I" " | £0 a a | - . er " . ! i: B i, B . . 1 - Br | n Bh i i . .- ) . in " Hie = . nl . = a er. 1 ! = ) = | 3 +] i » ' by’ i ' ~ “1 2. . ~, . = NH 1 on 1 - . i - B . , i i A. iB 3 ot . ) = IN - - LT - - be he ee at = Henn mb mm meee a5 E——— mc ——r el Seen cece ny . = B B . - gat =e, ads os - at wy = : n r Hy “. a. A] n= “> [ . = 1 nN . a - ean : 1 - oo v= EA SEER Fp, RE 2 Rd jt , rh " oo == ot = «=i van IE . 14: © Seat i= x = 24 i = i a =. 1 7d a. : - he cat VF 3 i Te iat Fe Hen i =H 1 ma olf a = | I = 7 Ep opi List of Illustrations Figure No. 1. Number of outpatient psychiatric clinics, by year opened, United States, 1954-55. _ 9 3. 6. 10. 11. 12. 13. Percentage distribution of professional staff and man hours in outpatient psychiatric clinies, by profession, United States, 1954-55 Percentage distribution of professional staff and man-hours in outpatient psychiatric clinics, by type of employment, United States, 1954-55 . Percentage distribution of outpatient psychiatric clinics, professional staff, and man- hours, by age group served, United States, 1954-55 . Percentage distribution of outpatient psychiatric clinics, professional staff, and man- hours, by State operation or support, United States, 1954-55 Percentage distribution of outpatient psychiatric clinics and clinic professional man- hours, by full-time and part-time clinics, United States, 1954-55 . Percentage distribution of professional man-hours in outpatient psychiatric clinics, by profession, United States, 1954-55 Number of professional man-hours per week in outpatient psychiatric clinies for each 100,000 population, by State, 1954-55 . Number of professional man-hours per week in outpatient psychiatric clinics for each 100,000 population, by geographic division and by profession, United States, 1954-55 Percentage distribution of 1955 population and of professional man-hours in out- patient psychiatric clinics, by metropolitan and nonmetropolitan areas of specified size, United States, 1954-55 Median number of professional man-hours per week in outpatient psychiatric clinies, by direct operating agency, United States, 1954-55 Median number of professional man-hours per week in outpatient prydtinitie clinics, by full-time or part-time clinic, State operation or support, and age group served, United States, 1954-55 Median number of professional man-hours per week in outpatient psychiatric clinics, by clinic location, United States, 1954-55 Page 10 10 12 13 13 14 18 20 24 26 27 28 List of Tables Table No. 1. 2. 3. 10. 11. 12. 13. 14. Number and percentage of outpatient psychiatric clinics, according to State operation or Support, United Stolen, TOBE-88. . . ue uw wwe wm ee wm wm www wim Number and percentage of outpatient psychiatric clinics, according to auspices, United States, 1954-55. ___ ee AF Outpatient psychiatric clinics, according to direct operating agency, by age group served, United States, 1954-55___ . Outpatient psychiatric clinics, according to State operation or support, by age group served, United States, 1084-88. . . cc me io on 5 mimo 0000 0 0 0 0m . Percentage distribution of outpatient psychiatric clinics, according to number of hours open weekly, by State operation or support and age group served, United States, 1954-55 ee . Percentage distribution of outpatient psychiatric clinics, according to frequency of clinic sessions, by State operation or support and age group served, United States, 1084-88. ee eee mmm mmm mmm ———————————————————————— Professional staff and man-hours per week in outpatient psychiatric clinics, according to type of employment, by profession, United States, 1954-55________ _________ . Estimates of equivalent full-time outpatient psychiatric clinics and professional staff needed in 1955, 1960, and 1965, based on varying assumptions of need for each 100,000 population in the United States. ___________________________________ Distribution of States, according to geographic region, by ratio of professional man- hours per week in outpatient psychiatric clinics for each 100,000 population, United States, 1954-55___ _ ees Rank order of States, according to number of professional man-hours per week in outpatient psychiatric clinies for each 100,000 population in 1954-55, by per- centage of urban population in 1920 and per capita income in 1954, continental United States. eee Median number of professional man-hours per week for each 100,000 population in States with and without accredited graduate training schools for psychiatrists, clinical psychologists, and psychiatric social workers, United States, 1954-55_____ Rank order of States, by number of professional man-hours per week in outpatient psychiatric clinics for each 100,000 population, by profession, 1954-55___________ Percentage of metropolitan areas and nonmetropolitan places with clinics and per- centage distribution of outpatient psychiatric clinics in the United States, by State operation or support, 1954-55, according to size of metropolitan area or non- metropolitan place in 1980... o.oo ooo eee mmm mm Distribution of outpatient psychiatric clinics, according to number of psychiatrist man-hours per 100 total professional man-hours, United States, 1954-55_______ Page ~1 ~3 11 17 19 20 List of Tables— Continued Appendix table No. 1. ro ~3 10. 11. 12. Number of outpatient psychiatric clinics in each State, by State operation or support, and number which did not report information on professional staff, 1954-55 . Number of outpatient psychiatric clinics in each State reporting clinic characteristics, by full-time or part-time clinics and by age group served, and number which did not report information on professional staff, 1954-55 . Number of professional staff and man-hours per week in outpatient psychiatric clinics, by detailed professional category and type of employment, United States, 1954-55 ' . Percentage distribution of professional staff of each category in outpatient psychi- atric clinics, according to type of employment, by State operation or support, and by age group served, United States, 1954-55 . Outpatient psychiatric clinics: Number of professional staff and man-hours per week according to State and profession, by type of employment, 1954-55: State mental hospital . State-operated . State-aided Non-State-aided _ __________ . Veterans Administration __________ . Serving children and adults _________ . Serving children only i. Serving adults only BR -~0 20 TP . Percentage distribution of professional man-hours per week in outpatient psychiatric clinics, by State operation or support and by age group served, by State, 1954-55 . Number of professional man-hours per week in outpatient psychiatric clinics for each 100,000 population, according to geographic region, geographic division, and State, 1954-55 . Number of professional trainee man-hours per week in outpatient psychiatric clinies per 100,000 population, 1954-55, number of 4-year medical schools with a depart- ment of psychiatry, and number of schools offering accredited graduate training in clinical psychology and in psychiatric social work, by State, 1956 . Number of outpatient psychiatric clinics and professional man-hours per week, by pro- fession, in each standard metropolitan area, according to rank order of standard metropolitan area, by 1950 population, United States, 1954-55_________._ ______ Percentage distribution of 1970 population and professional man-hours in outpatient psychiatric clinics in each State, by metropolitan and nonmetropolitan areas, 1954-1955 Distribution of outpatient psychiatric clinics by total number of professional man- hours per week, according to clinic characteristics, United States, 1954-55 Distribution of outpatiert psychiatric clinics by number of psychiatrist man-hours for each 100 total professional man-hours, according to clinic characteristics, United States, 1954-55 Page 38 39 40 41 42 47 50 53 57 60 64 69 73 77 79 80 82 85 86 87 viii Acknowledgments The authors wish to acknowledge the cooperation and participation of the Stale mental health authorities and oulpatient psychiatric clinics throughout the country in the voluntary reporting program which provided the data presented in this monograph. They also wish to express appreciation to Dr. Margaret R. Simpson, director, mental health division, Maine Department of Health and Wel- fare, and to Mrs. Ruth 1. Knee, psychiatric social work consultant, Dr. Jerry W. Carter, chief clinical psychologist, and Miss Pearl Shalit, chief mental health nurse, Community Services Branch, National Institute of Mental Health, for assistance with various sections of the text. I. Introduction The National Institute of Mental Health, in July 1954, initiated annual nationwide reporting of statistics by outpatient psychiatric clinics in cooperation with State mental health authorities. Heretofore, except for occasional surveys (1, 2), national statistical data had been available only on the mental hospital population and other psychi- atric institutional facilities (3). The increased emphasis on outpatient clinics as a method of diagnosing and treating the emotionally disturbed has highlighted the need for factual in- formation about this program (4). Federal and State legislation (6-10) providing for augmented research and expansion of facilities for the preven- tion, diagnosis, and treatment of mental disorders has further stimulated public interest in mental health clinics. The purpose of this monograph, the first of a series, 1s to provide statistical information to serve as a basis for program planning, and as a baseline . for measuring trends in the number and kinds of outpatient psychiatric clinics and their profes- sional staffs. The nationwide reporting program on outpatient psychiatric clinics in cooperation with the State mental health authorities which makes these data possible also gives the States and communities tools for mental health planning and programing functions. The data in this monograph are based on sec- tions I and V of the statistical reports of out- patient psychiatric clinics (11) submitted annually by the States to the National Institute of Mental Health. (See appendix, pages 36-37. For re- lated material, see references 11-13.) Individual clinic data have been published in the 1954-55 Directory of Outpatient Psychiatric Clinics and Other Mental Health Resources in the United States and Territories (14). II. Scope, Methodology, and Limitations of Data Facilities Included Mental health services on an outpatient basis are provided to individuals and families by many different types of community agencies. For the present, reporting to the National Institute of Mental Health has been limited to outpatient psy- chiatric clinics where a psychiatrist isinattendance at regularly scheduled hours and takes the medical responsibility for all patients in the clinic, or where there is a budgeted but temporarily vacant position for a psychiatrist.! When a clinic team provides services at more than one location, each In New York State, reports have been obtained only from clinics that are operated by the Federal or State Gov- ernment or that have met the requirenents for licensure by the New York State Department of Mental Hygiene (15). Public Health Monograph No. 49, 1957 such “outlet” is considered a clinic, provided that a psychiatrist is in attendance and that the ser- vices are on a regularly scheduled basis. Reports were not requested from the following types of outpatient mental health services: pri- vate psychiatrists; family service agencies which employ psychiatrists for consultation regarding specific cases, or for examination and treatment where indicated; counseling centers operated by clinical psychologists with the assistance of some psychiatric consultation; professional services pro- vided by personnel of public health departments, schools, hospitals, or other agency settings; and outpatient psychiatric clinics of the Armed Forces. Eventually it may be possible to extend the scope of reporting to include some of these other facilities. 1 In order to identify the “universe” of mental health facilities to be included in the reporting, the State mental health agencies were asked to list for their States every outpatient psychiatric clinic meeting the specified definition. These include clinics operated by a State agency such as the de- partment of health, department of mental health, department of public welfare, board of education, and other clinics receiving State financial aid or support, and clinics not receiving State aid. addition, the Veterans Administration was asked to supply a list of its clinics. Addressed report forms were then distributed through the State agencies or the Veterans Administration to the 1,234 listed clinics. Of the 1,234 outpatient psychiatric clinics in the country, 1,205 (98 percent) reported general ad- ministrative information, such as clinic schedule and groups served, and 1,178 (95 percent) re- ported professional staff data (appendix tables 1 and 2). Reporting Period Administrative information and data on profes- sional staff of clinics were requested as of Novem- ber 30, 1954. For this first report, however, over a third of the clinics, principally those in California, Massachusetts, and New York, reported informa- tion as of a date in 1955. Methodology and Limitations The reporting procedures, adjustments in the data, and other methods employed in this study that may affect the findings are listed below. Staff Classifications Reporting clinics were asked to follow the defini- tions for each of the classifications for psychiatrist, clinical psychologist, and psychiatric social work- er as given in Standards for Psychiatric Hospitals and Clinics, American Psychiatric Association (16). No information is available as to how these standards were followed in reporting by all clinics. The classification of employees by regular staff or trainee status may not be strictly comparable from clinic to clinie. Professional Staff Data This item refers only to filled positions. No summary of the data reported on budgeted but un- In . ‘ filled positions are presented since many clinics do not set aside budgeted funds for positions which cannot be filled in the immediate future. It was assumed that personnel as of the day reported represent the normal staffing of the clinic. TFluc- tuations in staffing are not reflected. A position filled on the reporting date may be vacant soon thereafter or a vacancy may be filled. A few clinics are not open during the summer months and a number of other clinics curtail their activi- ties during this period. The number of trainees during the year may vary. Professional Man-Hour Data This item represents the number of hours usu- ally scheduled for the week and not the number of hours of service actually provided since staff mem- bers may have been on leave for part of the time or may have worked additional hours. A number of clinics met less frequently than weekly. The hours such clinics were open and their professional man-hours have been prorated on a weekly basis in many of the tables in order to simplify the analysis. The tctal hours of profes- sional service may be overstated by the inclusion of man-hours of trainees since, (a) although trainees provide service, they do so in a work-learning capacity and (b) some regular staff time is diverted to trainee supervision. One hundred and six clinics were unable to re- port actual or estimated hours for a total of 297 part-time employees and 88 trainees. Most of these clinics were connected with hospitals where the same staff work in both inpatient and out- patient departments. Based on the average hours reported for similar employees in other clinics, an estimate of 9 hours per week was included for each part-time person and 18 hours for each trainee with unreported hours. Man-Hour-Population Ratios Several tables relate clinic professional man- hours to the population of the State in which the clinic is located. In some instances, these data may give an inaccurate picture of the population served by the clinic facilities for the following reasons: * Not all facilities in a State are available to the entire population of the State. Services may be limited to certain age, diagnostic, residential, or 2 Characteristics and Professional Staff of Outpatient Psychiatric Clinics other special groups or may be concentrated pri- marily in the metropolitan areas of the State and may be geographically inaccessible to residents of other parts of the State. * A number of facilities, particularly clinics in large metropolitan areas crossing State boundaries, serve residents of neighboring States. Subse- quent, studies will provide information on the State of residence of clinic patients. e United States Census Bureau estimates for 1954-55 were used for data on national and State population. For standard metropolitan areas, 1950 census data were used since estimates for 1954-55 were not available. 111. Characteristics of Clinics The characteristics and services of the 1,234 out- patient psychiatric clinics reported in the United States vary widely. Characteristics of clinics in- clude differences such as full-time or part-time operation, age and diagnostic groups served, geo- graphic radius of service, and methods of support and affiliation, for example, part of a hospital facility or of a health department. The broad framework of services for all clinics, however, in- cludes diagnostic, treatment, and related services for persons with mental and emotional disorders, as well as a variety of mental health services for the community. Looking at the historical development of these services, one finds distinet types of clinics. Those whose origin is related to the child guidance move- ment offer diagnostic and treatment services for emotionally maladjusted children. Some clinics connected with medical schools are basically train- ing centers. A number of traveling clinics are sponsored by State governments to provide diag- nostic service in less populated areas where psy- chiatric facilities would otherwise be entirely lack- ing. Still others serve the needs of general or special hospitals, conducting psychiatric examina- tions of hospital patients with possible mental disorders and furnishing other consultative services to the hospital staff. Provision of services for the mental hospital patient who is discharged or is on convalescent leave 1s the principal function of a number of other clinics which are usually part of a State mental hospital system. The Veterans Ad- ministration operates a number of clinics for veterans with service-connected psychiatric dis- abilities. In terms of staff, clinics vary from a mobile Public Health Monograph No. 49, 1957 2-man or 3-man team providing a half-day of service every 2 months in a number of semirural locations to a staff of 30 or 40 or even more pro- fessional persons in some of the larger metropolitan centers. No clinic facility is available in many semirural or rural areas. Even in large cities, services may be inadequate to meet the needs of a highly urbanized population. The number of patients diagnosed and treated ranges from less than 20 a year in smaller clinics to as many as 5,000 or more in some of the larger clinics. Services such as mental health education of public groups, consultation to community agencies, and other community-oriented activities likewise vary among clinics. The roles played by various clinics form an intri- cate pattern of service to people and to communi- ties. Careful study is needed to evaluate services today and to note the serious gaps in clinic re- sources. Effective planning for the steps that must be taken to insure clinic service that will contribute substantially to the final aim of pre- venting and reducing mental illness should result from such study. Growth “Psychiatric clinics for community service are a fairly recent development in this country and have come into being mainly since the turn of the century” (17). Of the reporting clinics in exist- ence in 1954-55, 8 were opened before the begin- ning of the century, 60 by 1920, 217 by 1930, reflecting the influence of the Commonwealth Fund (18) on the child guidance and mental hygiene movement, and 372 by 1940 (fig. 1). An 3 Figure 1. Number of outpatient psychiatric clinics, by year opened, United States, 1954-55. I] [ | | CUMULATIVE NUMBER OPENED 100 1500 T I T T - - MENTAL HEALTH | go|- 1290 ACT, 1946 »n ui L i 3 sol 1000 = = 7501 J 2 rol 750 3 ool COMMONWEALTH L 60} My oO — 250} x 50 i wl fr 0 | | | | @ 40 BerORE '20 '30 40 's0 ‘60 2 — 1900 z 30 B COMMONWEALTH sol FUND, 1922 A T Wine, 10 + | N NY =< N c= sn NR | BEFORE I1900—1900 1910 1920 LA 2A 2 \ 7h | I I MENTAL HEALTH _ ACT, 1946 —100 —90 —+ 80 -1 70 Tyr 60 50 40 30 | li 20 Zi Wer A & \\ ! 1930 1940 1950 1955 10 | YEAR OPENED SOURCE: Data based on reports from 1,140 of the 1,234 outpatient psychiatric clinics inthe United States, 1954-55 * Incomplete data average of 15 were opened each year between 1940 and 1945. This number jumped to more than 60 per year with the passage of the National Mental Health Act in 1946, which provided funds through Federal grants administered by State agencies for the support of existing and the development of new mental health facilities and the training of much needed mental health personnel. Nearly two-thirds of the clinics were opened in 1946 or later. Data on clinics opened since November 1954 are incomplete. Clinics administered by State hospitals had their primary growth before the passage of the National Mental Health Act, and about half of the clinics operating without any State financial aid were opened by that date. Clinics operated by other State agencies and clinics receiving State support had their greatest growth after 1946. According to the records of today’s clinics, slightly more than half of the clinics opened in each decade since 1920 served both children and adults. Of the 136 clinics serving adults ex- clusively, 105, principally clinics for World War II veterans, were opened since 1945. These data on the growth of clinics are based on the year current clinics were opened, and data are limited since they do not include information on discontinued clinics. Also, the character of a clinic, that is, the sources of support and the age group served, may have changed since the clinic was first opened. State Operation or Support Outpatient psychiatric clinics were operated by | the State government in all but 8 of the 53 States in 1954-55 (appendix table 1). Forty-one percent of the 1,234 clinics in the Nation were operated by the State, half under the jurisdiction of the State mental hospitals and the other half under the jurisdiction of some other State agency or depart- ment, such as a department of health, mental 4 Characteristics and Professional Staff of Outpatient Psychiatric Clinics health, welfare, public institutions, education, and so forth (table 1). Another 23 percent were not operated by the State but received State financial aid. Thirty percent of all clinics did not receive State aid, while 5 percent were clinics operated by the Veterans Administration. Table 1. Number and percentage of outpatient psychiatric clinics, according to Stale operation or support, United States, 1954-55 State operation or support Number| Percent PRA ccm 1,234 100.0 State-operated elinies_._____________ 508 41.2 State mental hospital clinies_______ 268 21.7 Other State-cperated elinies_.______ 240 19.5 State-aided olinies.. ee 286 23.2 Non-State-aided elinies______________ 374 30.3 Veterans Administration elinies_ -____ 66 5.3 Approximately 300, or over one-third, of the 794 clinics operated or given some financial support by States received assistance through Federal grant- in-aid funds under the National Mental Health Act (5). Auspices One purpose of clinic reporting was to gather detailed information on the auspices of mental health clinics. The data reported indicate a very complex pattern of sponsorship and affiliation. Clinics may be independent or they may be spon- sored, administered, or operated by one or more of a variety of different governmental or nongov- ernmental health, welfare, or social agencies. The various direct and indirect ways in which outpatient psychiatric clinics are affiliated with governmental units have been described by Barhash (17): A number of States operate psychiatric clinics as State services run by a department, such as the State department of health, of mental hygiene, or of welfare. In other places the clinic’s affiliation with the Government comes through being a part of some other service, such as a county hospital or school system; a branch of the county or State health depart- ment, a department in a State medical school, a clinic service in a State university, ete. More than 800, or about two-thirds of the 1,205 clinics reporting administrative data, including those connected with some type of governmental Public Health Monograph No. 49, 1957 facility, were under governmental auspices (table 2). Typically, these clinics were supported en- tirely or primarily by public funds, Of the total, 70 were Federal Government clinics, 4 adminis- tered by the Department of Health, Education, and Welfare and 66, by the Veterans Administra- tion. There were 540 clinics under the auspices of State governments. Another 35 clinics were under the joint auspices of State and local govern- ments and 159 were under the auspices of a local governmental body only. Of the 401 other clinics, 258 were administra- tively part of a nonofficial organization such as a nonprofit hospital, private social agency or foun- dation, mental hyeiene society, and so forth, while 143 were independent and, for the most part, non- profit clinics without administrative ties to other organizations. These 401 clinics drew their sup- port from one or more of a variety of sources—the “parent” agency or organization, community chest or other local sources, private foundations, and State (including Federal) aid. As in many public clinics, patient fees provided some revenue for these clinics. Very few of the reporting clinics, however, were either proprietary or con- nected with a proprietary organization, such as a private hospital. In table 3, both governmental and nongovern- mental clinics have been classified to show the specific agency or facility which directly operated the clinic. One-fourth (295) of all reporting clinics were part of a mental hospital; these were among the earliest types of clinics founded. While many such clinics served only the convalescent mental Table 2. Number and percentage of outpatient psy- chiatric clinics, according to auspices, United States, 1954-55 Auspices Yang Percent TOOL oe sim sm i ssa 1.205 100.0 Governmental auspices. _._____._. 804 66.7 Federal _ _ _ eo 70 5.3 Stateonly eee 540 44.8 State and city and/or county. _____ 35 2.9 City and/or county _______________ 159 13.2 Nongovernmental auspices_._________ 258 21.4 Independent. ________________ 143 11.9 1 Excludes 29 clinics which did not report information on clinic characteristics. Table 3. Outpatient psychiatric clinics, according to direct operating agency, by age group served, United States, 1954-55 . Clinics serving— Total reporting clinics 2 Direct operating agency * Chil- dren Chil- and dren Adults Number| Percent | adults only only Total. eee 1,205 100.0 688 381 136 Mental hospital (State and other) _________________________________ 295 24.5 223 40 32 General, children’s or special hospital, or medical center.______________ 203 16.8 150 28 25 Medical 26hool... uuu een 38 3.2 21 15 2 College or university ____________________________________________ 28 2.3 15 8 5 Elementary, junior or senior high school. _ __________________________ 17 1.4 3 14 feeeena Juvenile court _______________ 10 .8 3 TA oseensen Other court________________ 13 1.1 7 4 2 State health or mental health department________________ 161 13.4 48 109 4 State welfare, institutions, correction, or other department or agency _ _ _ 46 3.8 34 11 1 Local health department. .. co cove wenn mmm mm —————— re meen 77 6.4 60 17 lramassms Local welfare, education, or other department_______________ 29 2.4 2 25 2 U. 8. Veterans Administration or Department of Health, Education, and IV OH TR. eo mr em mm mm me ee ee wm mm 56 4.6 2 | 54 Mental hygiene society. ____________________________________ 33 2.7 28 B formers Other nongovernmental nonprofit association or foundation. __________ 56 4.7 28 21 7 Independent clinies_..____________________________________________ 143 11.9 64 77 2 ! Facilities, institutions, or Government departments which directly operate or of which the clinicis a part. For example, clinics which are part of a State or city hospital have been classifed under “Mental hospital” or “Other hospital,” although a Government department has top administrative responsibility. 2 Excludes 29 clinics which did not report information on clinic characteristics. hospital patient, some served other special groups or the whole community. Seventeen percent (203 clinics) were part of a general or special hospital or medical center. Thirty-eight clinics, or 3 per- cent, were operated in conjunction with State or private medical schools. Clinics operated by other universities, colleges, high schools, or elemen- tary schools represented less than 5 percent of all clinics. Although the earliest community clinics for children developed as a result of the interest of progressive juvenile court judges (17), there were only 10 clinics affiliated with juvenile courts and 13 clinics with other courts in 1954-55. A fairly recent trend has been for a clinic to be operated as a direct branch of a State or local public health, mental health, or other department; 207 State and 106 local governmental clinics (or 26 percent of all reporting clinics) were in this category. Mental hygiene societies directly administered 33 clinics, or 3 percent of the total. Outlets “Of the 1,205 reporting clinics, 757 were separate clinic units, while 448, or one-third, represented either a headquarters or a branch outlet for a clinic team. A total of 109 clinic teams provided regu- larly scheduled outpatient psychiatric service at these 448 locations. Of the 109 teams, 39 met at 2 locations, 46 at 3 to 5 locations, and 24 at 6 to 11 locations, including headquarters and branch outlets. In many instances, an entire 2- or 3-man clinic team traveled on a schedule to provide part-time service at these locations. Less frequently, a psychiatrist traveled to each outlet at which one or more psychiatric social workers or a clinical psychologist was stationed full time to provide con- tinuing patient care and services to the community. Age Groups Served Of the 1,205 clinics, 57 percent accepted both children and adults for diagnosis and treatment; 32 percent provided diagnostic and treatment serv- ices for children only, usually including some collateral services with their parents; and 11 per- cent served adults exclusively. Of the relatively few clinics accepting adults only, nearly half served veterans only; few clinic facilities were available exclusively for other adults with emo- tional or mental disorders. Data on the number 6 Characteristics and Professional Staff of Outpatient Psychiatric Clinics Table 4. Outpatient psychiatric clinics, according to State operation or support, by age group served, United States, 1954-55 Total Clinics serving— num- State operation ber of or support report- | Chil- ing dren | Chil- | Adults clinics! | and dren | only adults | only Total. _.___.___ 1,205 688 381 136 State mental hospital elinies______________ 266 202 36 28 Other State-operated elinies______________ 231 113 110 8 State-aided clinics. ___- 284 158 114 12 Non-State-aided clinics_| 358 215 121 22 Veterans Administra- tion clinies__________ 66 |__| 66 1 Excludes 29 clinics which did not report information on clinic characteristics. of clinic facilities serving each age group are shown by direct operating agency and by State operation or support in tables 3 and 4, respectively, and by State in appendix table 2. Eighteen years is the maximum age established by a majority of the clinics for admission of chil- dren since this is the usual upper school age limit. Of the 381 clinics serving only children, 194 speci- fied 18 years as the upper age limit. The ages 16 Table 5. and 21 established by 60 and 34 clinics, respec- tively, were the next most frequent maximum ages for clinics serving children only. In 12 chil- dren’s clinics, the maximum age for admission was under 14 years. Almost all (116 of 136) clinics exclusively for adults specified 18 years as the minimum age. Some clinics also specified lower (preschool) and upper (old age) limits for service. The age distribution of clinic patients will be presented in subsequent publications. Special Groups Served One-fourth (275) of all reporting clinics limited service either to selected diagnostic groups or to persons meeting other special eligibility require- ments. Of these, 90 served only the discharged mental hospital patient; in other places, this con- valescent care was provided by the community clinic or by the mental hospital staff. A small number of outpatient psychiatric clinics specialized in the care of selected diagnostic groups—25 for alcoholics, 5 for mentally retarded persons, 1 for epileptics, and 1 for juvenile delinquents. Clinics that limited their service to persons meeting other kinds of eligibility specifications included 66 serv- ing veterans, 54 serving students, and 26 for juvenile or adult court cases. Although many of the remaining 930 reporting Percentage distribution of outpatient psychiatric clinics, according to number of hours open weekly, by State operation or support and age group served, United States, 1954-55 Total State operation or support Clinics serving— reporting clinics 2 Hours open weekly ! State Other Non- |Veterans| Chil- hos- State- | State- | State- |Adminis-| dren Chil- | Adults pital | operated| aided aided | tration and dren only Number | Percent | clinics | clinics | clinics | clinics | clinics | adults only Total clinies______ 1,205 | 100.0 266 231 284 358 66 688 381 136 Full time (35 hours or more per week)_______ 619 51.4 10.9 44.2 77.8 57.8 90.9 42.3 60.4 72.1 Part time (less than 35 hours per week) _____ 586 48.6 89.1 55.8 22.2 42.2 9.1 57.7 39.6 27.9 DBT wis miss woe 22 1.8 2.3 0.9 2.4 18 mma 2.0 2.1 | __- HH-20 ... comnims srs 32 2.6 1.5 1.7 3.2 3.9 1.5 3.2 1.8 2.2 14-20... __________ 47 3.9 3.0 3.4 3.5 5.9 lew 4.5 3.7 1.5 7-13 __ 107 8.9 10.1 14.3 4.6 8.4 6.1 12.1 4.4 5.1 5-6. 62 5.2 6.4 10.8 2.5 2:7 lowwwwmme 4.9 7.1 +1 3-4. 116 9.7 18.8 5.7 2.5 12.6 1.5 11.5 7.9 5.1 2. ene mime 137 11.3 27.5 15.5 3.5 5:0 lensvsaus 12.9 10.8 5.2 Bosthan Loon cmmuns 63 5.2 19.5 3.5 |neuuun-- 8 |cceneins 6.6 1.8 8.1 1 Includes prorated hours of clinics meeting less often than once a week. 2 Excludes 29 clinics which did not report information on clinic characteristics. Public Health Monograph No. 49, 1957 7 clinics provided care for patients with all types of mental disorders, some clinics admitted only lim- ited numbers of persons with such disorders as alcoholism, drug addiction, mental deficiency, or epilepsy. Information on patients by psychiatric diagnosis will be presented in subsequent publi- cations. Hours The kind of clinic services that can be provided in a community is determined in part by the frequency of clinic sessions and the hours a clinic is open (tables 5 and 6). Approximately half (619) of all reporting clinics were full time, that is, they were open 35 hours or more per week. Such clinics, when adequately staffed, can provide long- term treatment to patients when necessary, offer a variety of mental health services to the com- munity, establish appropriate ties with other com- munity agencies, and otherwise become an integral part of the community’s daily life. The remaining 586 reporting clinics provided less than 35 hours of service weekly; half of these clinics were branch outlets. Ninety percent of the State hospital clinics and 56 percent of the clinics operated by other State agencies were part time. Many of these were traveling clinics which provided infrequent service in less populated areas where other psychiatric facilities were lacking. The 586 part-time clinics included 44 that met daily but for only a few hours each day, 334 that met 1 to 4 days each week, 186 that met semi- monthly or monthly, and 22 that met only once every 2 or 3 months. Two-thirds of the part-time clinics provided the equivalent of less than 7 hours, that is, less than 1 full day, of service each week. Due to their limited hours, many part-time clinics offered diagnostic service only; also, where clinic sessions were infrequent, psychiatric care on an emergency basis could not be provided. Part- time clinic service, however, is often all that can be provided in some areas because of limited funds or an inadequate supply of professionally trained persons. Not infrequently, part-time services have been used as an intermediate step in deter- mining community receptivity to the establish- ment of a full-time mental health clinic. Hours were particularly convenient for working people, housewives, or students in 28 percent of all clinics. These clinics had Saturday hours (13 percent), evening hours (11 percent), or both Saturday and evening hours (4 percent). A rela- tively high proportion (24 percent) of the clinics serving adults only were open in the evenings; 18 Table 6. Percentage distribution of outpatient psychiatric clinics, according to frequency of clinic sessions, by State operation or support and age group served, United States, 1954-55 State operation or support Clinics serving— Tota Irequency of clinic reporting sessions clinies ! State | Other Non- | Veterans) Chil- hos- State- | State- | State- |Adminis-| dren Chil- | Adults pital | operated| aided aided | tration and dren only Number | Percent | clinics | clinics | clinies | clinies | elinies | adults only Total elinies______ 1,205 100.0 266 231 284 358 66 688 381 136 Meets weekly ______ __. 997 82.7 47 .4 80.5 94.7 98.0 i 98.5 81.2 84.8 84.6 6-7 JOYS mmm 173 14.4 7.9 10.4 21.5 18.1 3.0 13.5 16.5 12.5 BAYS. ce meer 490 40.7 5.3 37.7 59.1 45.2 89.4 33.3 45.9 62.5 2-4 days ___________._ 130 10.7 9.4 6.0 9.5 17.9 |________ 14.4 7.4 2.2 day... ___ 204 16.9 24.8 26.4 4.6 16.8 6.1 20.0 18.0 7.4 Meets less than weekly _ 208 17.3 52.6 19.5 5.3 2.0 1.5 18.8 15.2 15.4 2 or 3 times amonth___ 80 6.6 19.2 6.9 2.8 1.1 1.5 6.4 8.4 2.9 Once a month________ 106 8.8 28.6 9.1 2.5 6 10.2 5.0 12.5 Once every 2 or 3 months ___________ 22 1.9 4.8 3.5 |e... BL 2.2 1:8 [enisnas ! Excludes 29 clinies which did not report information on clinic characteristics. Characteristics and Professional Staff of Outpatient Psychiatric Clinics sercent of the clinics for children reported Satur- lay hours. Geographic Radius of Service Gieoeraphic boundaries for clinic service usually reflect the jurisdiction and/or policies of the agency operating or supporting the clinic. More than half (56 percent) of the State-operated clinics served residents of more than one township or county, lar e portions of the State, or the entire State. Relatively few accepted out-of-State resi- dents. Lic hty percent of the clinics administered by municipal or county governments restricted admissions to local residents; only 20 percent served other counties. Independent clinics sup- ported by local nonprofit associations or the Com- munity Chest were established primarily to serve a specific city, metropolitan area (which may cross State boundaries), county, or other locality. Even in clinics which specify geogranhie borind- aries of service, residents outside the area were admitted in some instances, particularly for diacnosis or on a fee basis. Conversely, while some clinics reported that they served residents of the entire State or of other States, there were practical limitations to the distance a person could travel to a clinic. It is known that State clinies in the more outlyine areas and some of the clinics connected with medical schools are sometimes visited by patients traveling considerable dis- tances. Most clinics, however, draw their laroest caseload from the immediate or nearby com- munities. 1V. Professional Staff and Man-Hours of Clinics Information on the current clinic staff and man- hours of service by professional eateg ory is essential in evaluating our present mental health resources and in planning programs for training staff for our expanding resources. This section presents such data for the total United States; sections V and VI deal with totals by State and metropolitan or nonmetropolitan area, and with variations in size and staffing of individual clinics. The typical clinic staff includes a variety of professional persons and a supporting staff of clinical and clerical personnel. Seventy percent of all clinics had personnel from each of the three major professions— psychiatry, clinical psycholo y, and psychiatric social work—which traditionally provide the professional skills usually coordinated in the outpatient psychiatric clinic. Psychiatrists have the medical responsibility for the diagnosis and treatment of all patients in the clinic as well as for the supervision and training of other professionals on the staff. Psychologists and psychiatric social workers participate in the intake or social history taking, and in the diag- nostic and treatment processes (19-21). For example, clinical psychologists are especially con- Public Health Monograph No. 49, 1957 cerned with the measurement and evaluation of personality characteristics as a basis for developing treatment plans. In addition to taking social history, psychiatric social workers typically pro- vide services to family members or agency repre- sentatives in order to bring about environmental or other types of ameliorative changes in the interest of child or adult patients. The background and training of clinical psychologists and psychiatric social workers particularly fit them for the mental health education of lay groups and the inservice training and consultative services to the profes- sional staffs of other agencies, such as schools, courts, and social welfare agencies. The extreme shortage of psychiatrists through- out the country and particularly in some geo rraphic areas (22) has further stimulated the use of these other professional persons in clinic services (23). Whether the combination of psychiatrists, clinical psychologists, and psychiatric social workers in the proportion usually found in clinics is the optimum staffing pattern for different types of clinics in urban and rural areas and in various settings, and whether other types of professional persons may be 9 Figure 2. Percentage distribution of professional staff and man-hours in outpatient psychiatric clinics, by profession, United States, 1954-55. 100 — pry Bn A 7 80 7 Psychiatric — %. social worker —- b-4 Ww 60 |— % ini ] u W Clinical x V Psychologist a 0 7 7 7] 7 ) Psychiatrist 43% o- Bn 30% 9,521 TOTAL 188,141 TOTAL CLINIC CLINIC PROFESSIONAL PROFESSIONAL STAFF MAN-HOURS PER WEEK Source: Data based on reports from I,178 of the 1,234 outpatient psychiatric clinics in the United States used to a greater extent for certain tasks, requires further investigation.? Staff In 1954-55, 9,521 professional persons—full- time and part-time regular personnel and trainees —were on the staffs of outpatient psychiatric clinics across the Nation. Due to some under- reporting and some duplication in reporting of staff, this number is not exact. Fifty-six clinics in 19 States did not report staff information; the 1,178 reporting clinics, however, represented 95 percent of all outpatient psychiatric clinics in the United States. Balancing this under-reporting to some extent were the professional persons counted more than once because they worked part time in several clinics not under the same jurisdiction. All personnel that worked in several outlets of the same clinic network were counted once only. ° Profession of Employees Psychiatrists, including trainees, comprised the largest professional group—4,136 or 43 percent of Felix, R. H.: In Unpublished verba'im proceedings of First Conference of Mental Health Clinic ¢ wtisties, National Institutes of Health, Bethesda, Md., April 21-22, 1954. Figure 3. Percentage distribution of professional staff and man-hours in outpatient psychiatric clinics, by type of employment, United States, 1954-55. 1] 100 — ~~ Trainee 80 — = A Regular = 60 — g part-time z (Workweek of less than o 35 hours) ox “nr Regul. 1 a [oe gular full-time (Workweek of 35 hours or more) 20 wy 9,521 TOTAL 188,141 TOTAL CLINIC CLINIC PROFESSIONAL PROFESSIONAL STAFF MAN - HOURS PER WEEK Source: Data based on reports for 1,178 of the 1,234 outpatient psychiatric clinics in the United States the total (fig. 2 and table 7). There were 2,053 clinical psychologists and 2,453 psychiatric social workers, representing 22 percent and 26 percent of the total staff, respectively. These figures may be compared roughly with estimates that today there are 10,000 psychiatrists (22) and about 4,000 clinical psychologists throughout the country. In addition to the 2,453 psychiatric social workers in reporting clinics, there were about 1,300 in public mental hospitals. Estimates of psychiatric social workers in other settings were not available. Psychiatrists, clinical psychologists, and psy- chiatric social workers comprised 91 percent of all professional clinic staff. A relatively small num- ber of other professionals made up the balance, particularly in clinics that had training functions or that provided such service as occupational or recreational therapy, remedial reading, and speech therapy (24). Among these were such medical personnel as pediatricians, internists, medical resi- ? Unpublished information, American Psychological Asso- ciation, Washington, D. C., Russell Rogers, executive secretary, 1976. * Unpublished data from census of public mental hospitals (1954), Biometrics Branch, National Institute of Mental Health, National Institutes of Health, Public Health Service, Bethesda, Md. 10 Characteristics and Professional Staff of Outpatient Psychiatric Clinics dents, and medical students, totaling 4 percent of all professional staff, and nursing personnel, 2 percent. Psychometrists, group workers, occupa- tional and remedial therapists, research workers, technicians, and other personnel accounted for the remaining 3 percent of total staff (appendix table 3). Regular Employees Of the 9,521 professional clinic staff, 4,642 (49 percent) were regular staff employed part time (less than 35 hours per week, including part-time work in several regularly scheduled outlets of a clinic) and 2,967 (31 percent) were regular staff employed full time (fig. 3 and table 7). Although psychiatrists constitute numerically the largest group of professional employees, only 13 percent were employed full time and 66 percent on a part-time basis. As a result, the psychia- trists comprised by far the largest part-time pro- fessional category, accounting for 59 percent of the 4,642 part-time professionals and for only 18 percent of the 2,967 full-time employees. In contrast to this was the employment picture among the psychiatric social workers, numerically the second largest group of professional employees. Only 25 percent of the 2,453 psychiatric onl workers were part time and 58 percent were ful time. Thus, these workers accounted for one-half of all full-time employees and 13 percent of the 4,642 part-time employees. The employment situation for clinical psy- chologists was between that for psychiatrists and psychiatric social workers. About 40 percent of the 2,053 clinical psychologists were employed on a part-time basis and 40 percent, on a full-time basis. Thus, these professionals accounted for 17 percent of the 4,642 part-time employees and for 28 percent of the full-time employees. Most physicians, nurses, and other special per- sonnel worked on a part-time basis. An unknown but probably small number of unpaid or voluntary workers are included among the part-time staff. Data on full-time and part-time staff by type of clinic are shown in appendix table 4. More than half of all part-time employees were in full-time clinics. Seventy-nine percent of all full-time clinics had some part-time staff, while 5 percent had no employees working full time. Forty-six percent of all full-time clinics had a full- time psychiatrist while the remaining full-time Table 7. Professional staff and man-hours per week in outpatient psychiatric clinics, according to type of employment, by profession, United States, 1954-55 Number * Percentage distribution Profession Regular staff 2 Regular staff 2 Total Trainees| Total Trainees Full- Part- Full- Part- time time time time Total SUafl.. . own mmm em mm i 9,521 2,967 | 4,642 | 1,912 | 100.0 5.2 48.7 20.1 Psychiatrist... ... ecm em mmm mam mee 4,136 533 | 2,750 853 | 100.0 12.9 66.5 20.6 Clinical psychologist _______________.___ 2,053 829 812 412 100.0 40.4 39.6 20.0 Psychiatrie social worker... _____. 2,453 1,423 613 417 100.0 58.0 25.0 17.0 Physician (other than psychiatrist) and medical student... cosvemmmmesne 357 19 174 164 | 100.0 5.3 48.8 45.9 NULSE.. eco mmm m mm m m mrmmm re i R 167 45 107 15 100.0 26.9 64.1 9.0 ROT «. oc een me tm ime mmr mm mcm etm me 355 118 186 51 100.0 33.2 52.4 14.4 Total man-hours ________________ 188,141 | 116,039 | 39,171 | 32,931 100.0 61.7 20.8 17.8 Paychiahrist. cup omen wmmmms mummers 57,041 | 21,284 | 20,922 | 14,835 100.0 37.3 36.7 26.0 Clinical psychologist... cc cosenmvammwswen 47,467 | 31,942 | 7,816 | 7,709 | 100.0 67.3 16.5 16.2 Psychiatrie social worker ______________ 70,884 | 55,728 6,721 8,435 100.0 78.6 9.5 11.9 Physician (other than psychiatrist) and medical student_____________________ 2,706 748 894 1,064 100.0 27.7 33.0 39.3 NUTHOL. conn sommes mmr moms 2,963 1,787 880 296 | 100.0 60.3 29.7 10.0 NOE... cvs marmms amas sess shan 7,080 4,550 | 1,938 592 100.0 64.3 27.4 8.3 1 Based on data for 1,178 clinics; 56 clinics did not report professional staff information. 2 «Full time” refers to a workweek of 35 hours or more in clinics; “part time,” to a workweek of less than 35 hours. Public Health Monograph No. 49, 1957 11 clinics had only part-time psychiatrists. In only a third of these clinics without full-time psychia- trists did the hours of the several part-time psychiatrists employed total the equivalent of one or more full-time psychiatrists. Trainees The training of the future professional staffs of psychiatric agencies was early recor nized as an important clinic function. Today, more and more clinics are looking upon training as a primary responsibility (23). In general, there are three types of training undertaken by clinics today: (a) Training psychiatrists, clinical psychologists, and psychiatric social workers for the staffing of clinics, mental hospitals, and other psychiatric services; (b) instructing medical and nursing stu- dents and providing them with clinical experience to assist them in understanding human behavior and emotional disorders, as part of their general professional training and basic preparation; (c) providing other key persons in the community— the minister, the school teacher, and others—with knowledge about mental illness and emotional dis- orders better to fit them for their work with mem- bers of their congregations, their pupils, and so on. Five of every 10 full-time clinics and 1 of every 10 part-time clinics had professional trainees in addition to their regular full-tin.e and part-time staff. There were 1,912 trainees in clinics; 1,682, or 88 percent, were doing graduate work and re- ceiving supervised work-learning experience in a psychiatric clinic as an intecral part of a training program for 1 of the 3 major professions—psy- chiatry, clinical psycholo; y, or psychiatric social work. There was about 1 trainee to every 4 regular full-time and part-time staff members for each of the 3 major professions. Other trainees included 19 pediatricians and a few other medical specialists, 136 medical internes and students, 15 nurses, and 51 other professionals receiving psy- chiatric clinic experience (table 7 and appendix table 3). Man-Hours As a measure of the amount of clinic service available, the number of professional man-hours is more useful than the number of clinics, hours clinics are open, or professional persons on the staff. Man-hours reflect the number of staff and their full-time or part-time employment (25): Indexes on the availability of clinic services in the com- munity can be computed by determining the number of clinics and the number of clinic hours for each 100,000 per- sons; and also, the number of clinic professional man-hours for each 100,000 persons. Much more service is available to the community, for example, from clinic A, in which there are £00 professional man-hours of service each week, than from clinic B, which provides only 100 man-hours, although both may be full-time clinics. The number of professional man-hours in clinics can be used to describe and compare clinic ca- pacity for service just as the number of beds has been used to indicate hospital capacity. A total of 188,000 professional man-hours per week were scheduled in the 1,178 reporting clinics for their 9,500 professional staff members (table 7). These man-hours represented the equivalent full- time service (35 hours a week) of only 5,400 pro- fessional persons to meet the needs of the country. Seoments of the total 188,000 professional man- hours were directed to certain age, diacnostic, or other selected groups only. One-fifth of the total hours were in clinics exclusively for adults, two- fifths in clinics serving children only, and two- fifths in clinics serving both children and adults (fie. 4). Of the total hours, 14 percent were in clinics serving veterans only and another 14 per- cent in clinics serving other special groups, such as mental hospital patients under extramural care, Figure 4. Percentage distribution of outpatient psychiatric clinics, professional staff, and man- hours, by age group served, United States, 1954-55. 100 — = SERVING : 80 Adults only ~ z 601= O7 Children = w ZA only oO © ww 40 Child fe: P 1/dren = VV and 4 gdults DI oh 1,205 TOTAL 9,521 TOTAL 188,141 TOTAL CLINICS CLINIC CLINIC PROFESSIONAL PROFESSIONAL STAFF MAN-HOURS PER WEEK Source: Clinic distribution based on reports for 1,205 of the 1,234 outpatient psychiatric clinics in the United States; staff and man-hours based on reports for 1,178 clinics. 12 Characteristics and Professional Staff of Outpatient Psychiatric Clinics Figure 5. psychiatric clinics, professional staff, and man- hours, by State operation or support, United States, 1954-55. Percentage distribution of outpatient 100 [— State mental— hospital clinics 80 I— Other - State-operated| J clinics = 60 VV a Lu % clinics oc w a 40 — [777] Non-State- | V aided clinics [347% 20 30%. BE Veterans — A dministration clinics 5% 14%: %o 2 1,205 TOTAL ~~ 9,52I TOTAL 188,141 TOTAL CLINICS CLINIC CLINIC PROFESSIONAL PROFESSIONAL STAFF MAN-HOURS PER WEEK Source: Clinic distribution based on reports for 1,205 of the 1,234 outpatient psychiatric clinics in the United States; staff and man-hours based on reports for 1,178 clinics. alcoholics, court cases, and so forth. State mental hospital and other State-operated clinies provided 22 percent of the total professional man-hours; State-aided clinies, 28 percent; and non-State- aided clinics, 36 percent (fig. 5). Although half of all clinics were part time, part-time clinics pro- vided only one-tenth of all professional man-hours of service (fig. 6). Profession Psychiatric social workers provided the largest proportion of the total professional man-hours in clinics, 38 percent, reflecting the relatively large number of psychiatric social workers employed full time. Because so many psychiatrists are employed part time, there were fewer psychiatrist man-hours of service than the relatively large number of psychiatrists would seem to indicate. Thus, although psychiatrists comprise 43 percent of all professional personnel in outpatient psy- chiatric clinics, they supplied only 30 percent of the professional man-hours. Clinical psychologist hours represented 25 percent of the total man- hours, and hours of other professionals, 7 percent (fig. 2). Generally, psychiatrist man-hours represented Public Health Monograph No. 49, 1957 a higher proportion of total professional hours in State mental hospital clinics than in clinics under other auspices, while other State-operated clinics had the highest proportion of psychiatric social worker hours (fiz. 7). Veterans Administration clinics had a relatively hich proportion of clinical psycholo~ist hours, reflecting the large number of clinical psycholory trainees in these clinics. Com- pared with other clinics, those for children had a high proportion of psychiatric social worker hours and a low proportion of psychiatrist hours. Psy- chiatric social work services to parents and a~ency represert tives and the acute shorta e of child psychiatrists probably accounted for much of this difference. Regular Employees and Trainees Although only one-third of the total clinic staff were regular full-time employees, their hours ac- counted for nearly two-thirds of the total staff hours (table 7 and fix. 2). Full-time psychiatrists provided only slizhtly more than one-third of all psychiatrist hours whereas over two-thirds of the total hours in clinical psycholo2y and almost four- fifths of the psychiatric social worker hours were supplied by full-time workers. There were five times as many part-time psychiatrists as full-time psychiatrists (2,750 compared with 533) but the Figure 6. Percentage distribution of outpatient psychiatric clinics and clinic professional man- hours, by full-time and part-time clinics, United States, 1954-55. 100 — ha = _ Part-time _ i] clinics (Opened less than 35 hrs. po per week) > 60 |— — ua 91 % A 7 oO lo Full-time a _ gz clinics i 40 (Opened 35 hrs. or - _ more per week) 51% _ IR _ I 1,205 TOTAL 183,137 TOTAL CLINICS CLINIC PROFESSIONAL MAN- HOURS Source: Clinic distribution based on reports for 1,205 of the 1,234 outpatient psychiatric clinics in the United States; man-hours based on reports for 1,127 clinics. 13 Figure 7. Percentage distribution of professional man-hours in outpatient psychiatric clinics, by profession, United States, 1954-55. BY STATE OPERAT ION OR SUPPORT = 36 z B OQ : 3 I HE STATE MENTAL NON-STATE- VETERANS HOSPITAL STATE- AIDED ADMINISTRATION CLINICS OPERATED CLINICS CLINICS CLINICS 10,502 30,819 53, 311 67,191 26,318 TOTAL PROFESSIONAL MAN-HOURS PER WEEK BY AGE GROUP SERVED 50 I - — 4 15,29 O OF co a ll 7 Zz L 0% 5 7 ZEN CHILDREN CHILDREN ADULTS CLINICS SERVING: AND ONLY ONLY ADULTS 81,25I 69,708 37,182 TOTAL PROFESSIONAL Psychiatrist hours hours Source: Data based on reports for 1,178 of th United States. total weekly scheduled man-hours of each group was approximately the same (21,000). Full-time psychiatrists averaged 40 hours per week as against 8 hours for those working part time. Part-time clinical psychologists averaged 10 hours per week and psychiatric social workers, 11 hours, compared with an average of 39 hours per week for those working full time. Trainee hours comprised 26 percent of total psychiatrist hours, 16 percent of clinical psychol- ogist hours, and 12 percent of psychiatric social 14 MAN-HOURS PER WEEK Clinical psychologist{} Psychiatric social Other professional worker hours hours e 1,234 outpatient psychiatric clinics in the worker hours (table 7). On the average, trainees worked 17 hours per week. Distribution, by Population The 188,000 total professional man-hours per week in all outpatient psychiatric clinics repre- sented 115 man-hours per week for each 100,000 population of all ages in the United States: 35 psychiatrist hours, 29 clinical psychologist hours, 43 psychiatric social worker hours, and 8 other Characteristics and Professional Staff of Outpatient Psychiatric Clinics professional hours for each 100,000 population. Assuming that a 35-hour clinic workweek is full time, this is equivalent to 1.0 full-time psychia- trists, 0.8 clinical psychologists, 1.2 psychiatric social workers, and 0.2 other professionals, or a total of 3.2 full-time clinic professional persons per 100,000 population. If we assume that the professional man-hours in the 688 clinics serving both children and adults were allocated equally to each group, there was an average of 200 professional man-hours per week for each 100,000 population under 18 years of age, as compared with only 75 man-hours per week for each 100,000 persons aged 18 years and over. Clinic Resources Needed It is not possible to estimate with any accuracy the total number of outpatient psychiatric clinics that are needed in the country to diagnose and treat an unknown number of mentally ill and emotionally disturbed persons and to provide pro- fessional training, mental health education, con- sultation to other agencies, and other community services. In local situations, clinic waiting lists and number of referrals to and from clinics are used as empirical indications of the adequacy of present clinic services. Several estimates have been made of the minimum number of clinics re- quired per each 100,000 population. “A standard quoted in the report of the National Health Assembly in 1948 is at least one full-time clinic for psychiatric treatment for each 100,000 population. Subsequent experience in the operation of com- munity mental health clinics indicates that a more realistic estimate of minimum need may be one full-time clinic for each 50,000 population” (10). If it is assumed, for discussion purposes, that a Table 8. Estimates of equivalent full-time outpatient psychiatric clinics and professional staff needed in 1955, 1960, and 1965 ! based on varying assumptions of need for each 100,000 population in the United States Number of equivalent Total full-time staff 3 number of equiva- Actual and needed resources lent Psychia- full- Clinical tric time Total Psychia- | psycholo- social clinics 2 trist gist worker and other Actual resources 1954-55 _____ 1,344 5.375 1,630 1,356 2,389 Needed resources in 1955, 1960, and 1965 based on varying 1955 (population, 165,248,000) * assumptions: 1 clinic per 100,000 population... 1,652 6,608 1,652 1,652 3,304 2 clinies per 100,000 (1 for each 50,000). ________________ 3,304 13,216 3,304 3,304 6,608 3 clinics per 100,000 (1 foreach 33,200). _________._____. 4,956 19,824 4,956 4,956 9,912 4 clinics per 100,000 (1 for each 25,000). ________________ 6,608 26,432 6,608 6,608 13,216 1960 (population 177,840,000) ! 1 clinie per 100,000 population... ___ 1,778 7,112 1,778 1,778 3,556 2 clinics per 100,000 (1 for each 50,000). ________________ 3,556 14,224 3,556 3,550 7.112 3 clinies per 100,000 (1 for each 33,000). ________________ 5,334 21,336 5,334 5,334 10,668 4 clinics per 100,000 (1 for each 25,000) ____________ 7,112 28,448 7,112 7,112 14,224 1965 (population 190,296,000) ! 1 clinie per 100,000 population. __________ 1,903 7,612 1,903 1,903 3,806 2 clinics per 100,000 (1 for each 50,000). ________________ | 3,806 15,224 3,806 3,806 7.612 3 clinics per 100,000 (1 for each 33,000). ________ 5,709 22,836 5,709 5,709 11,418 4 clinics per 100,000 (1 for each 25,000)... ..... 7,612 30,448 7,612 7,612 15,224 1 Population estimates by U. S. Bureau of the Census. 2 Equivalent full-time clinic as defined here is one with a professional staff of 140 man-hours per week, or 1 psychiatrist, 1 clinical psychologist, 1 psychiatric social worker and 1 additional person, either psychiatric social worker or other pro- fessional, working 35 hours per week each. Thus, in 1954-55, the more than 188,000 professional man-hours of service per week in 1,234 clinics were equivalent to 1,344 full-time clinics each providing 140 man-hours of service per week. 3 Computed by dividing the total number of professional man-hours per week for each profession by 35, which, by definition, is the minimum number of hours worked per week by a full-time professional person. Public Health Monograph No. 49, 1957 15 full-time outpatient psychiatric clinic is staffed by 1 psychiatrist, 1 clinical psychologist, 1 psychiatric social worker, and 1 additional person (psychiatric social worker or other professional), providing a total of 140 man-hours per week, then the 1954-55 staff in all outpatient psychiatric clinics repre- sented 0.8 full-time equivalent clinics for each 100,000 population, or 0.4 equivalent clinics for each 50,000 population. If only one full-time clinic per 100,000 population is needed, the re- quirements were four-fifths met in 1954-55. If as many as two clinics per 100,000 population are needed, the requirements were only two-fifths met. Projected estimates of civilian population in the United States for 1960 and 1965 are 178 and 190 million, respectively (26). The number of full- time equivalent clinies and number of full-time staff of each major profession required on the basis of these population estimates and varying assump- tions regarding clinic-population ratio needs are shown in table 8. The full-time and part-time clinic personnel and trainees who worked 188,000 man-hours per week in 1954-55 could have staffed the equivalent of 1,344 four-person full-time clinics providing 140 man-hours of service per week. Assuming that 1 such full-time clinic is needed per 100,000 population, then 1,903 such clinics will be required by 1965. If the standard is in- creased to 4 clinics for each 100,000 population, then 7,600 clinics will be needed by the end of the next decade. Relatively high clinic-population ratios prob- ably are needed under special circumstances. Although the New York State Community Mental Health Services Act of 1954 (7) enables local establishment of a mental health board in each city with a population of more than 50,000 for the purpose of improving and expanding existing com- munity health services, the New Program for Community Mental Health Services, 1954, New York State Department of Mental Hygiene (27), states: Nowhere in the State were there adequate services at the community level. New York County (Manhattan) was the best served locality in the State. Here the ratio of clinic team (psychiatrist, psychologist, and psychiatric social worker) to the population was one clinic team to each 30,000 people. However, the agencies in Manhattan not only served the entire metropolitan area but also carried out many training functions. Thus the ratio in Manhattan is some- what misleading. Nevertheless, most clinics in Manhattan have long waiting lists ranging from 6 months to a year. Thus, estimates of need based on population figures only are rough indications of requirements. Tfurther study is necessary on the need for out- patient psychiatric clinic service in different geo- graphic sections of the country, in metropolitan and nonmetropolitan areas, and so forth. Dis- tance traveled to clinics, availability of private psychiatrists and other supporting facilities, such as family service agencies, any epidemiolozical differences in frequency of the various mental dis- orders among communities which future studies may reveal, and professional training programs and other special functions of clinies—all these should be considered in appropriate studies. Fundamental to any accurate measurement of need is the determination of the total number of mentally ill in a population by age, sex, and psy- chiatric disorder. Without better information on incidence and prevalence of mental disorders, planning is seriously handicapped. Overall planning for mental health in the next decade or two may stress the division of responsi- bility between psychiatric agencies and other mental health services. If there is considerable future expansion of facilities for preventive mental health services, such as school and family agency counseling or local health department services, then clinic requirements based on population growth may be lessened (22). Other possible changes, such as new treatment methods, may also affect the requirements, according to Kramer (28): Some of the possible problems that these [tranquilizing] drugs may create are considered in relation to the psychiatric manpower of the Nation and the availability of outpatient and other community psychiatric services. The widespread use of these drugs in our current state of knowledge concern- ing their immediate and short-range effects could result in situations that could tax seriously the limited psychiatric resources of the Nation. It is also suggested that administrators of community mental health programs scrutinize carefully the current or- ganization of psychiatric outpatient and inpatient services within their areas to determine how they must be modified and reorganized to meet the new demands that may well be placed on them by the advent of the age of pharmacotherapy in the psychiatric disorders. 16 Characteristics and Professional Staff of Qutpatient Psychiatrie Clinics V. Geographic Distribution of Clinic Resources Planning for a more adequate clinic service re- quires information on the geographic distribution of existing facilities. Data on the number of clinics, clinic professional staff, and man-hours in each State are given in appendix tables 1, 5, and 6. All States except one (Nevada) had some out- patient psychiatric clinic facilities. One State (New Mexico) had a Veterans Administration clinic only. In 15 other States, including 9 in the South and West, and in Alaska, Puerto Rico, and the Virgin Islands, all existing facilities were State-operated, State-aided, or Veterans Ad- ministration clinics; there were no clinics without State support. In 9 States over half of the man- hours were in clinics serving children only; in 2 of these States (Mississippi and Wyoming), all of the available facilities were for children. Professional Man-Hours For comparative study of the distribution of clinic resources across the country, clinic profes- sional man-hours have been related to the popula- tion served. Figure 8 and appendix table 7 indi- cate the number of man-hours for each 100,000 population by geographic region and State. This ratio may be seriously understated for a number of the 18 States which did not obtain reports from all clinics (see appendix table 1). For the Nation as a whole there were 115 pro- fessional man-hours of service available per week for each 100,000 population. There was consider- able variation in this ratio among the States. The median ratio was 64 man-hours for each 100,000 population, with a range from 0 to 467. Twenty States had less than 50 man-hours for each 100,000 population, 14 States had more than 50 but less than 100 hours, and 19 States had 100 or more hours (table 9). States in the Northeast tended to have relatively high ratios, States in the South low ratios. If the minimum need for clinic service is assumed to be one full-time clinie, that is, 140 or more clinic professional man-hours per week, for each 100,000 population, only 9 States (District of Columbia, New York, Massachusetts, Kansas, Connecticut, Illinois, Delaware, Rhode Island, and Hawaii) had Public Health Monograph No. 49, 1957 met this minimum requirement. In these States, we find typically a high percentage of urban popu- lation, clinics serving residents of neighboring States in addition to their own residents, consider- able training activities, and, in some, long waiting lists (27, 29). It is likely, therefore, that the minimum need in these States, also, had not been met. Urban Population, Income, and Training Centers A map of clinics (30) indicates high concentra- tion of clinic resources in industrial centers, par- ticularly along the coastal areas and the Great Lakes, following the pattern of population density and economic wealth. Not only are there more clinies in these areas but there are also more man- hours of service available for each 100,000 popula- tion. In table 10 the rank of each State by clinic Table 9. Distribution of States, according to geo- graphic region, by ratio of professional man-hours per week in outpatient psychiatric clinics for each 100,000 population, United States, 1954-55 1 Number of States with ratio of professional man-hours Total per week for each 100,000 Region 2 number | population of— of States 100 Less or more | 50-99 | than 50 Total. _ ____ 53 19 14 20 Northeast _______ 9 6 2 1 North Central _____ 12 4 6 2 South ___________ 17 5 1 11 Weslo cums swans 11 3 t 4 Territories and possessions _ _____ 4 1 1 2 t Based on data for 1,178 clinics; 56 clinics did not report professional staff information. 2 States in each region are as follows: Northeast— Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode island, Vermont; North Central—Iowa, Lllinois, Indiana, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin; South—Alabama, Arkan- sas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Caro- lina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia; West—Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Orecon, Utah, Washington, Wyoming; Territories and Possessions —Alaska, Hawaii, Puerto Rico, Virgin Islands. 17 Figure 8. Number of professional man-hours per week in outpatient psychiatric clinics for each 100,000 population, by State, 1954-55. Man-hours per week for each 100,000 population: NO. OF STATES 100 and more 19 50 to 100 14 [] Less than 50 20 Source: Data based on reports for 1,178 of the 1,234 outpatient psychiatric clinics in the United States. professional man-hours per 100,000 population can be compared with the rank according to the pro- portion of State population in urban centers in 1950 and per capita income in 1954.5 Among States with over 100 clinic professional man-hours for each 100,000 population are some with a comparatively low percentage of urban 5 Simple rank order correlation coefficients (Kendall’s Tau) were as follows: between professional man-hours for each 100,000 population and percent urban population, 4.53; between man-hours and per capita income, +.47; and be- tween percent urban population and per capita income, 4.66. Tests of significance (32) showed each of these rela- tionships to be highly significant (P << .001). The partial correlation coefficients between man-hours and percent urban population with income held constant was 4.33; between man-hours and per capita income with percent urban held constant 4.19. 1t appears, therefore, that the relationship between professional man-hours and percent urban popula- tion is greater than that between man-hours and per capita income. 18 A- B- C- D- West north TOTAL US.-HS Puerto Rico - 13 Virgin Is. -23 Alaska -70 Hawaii -149 Pacific Mountain central West south F - East south I-New England central G- South Atlantic H- Middle Atlantic central central - population, and/or per capita income (Kansas, Utah, Colorado, Minnesota, New Hampshire, Florida, and Louisiana). Medical and training centers in these States undoubtedly contribute importantly to the relatively large amount of clinic resources by providing a reservoir of profes- sional persons to draw upon. Blain (31) states, “Studies on the migration of medical students indicate that the great majority settle relatively close to their medical school regardless of what part of the country they originally came from. Preliminary analysis of the records of the Ameri- can Psychiatric Association indicates that this is generally true of psychiatrists also.” Appendix table 8 indicates the number of trainee man-hours by major profession for each 100,000 population and the number of accredited graduate training schools, by State. In 17 States with accredited graduate training schools for all three major professions, the median number of total Characteristics and Professional Staff of Outpatient Psychiatric Clinics Table 10. Rank order of States, according to number of professional man-hours per week in outpatient psychiatric clinics for each 100,000 population in 1954-55, by percentage of urban population in 1950, and per capita income in 1954, continental United States Number of pro- fessional man-hours Percent urban Per capita per week for each population income State 100,000 population 1950 2 1954 3 1954-551 Rank | Number Rank Percent Rank | Amount Continental United States__ __________________|________ BE enna 64.0 |________ $1,770 100 or more man-hours: District of Columbia ____________________________ 1 467 1 100.0 4 $2,220 New York_ _ _ _ 2 340 3 85.5 6 2,163 Massachusetts. _______________________________ 3 293 4 84.4 13 1,922 Kansas_ _ ee 4 191 28 52.1 22 1,689 Connecticut ___ _____ 5 170 7 77.6 3 2,361 HIN0180. vm som suse mmm: surmeemes ss EIR 6 170 8 77.6 8 2,155 Delaware... . .. on cmmememmems amet A Re EEE EEE 7 167 18 62.6 2 2.372 Rhode Island__________________ 8 153 5 84.3 15 1,823 Utah eee 9 130 14 65.3 32 1,483 Colorado ____ eo. 10 127 16 62.7 23 1,686 Minnesota _ _ ___ eo. 11 122 26 54.5 25 1,644 California _________________________________._ 12 121 6 80.7 7 2,162 New Hampshire. ..... coon vsmmems samme ens seas 13 114 22 57.5 28 1,605 MBE VA cee ss i fo SSR SE 14 114 12 69.0 12 1,940 Ohio. _ __ 15 113 11 70.2 10 1,983 New Jersey _ __ ___ ______ 16 107 2 86.6 5 2,219 Florida ____ ______ 17 107 13 65.5 27 1,610 Louisiana _ _________________ o_o ___________ 18 102 25 54.8 39 1,302 50-99 man-hours: VOUIONE i irs avo sm srs i Ew SE SE 19 91 43 36.4 36 1,408 PonNSY VAIN... o.com ir is em 0 20 88 10 70.5 16 1,785 Michigan. 21 88 9 70.7 9 2.017 WLTTIIIL co con smc cm mms so si es sss mss mgm 22 79 34 47.0 33 1,480 MiSSOUT _ - 23 74 19 61.5 19 1,747 Nebraska _ _ ____ __ ____ 24 72 35 46.9 26 1,635 orm rep ie ER AR 25 64 33 47.7 24 1,667 MONA. = oi 00m 0050 0000000500 26 64 39 43.7 20 1,729 RAO cs mmm mmm SR SR Sr eR Ra 27 62 40 42.9 35 1,433 I no re ET EE SE 28 59 20 59.9 14 1,834 Oregon _ _ __ oe 29 54 27 53.9 18 1,757 Washington_____________________ 30 52 15 63.2 11 1,949 Wisconsin. _ _ _ _ 31 51 21 57.9 21 1,706 Less than 50 man-hours: TIZONA_ _ eee 32 37 24 55.5 29 1,582 North Carolina__________________________________ 33 37 45 33.7 44 1,190 TD ON ce em 0 oR 34 37 17 62.7 30 1,574 SOULH CATON. ..... ccm on ms mim om io in SEER SE 35 34 42 36.7 47 1,063 West Virginia. _ _ _ oe 36 31 44 34.6 41 1.232 SOUEN DAKO. «ce ce omen om sm mm cmon 20 oe rm swe 37 30 46 33.2 38 1,332 DVLABIIR ccs sis sos st sr i si emi 38 29 29 51.7 31 1,492 Oklahoma _________________ 39 28 30 51.0 34 1,466 ATRIA coi mim oi oo mo 0 mr 40 24 47 33.0 48 979 Rentaolty oc «mums coms pn EE RE = EE 41 21 41 36.8 42 1,216 BOTTI. er ems ss i Eo SE 0 5 42 17 36 45.3 40 1.237 Tennessee. __ oo. 43 15 37 44.1 43 1,212 North Dakota __ o_o 44 14 49 26.6 45 1,186 MISSISSIPPI = - © Coe 45 11 48 27.9 49 873 New Mexico eee 46 10 31 50.2 37 1,387 Wyoming _____________________ 47 10 32 49.8 17 1,779 AAVOIRYIN. ons som Bin oe 5 i 48 9 38 43.8 46 1,091 IN EER Ic co mm oo i eS 49 0 23 57.2 1 2,414 1 Excludes data outside continental United States. Based on data for 1,166 clinics in 48 States and District of Columbia; 55 clinics did not report professional staff information. 2 Census of population: 1950, vol. I, Number of inhabitants. 3 Survey of current business, U. S. Department of Commerce, Office of Business Economics, September 1955. Public Health Monograph No. 49, 1957 19 professional man-hours for each 100,000 population was 88. This may be compared with a median of only 59 for the 18 States with schools for fewer than three professions and 34 for the 18 States without higher training facilities (table 11). Table 11. The emphasis in recent years on additional postgraduate education and further training under accredited specialists is likely to result in even more marked clustering of the supply of profes- sional persons. Further study is needed on ways Median number of professional man-hours per week for each 100,000 population in States with and without accredited graduate training schools for psychiatrists, clinical psychologists, and psychiatric social workers,! United States, 1954-55 Median number of professional man-hours per week for each 100,000 population Professional category fessions States with accredited grad- uate training schools for all three major profes- States with accredited grad- uate training schools for one or two of the three major professions States with no accredited graduate training schools for any of the three major professions Number of States___________ Total professional man-hours? Poyelinhisl. o.com enpne sss: wes Clinical psychologist ___ Psychiatrie social worker ________ Trainee man-hours. Psychiatrist... Clinical psychologist... Psychiatrie social worker 17 18 18 88.3 58.7 33.9 31.3 13.2 10.9 26.2 15.3 13.0 33.7 24.9 13.8 16.6 10.5 0 7.0 1.8 0 4.4 1.8 0 4.4 1.4 0 1 4-year medical schools with a department of psychiatry; schools with accredited doctoral training in clinical psychology; and schools with accredited graduate training in psychiatric social work. 2 Includes man-hours of regular full-time and part-time staff and of trainees. Figure 9. Number of professional man-hours per week in outpatient psychiatric clinics for each 100,000 population, by geographic division and by profession, United States, 1954-55. xT Oo < J lo - - 0 z 160 92 VA Psychiatrist Hours 2 2 PA Clinical Psychologist Hours < 80 | | — — XY | " J | 7) Psychiatric Social | 2 o Workers Hours z 4 | 60 | 5 60 I So ox wo |. 7 ao 40 — 2s” | 3°. 0 | I 20 | iG - | | 4,8 s 0 Ll 7 j A AL) er NEW MIDDLE PACIFIC EAST WEST MOUNTAIN SOUTH WEST EAST ENGLAND ATLANTIC NORTH NORTH ATLANTIC SOUTH SOUTH CENTRAL CENTRAL CENTRAL CENTRAL Source:Data based on reports for 1,178 of the 1,234 outpatient psychiatric clinics in the United States. 20 Characteristics and Professional Staff of Outpatient Psychiatric Clinics Table 12. Rank order of States, by number of professional man-hours per week in outpatient psychiatric clinics for each 100,000 population, by profession, 1954-55 ! Number of professional man-hours per week for each 100,000 population State Clinical Psychiatric Psychiatrist psychologist social worker Rank Number Rank Number Rank Number Total United States. _ ooo 85 | came 29 | _____.. 43 Disitict of Columb. cine smess mmm snows ms———— 1 168 1 116 2 142 IMO SERCIMBEEED.. . ce ec mm 0 0 sm i rr 2 128 5 56 3 96 NOW VOIR... cori mmm msm sommes SA AS Same 3 91 2 80 1 148 Kansas. oo oem mmm mmm mmm mmm —————— 4 86 4 62 13 43 Connecticut. - 3 62 10 33 5 69 Delaware _ 6 58 3 68 14 42 Hawaii eee 7 55 34 13 4 81 a msm oe i 8 52 9 35 12 43 SOIOTAG. emi mre ot AE AE 6 A RR 9 50 15 28 11 44 TED ccc cor wc sessns msm sss ts S30, 8 GR 10 44 14 28 20 33 EOP II ccc emi sss ss pms smi em ps mA 11 43 13 29 17 40 LOWISIANA _ — — CCC 12 43 26 20 21 33 Bote BIN cc vo ees smn sass mmm smi am mm 13 42 7 51 7 58 MArTIAN...... cc imi mo 0 5 rms 14 39 21 24 15 2 FI TE oo oor re A ER aii 15 33 6 52 6 65 PONE ITAITIN. ro immo sro sts i HR RAR BA 16 32 27 17 19 34 INCI TANID III. ee cen mcm sr sci 500 RR 17 32 11 32 8 49 Minnesota - — oe 18 31 19 26 18 39 Virginia 19 28 23 23 25 27 Nebraska _ 20 26 25 20 27 24 VOW JOLIET mimi wisi rs ae sro ss rrr 21 26 20 25 9 46 A RIE oo oe me ci HE me 22 23 22 23 28 23 IVTHOTEGEND cee ee em mm i or SR 5 23 19 16 2 16 41 TPLOTAL.. wo scree ms ms ms re 0 SH 24 18 8 39 23 28 IVD TOUTS caesarean or co tm si nrc 25 17 24 20 22 32 WOTTON io ee ss esr em i 8 26 15 12 32 10 44 WISCONSIN eee eee mem 27 13 32 14 30 22 BATIBO ce i mr i or 0 28 15 39 9 36 13 DONO IR oo ei er 29 14 17 26 33 17 IVOTEN COrOMOR.. ee irs iin ioe imi ii ni 30 14 38 11 37 12 OTBEON cc sir tro sss rt cm dw mm 31 14 33 14 29 23 Washington oem mmm 32 13 28 16 32 19 Arkansas _ oe 33 12 45 5 42 7 Idaho _ 34 12 35 13 45 6 TP eXAS oe em eeem———m——————mmmemm 35 12 37 11 38 n TOWA eee 36 12 31 14 24 a7 IV OT UE ceeds RH 37 12 18 26 26 26 AV TOTOIIIL ccm scm mss i SE ge 38 10 52 0 52 0 SUI DIA ROE ca em mscoom se memiomiomssit sm imi im pis SE SR 39 8 44 8 35 15 Virgin JHands. cove vam msi mmm sm om isin 40 7 29 15 53 0 FS OT IIORY e mnsannpsssivsino esaiso sms s sesssm 41 7 48 5 39 9 I BIE a Er RE RRR rere Sesame rie od ets 42 6 30 15 43 7 CO TOTTI... eee i gE esis in ce mm 43 6 36 12 40 8 SOTEIE CATON... oe oe er i os so a a 44 5 42 9 31 20 NEW NIBTUGD cc rere wecomsomeim mimmsmn sm sm SPR ipl wspsitis 45 5 47 5 51 0 PROTEO TRIO orm mim oo sr 5 5 0 i 46 4 46 5 47 3 West Virginia _ _ ee 47 4 41 9 34 17 North Dakota _ 48 4 40 9 49 0 TONNESSCO_ eee 49 3 49 5 41 7 ROTI oo er mmm A i 50 2 43 9 44 7 IV TEER. cc er rr im i 51 2 50 4 48 3 AVOID oe eo tm oss i 52 2 51 2 46 4 IR ON AI occassion sm ime SR RA A A se 53 0 53 0 50 0 1 Based on data for 1,178 clinics; 56 clinics did not report professional staff inf ormation. Public Health Monograph No. 49, 1957 21 of increasing the total supply of highly trained professional personnel and at the same time effect- ing a better distribution of these personnel throughout the country. Man-Hour Ratios, by Profession Generally, geographic regions and States which had a relatively high proportion of psychiatrist man-hours for each 100,000 population were likely to have high ratios for clinical psychologists and psychiatric social workers; conversely, regions and States with relatively few psychiatrist hours had relatively few other professional hours 6 (fig. 9 and table 12). High ratios for all three professions in a State may be due to favorable factors affecting the supply of all types of professional personnel, such as a high degree of urbanization and concen- tration of training facilities, as well as to close adherence to the typical clinic staffing pattern of 1 psychiatrist, 1 clinical psychologist, and 1 or more psychiatric social workers. In 11 States (Alabama, Florida, Georgia, Idaho, Illinois, Iowa, Mississippi, Montana, South Caro- lina, Vermont, West Virginia) less than one-fifth of the total professional staff time was psychiatrist time (appendix table 5). In some of these States where the supply of psychiatrists was limited there was some tendency to staff the clinics with a higher than usual proportion of clinical psy- chologists and psychiatric social workers to meet the demand for clinic service. Other factors as well may influence the State proportion of psy- chiatrist hours to total professional hours. Spe- cialized clinics, such as those serving the released mental hospital patient or providing remedial therapies may require different ratios of profes- sional personnel than the typical nonspecialized clinic. Clinics serving children may have differ- ent staffing patterns than other clinics. Metropolitan and Nonmetropolitan Areas It is important to determine to what extent facilities are concentrated in the urban centers as compared with areas located at considerable dis- 6 Simple rank order correlation coefficients (Kendall's Tau) for the three major professions, by State, were as follows: between psychiatrist and clinical psychologist man-hours -+.67, between psychiatrist and psychiatric social worker hours +.71, and between clinical psychologist and psychi- atric social worker hours 4.69. These relationships were highly significant (P << .001) (32). tances from the larger cities. Although more of the population of the United States resides in urban and suburban areas than formerly (33), many people live in rural or semirural areas where clinic facilities are likely to be nonexistent. Standard Metropolitan Areas In 1950, there were 172 standard metropolitan areas in the United States. A standard metro- politan area, as defined by the Census Bureau (33), contains at least one city of 50,000 or more popula- tion and nearby cities and contiguous counties closely integrated economically with that city. Twenty-three of the standard metropolitan areas included portions of more than one State. Because clinic facilities in the central city of a metropolitan area tend to serve the population of peripheral smaller cities and it is not possible to differentiate between services to the central city and to the outlying communities, this analysis combines data on clinic facilities in all cities within a metropolitan area. Cities in nonmetro- politan areas do not have the same pool of re- sources to draw upon and these cities present a different picture of the availability and utilization of services than cities of similar size in metro- politan areas. Data on clinic professional man-hours in the standard metropolitan areas are given in appendix table 9. Because intercensal population estimates of geographic units smaller than States are not made except for special purposes, clinic man-hour population ratios for these areas could not be computed for 1954-55. The 1950 population has been used as a rough index for comparing the clinic resources in standard metropolitan areas of approximately the same size. It is likely that a considerable growth has taken place in almost all metropolitan areas since 1950. Special recent estimates of population are available for four standard metropolitan areas (33). These esti- mates are as follows: Population Percent change January 1, 1956 from 1950 lo 1956 Washington, D.C____ 1,884,000 +28.7 Houston___ 1,077,000 +33.5 Milwaukee _ _ -. 975,000 +11.9 St. Louis_ ___ --- 1,892,000 +12.5 In the decade 1940-49, the population within standard metropolitan areas in the United States increased 22 percent; outside these areas, only 6 percent (34). The greatest increase in growth of 22 Characteristics and Professional Staff of Outpatient Psychiatric Clinics standard metropolitan areas is characteristically in the outlying areas rather than in the central city. Typically, more clinic facilities are located in the central city of the metropolitan area, while a higher proportion of the population resides in the outlying parts. Data for Washington, D. C., illustrate the useful- ness of analyzing clinic services grouped by metro- politan area. The number of clinic profes- sional man-hours per week for each 100,000 population in the District of Columbia was over 450 in 1954-55. Of the 15 clinics in the District of Columbia, however, half provided service to the entire metropolitan area. Grouping both clinic facilities and population of the entire metro- politan area reduces the ratio to less than 300. Clinic Distribution Table 13 summarizes the distribution of clinic facilities by size of area or place in which the clinic is located. Clinic facilities were located in 152 of the 172 standard metropolitan areas. In other words, there was no outpatient psychiatric clinic in 20 of these metropolitan areas which included at least one city with a population of 50,000 or more. Of the 79 standard metropolitan areas with a population of 250,000 or more, 78 had clinic facilities located within their geographic bound- aries, either in the central city or in adjoining smaller urban or suburban communities. Clinics were located in 74 of the 93 metropolitan areas with less than 250,000 population, in only 183, or one-fourth, of the 667 nonmetropolitan cities of more than 10,000 population, and in relatively few of the smaller nonmetropolitan cities or towns. Residents of some of these smaller places, however, may have access to the outpatient psychiatric facilities in the larger cities. Of every 10 clinics, 4 were located in one of the 14 standard metropolitan areas with a 1950 popu- lation of a million or more, and an additional 3, in one of the smaller standard metropolitan areas. Three of every 10 clinics were in nonmetropolitan places; many of these were part-time clinics of State agencies. Half of the State clinics, com- pared with only one-fourth of the State-aided clinics and one-twelfth of the non-State-aided clinics, were located in nonmetropolitan places. Table 13. Percentage of metropolitan areas and nonmetropolitan places with clinics and percentage distri- bution of outpatient psychiatric clinics in the United States, by State operation or support, 1954-55, accord- ing to size of metropolitan area or nonmetropolitan place in 1950 Metropolitan areas and Total reporting nonmetropolitan places clinics 2 Other Size of State | State- | State- | Non- [Veterans area or place hospital | oper- aided State |[Adminis- (1950 population) With clinics clinics ated clinics | aided | tration clinics clinics | clinics Total 1 Number| Percent Number| Percent Number. cc cums 14,021 449 3.21 1,205 | 100.0 266 231 284 358 66 Percent | Percent | Percent | Percent | Percent Metropolitan areas_____ 172 152 88.4 844 70.0 52.3 43.3 74.3 92.5 95.5 1,000,000 or more._.__ 14 14 | 100.0 467 38.8 28.6 20.8 31.3 65.6 28.8 500,000-999,999__ __ 19 19 | 100.0 101 8.4 3.0 6.5 7.7 11.2 24.3 250,000-499,999____ 46 45 97.5 140 11.6 14.3 7-8 15.5 7.3 21.2 100,000-249,999__ __ 75 67 89.3 121 10.0 5.3 7:3 18.7 7.0 18.2 50,000 99,999____ 18 7 38.9 15 1.2 1.1 .9 1.1 1.4 3.0 Nonmetropolitan placess| 13,849 297 2.1 361 30.0 47.7 56.7 25.7 7:5 4.5 25,000-49,999________ 160 76 47.5 102 8.5 9.4 17.8 9.5 2D Lemme 10,000-24,999________ 507 107 21.1 138 11.4 19.9 22.1 8.1 2.2 4.5 5,000~ 9,999... .<.- 791 49 6.2 52 4.3 6.8 6.9 5.3 8 |e 2,500 4,999_______. 1,391 34 2.4 37 3.1 5.6 6.9 ol 1.1 |... Under 2,5004....---- 11,000 31 .3 32 2.7 6.0 3.0 2.1 9 |e 1 Based on 1950 population. 2 Excludes 29 clinics which did not report information on clinic characteristics. 8 Includes (a) all incorporated places and (b) unincorporated places of 1,000 or more population, which are located outside of metropolitan areas. 4 Estimate based on proportion of total incorporated places of over 2,500 population which are located in nonmetro- politan areas. Public Health Monograph No. 49, 1957 23 Professional Man-Hours Because urban clinics tend to be larger than nonurban clinics (page 25), the concentration of clinic professional man-hours in urban centers is even more marked than the concentration of clinics. Whereas only an estimated 59 percent of the 1955 population of the United States resided in a metropolitan area (35), 91 percent of all pro- fessional man-hours were in clinies located in metropolitan areas. Only 9 percent of the pro- fessional man-hours, therefore, were in clinics located in nonmetropolitan areas, which contained 41 percent of the population (fig. 10). In other words, 176 professional man-hours per week were provided for each 100,000 population in metro- politan arcas compared with 23 professional man- hours in the nonmetropolitan areas. Not only are psychiatric clinic services extremely limited in the more rural areas, but supporting facilities such as family service agencies and private psychia- trists are largely absent (36, 37). Appendix table 10 compares the metropolitan and nonmetropolitan distribution of the popula- tion and clinic professional man-hours for each State. Inalmost all States, a considerably greater proportion of professional man-hours than of the population was in metropolitan areas. In no State was the converse true. The concentration Figure 10. Percentage distribution of 1955 population and of professional man-hours in outpatient psychiatric clinics, by metropolitan and nonmetropolitan areas of specified size, United States 1951-55. 100 — Nonmetro= pests Sem oy politan 9% } Nonmetropolitan areas with a population of: | © . ZZ 80 1% Nozmeire Less than 2500 politan Z LV 12,500 -49,999 E60 - Zz Metro- Metropolitan areas Ll politan 91% : ; O with a population of: Q LJ 50,000-999, 999 a 40 — : ii 59% Me tro- 2:1 [,000,000 or more politan 20 =) 0 ee inh Sed . ESTIMATED 188,137 1955 TOTAL PROFESSIONAL POPULATION MAN -HOURS PER WEEK IN OUTPATIENT PSYCHIATRIC CLINICS Source: Population data based on estimates by U.S. Census Bureau. Man-hours based on reports for 1,127 of the 1,234 outpatient psychiatric clinics in the United States. 24 Characteristics and Professional Staff of Outpatient Psychiatric Clinics of outpatient psychiatric facilities in urban areas appears to be related to several factors: the greater number of training centers and greater supply of psychiatrists and other professional per- sons in these larger cities; the greater population density; and, usually, the greater financial re- sources of the more urban communities. While in some parts of the country travel to a metropolis may not present a problem, it is probable that in almost every State there are semirural or rural areas where travel to the nearest clinic facility is a considerable hardship. For example, the survey report Mental Health Training and Research in the Western Region (38) states: In some areas the population is densely concentrated, with concomitant richness in traming and treatment facilities: in other areas the problem of combatting the mental illnesses are complicated by very sparse population and great distances from clinical help. VI. Clinic Variation in Professional Staff and Man-Hours Selected data on number and composition of professional staff in individual clinics are included for those planning new facilities or interested in comparing similar clinics. Data in this section represent 91 percent of all clinics; excluded are the 56 clinics not reporting any professional staff information and 51 branch outlets for which separate staff information was not reported. Staff The number of staff in each clinic, including regular full-time and part-time persons and trainees, ranged from 1 to almost 100. Clinics staffed by three professional persons were more numerous than other clinics as shown in the fol- lowing percentage distribution of clinics by num- ber of staff. Number Percent Number Percent of stuff of clinics of staff of clinics Total____ 100.0 56__ 12.7 1 1.9 7-9 _. 11.7 : . 15.0 10-24________ 16.8 BD im inti SR 21.3 25-49 ______._ 5.3 Bb msi 13.4 50 or more____ 1.9 Man-Hours One-fifth of all clinies provided fewer than 10 professional man-hours of service per week. The median was 74 professional man-hours. At the upper end of the scale were 23 clinics (2 percent) that provided 1,000 or more man-hours weekly, the equivalent service of more than 28 full-time professional persons (appendix table 11). Veterans Administration and Department of Public Health Monograph No. 49, 1957 Health, Education, and Welfare clinics, clinics affiliated with medical schools and other univer- sities and colleres, and clinics operated by city boards of education were among those with the largest number of professional man-hours per week (fig. 11). The median clinic in each of these groups provided more than 200 man-hours of service per week. The State mental hospital clinics, averaoing only 7 man-hours per week due to their infrequent schedule, provided the fewest man-hours. The median full-time clinic provided 176 professional man-hours of service weekly com- pared with 15 professional man-hours for the median part-time clinic (fig. 12). Clinics located in standard metropolitan areas of 100,000 popu- lation or more provided an average (median) of over 100 professional man-hours of service per week compared with less than 50 man-hours for clinics located in less populated areas (fig. 13). Clinic Team Sixty-nine percent of all clinics operated with a basic staff comprised of representatives of psy- chiatry, clinical psycholory, and psychiatric social work. Nine percent of all clinics had representa- tives of psychiatry and clinical psycholocy as members of a two-profession team, and 15 percent, psychiatry and psychiatric social work. In only a few of these clinics was there a vacancy for the third profession. Most of the two-profession clinics were: (a) clinics attached to courts or family service acencies which utilize the acency’s social work staff; (b) aftercare clinics for the con- 25 Figure 11. Median number of professional man-hours per week in outpatient psychiatric clinics, by direct operating agency, United States, 1954-55. 1,127 TOTAL REPORTING CLINICS Br Ja NUMBER OF BY DIRECT OPERATING CLINICS AGENCY: I | ! | 283 MENTAL HOSPITAL Is 195 OTHER HOSPITAL EN 38 MEDICAL SCHOOL TT He29 25 COLLEGE OR UNIVERSITY Tj 204 16 OTHER SCHOOL 49 20 COURT T 5 40 SEATS MEAN Sr MER. EE eo 38 CORRECTION OR OTHER DEPARTMENT ZA"! 69 LOCAL HEALTH DEPARTMENT ____]55 20 GinER berartnenT NOR 208 30 MENTAL HYGIENE SOCIETY TI 46 RISOCIATION OR FOUNDATION [7777 5° | 42 INDEPENDENT CLINICS oT /l20 1 | 0 100 200 MEDIAN NUMBER OF MAN-HOURS PER WEEK J Source: Data based on reports for |,127 of the |,234 outpatient psychiatric clinics in the 26 United States. Characteristics and Professional Staff of Outpatient Psychiatric Clinics Figure 12. Median number of professional man-hours per week in outpatient psychiatric clinics, by full- time or part-time clinic, State operation or support, and age group served, United States, 1954-55 1,127 TOTAL REPORTING CLINICS Pj 74 NUMBER OF BY FULL-TIME OR CLINICS PART-TIME CLINICS: ' I ! I ! _ (open 35 hrs.or 596 FULL-TIME "re per wk) ¥ (open less than 531 PART-TIME 35 hws.per wk) BY STATE OPERATION OR SUPPORT: 253 STATE HOSPITAL 192 OTHER STATE OPERATED 50 7 J 7 ZZ 282 STATE -AIDED 121 334 NON-STATE-AIDED 105 66 VETERANS ADMINISTRATION BY AGE GROUP SERVED: 640 CHILDREN AND ADULTS 233 g_Z To zz 1 1 51 352 CHILDREN "ONLY 103 135 ADULTS ONLY 0 100 200 MEDIAN NUMBER OF MAN-HOURS PER WEEK Source: Data based on reports for |,127 of the |,234 outpatient psychiatric clinics in the United States. Public Health Monograph No. 49, 1957 27 Figure 13. Median number of professional man-hours per week in outpatient psychiatric clinics, by clinic location, United States, 1954-55. 1,127 TOTAL REPORTING CLINICS 74 NUM E BER BY LocaTion: METROPOLITAN AREAS T T 1 CLINICS with a 1950 population = 45 | 1,000,000 OR MORE 74129 89 500,000 -999,999 128 133 250,000-499,999 12 100,000- 249,999 Ie 50,000 -99,999 NONMETROPOLITAN AREAS with a [950 population of: 9| 25,000 -49,999 123 10,000-24,999 50 5,000- 9,999 34 2,500- 4,999 28 UNDER 2,500 1 1 J 100 200 MEDIAN NUMBER OF MAN-HOURS PER WEEK Source: Data based on reports for [127 of the 1,234 outpatient psychiatric clinics in the United States. 28 Characteristics and Professional Staff of Outpatient Psychiatric Clinics valescent mental hospital patients; or (c¢) clinics using as consultants the clinical psychologists or psychiatric social workers of the university or hospital to which the clinic is connected. Six percent of all clinics, principally small consulta- tion clinics attached to a general hospital, had a psychiatrist but lacked both a clinical psycholocist and a psychiatric social worker; a few had some other type of professional person on the staff. In 1 percent of all clinics, the psychiatrist position was vacant. Psychiatrist vs. Total Man-Hours An outpatient psychiatric clinic is defined as one where a psychiatrist is in attendance at reeu- larly scheduled hours and assumes the medical responsibility for all of the patients in the clinic. No official standards are available, however, relating the number of psychiatrist hours to hours of other professionals. In one-tenth of all clinics, psychiatrist man- hours represented less than 10 of each 100 profes- sional man-hours (table 14). Vacancies accounted for only a small proportion of the limited psychia- trist man-hours in these clinics. The median number of psychiatrist man-hours per 100 total professional man-hours was 32. In a fairly large proportion (16 percent) of clinics half the man- ho rs were psychiatrist hours. These were typi- cally clinics staffed by two persons. The small, usually two-person, clinics radiating Table 14. Distribution of outpatient psychiatric clinics, according to number of psychiatrist man- hours per 100 total professional man-hours, United States, 1954-55 Number Psychiatrist man-hours per 100 of Percent professional man-hours reporting clinics ! TOU. mmiiimmismtrmimmmimmistims 1.127 100.0 Lions thom 10 con wma 116 10.3 10-19. cove crnnnm sms samae see 163 14.4 DD 20 mmm mR SR 251 22.3 30-39 221 19.6 40-49. 71 6.3 50-R9 eee 184 16.3 60-69 _ oo. 47 4.2 TOTY......co minum mm 17 1.5 BBD... ron meson ssi SF SR SI 16 1.4 90-99 _ oo 3 3 100. 38 3.4 1 Excludes 56 clinics which did not report professional staff information and 51 branch outlets for which separate staff information was not reported. from the State mental hospital and the large clinics connected with medical schools and other univer- sities and colleges were among those with a rela- tively hich proportion of psychiatrist hours (appendix table 12). The high proportion of psy- chiatrist hours in part-time clinics as compared with full-time clinics reflects the fact that many of the part-time clinics are State mental hospital branch clinics. The median number of psychia- trist hours per each 100 professional hours varied little by metropolitan or nonmetropolitan location of the clinic. VII. Summary and Discussion This report provides factual information on mental health cliniecs—their characteristics, geo- graphic distribution, and professional staff—for an objective appraisal of clinics today as well as a baseline against which future developments can be measured. It is hoped that these data will be helpful to local, State, and national program ad- ministrators and legislators, clinicians, and pro- fessional and public groups who are charting methods to solve the mental health problems of the Nation. Public Health Monograph No. 49, 1957 Principal Findings Some of the principal findings in this report are summarized below. e The 1,234 outpatient psychiatric clinics throughout the country in 1954-55 were staffed by over 9,500 professional persons, including regular full-time and part-time staff and trainees, and provided more than 188,000 professional man- hours of service per week. For each 100,000 population, there was an average of 115.0 profes- sional man-hours per week, or the equivalent of 29 3.2 full-time professional persons (each working 35 hours weekly). e Two-fifths of the total professional man-hours were provided by 688 clinics serving both children and adults, another two-fifths by 381 clinics serv- ing children only, and one-fifth by 136 clinics serving adults only. Of the relatively few clinics exclusively for adults, half, or 66, were for veterans only. If it is assumed that approximately half of the professional man-hours in the 688 clinics serv- ing both children and adults were allocated to the services of children and half to adults, then there was an average of 200 professional man-hours per week for each 100,000 population under 18 years as compared with only 75 man-hours per week for each 100,000 persons aged 18 years and over. e The ratio of professional man-hours to popula- tion varied considerably among the States. The median ratio was approximately 64 man-hours for each 100,000 population, with a range from 0 to 467. Twenty States had less than 50 man-hours for each 100,000 population, 14 had more than 50 but less than 100 hours, and 19 had 100 or more hours. States in the Northeast tended to have relatively high ratios, States in the South, low ratios. Degree of urbanization and the presence of medical and training centers within States probably explain many of the interstate differ- ences. Ninety-one percent of all professional man-hours were in clinics located in the standard metropolitan areas, which had only 59 percent of the population. e More than 4,100 psychiatrists, 2,050 clinical psychologists, 2,450 psychiatric social workers, and 900 other professionals served in clinics. On the basis of a 35-hour workweek, however, the 9,500 professional staff in clinics represent less than 5,400 equivalent full-time professional per- sons. Five staff members were employed part time to each three employed full time. Of the 4,600 part-time workers, 59 percent were psychia- trists; half of all full-time clinics had part-time | psychiatrists only. One out of each five profes- || sional persons was a trainee. eo Psychiatrist hours represented 30 percent of total professional man-hours in clinics; clinical psychologist hours, 25 percent; psychiatric social work hours, 38 percent; and hours of other pro- fessionals, 7 percent. Seven of each 10 clinics had a basic clinic team representing psychiatry, clinical psychology, and psychiatric social work. . clinics. e About one-half of all clinics were part time (open less than 35 hours per week), but part-time clinics provided only one-tenth of all professional man-hours of clinic service. State mental hos- pitals and other State-operated clinics provided 22 percent of the total professional man-hours; State- aided clinics, 28 percent; non-State-aided clinics, 36 percent; and Veterans Administration clinics, 14 percent. Need for Research and Planning Psychiatric Outpatient Care Overall planning for mental health clinic re- sources requires knowledge of the need for such services. Istimates of need based on varying assumptions of clinic-population ratios can only serve as rough indications of requirements. Fur- ther study is necessary to determine the actual outpatient clinic service needed in metropolitan and nonmetropolitan areas and in communities differing in socioeconomic and cultural patterns. Account must be taken of distances traveled to clinics, transportation patterns, availability of supporting facilities, and special functions of Fundamental to any accurate measure- ment of need for any specified population is the determination of the total number of emotionally disturbed persons, by age, psychiatric disorder, severity of mental illness, and other pertinent factors. Standard definitions and methods ap- plicable to case finding and more precise tools for measuring duration and severity of mental illness are needed. Further study is needed also on the way community agencies refer persons to various inpatient and outpatient facilities and on the pathways of the mentally ill to clinics and other psychiatric services. Any fundamental changes in the division of responsibility among psychiatric and social welfare agencies in providing patient and community men- tal health services will affect future requirements for clinic service. So also will any significant advance in knowledge of the etiology of mental illness and the application of such knowledge, and in the development of new and more effective treatment methods. Balanced Geographic Distribution A significant finding of this report is the marked variation in the number of clinic professional man- 30 Characteristics and Professional Staff of Outpatient Psychiatric Clinics hours provided for each 100,000 population among States and particularly between urban and rural areas. It would seem that this imbalance of clinic service exceeds any possible variation exist- ing among communities in the need for outpatient care due either to community differences in the frequency of various types of mental illness or to cultw al patterns of seeking and providing mental health care. Probably a major factor in the wide geographic disparity between clinic resources is the location of most of the accredited training centers in selected urban areas. The emphasis in recent years on additional postgraduate education and further training is likely to result in even more marked clustering of professional persons in these areas. Despite a concentration of professional resources, however, most or all of these large cities have insufficient facilities relative to the needs of their population, as evidenced by long waiting lists for clinic service. Considerable thought has been given to ways of increasing the number of highly trained profes- sional personnel and at the same time effecting a better distribution of these personnel throughout the country. Methods suggested include the strengthening of existing educational facilities to produce more qualified professionals and to meet standards for accreditation ; developing small nuclei of training centers in new locations if high stand- ards for training can be maintained; developing regional training centers and “compacts” to meet the needs of States which lack resources to develop their own training facilities; providing greater opportunities for the continued training of pro- fessional personnel either within or outside the State; intensifying programs to interest high- school and college students in mental health careers so as to increase the number of high-caliber candidates for training; and establishing salaries more commensurate with the training that is required for these professions. The data show that relatively few clinics were located in semirural and rural communities and that rural clinics were principally part-time travel- ing clinics and either State-operated or State- aided. Further study should be undertaken on the needs for mental health services in sparsely populated areas and ways such services can be provided. Possible areas for exploration are a study of the patterns of seeking and providing mental health services in rural areas; the relative Public Health Monograph No. 49, 1957 advantages and disadvantages of a traveling team compared with a stationary clinic, such as a tri- county mental health center; ways of attracting highly trained psychiatric professionals to the small community; and how to use more effectively in the program of mental health services local public health personnel and physicians by provid- ing them with special training. Balanced Clinic Services The provision of adequate services to all seg- ments of the population—the parents and other adults as well as the children, older persons,” and so on—is another problem area. More thought needs to be given to the special diffi- culties of clinic service in large cities, where there may be serious gaps in service to certain groups and problems of referral of individuals to the appropriate clinic resource for service. More centralized planning and coordination of clinic admission policies and a central agency for refer- ring individuals to the appropriate mental health resource may be possible solutions bearing study. The conceptualization of ideal patterns of men- tal health services in communities of different types may be helpful. Such guides might consider the ideal role of the various community agencies in counseling, diagnosis, treatment, and mental health education, and the advantages and dis- advantages of different kinds of clinics and their administrative settings in providing general and special psychiatric services of high caliber to all segments of the population. Clinic Staffing Patterns Constant reexamination is required of the con- tribution to clinic services made by each profes- sion. A staffing pattern appropriate yesterday may no longer be optimal today or tomorrow. The responsibility of each profession toward the child and the adult patient and the traditional and new roles of each profession in diagnosis and treatment are some of the principal areas requiring rethinking and reevaluation, in view of the general shortage of professional personnel, the changes in education and training for the professions, the advances being made in psychodynamics, and the possible changes that may occur as a result of the widespread use of tranquilizing drugs. 7 Unpublished data. 31 Special studies are needed that will take a more comprehensive “look see” at the clinic staff and their functions in order to help answer the follow- ing kinds of questions: How effective are the present combinations of professional personnel in achieving the goals of the various clinics? What other professional skills are needed in urban clinics? In rural clinics? Concomitant with earlier releases from mental health hospitals, are more vocational rehabilitation counselors and other types of specialists needed? Do we need more physicians and nurses to supervise patients on drug therapy? Is the employment of so many part-time professionals in clinics advantageous to clinic functioning? Should there be minimum standards of hours for psychiatrists in relation to other professional hours for clinics of different types and in urban and rural areas? And finally, how can services to the patient and the community be better evaluated for objective and realistic appraisal of accomplishments and to plan future goals? References (1) The National Association for Mental Health, Inc.: Directory 1952. Psychiatric clinics and other re- sources in the United States. New York, N.Y., 1953. (2) Pennell, M. Y., Cameron, D. C., and Kramer, M.: Mental health clinic services for children in the United States, 1970. Pub. Health Rep. 66: 1559— 1572, November 1951. (3) U.S. National Institute of Mental Health: Patients in mental institutions, 1947. Washington, D. C., U.S. Government Printing Office, 1954, pp. 1-113. (4) Felix, R. H.; and Kramer, M.: Extent of the problem of mental disorders. Ann. Am. Acad. Polit. & Social Se. 286: 5-14, March 1953. (6) National Mental Health Act. 60 Stat. 421 (Public Law 487. 79th Cong. 2d sess., 1946). (6) Mental Health Study Act of 1955. 69 Stat. 381 (Public Law 182, 84th Cong. 1st sess., 1955). (7) New York Community Mental Health Services Act, 1954. (8) 30 Conn. General Stat. chap. 181, sec. 3831. An act providing for expansion of psychiatric clinics for children. 1945. Public Act 563, as amended by Public Act 32. (9) Alaska, Mental Health Enabling Act. 832, 1956. (10) Council of State Governments Interstate Clearing House on Mental Health: State action in mental health, 1955. A summary of financial, legal and ad- ministrative developments in State mental health programs. BX Publication No. 300, Chicago, 1955. Looseleaf, 66 leaves. (11) U.S. National Institute of Mental Health: (a) Annual ’ statistical report of outpatient psychiatric clinics, (b) scope, and purpose of the report form, and (¢) n- structions for filling out form. Pethesda, Md., 1954. (12) U.S. National Institute of Mental Health: A manual on record keeping and statistical reporting for mental health clinics. Washington, D. C., U.S. Government Printing Office, 1957, 72 pp. Public Law (13) Conference report. Mental health clinic stat’stics Fub. Health Rep. 69: 1008-1011, October 1¢ £4. (14) National Association for Mental Health, Inec.: Di- rectory 1954-55. Outpatient psychiatric clinics and other mental health resources in the United States and Territories. New York, N. Y., 1956, 192 pp. (156) New York State Department of Mental Hygiene: 1957 directory of psychiatric clinics in New York State. Albany, N. Y., 168 pp. (16) American Psychiatric Association: Standards for psy- chiatric hospitals and clinics. Washington, D. C., 1954, 37 pp. (17) Barhash, A. Z., Bentley, M. C., Kirkpatrick, M. E., and Sanders, H. A.: The organization and function of the community psychiatric clinic. New York. N.Y., National Association for Mental Health, Inc., 1952, 105 pp. (18) The Commonwealth Fund: Eighth annual report for the year 1925. New York, N. Y., 1929, 82 pp. (19) Knee, Ruth 1.: Psychiatric social work. In Social work year book, 1957, ed. 13, edited by R. H. Kurtz. New York, N. Y., National Association of Social Workers, 1957, pp. 431-439. (20) Louttit, C. M.: Clinical psychology of children’s be- havior problems. Revised edition. New York, Har- pers, 1947, 661 pp. (21) Carter, J. W., Jr.: The training needs of psychologists in community mental health programs at State and local levels. In Psychology and mental health. A report of the Institute on Education and Training for psychological contribution to mental health, held at Stanford University, August 1955, edited by C. R. Strother. Washington, D. C., American Psycho- logical Association, 1926, pp. 21-40. (22) Blain, D., and Robinson, R. L.: Personnel shortages in psychiatric services. A shift in emphasis. New York State J. Med. 57 (2): 255-260, Jan. 15, 1957. 32 Characteristics and Professional Staff of Outpatient Psychiatric Clinics (28) Clark, R. A.: The psychiatric outpatient clinic. The administration, staffing, organization and control of outpatient departments, including mental hygiene clinics. Ment. Hosp. 7: 3-6, October 1956. (24) Coleman, J. V.: Workers in the field of mental health. Ann. Am. Acad. Polit. & Social Se. 286: 81-91, March 1953. (25) Bahn, A. K.: Mental health clinic statistics—needs, sources, methods. Pub. Health Rep. 69: 619-625, July 1954. (26) U.S. Bureau of the Census: Revised projections of the population of the United States, by age and sex: 1960 to 1975. Series P-25, No. 123. Washington, D. C., U. S. Government Printing Office, 1955. (27) New York State Department of Mental Hygiene: New program for community mental health services. Albany, N. Y., 1954, 15 pp. (28) Kramer, M.: Public health and social problems in the use of tranquilizing drugs. Tub. Health Monogr. No. 41. Washington, D. C., U. S. Government, Printing Office, 1956, 31 pp. (29) Vaughan, W. T., Jr., Conwell, M. B., and Kaplan, B.: Survey of community psychiatric resources in Massa- chusetts. East Gardner, Mass., Gardner State Hos- pital, Massachusetts Department of Mental Health, 1952, 163 pp. (30) U.S. National Institute of Mental Health: Listing of outpatient psychiatric clinics in the United States and Territories, 1954. P.IH.S. Pub. No.428. Wash- ington, D. C., U. S. Government Printing Office, 1955, 44 pp. Public Health Monograph No. 49, 1957 (31) Blain, D.: Private practice of psychiatry. Ann. Am. Acad. Polit. & Social Se. 286: 136-149, March 1953. (32) Kendall, M. G.: Rank correlation methods. New York, Hafner Publishing Co., 1955, pp. 49-66. (33) U. S. Bureau of the Census: Estimates of population of the standard metropolitan areas of Houston, Mil- waukee, St. Louis, and Washington, D. C.; January 1, 1956. Series P-25, No. 137. Washington, D. C,, U. S. Government Printing Office, 1956. (34) U. S. Bureau of the Census: Standard metropolitan areas: April 1, 1920. Series FC-9, No. 6. Wash_ ington, D. C., U.S. Government Printing Office, 1952_ (35) U.S. Bureau of the Census: Civilian population of the United States by type of residence, April 1955 and 1950. Series P-20, No. 63. Washington, D. C., U. S. Government Printing Office, 1955. (56) Southern Regional Education Board Mental Health Training and Research Project: Mental health train- ing and research in the southern States. A report to the Southern Governors’ Conference, Boca Raton, Florida, 1954. Atlanta, Ga., Southern Regional Edu- cation Board, 56 pp. (37) Family Service Association of America: Directory of member agencies. New York, 1957. (38) Western Interstate Commission for Higher Education: Mental health training and research in the western region. Report of a survey. Boulder, University of Colorado Press, 1956, 154 pp. 33 w eT Teer eT = aT TET = W = — Sr Ir 5 I i W = p— | FO— Appendix 9¢ soul) srneIyossg juaneding jo Jjeis [RUOISSIJOI] PUR SorSLIDORIRY) FORM APPROVED BUDGET BUREAU NO. 68-R516 PHS - 2145 2.54 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE ANNUAL STATISTICAL REPORT OF OUTPATIENT PSYCHIATRIC CLINICS NOTE FOR TRAVELING CLINICS OR OTHER CLINICS WITH BRANCHES: Please see instructions for reports to be prepared. In addition, please attach a list showing the name and address of the headquarters and of each branch or outlet. If you do not have branches, check here: [] Data for year ended (specify month, day and year) 195... Please submit completed report no later than 3 months after end of reporting period. A. NAME AND ADDRESS OF CLINIC OR BRANCH If name and address above are not correct please make needed corrections here: B. NAME OF DIRECTOR (INDICATE WHETHER M.D. OR OTHER) SECTION I. GENERAL INFORMATION C. YEAR CLINIC OR BRANCH STARTED D. CLINIC AUSPICES (Please complete answers under EITHER (1) or (2) belew, whichever is appropriate) 1. If this clinic is an administrative part of, or operated by, one or more institutions, organizations or agencies (such as health department, school, hospital, mental hygiene society, court, etc.), list the official name of each such organization. After the name of the organization, check the appro- priate box to indicate type of organization. Do not list organizations which provide financial support if this clinic is not an administrative part of such an organization. I NON-GOVERNMENT GOVERNMENTAL BN N pao a: CITY | COUNTY carl STATE | FEDERAL a. b. & oo 2. If this is an independent clinic (i.e., not an administrative part of, or operated by another organization), check one: [J NON-PROFIT [J PROPRIETARY E. GEOGRAPHIC AREAS SERVED F. Is there an age limit for service? J NO [J YES - if yes, specify: MINIMUM AGE_____ MAXIMUM AGE G. Is service provided to special groups only (e.g., veterans, alcoholics, juvenile court cases, mental hospital patients in extramural care, etc.)? specify Tot 2 _ Od NO [J YES - if yes, LS6T ‘6¥ "ON ydeisouoy yiuoH Aqnd Lg H. CLINIC SCHEDULE (includes all regularly scheduled hours one or more professional staff members are on duty) For clinics that do not meet weekly, give schedule of sessions For clinics that meet weekly or more often, indicate (e.g., every third Thursday): schedule by (X) in appropriate boxes below: MON. | TUES. WED. | THURS. | FRL SAT. MORNINGS AFTERNOONS EVENINGS TOTAL CLINIC HOURS PER WEEK— NUMBER OF CLINIC HOURS PER SESSION ee ee ee A ss ss A Is AN NNN NNN ANNAN ANAS ASSN SAAS SAAS SSSI A A A A A A A A AAA A A A A A A AAA AAA AANA NINN AA ANNAN ANNAN SECTION V. PROFESSIONAL STAFF MEMBERS 3/ as of NOVEMBER 30, 195___ (specify year) NUMBER OF STAFF MEMBERS TOTAL SCHEDULED MAN-HOURS PER WEEK 4/ FULL-TIME PART-TIME FULL-TIME " PART-TIME PROFESSION REGULAR §/ REGULAR 5/ TRAINEES REGULAR REGULAR TRAINEES (1) (2) (3) (4) (5) (6) A. SIGNATURE OF CLINIC DIRECTOR FILLED POSITIONS: 1. 2. 3. 4. 5. Other ( iatrists ists iatric social workers nurses ) 6. TOTAL (Sum of 1 thru 5) BUDGETED BUT UNFILLED POSITIONS 1. 2 3. 4, 5. Other ( iatrists iatric social workers iatric nurses ) 6. TOTAL (Sum of 1 thru 5) DATE 1/ Include here professional man-hours spent in community service activities after clinic hours for which compensatory time off was given. 2/ If none, enter “O”. 3/ Exclude non-professional personnel such as office managers, clerks, etc. 4/ If clinic does not meet weekly, report in columns 4, 5, and 6 scheduled man-hours per session, and check here []J. 5/ “Full-time” refers to work week of 35 hours or more in clinic or branches; “part-time” to less than 35 hours. Appendix table 1. Number of outpatient psychiatric clinics in each State, by State operation or support, and number which did not report information on professional staff,! 1.54-.5 Other Non- Veterans Total State State- State- State- Adminis- State clinics hospital operated aided aided tration clinics clinics clinics clinics clinics Total United States. ______ 1,234(56) 268(9) 240(11) 286(3) 374(33) 66 Alabama ____________ 6 | _ 1 Di cme mmm fmm AATIZONR vie n 50 erm mom eens mr mem 4 | EO JE I. 1 Arkansas_ ______________________ 2 eecesseneons 1 |. 1 California_____________ fmm aon 62 4 12 9 33 4 Colorado. ______________ 91) |________. 1 3 4(1) 1 Connecticut. ____________ 35(9) 6(6) 9 7 11(3) 2 Delaware. _______ 9 4 1 2 1 1 District of Columbia. __ _________ 15 |. Et loses imam 10 1 Florida. _ ________________ 19 Jomo 14 3 2 Georgia_________________________ 94) |... 1(1) 4 3(3) 1 Idaho. ___ _ _________________ 2 1 1 |e _. Minois_ ____ 68(1) 30 10(1) 9 18 1 Indiana. ____________ 13 2 2 6 2 1 7). 12 2 1 7 1 1 CNIS wii im mms mast sess sim 21(3) 5 5(2) 1 8(1) 2 Kentucky. ______________________ 11(6) 2 1(1) 2 5(5) 1 Louisiana ______________________ 17 msssesscsene 9 1 6 1 Maine _____________ SE 8 6 | ____ : A SO Maryland______ _____ 38(2) 3 28(2) 1 5 1 Massachusetts... 98(7) 33 4 24(1) 35(6) 2 Michigan __________ ___________ 2 45(8) 12 223(2) oo. 9(6) 1 Minnesota ________ __ __________ 183 | _____ 4 4 4 1 Mississippi... __________ T. esses pews samo smmmene Teens frente ead Missouri. _____________________ 19(2) 2 eee. 8 7(2) 2 Montana ______ __ _________ ___ 4 |. 4 eee Nebraska________ —— Ee 10 2 4 1 2 1 RR OVAA cnmummens 55am nm sm mmr ss pgm pan surg mnie rare wr ET eb erm ee New Hampshire _____ 27(2) 9 Il een peme 2(2) 5 New Jersey_______ __ ___ orm emt 67 17 ccs 15 32 3 New Mexico... _______________ boise smmne mate mmm mmm frm simi fos smi ine 1 New York. ______ __ _ __ __ _______ 318(1) 103 57 56 95(1) 7 North Carolina... ______ ______ 9 |e. 8 I fneendsnoe North Dakott...oczcnescnnmmmnme 1 1 er commune mmm Snes s ne femmnmsms mmm tif oii Ohl. cuvvessax om mE —— 43(2) 4 5(1) 17 14(1) 3 Oklahoma ______ _ ___ __ 4 } leconanog ames i 1 1 Oregon... ___ _______________ 12 2 4 4 1 1 Pennsylvania____________________ 64(2) 16(1) 1(1) 23 21 3 Rhode Island. _______ _ ___ 12 lee 4 1 South Carolina___ _____ __ ______ Bens s 4 | ______ 1 South Dakota. __________________ 4 2 1 Emm ens snares Tennessee... _._____.__________._ 52) |e. 4(1) UD [evan enmsie Er 21 I |feescinmmmmnms 7 10 3 TR. cc eon = ie erin maitre is A 3 |e. 1 1 Vermont ___________ ____________ hoo 4 A | — Virginia _______________________ 7 1 A — 2 Washinglon, c.ccones anes inner 8) |e |e. 4 2(1) 2 West Virginia __________________ 10(2) 11) | ___ 6(1) 2 1 Wisconsin... __________ 22 |e. 2 4 15 1 Wyoming. __ B |eemsensenmes dee Alaska ____________________ ____ 3 [mmesmsewnpme 3 eee Hawaii___________________ _____ 6(1) 1(1) 4 | ___. AE TN Puerto Rico... ___________ ______ 2 ee. V eemsrsrmmarolersmmen mmm 1 Virgin Islands. .coeni cose emam Deeside we 2 oma ammmmmm mmmmm mmsmist msi sensi ! Number which did not report shown in parentheses. 2 State-operated clinics reported incomplete data; did not include staff employed through local funds. 38 Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 2. Number of outp by full-time or part-time clinics an professional staff, 1 1954-55 atient psychiatric clinics in each State reporting clinic characteristics, d by age group served, and number which did not report information on Clinics serving— Total State reporting Full-time Part-time clinics 2 clinics 3 clinics 3 Children Children Adults and adults only only Total United States. _______ 1,205(27) 619(10) 586(17) 688(20) 381(4) 136(3) Alabama________________________ 6 3 3 5 } fesveseveewe Arizona. oo eee 4 3 1 1 2 1 ATRONBOB. .... cone smmmmmisssse wae 2 9D | Nemes senpenas Temps 1 CRNOTII.. corm om mmm sims iS 62 52 10 29 25 8 Colorado ooo 9(1) 6(1) 3 6(1) 1 2 Connecticut. ___________________ 34(8) 21(1) 13(7) 20(6) 10 4(2) Delaware __ o_o __ 9 3 6 5 3 1 District of Columbia_____________ 15 10 5 9 5 1 Florida. - sccm ermanmummens ess 19 16 3 11 6 2 COTE oem rm mii iE Sm 7(2) 5 2(2) 3(2) 3 1 TABNO... oe erm mm mmm me mm mi 2 D | eemmmepmmns DD [enw yw mms swim gee Tlinois. _ oo 67 35 32 49 14 4 Indiana oC 13 12 1 8 4 1 TOW cs min mmm sis so senor sem atin 12 9 3 9 2 1 TANIA. nvm ows ww 19(1) 16(1) 3 8 6(1) 5 Bentiucky.. cv sssssmnsumenmmnmss 11(6) 6(4) 5(2) 8(4) 2(2) 1 TL OUABINIU.. o.com. rm sss i Sp 58 17 9 8 13 3 1 Maine oe 8 2 6 7 eee - 1 Maryland _______________________ 36 8 28 33 1 2 Massachusetts _________________ 92(1) 36 56(1) 57(1) 29 6 Michigan emu sume eam ——— 39(2) 27(1) 12(1) 15(2) 17 7 Minnesota _____________________ 13 13 ec cemeessmes 8 3 2 Missiggippl... comm msmsssnmnsm sens 7 nm 7 |eeeieeeo T Aovremenmmmns JL T7010) o 17 12 5 7 3 Montana _________ 4 4 lecenmeemmm—— H emnmms mame sm——————— Nebraska _ ______________________ 10 5 5 7 2 1 I EVA oo ooo om rere em om 0 maf ff mi New Hampshire. . ioc vicaemmises 2601) |e mmm 26(1) 2 10(1) 14 New Jersey... concmommmmmomwns 67 17 50 55 9 3 New Mexie0....vvwmsn-srmsmmmmmss 1 1 || 1 NEW YOrK..... «mmm som ie iii 318(1) 123 195(1) 154(1) 134 30 North Carolina__________________ 9 8 1 7 1 1 North Dakota___________________ 1 ¥ | eccmewmmmm 1 |nresewususslsmesememnmos ONO. se mmm wm ————— 41 38 3 23 10 8 Oklahoma_______________________ 4 3 1 2 1 1 OIBION.... cnn smmmrsmma cnmamme 12 7 5 3 7 2 Pennsylvania... .....comsrmsasassmy 62 27 35 44 14 4 Rhode Island ____________________ 12 3 9 7 3 2 South Carolina__________________ 5 5 |e 4 |ecseewesewd 1 South Dakota_ __________________ 4 1 3 4 |enermreesmuelemumeeneie Tennessee. -_ -- oo 5(2) 4(1) 1(1) 4(2) I: lecrmeremeees ROE. io mmm br wi —————— 21 12 9 11 6 4 THB... co om imi i rom 5 4 1 1 3 1 VOTO... o.com min SG 5 4 1 1 Been WITHIN... comission sm sss HE 17 14 3 12 3 2 Washington_____________________ 8(1) 5(1) 3 4 2 2(1) West Virginia_ __________________ 9(1) 4 5(1) Sl) |ocrsnmpmnn 1 Wisconsin ___ ___________________ 22 13 9 5 15 2 Wyoming... comms summmmn esse Beem 5B feemmemmmee B | eonenwemmme AIRBHA.. ooo Em G 3 1 2 | comme sme mms mn Sm Hawtdl.. .. cor mmm mo mim msm i 5 5 leemmmmmmm— GI essai sme mm Puerto Rico _____ 2 21 ier 1 | 1 Virein Islands_ __________________ 2 fescenmmmnwes 2 9 |osmmmmommmelrremmemsisiies 1 Number which did not report shown in parentheses. 2 Excludes 29 clinics which did not report information on clinic char: 3 Classified as full-time when open 35 hours or more a week and part- Public Health Monograph No. 49, 1957 acteristics. time when open less than 35 hours a week. 39 Ve J Appendix table 3. Number of professional staff and man-hour by detailed professional category and type of empl s per week in outpatient psychiatric clinics, oyment, United States, 1954-55 ! Professional staff Professional man-hours per week 2 Regular staff 3 Regular staff 3 Professional category Total Trainees| Total Trainees Full- Part- Full- Part- time time time time Total _____________ 9,521 2,967 | 4,642 | 1,912 [188,141 [116,039 | 39,171 32,931 Medical personnel ___________ 4,493 552 | 2,924 1,017 | 59,747 | 22,032 | 21,816 15,899 POYCIIMPIOH.. oc ee ein mmm wm mee 4,136 533 2,7.0 853 | 57,041 | 21,284 | 20,922 14,835 Neurologist or neurosurgeon... _______ 42 10 30 2 535 395 108 32 Pediatrician _________________________ 60 1] 40 19 484 38 160 286 Internmist_____________________________ 29 |... 27 2 110 |________ 101 9 Other physician_______________ ee 52 3 44 5 563 115 396 52 Medical resident or intern______________ 12 5 1 6 250 200 1 49 Medical student _____________________ 162 |ecnmmane 32 130 764 |. ______ 128 636 Psychologists... _______________________ 2,059 831 816 412 | 47,625 | 32,026 | 7,890 7,709 Chnieal _____________________________ 2,053 829 812 412 | 47,467 | 31,942 | 7,816 7,709 Other. _________________________ ____. 6 2 4 _____. 158 84 74 | ______ Social workers. __________ 2,546 | 1,451 672 423 | 72.884 | 56,836 | 7,443 8,605 Ysyehatre. __________ 2,45: 1,423 613 417 | 70,884 | 55,728 6,721 8,435 Medical, group, other ______ Sores 93 28 59 6 2,000 1,108 722 170 NURS co co ein mmm RE 167 45 107 15 2,963 1,787 880 296 Fsychiatric or mental health ______ 106 34 60 121 2,092 | 1,350 508 234 Fublic kealth_______ pA 24 2 21 1 314 80 213 21 Other. ______ 37 9 26 2 557 357 159 41 Remedial therapists. ___ ___ _ _ 53 17 35 1 979 647 328 4 Reading... _________________ [EU 16 8 7 1 391 305 82 4 Speech_ __________ ee 27 9 18 |. ______ 492 342 Y2O mms Other________ ___ _____ ________ _____ 10 |... 10 (o_______ 96 |. ______ 00 |e Activities therapists ___________ SE 14 2 2 |e 186 75 1 inna Occupational __________ 6 |... 6 lnm 68 | ______ Li J Music, art, other recreation. ______ 8 2 6 |________ 118 75 48 |cciinnn Technicians... .. come enn mmm eamen 11 5 6 | _______ 243 197 46 |________ Electroencephalographic____________ 8 4 4 |. 187 162 D5 |e Other.____________ 3 1 2 wen ase 56 35 I oe erred Others________ ________________________ 178 64 70 44 | 3,514 | 2,439 657 418 ‘Lherapist, type not specified __________ 28 : 24 1 273 113 157 3 Marriage counselor________ 6 1 3 2 83 35 41 7 Sociologist. ______________ 15 14 Lei 569 560 9 {mmm Nursery school teacher. _________ 23 16 3 4 826 602 66 158 Minister ___________________ a 5 3 2 |. 116 105 11 oo. Miscellaneous. 101 27 37 37 1,647 1,024 373 250 ! Based on data for 1,178 clinics; 56 clinics did not report professional staff information. 2 Includes an estimate of 9 hours each for were not reported. part-time employees and 18 hours each for trainees for whom scheduled hours 8 “Irull-time” refers to a workweek of 35 hours or more in clinics; “part-time” to a workweek of less than 35 hours. 40 Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 4. Percentage distribution of professional staff of each category in outpaticnt psychiatrie clinics, according to type of employment, by State operation or support, and by age group served, United States, 1954-55 State operation or support Age group served Profession and Total State | Other Non- |Veterans| Chil- type of employment mental | State- | State- | State- |[Adminis-| dren Chil- | Adults hospital | operated| aided aided | tration and dren only clinics | clinies | clinics | clinics | clinics | adults only Number of reporting clinies *-____ 1,178 259 229 283 341 66 668 377 133 Total professional staff__________ 9,521 935 1,226 2,417 4,140 803 5,204 2,780 1,537 Full-time regular staff _________ 31.2 10.2 44.9 36.2 23.5 58.8 21.6 44.7 39.0 Part-time regular staff ________ 48.7 74.1 37.8 43.4 56.7 11.4 58.9 38.0 34.0 Trainees__. _________________ 20.1 15.7 17.3 20.4 19.8 29.8 19.5 17.3 27.0 Payobintristee, .. conadnpmmmenmnns 4,136 444 438 966 | 2,009 279 | 2,573 869 694 Full-time regular staff _________ 12.9 4.3 17.8 17.0 6.6 50.2 8.6 15.8 25.1 Part-time regular staff ________ 66.5 74.5 62.6 60.2 73.9 27.9 73.7 57.5 51.0 Trainees__________.__________ 20.6 21.2 19.6 22.8 19.5 21.9 17.7 26.7 23.9 Clinical psychologists. __________ 2,053 170 259 502 831 291 919 730 404 Full-time regular staff _________ 40.4 12.9 49.8 40.0 38.6 53.6 27.5 53.6 45.8 Part-time regular staff ________ 39.5 77.7 32.8 47.2 42.4 2.1 54.5 34.5 14.6 Trainees... ________ 20.1 9.4 17.4 12.8 19.0 44.3 18.0 11.9 39.6 Psychiatric social workers__ _____ 2,453 259 443 734 800 217 1,188 903 362 Full-time regular staff _________ 58.0 17.4 67.7 62.7 57.1 74.2 50.1 67.6 60.2 Part-time regular staff _ _______ 25.0 68.7 18.3 16.5 28.3 3.2 32.5 19.0 15.2 PLAINES ws wns me 17.0 13.9 14.0 20.8 14.6 22.6 17. 13.4 24.6 Other professionals. ____________ 879 62 86 215 500 16 524 278 77 Full-time regular staff _________ 20.7 14.5 51.2 23.3 12.8 93.8 10.1 38.1 29.9 Part-time regular staff. _______ 53.1 83.9 26.7 £0.2 56.6 6.2 53.8 47.1 70.1 Trainees. ____________________ 26.2 1.6 22.1 26.5 30.6 |____._.___ 36.1 14.8 |... ____ 1 Excludes 56 clinics which did not report professional staff information. Public Health Monograph No. 49, 1957 41 Appendix table 5a. Total outpatient psychiatric clinics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-55 [Data based on reports for 1,178 of the 1,234 clinics 1] Professional staff Professional man-hours per week 3 State and profession 2 Regular staff 4 Total Regular staff 4 Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time Total United States____________ 9,521 | 2,967 | 4,642 | 1,912 |188,141 100.0 (116,039 | 39,171 | 32,931 Psychiatrist. ________________ 4,136 533 | 2,750 853 | 57,041 30.3 | 21,284 | 20,922 | 14,835 Clinical psychologist _________ 2,053 829 812 412 | 47,467 25.2 | 31,942 7,816 7,709 Psychiatric social worker______ 2,453 | 1,423 613 417 | 70,884 37.7 | 55,728 | 6,721 8,435 Other_______________________ 879 182 467 230 | 12,749 6.8| 7,08 | 3,712 1,952 Alabama. _____________________ 22 4 18 |enioesm 278 | 100.0 160 HE mem Psychiatrist _________________ 11 [o_o ____. 11 {ee 46 16.5 |. _______ 46 ins Clinical psychologist ________ 5 loca. 3 |v 45 16.2 |_______. 45 | _____. Psychiatrie social worker______ 3 8: [oc voc cms] emai 120 43.2 120 [oe cpl wine Other _______________________ 3 1 D |cccumnne 67 24.1 40 NT | cammine ION wer res R SR 12 8 bh (eomnmvns 343 | 100.0 320 3 Psychiatrist. ________________ 5 3 2 |. 136 39.6 120 16 1... eee Clinical psychologist _________ 4 2 2 |. 87 25.4 80 4 I Psychiatrie social worker______ 3 3 |e 120 35.0 120 [ove femme Arkansas______________________ 2b 9 ? 9 429 100.0 360 46 23 Psychiatrist. __ ______________ 16 4 3 9 207 48.2 160 24 23 Clinical psychologist ________ 3 2 | IN SE——— 96 22.4 80 16 lon Psychiatric social worker______ 6 3 8 | {mmm 126 29.4 120 8 Jom sro California ____________________ 793 206 449 138 | 15,008 | 100.0 | 8,249 | 3,540 8,219 Psychiatrist__________________ 346 39 252 55| 5.342 | 35.6 | 1,574 | 2.040 | 1.728 Clinical psychologist__________ 156 55 56 45 3,636 24.2 2,209 624 803 Psychiatric social worker_ _____ 172 104 47 21 5,003 33.3 4,146 413 444 Other_______________________ 119 8 94 17 | 1,027 6.9 320 463 244 Colorado______________________ 76 21 26 29 1,872 100.0 892 262 718 Psychiatrist _________________ 24 6 9 9 744 39.8 249 90 405 Clinical psychologist _________ 18 5 4 9 410 21.9 209 25 176 Psychiatrie social worker_ _____ 28 10 7 11 648 34.6 434 YI 137 Other. _____________________ 6 | ______. 6 |. _____ 70 3.7 | - Winans Connecticut __________________ 178 59 88 31 3,756 100.0 2,278 960 518 Psychiatrist... .... on ——— 87 16 55 16 | 1,371 36.5 676 510 185 Clinical psychologist ________ 36 10 20 6 719 19.2 384 221 114 Psychiatric social worker_ _____ 47 31 9 7 1,518 40.4 1,145 168 205 Other. _____________________ 8 2 4 2 148 3.9 73 61 14 Delaware _____________________ 22 12 9 1 62 100.0 490 94 40 Psychiatrist _________________ 9 4 "J 215 34.5 167 48 | ______ Clinical psychologist__________ 8 5 2 1 254 40.7 200 14 40 Psychiatrie social worker______ 5 3 Domi pom mn 155 24.8 123 BZ Joie District of Columbia __________ 220 60 99 61 3,874 100.0 2,381 541 952 Psychiatrist. __________ 105 17 59 29 | 1,396 36.0 679 321 396 Clinical psychologist ________ 43 17 14 12 962 24.8 669 78 215 Psychiatric social worker _____ 46 22 13 11 1.173 30.3 873 96 204 TN 26 4 13 9 343 8.9 160 46 137 TP OT A. co mii mm eretar mii 159 58 77 24 3,520 100.0 2,301 683 536 Psychiatrist _________________ 39 8 27 4 597 17.0 318 103 176 Clinical psychologist _________ 51 25 12 14 1,276 36.2 992 135 149 Psychiatric social worker______ 28 17 6 5 929 26.4 669 89 171 Other_______________________ 41 8 32 1 718 20.4 322 356 40 Georgia_ ______________________ 21 12 6 3 591 100.0 473 58 60 Psychiatrist. ________________ 5 1 4 | _. 58 9.8 40 18 |... Chnical psychologist__________ 10 5 2 3 298 50.4 198 40 60 Psychiatric social worker_ _____ 6 6 | |ooos 235 39.8 235 || 42 Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 5a. Total outpatient psychiatric clinics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-55—Continued Professional staff Professional man-hours per week 2 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time Idaho_______ 37 1 BB |. mina 371 100.0 40 331 |. ____ _ Psychiatrist __________________ Toe. Tole 70 18. OF |oveme wes 70 | ______ Clinical psychologist. ________ 5 1 4 | _____. 76 20.5 40 36 | ____ Psychiatric social worker______ 4 | _____. I 36 D7 Lemmon 3 loons anes OLNEY iii imi mimi pt ii 21 |. 21 | _. 189 50.9 |_.____ 189 | ______ THHINIORS.. .. rc mmr mm mm mi 628 284 241 103 | 15,691 100.0 | 11,728 2,124 1,839 Psychiatrist _______________.__ 237 26 160 51 3,029 19.3 989 1,270 770 Clinical psychologist _________ 161 107 37 17 4,808 30.6 3,932 399 477 Psychiatric social worker______ 174 105 34 35 5,942 37.9 4,999 351 592 OUNEL ove comisimn mwnwismms www 56 46 10 |. 1,912 12.2 1,808 10% sown mnss INAIBNN.. oo ow mm rm mmm mii 112 42 42 28 2,518 100.0 1,667 219 632 Psychiatrist ET 43 10 29 4 611 24.3 403 75 133 Clinical psychologist _________ 42 17 5 20 | 1,119 44.4 677 51 391 Psychiatric social worker. _____ 22 15 4 3 722 28.7 587 72 63 Other ______________________ 5 |. 4 1 66 2.6 loncnames 21 45 Town... ne mms senna sene meme 118 19 65 34 1,706 100.0 729 679 298 Psychiatrist... euwee sens 34 2 25 7 310 18.2 80 180 50 Clinical psychologist __________ 22 6 11 5 385 22.5 232 116 37 Psychiatric social worker. _____ 33 11 17 5 728 42.7 417 279 32 Other_______________________ 29 |. __.___ 12 17 283 16.6 |..unmens 104 179 TOE so iss wm sm sir 166 52 81 33 3,824 100.0 2,166 787 881 Psychibtrist.......ceusnccones 85 17 48 20 | 1,716 44.9 728 453 535 Clinical psychologist _________ 42 19 15 8 1,246 32.6 768 199 279 Psychiatric social worker______ 35 16 16 3 849 22.2 660 129 60 Other_______________________ I 2 2 13 B [osm 6 7 Rentudey. . ocwvummmmn mmm 33 10 18 H 608 | 100.0 382 102 124 Paychitrist. ..conepemmmm snes 13 2 9 2 203 33.4 77 62 64 Clinical psychologist. _________ 5 3 2 Js smmge 134 22.0 115 19 cca Psychiatric social worker. _____ 12 5 4 3 254 41.8 190 4 60 OHBOL .. « «vio mmm smi LE WE Fl | eww amen 17 2.8 |oooaoo 17 | ____ Louisiana______________________ 196 32 67 97 2,931 100.0 1,326 442 1,163 Psychiatrist _________________ 97 6 57 34 1,239 42.3 251 379 609 Clinical psychologist _________ 21 11 5 5 567 19.3 461 43 63 Psychiatric social worker. _____ 31 15 5 11 935 31.9 614 20 301 HE 47 |e 47 190 8.5: Nh commie mmm 190 MING... cosy mim smo mem mm mpm 16 4 12 |ecanenes 252 100.0 160 92 | ______ Psychiatrist __________________ 7 lemme 7 omen 56 22.2 |_______ 56 |. Clinical psychologist _________ 5 3 2 | cms 136 54.0 120 16 |... ___ Psychiatric social worker______ 4 1 Bl lf scorns 60 23.8 40 20 |_.______ Maryland... coven mes emes wns 197 46 124 27 2,922 100.0 1,774 806 342 Peychiatrist... ovpounswwsmnss 98 11 67 20 1,006 34.4 426 361 219 Clinical psychologist. ________ 37 11 23 3 606 20.7 415 143 48 Psychiatric social worker______ 51 19 28 4 1,060 36.3 733 252 75 Other... 11 5 6 aaa. 250 8.6 200 50 |. Massachusetts ________________ 803 159 436 208 | 14,424 100.0 6,18} 4,413 3,827 Poychiotrist. cow snnnmmmmmmns 422 38 262 122 6,307 43.7 1,489 2,692 2,126 Clinical psychologist ________. 139 37 77 25 2,757 19.1 1,440 822 495 Psychiatric social worker______ 188 78 51 59 4,707 32.7 3,031 545 1,131 Other. _ oe 54 6 46 2 653 4.5 224 354 75 Michigan _____________________ 216 119 55 42 6,226 100.0 4,816 559 851 Psychiatrist _________________ 69 20 33 16 1,364 21.9 816 282 266 Clinical psychologist. _________ 57 39 6 12] 1,932 31.0 | 1,587 91 254 Psychiatric social worker. _____ 84 60 11 13 2,905 46.7 2,413 166 326 Other... . ccc. conunenmunmsmss=s 6 I _______ 5 1 25 4a 20 5 Public Health Monograph No. 49, 1957 43 Appendix table 5a. Total outpatient psychiatric clinics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-55—Continued Professional staff Professional man-hours per week 3 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Trull- Part- time time Number| Percent | time time Minnesota_____________________ 156 6H 26 65H 3,838 100.0 2,600 261 977 Paychiabrist. .. coy comammmmmns 43 17 13 13 985 25.7 630 85 220 Clinical psychologist__________ 29 12 6 11 806 21.0 480 74 252 Psychiatric social worker_ _____ 36 25 3 8 1,233 32.1 1,000 50 183 LA 48 11 4 33 814 7.2 440 52 322 Mississippi. oo... __ 7 5 2 leannssus 219 | 100.0 195 BF aia Psychiatrist ________________ 2 1 l bcocuses 42 19.2 40 2 limon Clinical psychologist ______ __ __ 2 2 [en mmm] mm—— 80 36.5 80 |__|. Psychiatric social worker______ 2 1 1. [hommmomne 62 28.3 40 22 |e Other_______________________ 1 1. 35 16.0 BD [sissies Missouri _ _ ___________________ 195 42 84 69 3,006 100.0 1,697 633 676 Paychintrist. .... cpmswsmmssion 74 6 5) 17 700 23.3 236 282 182 Clinical psychologist. _____ 42 11 17 14 819 27.3 445 196 178 Psychiatric social worker______ 42 25 9 8 1,315 43.7 1,016 118 181 NRE es mmm cc rma EE rs 37 leccnsans 7 30 172 B.7 lcm 37 135 Montana______________________ 1} 8 ff 395 100.0 320 28. Jeririmmiiarets Psychiatrist _________________ B [emi 5 emma 72 18.2 l.cuvuvsn 72 events Clinical psychologist __________ 5 4 1 feosnnuns 163 41.3 160 J jowmsnnns Psychiatric social worker_ 4 [wenn 160 40.5 F000 |r nt ummm Nebraska. cous oorcmummimas sss 84% 9 58 17 985 100.0 355 412 218 Psychiatrist _________________ 36 1 26 9 353 35.8 40 207 106 Clinical psychologist__________ 27 3 19 5 273 27.7 115 106 52 Psychiatric social worker______ 18 5 10 3 325 33.0 200 65 60 Other. _____________________ 3. 3 | ___. 34 BD lecocanns 34 |... New Hampshire___________ sw 33 12 18 3 627 100.0 457 127 43 Poyehiatrist. ccovuznansnnnsass 8 3 3 | ivmnenisa 175 27.9 115 60 |. connie Clinical psychologist _________ 9 4 4 1 177 28.3 152 13 12 Psychiatric social worker _ 12 5 5 2 271 43.2 190 50 31 Other. _____________________ _ 4 |. 4 | ______. 4 6 di [serene New Jersey. __________________ 294 105 179 10 5,661 100.0 8,925 1,475 251 Psyc hiatrist__________________ 115 20 91 4 1,356 24.0 £0 479 127 Clinical psychologist__________ 63 27 33 3 1,340 23.7 1,015 270 55 Psychiatric social worker______ 86 55 28 3 2,449 43.3 2,040 340 69 Other_______________________ 30 3 27 |e. 506 9.0 120 386 |e New Mexico. __________________ 2 2 ||. 80 | 100.0 80 |__|... Psychiatrist. _________________ 1 1. 40 50.0 30 lewensesilocnamnns Clinical psychologist______ 1 L hese selivermnee 40 50.0 0 soo mmm mmm New York. wc ce rn 2,986 860 1,623 503 | 64,046 100.0 | 31,978 | 13,249 8,818 Psychiatrist _________________ 1,318 97 1,003 218 | 14,526 26.9 3,717 7,445 3,364 Clinical psychologist__________ 642 208 307 127 | 12,704 23.5 | 7,655 | 2,680 2,369 Psychiatric social worker______ 851 495 208 148 | 23,553 43.6 | 18,339 2.277 2,937 Other....... een 175 60 105 10 | 3,262 6.0 | 2,267 847 148 North Carolina_________________ 61 27 17 17 1,549 100.0 1,085 207 257 Poychintrist. cocuns com emmpaes 27 9 10 8 594 38.3 346 96 152 Clinical psychologist. _________ 19 8 2 9 452 29.2 327 20 105 Psychiatiic social worker_ 14 10 FS 492 31.8 412 80 [________ Other_______________________ 1 He emir 1. 11 Toll Wr leeesaa Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 5a. Total outpatient psychiatric clinics: week, according to State and profession, by type o Number of professional staff and man-hours per f employment, 1954-55—Continued Professional staff Professional man-hours per week 3 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees TFull- Part- Full- Part- time time Number| Percent | time time North Dakota ._._______________ 20 lenin JO Jovian 891 100.0 |.anneen- 89 | oo. Payehiatrist, owe comsmmm sams 1 (__ 1 oneness 25 28.1 [ceemmmmn 28 eee Clinical psychologist. _________ To ecmaaae T lemummnss 56 63.0 |oooooo_- 56 | ______ Psychiatric social worker. _____ 1 |e L mmm 2 2.2 licus Toei OHHEE. co vm mm mmm sami 1 1 |e 6 8.7 |oncomioe 6 |________ Ohio eee 338 201 92 46 | 9,926 | 100.0 | 8,298 933 695 Payehinbrith. oo some ws mms 158 68 64 26 | 3,864 38.9 | 2,922 596 346 Clinical psychologist. _________ 72 54 14 4 | 2,467 24.9 | 2,192 180 95 Psychiatric social worker______ 86 64 10 12 2,891 29.1 2,583 123 185 Other______________________ 22 15 4 3 704 7.3 601 34 69 Oklahoma __ 36 12 23 1 602 100.0 480 118 4 Psychiatrist__________________ 20 2 18 ewes 120 19.9 80 40 | ______ Clinical psychologist__________ 10 5 4 1 265 44.0 200 61 4 Psychiatrie social worker______ 4 Be emmys fmm 160 26.6 160 |__| _______ KHHEGE commision momma 2 1 1 mmm 57 9.5 40 2 iv lf Tr Oregon__________. 60 19 36 5 88 100.0 760 108 16 Psychiatrist ___ oo .- 29 4 23 2 227 25.7 160 61 6 Clinical psychologist. _________ 11 5 4 2 222 25.1 200 16 6 Psychiatric social worker______ 13 9 3 1 377 42.6 360 13 4 QUIET 7 1 0 jonmesmss 58 6.6 40 18 | __.__ Pennsylvania_ _________________ 434% 145 164 125 9,760 100.0 5,643 1,660 2.657 Psychiatrist ________________ 206 26 92 88 | 3,559 36.5 | 1,041 763 1,755 Clinical psychologist _________ 72 31 27 14 | 1,848 18.9 | 1,207 309 332 Psychiatric social worker______ 119 80 26 13 3,727 38.2 3,084 303 340 ONG... moms rR 37 8 19 10 626 6.4 311 185 130 Rhode Island _ _________________ 68 26 34 8| 1,240 100.0 955 130 155 Psychiatrist. ________________ 32 7 24 1 343 27.7 263 78 2 Clinical psychologist _________ 15 10 3 2 414 33.4 357 13 44 Psychiatric social worker. _____ 17 9 4 4 470 37.9 335 27 108 QHDEE. «cco vm smi se 4 lemmas 3 1 13 1.0 | _______ 12 1 South Caroling....weeeeeeeenn- 26 16 9 1 747 | 100.0 616 93 38 Psychiatrist __________________ 9 1 B osmsmms 114 15.3 40 74 | _ Clinical psychologist _________ 5 5 Hnsimimimegpon yom smimsmmgion 192 25.7 192 |__|. Psychiatric social worker______ 12 10 x 1 441 59.0 384 19 38 South Dakota__________________ 14 4 9 1 202 100.0 160 39 3 Paychintrist. c.. .cussemsensns 3 1 2 Jesse 50 24.8 40 JO [commonest Clinical psychologist_.________ 4 1 8 |. commen 50 24.8 40 10 |o______ Psychiatric social worker______ 6 2 Ly mri 99 49.0 80 19 eens OHhEr....... «cm momma mimi mms 1 |oomoooe feces 3 3 Lok lovmamnnhe soe 3 Tennessee - - - coco 34 8 1} 12 512 100.0 324 78 110 Paychlgirist. pene vinummun 16 1 10 5 114 22.3 39 49 26 Clinical psychologist__________ 9 3 2 4 151 29.5 119 20 12 Psychiatric social worker______ 9 4 2 3 247 48.2 166 9 72 TEXAS — oem emma m 187 43 7 67 | 3,028 | 100.0 | 1,673 784% 571 Psychiatrist... ___________. 87 9 43 35 971 32.1 351 358 262 Clinical psychologist__________ 44 13 18 13 920 30.4 496 251 173 Psychiatric social worker. _____ 25 20 DB Vom 877 28.9 782 O03 lever om OLNEr.... «ecm 31 1 11 19 260 8.6 44 80 136 TEED cc oy mmm msn mi SI SHE 34 14 6 14 997 | 100.0 568 55 374 Psychiatrist _________________ 16 4 5 7 399 40.0 164 35 200 Clinical psychologist. _________ 9 3 1 5 270 27.1 124 20 126 Psychiatric social worker______ 9 Tle 2 328 32.9 280 {ovo 48 Public Health Monograph No. 49, 1957 45 Appendix table 5a. Total outpatient psychiatric clinics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-55—Continued Professional staff Professional man-hours per week 3 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- TFull- Part- time time Number| Percent | time time Vermont_ _____________________ 16 5 i J — 343 100.0 189 Bh lesen cnna Psychiatrist __________________ 4 1 B sms 58 16.9 38 20 | ______ Clinical psychologist__________ 6 2 & lemmas 119 34.7 75 44 | _____ Psychiatric social worker _____ 6 2 4 | ______ 166 48.4 76 90 |_______ Other___________ |e Virginia ________________ 140 39 76 25 2,687 100.0 1,510 756 421 Psychiatrist. _______________ 76 8 56 12 937 34.8 305 482 150 Clinical psychologist__________ 27 14 7 6 770 28.7 550 85 135 Psychiatric social worker______ 34 16 11 7 918 34.2 615 167 136 Other_________ __ ___________ 3 1 2 loc comm 62 2.3 40 BD [mieaiom Washington. __________ 73 20 18 35 1,275 100.0 800 155 320 Psychiatrist. _________________ 21 4 14 3 313 24.5 160 107 46 Clinical psychologist ____ 14 6 3 5 403 31.6 240 25 138 Psychiatrie social worker_ _____ 13 10 | _____ 3 464 36.4 00 evan o 64 Other __________ csi 25 |e 1 24 95 7:8 lev 23 72 West Virginia______________ 24 12 11 Z 617 100.0 492 85 40 Psychiatrist. ______ 6 1 —— 83 13.5 44 39 |._____ Si Chnical psychologist _________ 6 4 2 Jemma 175 28.4 162 13 |._____ bet Psychiatric social worker. ___ 9 7 1 i 331 53.6 286 5 40 Other______________ 3a 1 28 4.5 lowsueses 28 |. _____ = Wisconsin ____________________ 98 32 61 5 | 1,877 | 100.0 | 1,269 538 70 Psychiatrist... _________ 43 7 33 3 554 29.5 275 249 30 Clinical psychologist 24 8 16 |...mmmimn 508 27.1 318 190 | _____ Se Psychiatric social worker_ _____ 27 17 8 2 788 42.0 676 72 40 Other _____________________ 4 | ______ 4 27 1.4 | ____ ___ 27 boncnes 2 Wyoming _ ____________________ 1. 1 | ____ 30 100.0 |________ 30 |________ Psychiatrist. ______________ 1. [eon Y lemmannss 30 100.0 |____.____ 30 |. ______ Alaska _______________ 3 Eee 11} 100.0 1h |e. Psychiatrist. ________________ 1 1 oC 38 33.3 38 eo. Clinical psychologist ____ 1 | Le msn soared 38 33.3 38 ||. Psychiatric social worker_ _____ 1 1 |e 38 33.4 38 [ene mmnfm mmm 55 Hawaii. ____________ 30 10 11 9 737 100.0 400 61 | 276 Psychiatrist. _______________ 14 1 9 4 271 36.8 40 55 | 176 Clinical psychologist__________ 4 1 2 1 66 8.9 40 6 | 20 Psychiatrie social worker. _ 12 8 |. 4 400 54.3 320 |________ 80 Puerto Rico. __________________ 10 6 3 1 288 100.0 230 40 18 Psychiatrist. _____________ 4 2 2 loin 98 34.0 78 20 |. ____. Clinical psychologist______ 3 B fue seca) man 1153 40.0 115 | _____ Psychiatric social worker______ 3 1 1 1 75 26.0 37 20 | 18 Virgin Islands__________ _______ 3 3 |. 23 100.0 |... 28 |ecirnn Psychiatrist. _____________ 1. Le rom mn 7 30.4 |____ 7 Clinical psychologist__________ Ul 1... 15 65.2 |________ 13 fosmn ann Psychiatrie social worker______| | _______ mmm meme eee ee Other. ______________________ 1). 1 1 4.4 | _______ Linnie ! See appendix table 1 for number of reporting clinics by State. 2 Excludes States and professions for which no staff or man-hours were reported. 8 Includes an estimate of 9 hours each for part-time employees and 18 hours each for trainees for whom scheduled hours were not reported. 4 “Full-time” refers to a workweek of 35 hours or more in clinics; “part-time” to a workweek of less than 35 hours. 46 Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 5b. State mental hospital outpatient psychiatric clinics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-55 [Data based on reports for 259 of the 268 State mental hospital clinics 1] Professional staff Professional man-hours per week 3 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number | Percent | time time Total United States. __________ 935 95 693 147 | 10,502 | 100.0 | 3,839 | 4,734 1,929 Psychiatrist__________________ 444 19 331 94 | 4,291 40.9 774 | 2,246 1.271 Clinical psychologist _________ 170 22 132 16 2,093 19.9 912 986 195 Psychiatric social worker______ 259 45 178 36 3,336 31.8 1,798 1,097 441 TS — 62 9 52 1 782 7.4 355 405 22 Arizona_ ______________________ BD | sme 2 {awww 8| 100.0 |._______ 3 levesman Psychiatrist__________________ 1 |. comanzs 1. 4 50.0 |_______ 4 | _. Clinical psychologist ________ J | FE 1 Vow vm 4 50.0 | _______ ES California _ ___________________ 139 13 93 33 1,760 100.0 520 413 827 Payohintrist. cov npmmmmmm sss 71 1 51 19 823 46.8 44 211 568 Clinical psychologist. ~~ 23 2 15 6 287 16.3 80 135 72 Psychiatric social worker _____ 43 9 27 7 H88 33.4 356 67 165 Other______________ _________ 2 Xe rms 1 62 3.5 40 |______.. 22 Delaware _____________________ 11 6 4 1 358 | 100.0 244 74 40 Psychiatrist _________________ 3 1 2 {mm 86 24.0 44 42 | ______. Clinical psychologist__________ 5 4 | ______. 1 200 55.9 160 [oooweea 40 Psychiatric social worker. _____ 3 1 2 | 72 20.1 40 32 |. sccisns Idaho... c.cececcnenancn aman 8B l.onensn= 35 |. 315 100.0 |________ 315 |. ___. Payehiabrish. ower wenss suns —— ; J IE— 54 17.2 | _______ 54 |. ______ Clinical psychologist _________ 4 | _____. vO | 36 11.4 | _______ 36 [o_o _____ Psychiatric social worker. _____ 4 | __ 13 36 11.4 | _____ 36 |______ Te FL loca HM mmm 189 60.0 |. une 189 |. _______ Tinois________________________ 44 3 37 4 386 100.0 120 267 9 Psychiatrist__________________ 19 |________ 17 2 111 28.8 |______.- 108 3 Clinical psychologist _________ BVlnrne B |ovsmnmmn 46 11.9 |________ 46 | ____ Psychiatric social worker______ 19 3 14 2 226 58.5 120 100 6 Other_______________________ TL cram 1 {emma 3 Bi rm miinne 3. TaN ce ces sms es SE EE 9 b bee 226 100.0 205 PL |ooonmems Psychiatrist. ________________ 3 3 oes 123 54.4 1238 imap ans omnes Clinical psychologist _________ 2 sinenem 2 ea 19 8.4 | _______ 19 |. _____ Psychiatric social worker______ 3 2 1 | _- 83 36.7 82 1. Other_______________________ 1 | mimes | 3 E— 1 Dos J Towa... 30 |. _-_ 2 3 228 00 [su iawsns 225 3 Payehintrist.. cou nsanannmns 8 |. 8 | _- 88 38.6 |...onune 88 | _____. Clinical psychologist. ________ 5 foun 3 2 16 7% 2 3 WR 14 2 Psychiatrie social worker______ 6 |________ 5 1 40 17.6 |________ 39 1 Other. ______________________ TL ne ammn 110. 84 36.8 {ome 84 |________ Kansas_______________________ 30 7 15 8 565 100.0 296 117 152 Psychiatrist__________________ 14 1 6 7 228 40.3 44 52 132 Clinical psychologist__________ 7 3 4 | ___. 156 27.6 126 30 |... Psychiatric social worker. _____ 7 3 3 1 175 31.0 126 29 20 Other_______________________ 2 |. 2 (_. 6 Lod fovomimmommonns 6 {enc anmen Kentucky. «ooo 6 |ommemins O |e ann 12 100.0 |... ____ 12 |... Psychiatrist. _______________ D | emrmmn 2 Vesa 4 33.3 [cemmmnnn 4 |________ Psychiatric social worker______ 2 |e eine 4 33.8 |.cownwas 4 | _______ Other... eee 2 jem Di rime 4 38.4 fawn 4 | _______ Mane. .....cces-sesnerminsmais 6 |. _____. 6 |. 32 100.0 \...ceneivn E22 livswnunn Psychiatrist__________________ 2 | __. 2 Jae misnnn 8 25.0 |________ 8 licovmess Clinical psychologist__________ 2 | inss 2 crnmenes 16 50.0 |.-vuum-- 16 ler Psychiatric social worker______ 2 |. 2 |v 8 25.0 |. 8 Yr Public Health Monograph No. 49, 1957 47 Appendix table 5b. State mental hospital outpatient psychiatric clinics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-51—Continued Professional staff Professional man-hours per week 3 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number | Percent, | time time Maryland. ____________________ 11 Z 9 1 89 | 100.0 40 33 16 Payehiatrist. wn snss sem 0 |i + J WC 13 14.6 |. ______ 13: le sommes Clinical psychologist__________ 1. 1 | _. 2 2.3 |... 2 | naman Psychiatrie social worker_ _____ 4 1 2 1 74 83.1 40 18 16 Massachusetts. ________________ 184 14 121 49 2,138 100.0 560 1,080 498 Psychiatrist _________________ 99 3 65 31 1,061 49.5 120 674 267 Clinical psychologist__________ 31 3 25 3 347 16.4 120 173 54 Psychiatric social worker_ _____ 50 8 27 15 677 31.6 320 180 177 Other... ooo 4 |. 4 | ______ 53 2.8 leone 33 |esnomnus Michigan______________________ 51 3 34 14 635 100.0 158 327 150 Psychiatrist__________________ 33 1 20 12 306 48.2 40 152 114 Clinical psychologist__________ 7 1 5 1 160 25.2 59 83 18 Psychiatric social worker_ _____ 10 1 8 1 167 26.3 59 90 18 Other_______________________ Leen eee 1. 2 iB} freien 2 lcvemsanw MUSSOUTL. . «. 2mm mrs mmm mere mms 23 2 14 ? 267 100.0 80 140 47 Psyehiatrist__________________ 12 1 6 5 149 55.8 40 65 44 Clinical psychologist__________ 8 | ___ 6 2 68 253.8 |< vm 65 3 Psychiatric social worker______ 2 1 1 imme 45 16.8 40 5 loo. Other_______________________ les cccnen 1. 5 1.9 |... Di |. Nebraska______________________ 16 | ______ 16 | ______ 94 100.0 |. ______ EA Psychiatrist _________________ 6 | _______ 6 |o_______ 44 46.8 [-_______ 4 lnnnen Clinical psychologist__________ B [owen 5 |e. 25 26.6 lunes 25 amma Psychiatric social worker______ 5 feemaa. 5 lo 25 26.6 |i-nmwaen 25 | memmm ne New Hampshire________________ Gl a ams 2 lor 64 100.0 |_____ ___ Oh feo Psychiatrist. _________________ Lb ferent 1 |ommmmimime 35 54.7 |... B35 fitch Psychiatric social worker______ : NY 1. 29 45.3 |. _____ 29 |eeennnnw Newdersey.. .. ________________ 26 10 IE |omwmma 423 100.0 860 i J Te — Psychiatrist__________________ 9 1 8 [oeecemene 60 14.2 35 25 lene Clinical psychologist__________ 1 1. 35 8.3 35 |e |e Psychiatric social worker______ 16 8 J EE, 328 77.5 280 48 (_______ New York ____________________ 188 16 156 16 1,606 100.0 626 91; 66 Peyehintrist. coven ose mmme 89 4 77 8 624 38.9 156 440 28 Clinical psychologist__________ 33 4 29 |... 330 20.5 160 170 (cmvansy Psychiatric social worker______ 59 1 50 8 377 23.5 35 304 38 Other. ______________________ 7 7 |conmmeonorenmmens 275 17.4 DUD em mmmon [mm moni win North Dakota_________________ % {1 J TO Jr. mmm 89 100.0 |... _____ 8 oui in Paychintrish. . oo summnssn meme L [orm XI] cere 25 28.1 |... ___ 25 [-cennes Clinical psychologist _________ T [oem Tee 56 62.9 (..__.___ 56 |ermunmes Psychiatric social worker_ _____ 1. ; Hi 2 2:3 leewmpas J I, Other_______________________ 1. ; J rr —— 6 0.7 [connunmn B |... ime Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 5b. State mental hospital outpatient psychiatric clinics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-55—Continued Professional staff Professional man-hours per week 2 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number | Percent | time time Ohio_____________________ 19 10 |! SF meet 477 100.0 440 BY |ewenmnns Psvehiatrist__________________ 6 2 4 |. 105 22.0 88 HT amenmmn Clinical psychologist _________ 5 3 2 | rneins 140 29.4 132 J ' Psychiatric social worker______ 6 5 i J 222 46.5 220 2 | amr HHL. cc conn snr san 2 |e DP: | roe mm momen 10 2:1 |ncennaa 10 |euoecn- Oklahoma_____________________ 1G amas 19 {ceo 65 100.0 |________ BF |.weesuns Psvehiatrist__________________ 17 bes mmnn 17 lonwswnes 31 47.6 |________ BN vem Clinical psychologist __________ sms 1 |loscasans 17 26.2 |_______. 17 |. Other... coms unamenswwnann BE |} sisson 1 mmm 17 26.2 |____.._. 17 | __- KOPIN om ii i mi mii 10 5 3 2 213 | 100.0 200 7 6 Psychiatrist. __________ 4 1 1 2 49 23.0 40 3 6 Clinical psychologist. ________ 2 1 bs pmmemera 43 20.2 40 3 enema Psychiatric social worker. ____ 2 D es crema) eam wm 80 37.6 BO le cm opp emission Other ______________________ 2 1 L | enemas 41 19.2 40 ¥ eosin Pennsylvonin. sees ssswvomsmns Bh eee 30 4 178 100.0 Uc. ames 153 25 Payehiatrist. uur consumes 17 13 3 80 44.9 |________ 61 19 Clinical psychologist _________ BO {owwnncen 5 1 40 22.8 [nme 34 6 Psychiatric social worker______ 1 3 10 |________ 52 29.2 |_______. B52 |e Other____________ ________ ___ 2 | nim 2 eum 6 3.4 | _______ 6 | _____-- South Dakota _ _____ _________ | A 5 | mmm Od 1000 leasvniwnn 9 | ae Poyehistrist. .. ocrppeavimenes 1 ecccnwes T, [eicmrnbinmsines: 2 02.2 |ecocmnns 2 fom mma Clinical psychologist _________ Donen 2 |. 2 22.2 [ecm 2 cscs Psychiatric social worker______ D orcs ines 2 |. 5 55.6 |. _______ 1 | ——— Texas. ______ BF |e 20 5 265 100.0 |________ 175 90 Psychiatrist __________________ 15 |. 10 5 178 67.2 |_____.___ 88 90 Clinical psychologist. ________ Teo 7 48 18.1 Leccuuues 48 | ____... Psychiatrie social worker______ 2 |. 2 | 21 TD lo ncass 2] |econnnes OUher. .concvsesmsmmnmmsuns us 1 | 1 |. 18 6.8 |_____.__ 18 acne 1 See appendix table 1 for number of reporting clinics by State. 2 Toxeludes State and profession for which no staff or man-hours were reported. 3 Includes an estimate of 9 hours each for part-time employees and 18 hours each for trainees for whom scheduled hours were not reported. 4 «Pull-time”’ refers to a workweek of 35 hours or more in clinics; “part-time” to a workweek of less than 35 hours. Public Health Monograph No. 49, 1957 49 Appendix table 5c. State-operated outpatient psychiatric clinics: Number of professional staff and man- hours per week according to State and profession, by type of employment, 1954-55 [Data based on reports for 229 of the 240 other State-operated clinics 1) Professional staff Professional man-hours per week 3 State and profession 2 Regular staff 4 Total Regular staff ¢ Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time Total United States_____________ 1,226 551 463 212 | 30,819 | 100.0 | 22,436 | 4,572 3,811 Psychiatrist __________________ 438 78 274 86 7,333 23.8 3,065 2,521 1,747 Clinical psychologist__________ 259 129 85 45 6,654 21.6 5,061 897 696 Psychiatric social worker______ 443 300 81 62 | 14,700 47.7 | 12,563 996 1,141 Other. ___________ ___________ 86 44 23 19 2,132 6.9 1,747 158 227 Alabama... ______.__________. D [aimomnre 2 sees 27 | 100.0 |... ___ 27 {slits 8 2 | __ 1 — 2 100.0 |________ 27 lsnonuns Arkansas _____________________ 22 6 7 9 309 100.0 240 46 23 Psyechiatrist__________________ 15 3 3 9 167 54.1 120 24 23 Clinical psychologist__________ 2 -1 1... 56 18.1 40 1 J —— Psychiatrie social worker. _____ 5 2 J: 3 86 27.8 80 0 | cmnomin California. ___________________ 83 51 19 13 2,526 100.0 2,040 318 168 Psychiatrist__________________ 32 11 18 3 798 31.6 440 298 60 Clinical psychologist _________ 20 9 1 10 488 19.3 360 20 108 Psychiatric social worker. _____ 28 2 RN 1,120 44.3 | 1,120 |_______ |. -- Other_________ 3 J RE 120 4.8 120 | |-- Colorado. ____________ __ 81 9 z 21 966 100.0 405 12 549 Psychiatrist. .___________ - 12 2 1 9 507 52.5 90 12 405 Clinical psychologist _______ _ 6 i A 5 105 10.9 45 |. ______ 60 Psychiatric social worker _____ 13 6 |. ___.. 7 354 36.6 270 |________ 84 Connecticut ________________ -— 32 15 16 1 728 100.0 930 197 1 Psychiatrist________________ wn 10 1 9 | __. 163 22.4 35 128 Vevamummnes Clinical psychologist________ i. 7 2 4 1 91 12.5 70 20 1 Psychiatric social worker _____ 13 11 2 |. 423 58.1 390 88 |emmmmniss Other__________________ ___ - 2 1 L Lecvammen 51 7.0 35 16 |e mimimie District of Columbia____________ 27 18 3 6 939 | 100.0 720 27 192 Psychiatrist_...____________ wn 7 5 et J SET 224 23.9 200 24 onan Clinical psychologist________ =a 6 5 1... 203 21.6 200 8 Jownanans Psychiatric social worker. _____ 10 6 |________ 4 352 37.5 240 |________ 112 BT cir ccm mein re rei _ 4 15 2 160 17.0 80 |________ 80 Idaho __________ em 2 1 IL |eenmmnns 56 100.0 40 IE foresee Psychiatrist______ _- 1 fornia 1. 16 28.6 |_______. 16 |.cueuua Clinical psychologist. _______ - 1 | 40 71.4 40 |__|. Minos... - 262 123 79 50 | 7,491 | 100.0 | 5,708 78 1,005 Psychiatrist ______________ _ 91 9 55 27 1,456 19.4 330 524 602 Clinical psychologist________ - 34 22 8 4 | 1,117 14.9 863 101 153 Psychiatric social worker_ ___ 85 55 11 19 3,389 45.3 3,043 96 250 Other_____________________ so 42 37 S| - 1,529 20.4 1,472 37 oeine wn Indiana____________ — 19 6 3 10 428 100.0 240 28 160 Psychiatrist ___ ____________ 2% 5 1 2 2 128 20.9 40 8 80 Clinical psychologist________ -- 14 5 1 8 300 70.1 200 20 80 E17 2a 38 2 9 27 436 | 100.0 80 126 230 Psychiatrist. _______________ = 10 1 2 7 100 22.9 40 10 50 Clinical psychologist _______ = By | momnrems 2 2 36 2.3 leenunowe 16 20 Psychiatric social worker____-- 7 1 4 2 136 31.2 40 80 16 Other ____________________ i 17 | ncmomemen 1 16 164 37:8 mmm 20 144 Kansas._____________________ et 12 7 1 4 416 100.0 284% 20 112 Psychiatrist________________ _ 5 3 1 1 184 44.2 124 20 40 Clinical psychologist _________ 3 2. 1 112 26.9 SO | _______ 32 Psychiatric social worker _____ 4 2 [.. 2 120 28.9 80 I________ 40 50 Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 5c. State-operated outpatient psychiatric clinics: Number of professional staff and man- by type of employment, 1954-55—Continued hours per week, according to State and profession, Professional staff Professional man-hours per week 3 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time Louisiana______________________ 33 11 16 6 631 100.0 440 129 62 Psychiatrist _________________ 16 | ______. 13 3 135 21.4 (______. 117 18 Clinical psychologist _________ 8 5 1 2 232 36.8 200 8 24 Psychiatric social worker______ 9 6 2 1 264 41.8 240 4 20 Maine_ _ ______________________ 6 DD | simian 196 100.0 160 7 i Psychiatrist__________________ Dil ose 2 femme 36 18.4 Joe... B36 ms Clinical psychologist _________ 3 :: J T——— A — 120 61.2 120 |... mmm] mem Psychiatrie social worker______ 1 1 |emmmos oe min 40 20.4 40 | |ooooo- MarVIBnL..... om mio mo im moms 85 8 73 4 841 100.0 284 519 38 Psychiatrist__________________ 30 1 27 2 215 25.6 36 176 3 Clinical psychologist _________ 22 2 20 |o___..__ 207 24.6 70 £7 gl I— Psychiatrie social worker______ 29 5 22 2 403 47.9 178 190 35 Other___________________.___ 4 " J — 16 1.9 [oo ___ 16 |________ Massachusetts ________________ 29 11 17 1 568 100.0 423 122 29 Psychiatrist. _________________ 16 3 i 212 57.3 124 88 | _____ Clinical psychologist _________ % 4 :- J 180 31.7 150 30 |L.______ Psychiatric social worker. _____ 6 4 1 1 176 31.0 149 4 23 WH Io mew cere sme sims 113 87 12 14 3,998 100.0 3,480 138 380 Payohinbrivh. cous comm summa 22 11 9 2 558 14.0 440 62 56 Clinical psychologist _________ 31 30 |e 1 1,240 31.0 | 1,200 | _______ 40 Psychiatric social worker______ 60 46 3 11 | 2,200 55.0 | 1,840 76 284 Minnesota. ________ 19 12 7 eee 562 100.0 480 82 |. cccen Psychiatrist ________________ 9 3 | J — 178 31.7 120 58 |_.______ Clinical psychologist _________ 4 160 28.5 160 |__|. Psychiatric social worker______ 6 5 L lemme 224 39.8 200 24 |______. Montana _____________________ 14 8 6 |. __ 395 100.0 320 76 |e. Psychiatrist. _________ 5 leumseauw B {umes 72 18.2 [wweeens= 72 loemnsuns Clinical psychologist _________ 5 4 formas: 163 41.3 160 3 lencumens Psychiatric social worker______ 4 [cemcnuee)smmmones 160 40.5 160 |... msm maf ems Nebraglea. . cuuss= spans onmmmewes 42 1 26 15 388 100.0 35 167 186 Pryehiatrist. one rem sess nase 19 |________ 10 9 179 46.1 | _._.__. 73 106 Clinical psychologist. _________ 16 1 11 4 A133 34.3 35 54 44 Psychiatric social worker______ 7 occonnne 5 2 76 19.6 looconane 40 36 New Hampshire________________ 28 9 16 3 443 100.0 337 63 43 Psychiatrist __________________ 6 2 4d os nwean 100 22.6 75 25 |... Clinical psychologist _________ 8 3 4 1 137 30.9 112 13 12 Psychiatric social worker______ 10 4 4 2 202 45.6 150 21 31 Other ______________________ 4 |_______. 4 {enn 4 0 Jum 4 | ___ New York. _______ __________ 15 100 Sh |aee 4,614 | 100.0 | 3,764 $00 | snsunnn Psychiatrist. ________ 39 9 30 |________ 620 14.1 340 MOL. unos Clinical psychologist _________ 15 4 1 |e cnnne 408 8.8 152 256 |... Psychiatrie social worker. _____ 100 87 13 lememmmsa 3,556 77.1 3,272 284 i.e win THI0...«. co pm mmm nr sp mm 33 13 15 5 913 | 100.0 560 195 158 Psychiatrist. _________________ 14 2 9 3 285 31.2 88 103 94 Clinical psychologist _________ 10 4 6 |______ __ 264 28.9 172 2 Psychiatrie social worker______ 9 V Ves 2 364 39.9 300 |....-v-- 64 OTORON toi iars 27 3 Ty 169 100.0 120 12 J Payehindrist. coun mmsonwsnmss. 18 1 7 ot imi 75 44.4 40 35 ooo Clinical psychologist ______ 2 1 A, feces 42 24.9 40 2 evens Psychiatric social worker. _____ 3 1 TD atm 44 26.0 40 4 (oem. Other_____ _________________ Be: Wrens 4 |o__ 8 4.7 |msims mi 8 lesvssuwes Public Health Monograph No. 49, 1957 51 Appendix table 5c. State-operated outpatient psychiatric clinics: Number of professional staff and man- hours per week, according to State and profession, by type of employment, 1954-55—Continued Professional staff Professional man-hours per week 3 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time Rhode Island. _________________ 18 15 SH —— 543 100.0 525 18 | snes Psychiatrist _________________ 5 3 i 114 21.0 105 G | ewan Clinica psychologist__________ 8 J | —— 280 51.6 DRY: [cori misisin] rs mismimree Psychiatric social worker______ 4 I EE, 140 25.8 140: Leonie fmm Other_______________________ Le emi : 9 1.6 |________ 0 |epaaitios South Dakota__________________ 1 erm 3 1 27 100.0 |________ 24 3 Isyvehiatrist__________________ 1 coms 1 |. 8 20.6 |._______ 8 Clinical psychologist__________ 1 | ____ 1 {mmm 8 29.6 |_______. 8 |. emmmmn Psychiatric social worker. _____ 4 1 |e. 8 20.6 [._______ 8 lemma Other_______________________ 1 mmm] meme mm 1 3 11.2 |v emmmmn]mm mms mms 3 Utah________ 25 9 8 13 714 100.0 368 6 340 Isychiatrist__________________ 13 3 3 7 330 46.2 124 6 200 Clinical psychologist__________ 6 2 |uimanans 4 176 24.7 8 Laces 92 Psychiatric social worker. _____ 6 4 | ___ 2 208 29.1 160 [ummm 48 Vermont______________________ 16 5 Tl cmimmimio 343 100.0 189 155 |... Psychiatrist _________________ 4 1 B |e 58 16.9 38 20; Joma Clinical psychologist__________ 6 2 : 119 34.7 75 4 | _____. Psychiatrie social worker______ 6 2 4. 166 48.4 76 1 AN VITZINI,..c. r e e emsemr m si sie 18 1 16 1 172 100.0 40 122 10 Psychiatrist__________________ 14 | ______ Milan 95 55.2 mmm 95 | oo __. Clinical psychologist__________ 2 | _. 1 1 30 17.4 (________ 20 10 Psychiatric social worker. _____ 1 |e mms 1 7 4.1 |__.___ 7 Jemma ther ______________________ 1 1 eerie fers smn 40 23.3 40 |. Wisconsin. ____________________ 2 3 7 2 97 100.0 |... cuwuns 87 10 Psychiatrist __________________ 6 | ____. 4 2 69 Yd [-csocesn 59 10 Clinical psychologist__________ 2 |ommeaan 2 losenmnan 19 19.6 |...cnmmm= BD svn sre Psychiatric social worker______ 1 lcueanue 1 [mmm 9 9.3 (nnn 0 errr Wyoming. _ ___________________ Lennie 1 oem 30 | 100.0 |.___.__.__ 1 Peyohlodrift. cc cnn mcm mmmmms 1 mnie 1 lms 30 | 100.0 |.____.___ 30 |i AON ir ims mim ism 3 8 [emis] wm 11} 100.0 11h | mm mswmm fon mine ersemisn Psychiatrist __________________ 1 1 ||. 38 33.3 BF Verrier meer om secommmrmros Clinical psychologist__________ 1 1 ||. 38 33.3 88 || meeeeem Psychiatric social worker. _____ 1 |e 38 33.4 38 | |eeaa Hawaii________________________ 18 9 4 b 508 100.0 360 48 100 Psychiatrist _________________ 5 1 4 | ____ 88 17.3 40 48 cima Clinical psychologist _________ 2 1 | ___ 1 60 11.8 40 | inn emee 20 Psychiatric social worker. _____ ffi § Tl. 4 360 70.9 280 [.- ... 80 Puerto Rico. ___________________ 8 4 3 1 208 100.0 150 40 18 Psychiatrist _________________ 3 1 2 lemme 58 27.8 38 20: [emma Clinical psychologist. ________ 2 D {eee momen {em re 75 36.1 701 eam cin femme Psychiatric social worker. _____ 3 1 1 1 75 36.1 37 20 18 Virgin Islands__________________ 3. 3 lenin 23 | 100.0 |... _. 85 Jimena Psychiatrist. _________________ 1 een 1 ecasunne 7 30.4 |________ Ym mine Clinical psychologist _________ 1. 1 lcicminn 15 65.2 |. __.__. 15 [omen Other_______________________ ; J SE OO 1 4.4 | _______ | Yeti 1 See appendix table 1 for number of reporting clinics by State. 2 Excludes State and profession for which no staff or man-hours were reported. 3 Includes an estimate of 9 hours each for part-time employees and 18 hours each for trainees for whom scheduled hours were not reported. 4 “Full-time” refers to a workweek of 35 hours or more in clinics; “part-time” to a workweek of less than 35 hours. 52 Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 5d. State-aided outpatient psychiatric clinics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-55 [Data based on reports for 283 of the 286 State-aided clinics '] Professional staff Professional man-hours per week 2 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Tull- Part- time time Number| Percent | time time Total United States_____________ 2,417 875 1,048 494 | 53,311 100.0 | 34,064 | 10,635 8,612 Psychiatrist. ____________ 966 164 582 220 | 15,373 28.8 6,651 5,036 3,686 Clinical psychologist _________ £02 201 237 64 | 11,485 21.6 7,810 2,671 1,004 Psychiatric social worker______ 734 460 121 153 | 22,733 42.6 | 17,653 1,926 3,154 OLEEL .. we ve wm mmm mm isin ie 215 50 108 57 3,720 7.0 1,90 1,002 768 Alabama _ ________________ 20 4 16 |. ____ 251 100.0 160 Gl \. cen Psychiatrist. ______._____ A fermi 11 |. 46 18.3 |_._--_- 46 |________ Clinical psychologist__________ 5 {mmmmmmen 8 Jems amame 45 17.9 | ______ 45 |. _____. Psychiatric social worker. ____. 3 B |. cms immmdans 120 47.8 120 |_| - Other. . .csmswmumsenss sss 1 B32 realm 40 16.0 40 || oo Arizona_ ______________________ 5 3 2 | 135 | 100.0 120 7; J Psychiatrist _________________ 2 1 1 |. 52 37.4 40 120. caus Clinical psychologist _________ 1 ferns ; fl EO 3 3.0 |. cmp 3 fumes Psychiatric social worker______ 2 D1 ee im ri fm mm 80 57.6 80 | ____|ooo-- California. ceummenswmmn esses 100 12 79 9 1,461 100.0 480 709 272 Pyoychiatrist. ...cccosvmssneens 51 1 47 3 453 31.0 40 301 112 Clinical psychologist__________ 23 2 18 3 351 24.0 80 199 72 Psychiatric social worker______ 18 8 8 2 534 36.6 320 166 48 ONBEL. mimesis sis 8 1 6 1 123 8.4 40 43 40 Colorado - coo Th Veco Th Ye meri 162 100.0 |________ 162 |________ Poyehiatrist. .. .ccxoemsmmmmees 5 een Br | meme 31 20.4 |________ 31 |... ___ Clinical psychologist__________ 3 lorem Bi [osm 25 18.4 | ee 25 |e Psychiatric social worker. _____ 3 feomwmans 8 lle ummm 27 17.8 1. cvnrnes 27 lemeoeees Other_______________ 2 5 [eamennes 69 45.4 |. __.-.-. 69 |. mmm Connecticut. _____________ 66 17 36 13 1,205 100.0 715 342 148 Poyohiotrish. cca cn wn smwmvawen 39 10 22 v 645 53.5 470 166 29 Clinical psychologist _________ 13 2 10 1 198 16.4 77 103 18 Psychiatric social worker______ 12 5 4 3 348 28.9 188 73 87 OIHIBE .. ce com om mmm i i i p20 I 2 14 LoD |. ein] om 14 Delaware _ Bh hesemmane blooaao 8 100.0 |. _______ 81min Psychiatrist __________________ SN 3 | cnane 6 75.0 | _______ 6 | _______ Clinical psychologist__________ : [J ES Icons 2 25.0 |________ 2 | BOTA mmm wm se ssi 113 43 52 18 2,497 100.0 1,693 518 286 Payehinbrist..coummesmmmmmmmss 15 3 i i 159 6.4 114 45 |. ___ Clinical psychologist__________ 43 20 11 12 994 39.8 788 131 75 Psychiatric social worker______ 22 12 5 5 720 28.8 469 80 171 Other_ ___________________ 33 8 24 1 624 25.0 322 262 40 Georgia ooo. 13 z 6 | __ 331 100.0 273 58 ) rrimein Payehintrist. cucu mums we cans 4 | _______ 4 | ____ 18 5:8 lewsnpuws 18 cain Clinical psychologist _________ 5 3 2 |. 158 47.7 118 40 |. _____- Psychiatric social worker______ 4 4 | |aoo 155 46.8 155 |e ee Tlinois_ __ ooo. 68 19 34 5 1,111 100.0 724 308 79 Psychiatrist. oe 24 2 21 1 255 23.0 75 176 4 Clinical psychologist__________ 14 5 8 1 260 23.4 190 67 3 Psychiatric social worker______ 18 11 4 3 541 48.7 424 45 72 Other. . . cosnsmmmremmsssmen= 2 1 Herikimer 55 4.9 35 2-1 | — Indiana_ ______________________ 46 26 12 8 1,351 100.0 1,02} 126 201 Psychiatrist _________________ 13 5 7 1 293 21.7 200 48 45 Clinical psychologist _________ 13 9 1 3 410 30.4 359 3 48 Psychiatrie social worker. _____ 18 12 3 3 599 44.3 465 71 63 Other. ceucinmmsanssswwmms ees 2 fe wmrminn 1 1 49 9:8: samp 4 45 Public Health Monograph No. 49, 1957 53 Appendix table 5d. State-aided outpatient psychiatric clinics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-55—Continued Professional staff Professional man-hours per week 8 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time Towa ___________________ 42 13 26 3 840 100.0 489 301 50 Povohintrist. on 18 feeoao 14 |________ 73 WW Cf 7 J Clinical psychologist__________ 9 4 :. Jf I 229 27.2 152 if if NE Psychiatrie social worker______ 18 9 7 2 503 59.9 337 151 15 Other_______________________ 1 heesescsloncmmmme i 35 4.2 |__| ____ 35 Kansas _______________________ 15 4 3 8 249 100.0 160 12 77 Psyehiatrist__________________ 8 1 2 5 117 47.0 40 10 67 Clinical psychologist _________ 3 2 |. 1 83 33.3 80 |... ____ 3 Psychiatrie social worker______ 2 1 1 J 42 16.9 40 2 fronds ther. _____ J 2 7 2.8 maim rena 7 Kentueky_ ____________________ 23 7 11 5 467 100.0 262 81 124 Psychiatrist _________________ 9 1 6 2 120 32.1 37 49 64 Clinical psychologist__________ 4 2 2 | _. 94 20.1 75 19 focnnnm Psychiatrie social worker______ 9 4 2 3 210 45.0 150 [cvmmmnm= 60 Li 17 1... 1. 13 2.8 |._.__._. 13 [emimmiion Louisiana______________________ 18 |ysammanw 4 9 90 100.0 |___.____ 25 65 Psychiatrist _________________ 0 |ecnmciams 2 7 65 72.2 Joe. 10 55 Clinical psychologist__________ 1 __.. 1... 5 5.6 |________ B fesmmmmewn Psychiatric social worker______ 1. 1. 10 11.1 | ______ 10 [ocuvanns her. nnn smn ——— 2 |e 2 10 01.1 Lecronc Jonmancss 10 Massachusetts. ________________ 306 74 146 86 6,604 100.0 2,835 1,846 1,924 Psychiatrist _________________ 162 15 93 54 2,959 44.8 575 1,121 1,263 Clinical psychologist__________ 49 12 28 9 | 1,026 15.5 455 440 131 Psychiatric social worker. _____ 69 42 6 21 2,222 33.7 1,616 151 455 Other_______________________ 26 5 19 2 397 6.0 189 133 75 Minnesota ____________________ 81 23 13 45 1,626 100.0 920 146 560 Psychiatrist. _____.____________ 18 7 4 7 458 28.2 280 18 160 Clinical psychologist__________ 9 1 5 3 15 9.2 40 70 40 Psychiatric social worker______ 13 6 2 5 386 23.7 240 26 120 Other_______________________ 41 9 2 30 632 38.9 360 32 240 Mississippi. ooo. __________ 7 5 2 219 | 100.0 195 245 |. Psychiatrist _________________ 2 1 1 fcossnes 42 19.2 40 2 J — Clinical psychologist__________ 2 2 |ivnnnsnn]e mm 80 36.5 80 |r mmm Psychiatric social worker_ _____ 2 1 feces 62 28.3 40 23 Lemire Other_______________________ 1 1 A nn femme 35 16.0 BI [emma mm. Missouri ______________________ 63 19 28 16 1,287 100.0 762 274 251 Psychiatrist _________________ 27 2 15 10 315 24.5 76 123 116 Clinical psychologist__________ 15 7 6 2 420 32.6 280 90 50 Psychiatrie social worker. _____ 19 10 5 4 547 42.5 406 56 85 OEIGE. emma mare 2 2 le ammises 5 4. Bt fen ieee Nebraska _____________________ 7 4 Eee 187 100.0 160 7 4 Psychiatrist__________________ 1. 1 [eee 9 4.8 (________ 9 | _______ Clinical psychologist______ 1 I | errmommsapurarmsmsrmerarss 40 21.4 A |ecumvsnnlmsnenmns Psychiatric social worker______ 3 3 emma 120 64.2 ; 22 I TE ther ________ i 2 meas 18 9.6 |..nemmen IB cir New Jersey ____________________ 49 30 17 2 1,407 100.0 1,140 211 56 Psychiatrist__________________ 14 6 8 | __._. 349 24.8 225 2 Sm a— Clinical psychologist__________ 13 8 4 1 392 27.9 305 52 35 Psychiatric social worker______ 20 16 3 1 663 47.1 610 32 21 Oh, ome cii msm mi 2 ein 2 Jesmnnmen 3 v2 ln vnaaes B lemisianen Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 5d. State-aided outpatient psychiatric cl inics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-55—Continued Professional staff Professional man-hours per week * State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time New York______ 632 204 329 99 | 12,391 100.0 | 7,614 | 2,965 1,812 Psychiatrist _________________ 207 14 171 22 | 2,358 19.0 528 | 1,455 375 Clinical psychologist __________ 129 36 87 6 | 2,313 18.7 | 1,347 770 196 Psychiatric social worker______ 252 146 37 69 7,118 57.4 5,445 480 1,193 Other. ______________________ 44 8 34 2 602 4.9 294 260 48 North Carolina_________________ 52 2} 16 12 | 1,286 | 100.0 964 187 135 Psychiatrist__________________ 24 8 10 6 473 36.8 305 96 72 Clinical psychologist__________ 15 7 2 6 370 28.8 287 20 63 Psychiatric social worker. _____ 12 9 3 |sncummes 432 33.6 372 60 |________ A ) I I {mmm 11 23 lemma 11 |. __ ODIO... rope mmm md min 158 127 14 17 | 5,856 | 100.0 | 5,258 234 364 Psychiatrist__________________ 78 55 12 11 | 2,801 47.8 | 2,376 191 234 Clin’cal psychologist _________ 28 27 1 |. 1,106 18.9 1,086 20 |_______. Psychiatric social worker______ 43 37 1 5 1,601 27.3 1,472 23 106 OLNEY. « vv mie mn wT wine 9 Sls 1 348 6.0 324 |________ 24 Oklahoma ___________________ 9 6 BL imei 284 100.0 240 bg Nooo Psychiatrist. _________________ 1 lL [sums fest 40 14.1 40 |. . sommes ewnnamye Clinical psychologist _________ 5 2 Beirne 124 43.6 80 44 | ______. Psychiatric social worker. _____ 2 D ummm] mmm 80 28.2 80 |__| Other__________ ____________ 1 1 [rem] semanas 40 14.1 40 |__|. Oregon. _______________________ 11 2 9 femme 132 | 100.0 80 62 | Psychiatrist _______ Bee BJ mimi 23 17.4 |.cmmnens 23 loan Clinical psychologist__________ J 2 |eeaeeme 11 8.4 |. | ccs Psychiatric social worker. _____ 3 2 1 |-- 89 67.4 80 9 | _______ Other___________ _ __________ Jimi 1 lesmmene- 9 6.8 [.ooo--_ 9 | _____. Pormnsy vanin. oss ansnnammsnmms 221 94 57 70 | 65,813 | 100.0 | 3,691 792 1,430 Psychiatrist__________________ 88 14 30 44 | 1,699 29.2 555 316 828 Clinical psychologist__________ 34 15 15 4 937 16.1 566 215 156 Psychiatric social worker. _____ 78 58 8 12 2,701 46.5 2,199 186 316 Other_______________________ 21 7 4 10 476 8.2 271 75 130 South Carolina_________________ 22 12 9 1 587 100.0 456 93 38 Payehintrist. .. ...ovvuonevaves 8 | ___. 8 [ummm 74 12.6 |e. 74 | _____ Clinical psychologist ________ 4 4 fee 152 25.9 152 oe. Psychiatric social worker______ 10 8 1 1 361 61.5 304 19 38 South Dakota__________________ 5 4 1. 166 100.0 160 6 |._______ Psychiatrist _________________ 1 1 || 40 24.1 40 |________ I Clinical psychologist. _____ 1 1 J cmeenu)n mms 40 24.1 40 |__| Psychiatric social worker______ 3 2 LL locscnnnn 86 51.8 80 6 |._______ Tennessee _ ______________ 34 8 14 12 512 100.0 324 78 110 Psychiatrist ________________ 16 1 10 5 114 22.3 39 49 26 Clinical psychologist _________ 9 3 2 4 151 29.5 119 20 12 Psychiatric social worker______ 9 4 2 3 247 48.2 166 9 72 Texas oe 73 27 13 83 | 1,495 | 100.0 | 1,039 204 252 Peychiatrist. cvoviwmmansessns 36 6 5 25 359 24.0 231 30 98 Clinical psychologist _________ 19 7 6 6 482 32.3 266 122 94 Psychiatric social worker. _____ 16 14 2 | 594 39.7 542 52 oncom Other __________ _____________ DB Foon smn hmm wa 2 60 B10 Lone mmm sm 60 Public Health Monograph No. 49, 1957 55 Appendix table 5d. State-aided outpatient psychiatric clinics: Number of professional staff and man-hours per week, according to State and profession, by type of employment, 1954-55—Continued Professional staff Professional man-hours per week 3 State and profession 2 Regular staff 4 Total Regular staff ¢ Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time Virginia_______________________ 102 38 47 ww 2,133 100.0 1,470 441 222 Psychiatrist tS 51 8 35 8 638 29.9 303 255 78 Clinical psychologist _________ 19 14 3 2 592 27.8 520 34 8 Psychiatric social worker______ 30 16 7 7 881 41.3 615 130 136 NEL rom rms mrmmiemm meme 2 lee. 2 eas 22 1.0 | _______ 22 |... Washington. .._..____________._._ 17 6 9 2 411 100.0 240 115 56 Psychiatrist__________________ % {eosvaens 6 1 113 27.5 |... ____ 73 40 Clinical psychologist__________ 3 1 2 (eee. 59 14.4 40 VO lecuensns Psychiatric social worker. _____ 6 5 |o__. 1 216 52.5 200 [concn ins 16 ther ______________________ 1 |emeeeane 1 | _____ 23 5:0 luwesirins + ME A West Virginia__________________ 12 4 7 1 238 100.0 156 42 40 Psychiatrist__________________ 4 | __. A |onmemees 24 10.1 {emma 24 |... Clinical psychologist__________ 3 1 2 jemrmmmm 51 21.4 38 18 Ledges Psychiatric social worker. _____ 5 3 1 1 163 68.5 118 5 40 Wisconsin_ ____________________ 2} 9 12 3 529 100.0 360 109 60 Psychiatrist__________________ 11 1 9 1 122 23.1 40 62 20 Clinical psychologist. _________ 4 3 1 | ___. 132 24.9 120 12 |onmmmn Psychiatric social worker_ _____ 9 5 2 2 275 52.0 200 35 40 ! See appendix table 1 for number of reporting clinics by State. 2 Excludes State and profession for which no staff or man-hours were reported. 3 Includes an estimate of 9 hours each for part-time employees and 18 hours each for trainees for whom scheduled hours were not reported. # “Full-time” refers to a workweek of 35 hours or more in clinics; “part-time” to a workweek of less than 35 hours. 56 Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 5e. Non-State-aided outpatient psychiatric clinics: Number of professional staff and man- hours per week, according to State and profession, by type of employment, 1951-55 [Data based on reports for 341 of the 374 non-State-aided clinies 1] Professional staff Professional man-hours per week * State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time Total United States... ___ 4,140 974 | 2,346 820 | 67,191 100.0 | 36,820 | 18,304 12,067 Psychiatrist... ______ 2,009 132 1,485 392 | 21,413 31.9 | 5,194 | 10,348 5,871 Chnical psychologist___ 831 321 352 158 | 17,861 26.6 | 11,919 3,204 2,738 Psychiatrie social worker. 800 457 226 117 | 22,375 33.3 | 17,274 2,614 2,487 RHEL... cc een mimmmmonim mms 500 64 283 153 5,542 8.2 2,433 2,138 971 California________________ orb = 398 89 242 67 7,029 100.0 3,669 1,956 1,504 Psychiatrist __________ a 163 13 122 28 2,542 36.1 53 1,104 908 Clinical psychologist 66 28 22 16 1,678 23.9 1,129 270 279 Psychiatric social worker 63 45 10 8 2,087 29.7 1,790 162 135 Other... 106 3 88 15 722 10.3 120 420 182 Colorado... __________. I 16 4 10 2 261 100.0 1€7 89 5H Psychiatrist. _______ 6 2 4 | _. 117 44.8 79 38 [erm Clinical psychologist. __ 2 1 Ll 44 16.9 BE |. erent rma Psychiatric social worker ___ 7 1 4 2 99 37.9 44 50 5 Other. ____ ___________ ___ | ON | PE 1 A E Jeroen Connecticut __________________ 60 7 29 1 1,281 100.0 633 358 290 Psychiatrist __________________ 28 2 17 9 380 29.6 71 153 156 Clinical psychologist_______ 10 2 6 2 215 16.8 77 98 40 Psychiatrie social worker _____ 18 12 3 3 603 47.1 447 62 94 Other....cociecmacaceamaanws 4 1 Dl] rb 83 6.5 38 45 |... Delaware... cose cinensnmene _ 3 2 1 98 100.0 86 1 3 Psychiatrist. 1 1 lmssemed]eomeis. 43 43.9 43 |_|. Clinical psychologist. i NE —— L | csnnns 12 12.2 |ovun oe i 1 if Psychiatrie social worker 1 I |e bem me 43 43.9 43 |vemrmnmn| enn m—— District of Columbia______ 172 LO 96 48 | 2,253 100.0 1,181 51/4 568 Psychiatrist__________________ 93 8 57 28 972 43.1 319 297 356 Clinical psychologist. __ _ 26 7 13 6 445 19.8 269 75 101 Psychiatric social worker__ 31 13 13 5 653 29.0 513 96 44 Other_________ rier ved STS 22 2 13 7 183 8.1 80 46 57 Florida _____ _ _ _____________ 22 3 25 4 469 100.0 128 165 176 Psychiatrist____________ 20 | 1 15 4 278 59.3 44 58 176 Clinical psychologist. 2 | 1 Il mn 48 10.2 44 4 bedi Psychiatrie social worker__ 2 1 etter 49 10.5 40 9 |. Other. o.com 8 | _. Ble crsunan 94 20.0 |________ 94 |________ linois_ ______ _ _ ___________. 232 114 91 27 5,312 100.0 4,176 781 3556 Psychiatrist_____________ 92 7 67 18 833 15.7 264 462 107 Clinical psychologist _______ a 92 74 16 2 2,904 54.7 2,639 185 80 Psychiatric social worker_ 39 27 5 7 1,330 25.0 1,072 110 168 Other. ________________ _ ___ 9 6 3 lee. 245 4.6 221 24 |. _____._ Indiana. __________ 25 1 23 1 90 | 100.0 38 4 8 Psyechiatrist__________________ HW loc consus 20 1 27 30.0 |________ 19 8 Clinical psychologist_____ trite 2 3 : 1 ———— 47 52.2 38 J NR Other. ______________________ 2 |. I RT 16 ¥7:8 les wmmmme 16 |e Iowa______ 3 ee 8 ems 27 100.0 |. _______ GE iis Psychiatrist _____________ I fen Leics 9 33.3 |... 9 | _______ Clinical psychologist__________ J m— 1 cna 9 33.3 |e 9 | ___._. Psychiatric social worker______ I foo cms Bilocrmmes 9 33.4 [nanan 9 |eeese Kansas. _______ ___ 102 30 62 10 2,314 100.0 1,256 638 420 Psychiatrist _____________ __ 53 10 39 4 987 42.7 440 371 176 Clinical psychologist ______ 28 11 11 6 855 36.9 442 169 244 Psychiatric social worker______ 21 | 9 | 12 472 20.4 374 98 |... Public Health Monograph No. 49, 1957 57 Appendix table 5e. Non-State-aided outpatient psychiatric clinics: Number of professional staff and man- hours per week, according to State and profession, by type of employment, 1954-35—Continued Professional staff Professional man-hours per week 3 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time Louisiana _____________________ 143 15 47 81 | 1,946 | 100.0 646 288 1,012 Payehintrish. ....ccomnenmmmmns 70 4 42 24 959 49.3 171 252 536 Clinical psychologist _________ 10 4 3 3 250 12.8 181 30 39 Psychiatric social worker _____ 18 7 2 9 557 28.6 204 6 257 Other. ______ ________________ 45 || 45 180 0. Tl lens capable wmmns wn 180 Maine. _______________________ Sooo Sloe 24 100.0 |_._______ 24 ome. Psychiatrist _________________ 3 [eames 3 [sn 12 50.0 |________ 12 |. Psychiatric social worker. _____ 1 fosscscnn Lee mm sie 12 50.0 |_______ 12... Marviand..... cess smmmmeses mmm 81 22 42 17 1,240 100.0 850 254 136 Psychiatrist _________________ 56 5 17 498 40.2 190 172 136 Clinical psychologist _________ 7 5 2 [macnn 189 15.2 185 Bh |} iomimmnmet Psychiatric social worker______ 12 8 ES 359 29.0 315 4 (o_o ______ Other_______________________ 6 4 2 niin 194 15.6 160 32 andi Massachusetts ________________ 228 32 147 49 | 8,847 | 100.0 | 1,246 | 1,321 780 Paychintrist....c.uvesmsssnsss 127 8 86 33 | 1,510 45.1 310 764 436 Clinical psychologist _________ 39 12 21 6 810 24.2 475 179 156 Psychiatric social worker. _____ 38 11 17 10 788 23.6 426 210 152 Other _____________________. 24 1 23 Joos 239 7.1 35 168 36 Michigan. ___________________ 24 12 9 3 693 | 100.0 498 94 101 Psychiatrist. _________________ 8 2 4 2 260 37.5 96 68 96 Clinical psychologist__________ 4 3 1. 136 19.6 128 3 Vonuifiores Psychiatric social worker______ 7 Tee 274 39.6 DE oe ve wpm wines Other ______________________ 5 eas 4 1 23 3.3 | ___ 18 5 Minnesota __________________ 41 22 6 13 1,150 100.0 880 33 237 Psychiatrist__________________ 13 5 3 5 229 19.9 200 9 20 Clinical psychologist__________ 7 4 1 2 236 20.5 160 4 72 Psychiatric social worker_ _____ 14 LL loci 3 503 43.8 440 |._______ 63 OUNBY, «ovens matin mmm 7 2 2 3 182 15.8 80 20 82 Missouri... 91 10 42 39 870 100.0 415 219 236 Psychiatrist _________________ 32 |e... 30 2 116 13.8 loscnunus 94 22 Clinical psychologist __________ 13 1 3 7 165 19.0 45 41 79 Psychiatric social worker______ 12 9 3 lena 427 49.1 370 B7 |ocumnnms Other_______________________ 34 finn 4 30 162 18.6 |________ 27 135 Nebraska______________________ 13 |... 13 |... 124 | 100.0 |._______ 1 — Psychiatrist__________________ 9 |e 9 | __. 81 i I TL omens Clinical psychologist _________ Bee 3 lennnne 27 21.8 lscuamen 27 Jor wmminn Other_______________________ ) } lossmwans 16 12.9 |. wermnn 16 |e New Jersey ____________________ 186 43 141 2 2,710 100.0 1,555 1,146 9 Psyolintrist. .. covevsnsss ammo 81 7 73 1 569 21.0 250 312 7 Clinical psychologist__________ 38 10 27 1 557 20.5 355 200 2 Psychiatric social worker______ 41 24 17 | ___. 1,130 41.7 870 260 [cnn Other_______________________ 26 2 24 (..... 454 16.8 30 374 | _______ New York_____________________ 1,819 438 | 1,061 325 | 29,002 | 100.0 | 15,694 | 8,313 4,995 Psychiatrist _________________ 899 39 702 158 | 8,313 28.7 | 1,433 | 5,033 1,827 Clinical psychologist__________ 407 130 180 97 | 7,698 26.5 | 4,636 | 1,484 1,578 Psychiatric social worker _____ 399 229 108 62 | 11,006 38.0 | 8,307 | 1,209 1,490 Other. ______________________ 114 35 71 8 | 1,985 6.8 | 1,298 587 100 North Carolina. ________________ 9 3 J a 263 | 100.0 121 20 122 Psychiatrist _________________ 3 ) sensors 2 121 46.0 41 | ___. 80 Clinical psychologist _________ 4 L Lesevmme 3 82 31.2 40 |. __ 42 Psychiatric social worker. _____ 2 1 1 Hsin 60 22.8 40 20 {cen Characteristics and Professional Staff of Outpatient Psychiatric Clinics Appendix table 5e. Non-State-aided outpatient psychiatric clinics: Number of professional staff and man- hours per week, according to State and profession, by type of employment, 19514-55—Continued Professional staff Professional man-hours per week 3 State and Regular staff 4 Total Regular staff 4 profession 2 Total Trainees Trainees Full- Part- Full- Part- time time Number| Percent | time time Ohio____ 103 35 49 19 1,878 100.0 1,400 400 78 Psychiatrist __________________ 56 7 37 12 575 30.6 290 267 18 Clinical psychologist _________ 15 11 4 |. 493 26.3 442 51 o.oo... Psychiatrie social worker _____ 21 10 6 5 464 24.7 391 58 15 Other... - cscvsnmens sense cemme 11 7 2 2 346 18.4 277 24 45 Oklahoma _____________________ 4 2 [Simm 1 124 100.0 120 |... 4 Psychiatrist__________________ 1 1 |e 40 32.3 40 |_|. Clinical psychologist__________ 2 ) I 1 44 35.4 40 | _._ 4 Psychiatric social worker. _____ 1 i (ON! SO 40 32.3 40 |__|. Oregon... ou oun wm wwsmmenwmen 9 J FO 3 250 | 100.0 240 lonnwenes 10 Paychindrist. .. cov mmm mmans 1 1 essere o]mmmessus 40 16.0 40 | svransslesnrmnnss Clinical psychologist _________ 4 2 Js wmrmmre 2 86 34.4 80 |________ 6 Psychiatric social worker. _____ 4 3 ooo 1 124 49.6 120 | ..___ 4 Pennsylvania__________________ 112 16 64 32 1,698 100.0 652 498 548 Psychiatrist _________________ 70 2 36 32 903 53.2 86 269 548 Clinical psychologist__________ 11 4 7 {ovmmames 221 13.0 161 OD! |ennmnn Psychiatric social worker. _____ 18 10 J — 470 27.7 405 1 Other_______________________ 18 onions 13 |