When the American Psychoanalytic Association held its Annual Meeting in Washington, that beautiful city was enjoying a spectacular display of spring color — the dogwoods, flowering crabapple trees and azaleas were all in bloom at once. But at the same time one knew that the May Day protestors were gathering and that a confrontation was in the air; and within the ranks of the mental health professions there was dismay over the news that the Nixon Administration was planning to discontinue financial support for training in psychiatry and in related disciplines.
Not long before the meeting, word had gone out that in fiscal year 1972, the National Institute of Mental Health (NIMH) would reduce its outlay for the funding of psychiatric residency training programs by $6.7 million (roughly 20% of the total training budget), and that all training funds would be “phased out” in three years, i.e. by 1974.
The psychoanalysts gathered at the Shoreham Hotel saw the planned budget cuts as ominous in a variety of ways. A drop in the number of psychiatric residents in training seemed inevitable, and this would have to result in a decrease in the care available for the mental health problems of the indigent, whether in hospitals, out-patient clinics, community mental health programs or wherever. Those analysts who are involved in residency training programs — and there are many — saw in the cuts a grave and possibly fatal
threat to their programs. Within the analytic community itself, it was obvious that any significant decrease in the number of physicians entering psychiatric training would shrink the pool of potential candidates for analytic training.
The impending cuts were discussed all through the period of the Convention. The Executive Committee met with officers of the APA; the matter was taken up in the Executive Council and was discussed at some length in the Meeting of Members.
From these discussions, a clearer picture of the situation emerged. Information from a variety of sources indicates that the decision to discontinue Federal support for psychiatric training originated in the Office of Management and Budget (OMB), and not in the NIMH, although the NIMH will have the obligation of carrying out the policy if it remains unchanged.
A subcommittee of the House Appropriations Committee, chaired by Congressman Daniel Flood, is conducting hearings on the proposed budgets cuts, and in time they will have to be acted on by the Congress. It is believed unlikely that the Administration will alter its policy, so that only Congressional action can stave off the cuts.
It was announced at the Meeting of Members that a number of organizations had already joined forces in a National Coalition on Mental Health Manpower, whose purpose will be to mobilize Congressional support for retention of training funds.
The Members' Meeting unanimously supported a resolution introduced by President-Elect Edward D. Joseph (and previously endorsed by Council), stating it to be the sense of the meeting that:
the APsaA should join the National Coalition on Mental Health Manpower,
APsaA members be urged to contact their own Congressional representatives, and
the APsaA, as an Association, opposes the proposed budget cuts.
At the time the Newsletter was being prepared for press, some 14 groups had joined the Coalition, including, in addition to the APsaA and the APA, major organizations in the fields of psychology, social work and nursing, hospital and medical school groups, and a number of others in the mental health field. The AMA's participation was still undecided.
Speakers at the Meeting of Members decried the air of defeatism that had grown up since the cuts were announced and at the same time urged recognition of the fact that the NIMH, contrary to widespread belief, was not the originator of the new policy. Politically knowledgeable people in the field were said to have estimated that there is at least a 50-50 chance that Congress can be moved to cancel the budget cuts, and that much will depend on mobilizing sentiment across the country in favor of continuing Federal support for psychiatric residency training.
David Kairys, M.D.