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The role of the federal government in the field of mental health has seen many false starts and near misses. A variety of serendipitous factors and the dedicated efforts of a few committed men and women mark the history of what we now know as the National Institute of Mental Health.
-Dilip Ramchandani, M.D.
History Notes Editor
By Lucy D. Ozarin, M.D., M.P.H
The federal government entered the field of mental health in 1946 with the passage of the National Mental Health Act (PL 410), which authorized the establishment of the National Institute of Mental Health. A hundred years earlier, Dorothea Dix had been importuning state legislatures to set up mental hospitals, but her efforts to obtain federal support for them through sale of public lands was vetoed by President Franklin Pierce.
The federal government's interest in mental health was eventually sparked by concern about the rampant use of drugs and drug addiction. The Harrison Narcotics Act in 1914 sanctioned funds to study these problems. In 1929 federal hospitals were established in Lexington, Ky., and Fort Worth, Tex., for the treatment of drug addiction. The Narcotics Division within the U.S. Public Health Service (PHS) was also created and in 1931 was renamed the Division of Mental Health. From 1930 to 1938 the director was Dr. Walter Treadway, a psychiatrist in the PHS, and he was succeeded by Dr. Lawrence Kolb Sr. (1938-44).
Dr. Kolb envisioned an institute called the National Neuropsychiatric Institute (1937), modeled on the National Cancer Institute (1937) and the National Heart Institute (1938). While World War II interfered with and delayed Dr. Kolb's effort, it also succeeded in refocusing attention on the numerous people rejected for military service, many for psychiatric reasons, and the huge toll of war casualties with psychiatric sequelae. At the end of the war, therefore, large numbers of veterans with mental health problems were in the public eye, and the time was ripe to promote a national institute in the area of mental health.
Dr. Kolb meanwhile had retired and been replaced by Dr. Robert Felix, a Colorado-trained PHS psychiatrist with a degree in public health from Johns Hopkins University. With much help from influential public and private organizations and individuals, including some sympathetic members of Congress, especially Percy Priest, Dr. Felix was able to bring Dr. Kolb's idea to fruition.
The National Mental Health Act was much broader in scope than the legislation establishing the Cancer Institute. It not only addressed research and research training, but also made provision for some community service; it did not, however, provide support for public mental hospitals or appropriations for the establishment of an institute.
The community funds were channeled to state mental health authorities, usually state health departments. With authorization for an institute but no funding, Dr. Felix was forced to seek donations. He was able to obtain $15,000 from the Greentree Foundation and used it to call a meeting of his National Mental Health Advisory Council (established by the National Mental Health Act) and to start recruiting staff.
The first Congressional appropriation was not made until 1949. Since that time, the institute has had its share of ups and downs. In 1960, during a PHS reorganization, an effort was made to dismember the NIMH. Under the proposal, research functions were to be left within NIH, and training and service moved elsewhere in the PHS. Felix resisted this effort successfully. In 1968 Dr. Stanley Yolles, who had succeeded Dr. Felix as director of NIMH, was able to move NIMH out of NIH so that it became an autonomous bureau of equal stature to NIH.
This lasted for five years. In 1973 NIMH underwent another reorganization with the creation of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), which was the umbrella organization for NIMH, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. In 1992, in still another reorganization, the research program of the three institutes was moved to NIH, while the service programs became the Substance Abuse and Mental Health Services Administration (SAMHSA).
During the last 50 years, NIMH has provided billions of federal dollars for mental health research and training. Thus the vision of Dr. Kolb and the skill and leadership of Dr. Felix and his successors are the foundations of today's Decade of the Brain.