the reduction or elimination of specialized Federal support for the training of mental health professinals, training centers in state, county, municipal or private jurisdictions theoretically have the option of securing other funding resources to compensate for the phase-out of Federal support. 3. Any type of alternative funding option, however, is not open to Saint Elizabeths Hospital because of its Federal status: Saint Elizabeths Hospital cannot look to. any other treasury, public or private (including payments from students), to compensate for DHEW training support should it be terminated. Further, it should be noted that support for training programs at SEH cannot legally derive from categorical grant programs or student fellowship grants. Rather, its funds can only be obtained through the annual DHE Appropriation Act which supports the hospital as a totality. Therefore were DHEW and OMB to eliminate the llospital's training budget, professional mental health training at Saint Elizabeths Hospital would cease to exist. This move would place DHEW's largest mental hospital, serving mainly the citizens of the District of Columbia, at an overwhelming disadvantage in relation to other non-Federal institutions, and thus irrevocably damage the prospect of Saint Elizabeths Hospital ever becoming a really first rate, fully accredited, institution. Further, such an act would discriminate against SE in relation to other PHS and VA hospitals where Federal dollars clearly support extensive categorical mencal health training. OTRD takes seriously its obligation and accountability in wisely managing the expenditure of Federal dollars for training activities. For the past four years it has conducted its operations well within assigned budget levels, and for the last two fiscal years, training budgets have generated excess funds which have been applied to other hospital allotments to meet critical financial shortages. Monthly and quarterly financial statements are provided to key program managers in order to enable sound fiscal planning and monitoring. In addition, program directors are given an annual allotment in key resource areas such as travel to professional meetings, consultants, and staff development. The Division has also made attempts to evaluate the benefits derived from its mental health training programs in relation to their cost. This effort, however, has proven extremely difficult for the following reasons: a. There are no reliable data on the extent and nature of mental disorders, their incidence and prevalence, in the United States today. b. There are no reliable data on the total cost of mental illness to society (including treatment costs and loss in productivity). Estimates range from $9.4 billion to $21 billion annually. C. Consequently there are no reliable data on the public value of a competently trained mental health professional (his services in prevention, treatment, and rehabilitation of mental disorders) and his impact on the public weal and welfare. In spite of these difficulties, however, it can be confidently asserted that a supply of mental health manpower will be needed for the foreseeable future to provide care and treatment for the mentally and emotionally ill, which is increasingly becoming recognized as a "citizen right." This manpower supply will have to be trained and deployed throughout the nation's mental health service delivery system. In the cost-benefit analysis of mental health training at SC which follows, primary emphasis is placed on demonstrable benefits to the local institution and to the Washington, D.C. metropolitan community, although not neglecting the substantial benefit in terms of contributing to national mental health manpower resources. The cost of professional training at SEH is best represented by OTRD's total obligated funds for training (allotment 5) for the fiscel This amount covers resources for: year. a. b. c. d. Trainee stipends Professional training staff salaries Administrative, secretarial and support staff salaries These expenditures represent the basic recoverable costs which could be realized if professional training at SER were terminated. While it is true that Hospital staff other than OTRD personnel contribute to training activities (e.g., supervising trainces in clinical settings), the cost of their time would not be recoverable in the event that professional training were terminated. The same is true by and large for office space and other overhead costs for the training operation. In order for building space currently used exclusively for training operations to be converted to other uses, it would require so substantial a refurbishing investment as to render our current space cost in effect a non-recoverable item. The project obligations (in terms of recoverable costs) for professional mental health training at Saint Elizabeths Hospital during fiscal year 1975 is $2.2 million. The benefits derived from the professional mental health training at Saint Elizabeths Hospital are located in six discrete areas: 1. Contributions of trainees to patient care:* Trainees at Saint 2. Inservice Training and Staff Development: Members of the OTRD Graduates of training programs 3. Recruitment of Qualified Staff: *The dollar value of trainee services is computed according to the following formula: 70% of the beginning hourly wage of a staff person fully prepared at the traine's level, multiplied by the number of hours the trainee actually rends in patient service, multipled by the number of trainees at that level. This formula is being used as a basis for client billing and third-party payants in Maryland and the state of New York. mental health professionals. This is particularly significant in light of the fact that the job descriptions and professional role requirements of at least 7 service disciplines include the teaching and supervision of professional level trainees. Although it is difficult to assess in precise dollar values, the contribution of SEH training to the recruitment of qualified staff clearly constitutes a substantial benefit to the Hospital. 4. Enhancement of Patient Care: In the opinion of many, the most important benefit of professional training activities to SEH is the general enhancement of patient care. At one level, this benefit can be portrayed in dollar amounts in terms of the direct patient care provided by the OIRD training staff. This sum is $113,210. At a more profound thought perhaps less tangible level, however, the presence of vital training activities provides powerful incentives toward competence in all phases of "ospital operations. The presence of highly motivated and questioning trainees, the discipline of organizing and synthesizing behavioral science data in order to teach it, the sharpened clinical accumen derived from trainee supervision, the necessity of keeping abreast of latest developments in the field, the utilization of clinical activities and events as opportunities for teaching and learning--all of these factors strongly influence therapeutic services toward standards of excellence as long as training mental health professionals remains a significant aspect of the Hospital's mission. The "teaching hospital" environment enjoyed by SEH is among the institution's most valuable therapeutic assets. 5. Contributions to Other Federal and Metropolitan Area Agencies: Training progtans at SE provide significant benefits to other Federal and area agencies and institutions in terms of training, consultation, direct patient services, clinical affiliations and staff recruitment resources. These contributions are enumerated as follows: d. Clinical affiliation relationships (formal and inferral) with some 35 educational agencies and training centers in the Washington area. In many instances, SEH is the only institution in the general area which con provide the required affiliations. b. No cost, short-tern training and consultation for staff of |