Repond, President of the World Federation for Mental Health, emphasizes the point that 'a burst appendix in Switzerland or Japan or Nebraska is absolutely the same' as regards treatment, but in mental hygiene this situation does not prevail. The importance of comprehending the local culture is basic, and adequate mental hygiene is impossible without an understanding of variations in mores. The mobility of therapists in the United States is in sharp contrast with their relative stability in Switzerland where the social worker in a given community knows not merely her client but also his parents, grandparents, uncles, aunts, etc. Organizations on the national and international level are of the utmost importance but mental hygiene to be effective must begin at the grass roots level, must work with people as individuals and in small groups.