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

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

COMMENTS BY DIRECTOR OF NURSING SERVICE

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

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

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

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

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

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

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

COMMENTS BY DIRECTOR OF SOCIAL SERVICE

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

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

COMMENTS BY EDUCATION DIRECTOR

We could improve our program by assigning National

Service Corps people as follows:

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

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

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

Newberry State Hospital,
Michigan

City of Chicago Board of Health

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

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

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

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

Division of Mental Health

Services

Chicago, Illinois

Department of Public Welfare

State of Minnesota

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

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

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

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

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

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

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

Welfare

Saint Paul, Minnesota