DOCUMENT RESUME RC 007 e89 AUTHOR Riley, Susan G., Ed. … · 2014-01-02 · DOCUMENT RESUME ED 078 982 RC 007 e89 AUTHOR Riley, Susan G., Ed. TITLE Mental Health Planning Conference

DOCUMENT RESUME

ED 078 982 RC 007 e89

AUTHOR Riley, Susan G., Ed.TITLE Mental Health Planning Conference for the Spanish

Speaking (Bethesda, Maryland, January 11-12,1972).

INSTITUTION National Inst. of Mental Health, Rockville, Md.PUB DATE 12 Jan 72NOTE 101p.

TORS PRICE MF-$0.65 HC-$6.58DESCRIPTORS Alcoholism; *Conference Reports; Drug Abuse; Health

Services; *Mental Health Programs; *Program Planning;Research; *Spanish Speaking; *Speeches

ABSTRACTThe National Institute of .Mental Health (NIMH) Mental

Health Planning Conference for the Spanish Speaking was held onJanuary 11-12, 1972, in Bethesda,. Marylandi.Thirty Spanish= speakingprofessidnals and nonprofessionals from 14 states and tije District ofColuMhia met with NIMH atici the National Institute of-AlcOhol Abuse-and Alcoholism. The conference proceedings are listed in 5 sections:tly th'i conference in perspective, (2) reports of group meetings, (3)responses by the-various -NIMH divisions, (0-summary ofrecommendations by the participants and.solme divisions, and (5) aIist-of conference participants. Opening remarks by NIMH staff

fiadetailed. the conference purpose a-ekPeetationgl the cenfe.7ence as a-step-toward program, planning for/the Spanish Speaking; DHEW healthinitiatiVvs; present and fhturelstatuS-of the minority center; andNIMH-priorities. Reports discussed mental health_ services, manpowerand= training, special mental healtkpiograms, alcoholism and drugabUSe, and-mental health research. The divisions of mental healthservide, manpower and training, extramural research, special mentalhealth, and the.ffational Institute of Alcohol Abuse and Alcoholismmade responses. (NQ)

FILMED FROM BEST AVAILABLE COPY

co MENIAL HEIM

1:=3

P1ANNING CNFERENCEfor the

SPANISH SEI(INGU S DEPARTMENT OF HEALTH.

EDUCATION &WELFARENATIONAL INSTITUTE OF

EDUCATIONTHIS DOCUMENT HAS BEEN REPRODUCED EXACTLY AS RECEIVED FROMTHE PERSON OR ORGANIZATION ORIGINATING IT POINTS OF VIEW OR OPINIONSSTATED DO NOT NECESSARILY REPRESENT OFFICIAL NATIONAL INSTITUTE OFEDUCATION POSITION OR POLICY litioceedings

January 11-12 1972

Bethesda, Maryland

Sponsored by:

Planning Branch, Office of Program Planning and EvaluationSpecial Assistant to the Dirt dor, Office of Program Coordination

in cooperation withCenter for Minority Group Mental Health Programs

Edited bySusan G. Riley

National Institute of Mental Health5600 Fishers Lane

Rockville, Maryland 20852

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFAREHealth Services and Mental Health Administration

DHEW Publication No. (HSM) 73.9064Printed 1972

For sale by the Superintendent of Documents, U.S. Government Printing Oaks, Washington, D.C. 20402

Table of Contents

Introduction 1

II. Agenda . 5

III. Conference in Perspective

Purpose and Expectations of theConferenceJuan Ramos, Special Assistant tothe Director, Office of ProgramCoordination, NIMH 9

The Conference as a Step Toward ProgramPlanning in Relation-to the SpanishSpeakingHarry P. Cain II, Assistant Directorfor Planning and Evaluation, Officeof Program Planning and Evaluation,NIMH 12

PHEW Health Initiatives Relating toSpanish-Surnamed AmericansArthur E. Raya, Special Assistanton the Health Needs of Spanish-Surnamed Americans, Office of theAssistant Secretary for Healthand Scientific Affairs, DREW . . 14

Status of the Minority Center: Presentand FutureJames R. Ralph, Chief, Center forMinority Group Mental HealthPrograms, Division of SpecialMental Health Programs, NIMH . 16

IV. Mental Health and the Spanish SpeakingTomas Atencio, Coordinator, LaAcademia, Dixon, New Mexico . . . 19

V. NIMH PrioritiesBertram S. Brown, Director,NIMH 33

VI. Demands of the Spanish SpeakingParticipants 37

iii

VII. Reports of Group Meetings

Mental Health ServicesAmelia M. Castillo, ChairmanMilton N. Silva, Resource

Manpower and TrainingRaquel E. Cohen, ChairthanIsmael Dieppa, Resource

ResearchAmado M. Padilla, ChairmanThomas Langner, Resource

Special Mental Health Programs .

Magdalena Miranda, ChairmanRobert Peria, ResourceTrinidad Piga, Resource

Alcoholism and Drug AbuseJuan D. Acevedo, ChairmanCelia Dulfano, Resource

VIII. Response: NIMH Divisions

Division of Mental HealthService ProgramsClaudewell S. Thomas, Director

Division of Manpower and TrainingProgramsBernard Handler, Director

Division of Extramural ResearchProgramsLouis A. Wienckowski, Director

Division of Special Mental HealthProgramsWalter M. Smith, Deputy Director

National Institute of Alcohol Abuse

and AlcoholismKenneth L. Eaton, Deputy Director

Division of Narcotic Addiction andDrug AbuseRobert W. Carrick, Assistant Chief,Narcotic Addict RehabilitationBranch

iv

IX. Summary of Recommendations 73

X. Conference Participants 82

Planning Committee

George L. AdaMsRoberto L. DuronMartin M. KatzRalph LittlestoneK. Patrick OkuraMarion E. PrimasJames R. RalphJuan RamosArthur E. RayaHumberto RosselliE. Fuller Torrey

INTRODUCTION

In response to the high priority the National Instituteof Mental Health has assigned to minoritygroup mentalhealth problems, the Planning Branch, in cooperationwith Dr. Juan Ramos, Office of Program Liaison, initi-ated a planning effort focusing on the over ten millionSpanieh.speaking. It was hoped that such a programrelating to the second largest racial-minority groupwould serve as a model for future planning with respectto other minorities -- Blacks, Asian Americans andAmerican Indians. The NIMH Mental_Healtb_PlanningCohference for the Spanish Speaking, which was held inJanuary 1972, is only a step in an ongoing process con-cerning the Spanish speaking and is one part of a morecomprehensive minority related plan. Activities direc-ted toward minorities, particularly the Spanish speak-ing and Blacks, have continued throughout NIMH andfuture efforts have been planned.

In Spring, 1971, a working group from within the In-stitute, including Spanish speaking staff members, wasconvened to consider the directions to be taken in thisinitial planning effort. This group decided that thePlanning Branch should first of all examine what NIMHhad previously accomplished In relation to the mentalhealth of the Spanish speaking before developing anynew plans. In addition, it was decided that informa-tion should be obtained from a number of Spanish speak-ing communities which could provide a basis for NIMH'sunderstanding of the perception of mental health asseen by the communities and the existing organizationalstructure and forces at work. Accordingly, the PlanningBranch and the Office of Program Liaison arranged sev-eral contracts emplying Spanish speaking graduatestudents and faculty to develop this information.

Dr. Amado Padilla, a psychologist now with the Univer-sity of California, Santa Barbara, evaluated the NINE!service, training, and research programs relating tothe Spanish speaking on a national level. In addition,he compiled a preliminary bibliography of the liter-ature pertaining to mental health and the Spanishspeaking. Two other projects focused on two distinctgeographic areas with large Spanish speaking popula-tions. Mr. Ray Valle and Miss Esmeraldo Vallejo, both

1

social work graduate students, conducted a two-partstudy in the largely Chicano community of East LosAngeles. Miss Vallejo surveyed the consumer's per-spective of mental health and appraised the servicesin terms of this perspective, and -Mr. -Valle exam-_fined the proVider services aimed at meeting the mentalhealth needs of this Chicano community. Finally,

Mr. Bernardo Eureste, a graduate student at theUniversity-of Michigan, met with Spanish speakinggroups in Detroit, Chicago, Toledo, and Washington,D.C.

In-order to involVe Spanish speaking from outside-the Institute in the planning process, a meeting washeld in July, 1911 with Spanish speaking "individualsand NIMH and-DHEW staff to evaluate the work planned_for the summer and to outline the next steps in theplanning process. This group agreed that after thepreliminary studies were completed, _a conferenceshould be held bringing together Spanish speakingindividuals from across the country to meet with NIMHstaff. It was felt that both parties could benefitfrom such a meeting. The Spanish speaking constit-uents could provide NIMH with ceful informationabout the Spanish speaking communities' mental healthneeds. They could also evaluate the current Instituteprograms. On the other hand, NIMH staff -could answerquestions regarding the NIMH mechanisms and programsfor the Spanish speaking. In addition, the conferencewould give the Spanish speaking participants and theNIMH staff an opportunity to work out a set of recom-mendations to guide mental health planning.

These elements form the background leading up to theJanuary conference held in Bethesda. -Approximately-thirty Spanish speaking professionals and nonpro-fessionals came from twelve states and the Districtto meet with NIMH staff from each Division and fromthe National Institute of Alcohol Abuse and Alco-holism. Included in the proceedings are the openingremarks made at the general session by NIMH staffincluding Dr. Bertram Brown, Director, and the key-note address by TOmgs Atencio. It includes, inaddition, workgroup reports, recommendations andeach Divisions' response.

While this material reveals the substantive events,there were feelings expressed on both sides that

2

established the tone of the Conference. In previousyears, Spanish speaking constituents were reluctantto meet with NIMH until they could better definetheir own situations and-priorities. Further, manyof the Spanish speaking claimed a certain uneasinessin dealing face to face with an agency that theybelieved insensitive to the mental health problemsand needs of the Spanish speaking. On the other hand,NIMH staff, who are daily Confronted with requestsfrom various minority groups and from other highpriority interests, looked optimistically at theConference, but perhaps with some reservation aboutthe substantive results. One of the NIMH Spanishspeaking staff summarized these feelings in sayingthat the Spanish speaking participants and the NIMHstaff came to the Conference with "suspiciouslycommon interests."

Early in the Conference the Spanish speaking memberspresented to Dr. Brown a set of eleven demands re-questing change in NIMH's actions in relation to theSpanish speaking. The major issues dealt with-theappointment of Spanish speaking members to the GrantApplication Review Groups and to the National AdvisoryMental Health Council, the elimination of racism inNIMH staffing practices, and a bilingual and bicul-tural focus of mental health programs concerning theSpanish speaking. Dr. Brown summed up the demandsby defining the basic issue as one of gaining polit-ical power for the.j6'allocation of resources directedtoward programs for the Spanish speaking. Dr. JuliusRivera, in his remarks at the end of the Conference,concluded that "tbe minorities must establish a powerbase from which to operate in their efforts to affectdecision-making proceises."

This initial confrontation focused the feelings ofskepticism on the part of both groups. The Spanishspeaking participants proposed that the workgroupsessions be spent discussing their demands with theNIMH staff. While one workgroup did exclusivelydeal with these demands, the others discussed specificproblems in the areas of service, training, research,alcoholism, and drug abuse. The workgroups compiledspecific recommendations for NIMH action to meetthe special needs of the Spanish speaking in eachfield. A major point that was stressed throughoutthe Conference concerning these recommendations wasthat any provisions for change should involve both

3

the Spanish speaking constituants and the NIMH staff.One of the Spanish speaking participants summed upher assessment of the Conference as noting "someskepticism, some negativism, and some positivism"on both sides.

In the closing session, recommendations were madethat there be a follow-up conference involving thesame group, taking advantage of progress made atthis meeting, the first national mental health con-ference of representatives of the major Spanish speak-,,ing sub-groups meeting with top NIMH staff.

4

Agenda

Tuesday.-January 11. 1972

9:00 a.m. - 10:30 a.m.General Session

Chairman: Ralph Littlestone

Purpose and Expectations of the ConferenceJuan Ramos, Special Assistant to the Director,Office of Program Coordination, NIMH

The Conference as a Step Toward Program Planningin Relation tc the SPanish SpeakingHarry P. Cain II, Assistant Director for

Planning and Evaluation, NIMH

DHEW Health Initiatives Relating to SDanish-Surnamed AmericansArthur E. Raya, Special Assistant on the Health

Needs of Spanish - Surnamed Americans, Officeof the Assistant Secretary for Health andScientific Affairs, DHEW

Mental Health and the Spanish SneakingTomgs Arencio, Coordinator, La Academia,Dixon, New Mexico

10:30 a.m. - 11.00 a.m.General Session of the Spanish Speaking Participants

Chairman: Juan Acevedo

11:00 a.m. - 1:00 p.m.General Session


NIMH PrioritiesBertram S. Brown, Director, NIMH

2:00 p.m. - 3:30 p&a.General Session

Chairman: Juan Ramos

5

3:30 p.m. - 5:00 p.m. Workgroups

Mental Health ServicesAmelia M. Castillo, ChairmanMilton N. Silva, Resource

Manpower and TrainingRaquel E. Cohen, ChairmanIsmael Dieppa, Resource

ResearchAmado M. Padilla, ChairmanThomas Langaer, Resource

Special-Mental Health ProgramsMagdalena Miranda, Chairman..Robert Pega, ResourceTrinidad Pina, Resource

Alcoholism and Drug Abuse.Juan D. Acevedo, ChairmanCelia Dulfano, Resource

5:00 p.m, - 6:00 P.m.General_ Session


8:00 p.m.

General Session of the Spanish Speicing ParticipantsChairman: Juan Acevedo

Wednesday. January 12. 1972

Workgroups continued

1:00 p.m. - 3:99 p.m.General Session


Status of the Minority Center: Present and FutureJames R. Ralph, Chief, Center for Minority GroupMental Health Programs, Division of SpecialMental Health Programs, NIMH

6

Workgroup Reports

3:00 p.m. - 4:00 p.m.General Session


Response: NIMH Divisions

Division of Mental HealthService ProgramsClaudewell S. Thomas, Director

Division of Manpower and Training ProgramsBernard Bandler, Director

Division of Extramural Research ProgramsLouis A. Wienckowski, Director

Division of Special Mental Health ProgramsWalter M. Smith, Deputy Director

National Institute of Alcohol Abuse andAlcoholismKenneth L. Eaton, Deputy Director

Division of Narcotic Addiction and Drug AbuseRobert W. Carrick, Assistant Chief,Narcotic Addict Rehabilitation Branch

7

Conferencein

IlDersucctivc

Purpose and Expectations of the Conference

Juan RamosSpecial Assistant to the Director

Office of PrograM Coordination, NIMH

Tho two areas that I am going to try to express some-thing about this morning are the purpose of this Con-ference and our mutual expectations. This meeting isa step in an ongoing process that can be traced backas far as ten to fifteen years, but that has gainedmomentum more-so in the last four years. It involvesboth an external process that has been going on forsome time and an internal NIMH process that startedearly in 1971.

The external process involves at least three meetingsbeginning, as I.recall, back in micLor late 1969. Ameeting was held in Tucson, Arizona which brought to-gether a number of people from the Southwest and fromthe three NIMH Regional Offices in that area, Denver,Dallas, and San Francisco. At that time there was avery strong feeling that_Spanish speaking people oughtto get together by themselves to define the situationswithin their oWn communities, to try to develop someawareness and concern regarding this definition, andto begin to lay down the steps to do something aboutthese particular situations. After that meeting therewere additional meetings held in Las Cruces, in SanAntonio, and in other cities across the country. Again,the Spanish speaking expressed a strong feeling at allof those meetings that they wanted to get together todefine their concerns on their own terms. They feltthat bringing in non-Spanish speaking participantswould prevent them from dealing with the concerns andthe discussions at hand.

This meeting today is probably the first time that alarge group of Spanish speaking people from across thecountry has met with a similar number of NIMH people.There is a feeling that now the Spanish speakingparticipants have a clear idea or definition of theirpriorities for certain areas because of a number ofprojects and efforts that have taken place and becauseof some of the discussions that have gone on with NIMHpeople. We thought that now Spanish speaking partici-pants would talk with NIMH staff and come up with somefeasible and constructive programs. So then, the

purpose of this meeting is to work together in a co-operative way and through the process of negotiation,hammer out some proposals, ideas, and future stepsso that we can move forward together with the kind ofsupport that is needed both from within the Instituteand from outside.

The internal process that has taken place has involveda small NIMH staff committee and a number of consult-ant contractors that have done some work for NIMH.For example; Amado Padilla, who is here at this meeting,worked in the Planning Branch last summer. Two graduatestudents did some work in East Los Angeles while otherindividuals made some visits to some of the midwesternSpanish speaking communities. You will find summariesof their reports in your folders. So then, this meetingoffers, in terms of the internal process, an opportunityfor discussing those specific things that have been doneor are in-the process of being done here in the Institute.

Now, as-to the expectations of this C6nference. We havehad small meetings here in the Institute with peoplebrought in from the outside to discuss what could beexpected from this kind of meeting. We came up withthree main areas that vary to some extent. It was feltthat participants would come here with the idea thatthe Institute, because of its knowledge and expertise,has a workable plan for the Spanish speaking populationin the area of mental health. One expectation, then,is that people are coming to listen to the staff atthe Institute to learn what has been done by NIMH. Therewas another feeling that people in the Institute,which is located in Rockville, and in the Northeast,could not be sensitive to Spanish speaking concernsof communities in New York City, Florida, the Southwestor the Midwest. Because these NIMH people are thoughtto be insensitive, and unconcerned, it was then expected

-that outsiders would come in to sensitize the staff withtheir ideas abcut the needs of the Spanish speaking.A third set of expectations goes something like this:there are for the most part in-the Institute a numberof well-meaning, hard - working people that are veryconcerned about progress, the delivery of services tohuman beLlgs, and the eradication of institutionalizedracism. These people need to learn about the community'sperspective they know very little about. To accomplishthis goal would require participants to come in and getinvolved in the process of assisting and working together

10

with NIMH in a cooperative fashion to weld the insideand the outside interests together into some work-able plan that has an opportunity to be implementedand to see the light of day. It seems to me that thisthird kind of perception is what we would like to seeexpressed in this meeting. There are a group of peoplein the Institute, many of whom are here today, thatyou will find to be willing and ready to provide waysand means of relating to the critical issues that youbring before them and to work out, in a cooperativeway, efforts that will make a difference. Likewise,seeing &number of peopleilere,that have been involvedwith us in several other conferences, I know that youare ready to engage In this process in a constructiveway to come up with some suggestions that are workable.

I hope at the end of the two days, through the work-shops and general discussions, that we can come up withsomething that is feasible, that makes sense, and interms of your point of view, will make a difference inyour communities throughout the country.

11

The Conference as a Step Toward Program Planningin Relation to the Spanish Speaking

Harry P. Cain IIAssistant Director for Planning and EvaluationOffice of Program Planning and Evaluation, NIMH

Speaking for myself and on behalf of NIMH, I wouldlike to say that we are very happy that you are here.I had planned to keep these remarks short, and afterhaving heard Juan, I can keep them even shorter. Hehas said, I think, most of the things that I wouldhave said. I had intended to reconfirm the serious-ness that NIMH attaches to this Conference and allit stands for, but now I do not think that isneces-sary. If there are still pockets Of acepticism onthat issue, as I think there ought to be, you willhave to judge that issue for yourselves. From theperspective of prograM planning and evaluation inNIMH, which is the area of NIMH in which I spendmost of my time, I think it is essential- for ylu tosee that there is a lot of knowledge that we do nothave, that we need, and that in substantial partyou can provide by developing-the kinds of programsthat will appropriately respond to Spanish speakingpopulations. Incidentally, I have seen the severalpages of questions that you will be addressing in theworkgroups over the next two days, and if you cananswer those, I think we will have the knowledge thatis required.

I would emphasize another point. If we have agreednow to a partnership between NIMH and the Spanishspeaking populations, as I think we have, then thatagreement implies that there are very strong obliga-tions for serious kinds of performances on both sides.NIMH-has its own resources in substantive knowledge,in administrative skills, and in a certain amount ofclout on Capitol Hill and other places. None of theseis available, however, in sufficient power to achieveeverything that we would like. I think that theSpanish speaking have a lot to contribute. I knowthat in the area of clout that you are becoming sub-stantially stronger all the time. From our point ofview, this development is going to be helpful.

There is one further item I would mention. As aresult of some of the exercise of clout that you have

12

developed, it has become clear that although there isan appropriate concentration on Spanish speaking popu-lations, there is a lot beside language that ties youall together. It is also clear that you do not allspeak with the same accent. Since that is the case,it becomes incumbent on us to assure that we attendto every significant viewpoint that comes out of theSpanish speaking population, and we intend to do this.

Let me conclude, then, as I started, that we arehappy that you are here.

13

DHEW Health Initiatives Relating toSpanish-Surnamed Americans

Arthur E. RayaSpecial Assistant on the Health Needs

of Spanish-Surnamed AmericansOffice of the Assistant Secretary

for Health and Scientific Affairs, DHEW.

I want to bring greetings to you from Dr. Duval, theAssistant Secretary for Health, for whom I work, andwith whom my office has been developing broad.initi-atives in the area of physical and mental health onbehalf of the Spanish speaking constituency. It

would be redundant for me to tell you that onlyrecently have the unique problems of the Spanishspeaking communities been recognized. I am sure theissues, by now, are quite clear to you who are ex-perts in the fields of mental health. I know-youwill be addressing issues such as the lack of accuratedata; underrepresentation in health professions,particularly in the area of mental health; the lackof coordination of program development, not only onbehalf of the Spanish speaking, but, also, on behalfof the total under-served community; and the lack ofrelevancy of programs. Correcting these errors re-quires staff participation and includes buildingcultural and linguistic elements into programs. Theseare the kinds of measures, I am sure, NIMH is con-sidering.

As you know there is a commitment in the Office of theSecretary in relation to the Spanish speaking. The

Secretary has expressed that commitment a number oftimes as has the Assistant Secretary for Health. Andthis meeting here is a tangible demonstration of whatNIMH is doing on behalf of the Spanish speaking.

As Dr. Ramos indicated, there are a number of concernedpersons within the NIMH structure. Many of theserecognize the problems and are planning and developingways to resolve them. Because NIMH is much furtheralong than other agencies, it has been much easier forme to relate to this Institute. We have received,certainly, some very positive response and are lookingfor the kinds of efforts that will make mental healthservices relevant to the Spanish speaking communities.I think this effort is in good hands.

14

In addition, in developing broad initiatives ir. theentire area of physical and mental health, it is againa pleasure to meet those of you here who are experts.There are a number of things which are underway nowwhich will need your support if, in fact, there is tobe a successful outcome. We are in the process of pre-paring in final form a rather comprehensive documentidentifying the major issues in health including recom-mendations for the Assistant Secretary. Dr. Ramos,incidentallyhas been working very closely with us onthat report. As a matter of fact, we met yesterdayregarding the final draft.

Another upcoming event which will be of interest toyou is.a conference to be held later on this month inSan Antonio where we will address the health needs ofthe Southwest. NIMH has been extensively involved inthis conference and Dr. Bertram Brown will make aformal presentation there. We plan to address themajor areas in the mental health programs in our work-shop discussions. And so the outcome of that confer-ence will be an important,documentation that we willshare with yoU and hope that you will support.

Another item-of interest is that, as-part of theeffort to develop linkages of communication betweenthe Spanish speaking community and the Office of theSecretary, my office is publishing a newsletter.Only the first issue has been released, and it in-cludes mostly personnel items and a few brief des-criptions of program activities within FDA, NIH, andHSMHA that are in some way affecting the Spanishspeaking. We did have some trouble in identifyingmaterial but hope that it will not be so difficultin the future.

Yes, there are many things happening. There aremany initiatives being developed, and I hope thatyou will have success today and tomorrow in identi-fying those points that will make mental health pro-grams more relevant to concerned Spanish speakingcommunities.

15

Status of the Minority Center: Present and-Future

Division of Special Mental Health Programs, NIMB

Center for Minority Group Mehtal Health Programs

James R. Ralph, Chief

First of all, I would like to tell you that the Center

for Minority Group Mental Health Programs is not the

Center for all minority problems or affairs within NIMH.

I think. this is obvious when'you remember that the

Center-has a budget of only $3 million while the entire

NIMH budget is something close to $600 million. So,

you can see that the resources that we have for minority

affairs, of course, cannot begin to deal with all of

the problems. However, the Center can and will serve

a-very important and significant function within NIMH

.by being an in-house minority advocate and consultant

to encourage other areas within NIMH to spend their

money more effectively in terms of the needs of minority

people.

-I understand that there are many negative ideas cir-

culating throughout the country about the Minority Center.

I would like to take this opportunity simply to tell

you the facts about the Minority Center. As-you know,

the Center officially came into being July 1 of this

year. I am the Center's Chief, and my background is

in psychiatry. In additioh to my position, we have six

other staff positions. At this point we have aBlack grants clerk, a Cuban secretary, and a Black

psychologist who serves as the Executive Secretary. We

have two other positions which are it the process of

being filled. One will be filled by a Mexican American

social worker, Mr. Valdemar Gonzales. As you probably

know, he is an associate professor of social work at

Sacramento State College. He will have the position of

Assistant Chief of Social Work Programs, and will be

concerned with social work programs pertaining to all

minorities. The other position will be filled by Mary

Harper, a Black registered nurse as well as a Ph.D.

sociologist. I felt that it was quite important that

in the beginning we acquired a broad representation of

the behavioral sciences on the staff. By no means is

the staff complete. We plan to have representation

from other minority groups. I have been informed that

by the beginning of fiscal year 1973, we will have three

additional professional staff positions. At that time

we will be able to bring in other minority representa-

tives on a full time basis.

16

Now, I have heard many criticisms that my immediatestaff is weighted too heavily toward Blacks. This istrue. But as we are constrained in the first place bylimited positions, it is very hard to cut the pie tosatisfy everybody. My own conviction about the Centeris that I am not here to win a popularity contest oranything of that sort. My staff And I have some verystrong feelings about truly representing minoritygroups. We cannot please everybody at the same time,but our intentions are to do so. In my estimation,we have very good minority representation. I thinkthe Initial Review-Committee of the Center is a goodexample of this representation.

The committee consists of fourteen members. It is anad hoc review committee at present. Certain paperwork is required before it becomes permanent. Of thosefourteen persons serving on the review committee, sixare Black; four are Spanish speaking; two are AmericanIndian; one is Japanese American; and one is ChineseAmerican- I would like to take a moment to point outour Spanish speaking members. We have present today,Mr.'Ismael Dieppa. Miss Deluvina Hernandez, 'h Ph.D.candidate in sociology at the University of California,is_anothbr member. Dr.. Edward Casavantes, the founderof Psychologists de La Raza as well as Dr. VictorBernal Del Rio, Puerto Rico's senior psychiatrist andpsychoanalyst are also members. So, I,think, by nomeans have we avoided or neglected our responsibilitiesas far as the Spanish speaking people are concerned.

Let me tell you briefly, what the basic projects ofthe Center are at this point. First of all, in plan-ning the Center's program, I decided that we wouldplan from the outside in, rather than from the insideout, as seems characteristic of so many Federal agen-cies. Often times people sit inside these Federalbuildings here in Washington and plan for programs forpeople on the outside. I am going a different route.We decided to have four separate meetings, one eachfor Blacks, Spanish speaking, Asians, and rndians. Themodel is this: I will ask the chairmen of the nationalbehavioral science groups to serve as my planningcommittee for the meetings. For example, we willshortly have a meeting for Spanish speaking people. Iwill be asking the chairmen of the sociologist, psy-chologist, psychiatrist, and social worker groups toserve as my planning committee. I will ask them forsuggestions and recommendations regarding the Minority

17

Center's program in relation to Spanish speaking people.I will ask, first of all, for recommendations of peoplewho should be involved in this meeting. We have fundsthat will allow us to bring in forty experts, both lay

and professional. These experts will be named by the

planning committee. The format, the style of the meet-ing, the location will be determined by this advisorycommittee. We have already followed this process inregard to the Blacks and will use it for the Asians and

the Indians.

Secondly; we decided tkRt in order to determine wherewe should go as far as mental health affairs is con-

cerned, that we should find out where we have been.Along that line, we are developing contracts for anno-tatdd bibliographies of literature on minority mental

health concerns. We have already given out a contractfor the Spanish speaking bibliography which Dr. Padillawill be doing for NIMH. This will be-a comprehensivereview of the mental health literature related to theSpanish speaking. The editions w:11 appear in Spanish

as well as in English.

Another project that we are working on right now isthe development of a roster of mental health profession-

als. We often hear in the Federal government, "Wewould like to have a Chicano social worker, but wecannot find one. We would like to have a Spanish speak-ing psychologist, but we cannot find one." Well, this

is just an excuse. And it will be very difficult touse that excuse when we have a roster which will becomputerized and kept up to date indicating the qualityand quantity of minority professionals in the mentalhealth field.

We are also instituting a minority scholar program.We will be employing Spanish speaking, Black, Asian andIndian students to join our staff on a temporary basisfor 365 days minus one day to do special projects.

So, these are some of the things we are doing now andplan to do in the future.

18

Mental Health and the Spanish Speaking

La Academia Dixon, New MexicoTomgs Atencio, Coordinator

It says here on the agenda that I'm supposed to talkabout "Mental Health as Seen by the Spanish SpeakingCommunity", -We-haVe-a-saying-in Old Mexico, "Aunquesea del mismo barro, no as el mismo bacin que jarro."So I don't know whether I'm bacin or jarro, but I doknow that I cannot speak for everybody in the Spanishspeaking community. I can only speak for what thisparticular head perceives,. Some people perhaps expectthat I'll be talking about el barrio. Well, I don'tcome from el barrio. I live in a beautiful village innorthern New Mexido. Every now,.and then I go toSan Antonio-to work with the outreach program there,and sometimes I go to work with .COPAS, a communityorganization in Santa Fe. But I will have to speakfrom my point Of view, and you will have to sift throughmy perceptions to see if they make any sense to you.

I want to divide this presentation into three parts.First, I want to describe the kind of work I'm doing.That part looks like a political- speech, but este es elarlo del marrano, the year of politics, and everybodyis going back to la canoa. I can't translate that. I

heard someone say it means trough. That comes fromone of our friends up in the mountains. I guess sinceI'm at the canoa too, I'll have to respond to this par-ticular year. And then I'd like to outline same ofthe problems that we have such as malignant concern.That expression is a take off from the egghead atHarvard. Finally, I'll talk about some of the direc-tions we should be taking.

Most of my work is dedicated to developing a body ofknowledge which reflects the experience of La Raza.Although I consider myself a Chicano, I suppose it'sbetter to say I'm an Hispano-Americano from New Mexico.I don't have much Indian in me except I was born witha spot on my cola so I guess that makes me an Indian.I can't deny that. But somehow they have called usHispanos. Well anyway, my work consists in borrowingfrom the great pragmatists who say that knowledge isderived from experience and from action. We Hispanosagree with that statement, but as we look around we

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find that our body of knowledge has been derived fromsomebody else's action. This creates, Problems. I

don't mean that we Latinos have to accept pragmatismor John Dewey as our god, but this is just the way itends up. I hear people say, "As our forefathers pushedwestward..." and things like that. This doesn't makeany sense in terms of where I come from. This justisn't my experience.

So as we begin to analyze this kind of inconsistency,we finally reach the conclusion that perhaps we do Ilavea different body of knowledge that we must derive fromour own experience. How,then,_do we go about findingit? I'm un poco loco, you know, and I decided that thiscan't be done under the auspices of anybody else,because it might turn into malignant concern or turnour virtues against us. We have to-do it ourselves andgo into the field to find out what is really el oro delbarrio, what is really the wisdom of the people, whatis really the chemistry which has allowed us to survivethese many years with the kind of conditions that wehave had to live under. What is it that affords ourpeople the-ability to be able to exercise their owntype of therapy or in some cases hydrotherapy? That'swhat was used in Mexico when-someone had la melancolia.They used to call it the T's T's was associatedwith T.B., tuberculosis. The whole thing was all mixedup. -And a person who suffered from la melancolla wouldcome out the door and le voIteaban una culeta de aqua.They just poured a bucket of cold water on him, andthat would cure him of la melancolfa. I don't knowwhether that means anything. We also have herbs thatwe use. We have mild sedatives that now everybody elseis using in cigarettes. But they use them for a dif-ferent reason: to waste time.

We also have other experiences which come from our oralhistory, our traditions, and our folklore. At thepresent time, we are developing el concepto de picaresco.El pfcaro dates back to Lazarillo de Tormes in Spanishliterature and to La vida indtil de Pito Perez inMexico. I've just developed a paper for a Detroitmeeting based on this defense mechanism, la vida delpicaro. It is an important mechanism for survival butis usually considered as a sociopathic type of behavior.So, I find in the kind of work I am doing even Pedrode Malas, a very common character in New Mexico folk-lore, is really another plcaro. Picaresco as well asmachismo are elaborative ways of working out problems

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in an oppressive society. The picaro is a guy who isable to use his master's technique to screw himself.In an oppressive society that is the only way you cansurvive. So, perhaps we just ought to make everybody acommunity pfcaro. These are all important latinodefense mechanisms.

My work, La Academia de La Nueva Raza, is based on theconcept that, an ideological approach to education isnecessary. This old idea of pouring in and pouringback, a banking kind of education, leaves the oppressedperson or the minority person in the position where heis always looking at somebody else and getting from himand giving back to him for acceptance only. He neverreally develops his own identity or his own way offinding his health. So La Academia is engaged in aprocess of collecting a body of knowledge and of turningthis body of knowledge into an educational process. AndI think this process is applicable to the mental healthand social service fields. For too long we have beenworking around an adaptation-adjustment model - anadjustment and adaptation to.what? I think that as webegin to look at what we are adjusting to, we willrealize that becoming middle class is not really oursalvation. Finding a way to live within the structuremight not really be the answer. So we are trying tofind some way of developing a body of knowledge, para-doxical as it may seem, that reflects our experience,our life style, and our identity. And then we mustturn this body of knowledge into an educational pro-cess or a process of "concientizaci6n. to develop ahumanity -- or better, to rehumanize humanity.

While we know that racism is one of the greatest prob-lems in mental health, I think that the oppressivecolonial aspects that created the conditions in ourcommunity must also be examined. We also have to lookat the homeopathic type of medicine that comes down thepike. This is the kind of medicine that causes theillness it is supposed to cure. Then there are thedelivery systems that often act as weapons and notsources of cure. The target is usually the guy outthere who is receiving the services. He thinks he isgetting cured, but maybe the services are just weaponsmaking him worse. All of these things go into makingour body of knowledge.

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40.

I mentioned at first the idea of malignant concern. Too

often foundations and government agencies are not able

to relate to counter-institutional models which crop up

in the barrios and the communities. The big agencies

can't relate to these counter-intitutional models be-

cause they are not able to send in the kinds of reports

and other bureaucratic stuff that are necessary. As a

result, NIMH and other government agencies can relate

only to institutions which we don't have. If that is

the case, then could it not be -- and I raise the

question -- that the same system which has been part_of

the problem is now trying to be part of the cure? Bk.

getting a body of knowledge, we are beginning to avoid

many of the cultural value conflicts that could occur.

I try to deal with this issue in social work by analyz-

ing the body of knowledge which underpins social work

education. If I really were to follow these value con-flicts all the way down, I would be the biggest iacist

and oppressor- of all. I think we have to look at this

problem to and I frankly don't think that the insti-tutions can look at it accurately. This is why I

decided to start La Academia.

You know, it is very interesting to note the interest

of organizations, such as WICHE, that all of a sudden

have become interested in Chicanos. That's fine, but

I remember when I got into a WICHE thing back in '64

when I was organizing ditch associations in Old Mexico.

In Mexico we have ditch systems for irrigating our land,

very small plots of land, and we found that the best

way to work with mental health was to work with thesocial structures that were indigenous to the people.Then I didn't see any interest from the organizations

that have all of a sudden become interested in getting

into the socioeconomic and political factors of mental

health as they affect La Reza. So, I think we see the

handwriting on the wall. Cuando se caiga la gguila,

you know, when the money comes down, there are various

groups that are interested in getting into it. We've

got to look at some of our own diagnostic approaches,

some of our own problems, and some of our own ways of

looking at life by going through these intermediarygroups. But I don't think this process is the way to

get at the real problem. Pero como les dije, I'm notspeaking for the whole shebang, and I'm not talkingabout el barrio because I think you have enough peoplefrom the barrio who can talk about that.

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What do you do when you accumulate a body of knowledge?You can begin to translate it into power. I think oneof the greatest sources of power is information like aparticular body of knowledge. And it makes me verynervous to see that I am giving all of this to NIMH,whether it is good or not because I'm not sure-if itis gmng to get back down to the people. There mightbe a hustler here who might put some of this informationinto a proposal. Who knows? I know for sure I can'twrite a proposal. As you begin to translate this bodyof knowledge into power, then you can begin to develop

. a kind of system for allocation of resources that willreflect the condition of the people.

For example, I'll talk a bit about drug addiction andalcoholism. I think these are probably two of the bestillustrations where indigenous resources and indigenouslife styles can really help. Can you imagine using aservice system that is modeled after a mental healthclinic or a welfare department or a hospital in workingwith a tecato. You wouldn't be able to do anything.Another thing is that as you begin to develop thesekinds of problems with groups like these, you get rightback to one of the greatest defense mechanisms of LaRaza which is el picarismo. These groups too recognizethe hypocrisy of the society and se cobijan con la mismacobija. You know, you cover yourself up with the sameblanket that covers up the hypocrisy of the wholeAmerican society. You have all kinds of problems ifyou try to use the models that have always been there.They just don't work. And if these models don't workwith the tecato and the alcoholic, why should they workwith anybody else? This is a very pragmatic way oflooking at the whole aspect of service delivery. Arewe going to be just using indigeneous types of programsonly with those who cannot be reached any other wayor are we going to learn from these programs and gen-eralize them?

In Santa Fe about a year and a half ago through COPAS,Corporacion Organizada para la Accion Servidora, wemanaged to use the 25 percent of model cities moneynormally used for day care, to develop a day care pro-gram as well as a mertal health program. There is noNIMH money in it because we managed to find a loopholein the law and took the money out of Title IV SocialSecurity. So, we have Welfare, Title IV money support-ing a mental health program which is geared to preven-tiveas well as rehabilitative types of programs. We

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can do the same thing with drug addiction. And there

are ways to begin to tap those sources. We haven'tlooked at NIMH because they don't have any money orCOPAS can't write reports or something.

In the area of training, interestingly enough, when thecollege in Santa Fe saw that there was something goingon, they were the first to apply for their training

grant. And they got it. I boycott this effort per-sonally because I don't want anything to do withinstitutions that all of a sudden grab onto ideas thatare being developed by the grassroots community. This

training grant was an experience in constituency planninggood or bad, whichever the case may be. The people were

saying, "These are our problems;- This is the way wewant to solve them. We want to examine el oro del

barrio. Is there something,-in our community whichmight be healthy? Nobody else has ever taken that

gamble." O.K., so in six months, the Welfare Department,who was the contractor, assessed the project and said,"You have been at it for six months, and you stillhaven't cured the barrio." Well, you know, the WelfareDepartment has been screwing up the waole situationsince 1935, so it could give the barrio community atleast half that time to do a better job.

We Latinos are faced with a difficult task. First, we

have to develop the body of knowledge, and then wehave to begin to recycle it. And it doesn't come de

volada, you know. It takes a while for it to happen.It's the same thing with the work that I am doing atLa Academia in San Antonio with some of the guys aroundthere. We are trying to find a method of using"concientizaciOn" as a mental health process or as asocial service process in the planning, prevention,and rehabilitatidn aspects. Now, we don't know howwell we will succeed in getting into this. We arehoping to have a meeting in March to see if there is away this educational approach can really be just assuccessful as the adjustment model that we have beenusing. It's like when you get together with La Razapeople, at least Chicanos, and you try to use a T-groupapproach to help them express their feelings. Youdon't need that. If anything, yuu need to help them

control their feelings. I would like to see theT-group guys use our approach. Just recently I was inSan Antonio with a National Training LaboratoriesT-group guy who was working with an interstate researchassocle.tes group, a Chicano consultant firm. I wish

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Thad had a tape recorder so I could have analyzed themeeting to learn just how not to work with La Raza. Sowe are getting a big body of knowledge that must bereJycled. I am suggesting that these are some of thethings that are necessary for us to be able to weaveour blanket and to change things. We've got to get ourship together. Dejemos el serape.

You know, throughout the whole discussion, I have beentalking about the idea of oppressed and oppressiverelationships. Now many people don't want to look atthis. Maybe it is rhetoric. Maybe we have changedfrom racism to rhetoric, but I think it is, at leastfor the area where I come from, still quite importantto look at racism. You know, we Latinos are part ofthe vanquished. I don't know how the rest of La Razafeels about it, but my ancestors didn't ask to come toNew Mexico years ago. They just happened to be there.Somebody just planted them there.

So it is important to look at all of these differentaspects and pick out the kinds of techniques andmethods that might be useful in programs today. Now,I'm not suggesting that we discover the wheel all overagain, because we know that there are some universalaspects of a body of knowledge already available thatwe don't have to rediscover, but I think we have torediscover what is part of our own experience. Therehas to be a way to do this. I know that the WelfareDepartment alone has enough records to give you anidea how a personal experience through profound anal-ysis of the social and economic situation can begin tohelp people to deal with this problem. In mental healthalso, personal experiences can begin to help people.Just as you would look at these experiences in apsychoanalytic way, you could also look at them in alearning way and make a profound analysis of thoseforces that have been impinging on these peoples lives.And I haven't seen this happening. I've seen a lot ofproblems with national programs and federal agencies,including NIMH. We have had several meetings where wehad to play the old Chicano versus the Anglo trickwith NIMH. And I'm tired of that because it doesn'tdo anything to help my mental health. I'm perfectlyall right now, you know. It is not NIMH's fault/ itis the way the system is made. Now, the Latino playsthis game in research and training, and siempre salecola. You know what I mean? He comes out in the endsomewhere. Maybe that is fine, except that these

25

institutions are modeled after that body of knowledgewhich is not from our experience.

That's fine. But on the other side of the coin, we,know that bodies of knowledge can be myths too. I

remember when I directed the Colorado MAYO Council,under a myth and said that there were_uch things askinship crews. The anthropologists were going crazytrying to find them. Se los llevd la fregada becausethey couldn't find one. Finally we found about 10percent. But it was a way to get money, you know. Soit's easy. That can also be a myth. So you can continuerelating to the institutions, and they can continue tolend you reports for you to put together. You knowwhat I'm talking about. sPara qu4 le pego mAs? Youuse the community cooperation for services as a tool.For example, we have used model cities in this mannerbecause it opened a way for us. But the problem here

that the expectations of the agencies are very high,as I mentioned earlier. They expect this grass rootseffort right away to resolve the problems that havebeen created over a period of years and years. Well,

I'm interested in this. But as I said este es el agodel marrano so I'm at the trough too.

So what is it that we're looking for? Is there anyoro in the San Antonio Outreach Mental Health programswhich has NIMH money as well as some very good Presby-terian money? Is there any oro in Santa Fe or is itpart of the myth? I really would like to find out.Naturally, we use el oro del barrio concept, but do wereally know if there is something there? We getevaluation teams coming in from hustling consultantfirms and, you know, these guys act just like themiddle-class patron. But what else do you have toemulate, except the system itself. We just have to getinto our own oro and begin to look at the kinds ofprograms that are using the indigenous structures totry to find a way to reorganize life for a healthiersociety. Many times the considerations for fundingare very politcally motivated. And least of all,people in health ought no to be concerned with suchthings. But probably the people in NIMH are forced toconsider politics because they have to deal with theHill. Then there are some people who are not concernedwith the political motivations or the political aspectsbut decide whether to fund this Chicano or that Black.The hell with that. There are all sorts of people outthere suffering, and I've already pointed out from my

26

point of view what we need to do. So if taking care ofthese folks is important from the point of view of aperson committed to the health of a society, let's for-get the political aspects, let's forget the partisanpolitics, let's forget the racial politics.

I have just seen a letter here concerning a L. A. groupwhere the whole issue concerns the emphasis on Blacksand their control within the minority group. I knowthat very well in my awn efforts in dealing with thePresbyterian Church that this is a political issue thatis creeping more and more into the whole aspect ofinter-minority relationships. I am not a minister, butI am a very good Presbyterian. I'm predestined to be

sane. The Chicanos say ":Que-bArbaro, pues el negroagarra a todo:" He has the institutions; he has thecolleges. The Chicanos have no colleges, and maybe wedon't want colleges -- I don't think we do. We want

Academies. It gets the colleges bankrupt, too. It is

going to take a while to sell the AcadeMia conceptjust because of the way the American society runsitself. Once it pollutes the earth it will go to Mars,and someone will find a way to live on Mars. Thenthese Anglos will say, "O.K., Chicanos', you can havethe earth now." That is what they have done with the

colleges, too. They screwed them all up and then said,"O.K. guys, now you can have Chicano Studies." I don't

think this is paranoia. This is basic reality. En mis

locuras, I get far out_ on these trips. I can see it all.Space buses taking gabachos to the moon, and fihding away to live out there, and then saying, "O.K., nowyou can have the Potomac." That's what has happened

with institutions. So Chicanos have to form counter-institutions. We cannot emulate and mirror the sameinstitutions in the American society. To change allthat,we need to do our own research.

I got in to the technical language a little bit a whileago, and that is another problem. Now, the technicallanguage and the technique are very important. I was

talking to a man from Colombia a noche about one of thefellows I relate to in Colombia who is a sociologist.He may be a revolutionary, but others O.: are morerevolutionary than he is say he's not. But he is agood sociologist, I think, and he comes 4;7"e" with theconcept of a balance between the Utopian , ims and

technology. And I think we really have 1.o look at

thia_idea. Just because we are La Raza and are peoplewho are using indigenous efforts, it doesn't mean that

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we are not interested in technology. I thi:.k it is thatbalance which allows us to use technology in such a wayto bring about something like a marriage between themystery and the technique. We can call it a "misteco",something that brings about a balance between the Uto-pian dreams of minority people and the use of technology.And for that we've got to begin to control something andbegin really to look at our knowledge.

It is really funny when you talk about the power of thepeople. Ya me estoy poniendo viejo, pero at thirty-eight I know what it is all about all of a sudden.Before, it was rhetoric. How did I find out? Throughthe "concientizacion" method that La Academia hasdeveloped. All of a sudden by talking to a person whorelates his story, oral history or folklore, you beginto find the insight that people have. "No pues, we lostthe land grants because of the politicos. The politi-cians did it." O.K. I hear that no hay politicos hoy.Oh, yeah, there are politicos today, but they aredealing in other areas like welfare,-health, estampas,food stamps, things like that. I guess all of a suddenyou begin to find that the people do have a hell of alot, and somehow we have lost it. That's el oro delbarrio and that's also power to the people, and all ofa sudden it clicks.

It's just like Pacheco, a mythological character wehave in Mexico. He is the guy who says, "Me dijo elloco en el hospicio que no son todo lo que estan y noestan todo lo que son." I can't translate that. Butanyway, we're all a little crazy and we are all a littlesane. Pacheco also says that the reason we need tohave our own body of knowledge es que "Cuando yo lesdiga que la burra es parda es que traigo los peinos enla mano." That's empirical. When I say that the barrais gray, it is that I have the hairs in my hand. Andwe've got to be able to say that. And we are saying it.But I guess we are talking about el a& del marrano andmaybe some of us are concerned with resources. MaybeNIMH is more concerned than we are. But anyway, what'simportant, I think is the relating to individuals andto groups who are concerned with the use of technologybut also who reflect their identity and hold on to thatUtopian dream that things might be better someday. Thisis where you get, again, into the oppressive colonialaspects of society. Some Chicanos, at least those inNew Mexico, are yen, concerned not about the benignneglect, but al--)ut the malignant concern. It could be

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that if we don't control our information that our virtueswill be turned against us. You've got to keep pushing,you know. For every loco in the barrio thinking newways of succeeding, there are ten B. F. Skinners makingsure that you make it or else you'll fall down wherethere are about twenty McNamaras.

So I think it is important that we begin to control ourinformation to develop our power. We have to create theknowledge upon which we base our actions and to discoverthe normsby which we define our behavior. So we canuse these methods very well in such areas as constitu-ency planning. This is how I got tied to NIMH. I was

starving-to death up in New Mexico, trying to get LaAcademia going, and Juan asked, "How would you like todo a job?" I said, "I'll have to sell out." So I sold

out for a while. Well, I still sell out. I am avendido, not a comprado. When you sell yourself, youset the price, but when they buy you, eQu va a hacer?It's only a figment of my imagination that I'm reallystrong. I guess I am & comprado too. Who isn't?

I just wish to summarize what we have to do. We have todevelop our body of knowledge, use counter-institutionalmethods to do the research-and the training and thenmake use of the total barrio experience. Since I'm notfromthe barrio I can't tell you about this last part.Ask Rogelio Chapa and other people who are here aboutthat experience and the viability of that experienceand how really to put it together.- And then we can usethe techniques that come from the wheel that was invented

.by someone else. We can combine all this knowledge inthe whole effort of constituency planning. I think thatis where it begins. I think it begins by discoveringhow the people themselves view the world, how the peoplecategorize their illnessess.

I just want to show you some of these categories, andthen I will sit down and let you weave your own blanketde un modo o otro. I was talking to this bato and hesaid, "Oh, I know this guy, and the other day somebodybumped his car and hit his fender." He said the guycame out of the car, picked up an ax and established asymmetrical balance on the other side. So I asked thisguy, "eQue tiene este-bato? What's the matter with thisguy?" And he said,,"Est loco y poco pendejo." Now Iunderstand that pendejo to Cubans is something else.See, that is why you have to get your categories straight.To us it's just foolish. That's all.

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Well, anyway, another guy's wife had a tumor, an ovariantumor and after ten months, the husband finally told her,"No esta eMbarazada. You can't be pregnant:" But shecontinued waiting. After two and a Half years she stillhad the layette and-was waiting for the arrival.. So Iasked the guy, "What is the matter with her?" He said,

"Esta loca y muy pendeja. She is crazy and extremelyfoolish."

Now these people are considered desprovista de ganado.You know, they're lacking their flock. Well, what doyou do about them. "No mas to cures y miras de que lapata cojea." You know, you just kind of sit back, andyou understand that these people have a problem and thatthey have lost their goats, they have lost their flock.The differentiation is that one is poco loco y pendejoand the other is very pendejo. You know, very foolish.Well, what do you do? Well, you take the woman to thedoctor. What for? To remove the tumor. Then whathappens to her illusions or delusions? Ya se acabo.Empirically it's all over.

Then there was anotbg" case. We have a tradition inthe Hispano community where we go out and sing LasManuelitas on New Year's morning. We get out with theguitars and sins to los manueles, and then we sing tothe other people. When you go into a house, they offeryou something. Some people have good booze, and somepeople have bad booze, and by the time you are throughwith about seven houses, ya andas que....You can't hold the guitar and you don't know what todo. So, this one guy lost his goats, see, right away.He was a raquinto player. We needed him very badly.And all of a sudden se le tiro otro a ese bato. Andthen he said, "You've been looking at my wife" Well,the wife had no business dando los dies. But somehowshe wanted to break the tradition. You know, women'slib and all of this business has been encroaching intoour culture, too. And before we knew it the guy hadbroken a bottle, and he was out there really trying torallarle el disco. So being a mental health guy aswell as a bato from the village, I said, "z0u4 va?What do we do?" Well, the other guy decided that theonly way to cure this cat was to go get his gun. So

he went for his gun. After a while, we went over andevaluated the whole situation. The guy who had run forhis gun said, "You know, this guy has to drink to expresshis feelings. He is always afraid that someone willlook at his wife." So I asked, "What's wrong with him?"

30

And he answered, "Ese bato estg loco y tonto. He is

crazy, and he is also violent." Well, how do you handle

this kind of guy? You must be careful. The only thing

he understands is a few shots fired around him. Fine,

so that's what goes on.

Then we have this other situation. This guy would not

drink water from his own well. He would walk six miles

to get his water. Finally, he got so scared and para-noid, to the point where he felt that he couldn'teveneat the food that was being brought in. He was kind of

a recluse, you know. That is what we called him anyway.

I think the doctor called him paranoid schizophrenic,

or something like that. Anyway, this guy keeps going

for his water. Finally, he can't take any food. So he

cleans each bean individually with a towel. And he pre-

pares his own food. And I asked, "What's the matterwith that guy?" "Oh, that guy, estg loco...loco loco.Youknow, he is out of contact with reality." So I asked,

"What if some day he thinks that you are going to pickup the gun and go after him? Then what would he do?"See,he is already setting up his whole defense system.And this guy says, "At that point, you just watch himand you understand that you cannot encourage his fear.But you just go along with him?" Then he added, "Butthe problem with a guy like that is that if you treat himfraternalmente, brotherly like, and go along with hislocura, with his cabra that went away, then the guy willprobably not develop to that point. You don't encourage

his fears. If he says he is not going to eat, don'tinvite him to eat. If he cleans each bean individually,

let him do that. And then he will never grab a gunbecause, you know, it will subside."

So, tenemos in our culture, where I come from, our owndiagnosis, our own diagnostic terminology. And that,

as crazy as it looks, is part of our body of knowledge.And if el bato este desprovista de ganado, if he haslost his flock, that is just the way it is. If he is a

little tonto or safado above that, you know, then youdeal with that accordingly. And if he's pendejo, NewMexico style, then you deal with that accordingly, also.You try not to do anything to encourage the fear.

As I was doing this the last couple of weeks, I wasthinking how you just take things for granted. You haveyour own technical language and your own method ofdescribing behavior, and somehow you forget that thereis a big gulf between the way that you describe the

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behavior and the way the people themselves describe thebehavior. And the way they describe the behavior isvery important because their description also offersways of solving whatever problem is there. So I thinkit gives a lesson, that maybe it is O.K. to go alongwith el loco del, hospicio and understand que no sontodo lo que estan y no estan todo lo que son.

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NIMH Priorities

Bertram S. BrownDirector, NIMH

This morning I have just two or three minutes of

half-prepared thoughts or perhaps five to tenminutes of thinking out loud. I suspect it will be

most worthwhile, however, to spend most of this timelistening to comments that you can bring to my atten-tion and that will be of interest to everybody here.

I think the most important thing about this Conference

is that it is taking place. I suspect that it is,

perhaps, twenty Years too late for NIMH finally to be

having such a Conference and perhaps a hundred years

too late for the country to be taking such steps.

When there is this-length of procrastination and delay

in doing what is necessary, there are inevitably many

problems to be faced that have built up during that

time. I think that dealing with these problems that

have arisen in the twenty years of delay or the century

of oppression are perhaps the most challenging part of

the task placed before us.

Now, I am here for two reasons. One of them is symbolic

and the other is substantive. I am fond of saying that

there are two types of people in this world, those who

divide people into two types-and those whb do not. So

when I say that there are just two reasons why I am

here, that statement is a simplification. Symbolically,

I am here because I wanted to express personally my

interest, concern, awareness, and sincere desire to help

in the challenges we, the NIMH staff, the Spanish speak-

ing populations and others, have together. The substan-

tive part of my presence involves learning. I mean that

not only just in the sense that there is much that I

do not know, but also in the sense that I think we have

much to learn in order to interact with each other well

enough to be helpful to each other.

An illustration of this task might be in the area of

language. I have often been fascinated with how close

language is to basic thinking and culture. There is

a very famous hypothesis in anthropology which essen-

tially says that language itself expresses the basic

ability to think. For example, there are certain lan-

guages which have no words for our prepositions "before"

33

and "after". These languages have no cause and effect.Such differences in language and culture show up in act-ual diplomatic work. I know in Spanish the clock some-times walks while it runs in English. It becomes pos-sible to look at a language and to begin to see certainsubtle differences of how time feels as seen throughthe language. This is surely the case with Spanish.And to complicate matters in this language, there isno simple stereotype among the Spanish speaking peoples.I,have become aware of the large coalition of all sortsof Spanish speaking people: Puerto Rican,,Cuban,Chicano, Mexican American, Central American, SouthAmerican, and Spanish. Each of these groups has a dis-tinct vocabulary expressing a somewhat different cul-ture and way of looking at things. We have much tolearn to understand eadh other if we accept this hy-

pothesis.

The most important thing that I have to offer to thegroup, I think, comes out of my experience in dealingfor ten years with the raw reality that the name of thegame is politics. So in that sense, I think that thekind of conversation that goes on at coffee breaks andat caucuses is of real importance. For example, ifthis were a meeting to elect a President or a Governorhow would you turn it to your advantage to get thekind of resources that you need: I think dealing withsuch issues as the pplitics of the situation, be itpresidential, state, local, or NIMH politics, is theonly practical way of looking at any given situationrealistically. This political frame of reference isone that I also think gets at the most fundamentalissues.

'For example, one of the things that was very hot atthe time when I became Director of NIMH was a vigorousissue over decentralization. There were such questionsas whether the Federal government would decentralizeto the regional offices and what would be the roles ofthe regional offices in the states and so forth. This

issue around decentralization was started not in thecurrent administration but in the past administrationand has both a "good" and a "bad" side. The goodside concerns those who are sincerely trying to get"government" closer to the people so that citizensfeel they have a voice in their own destiny and canbe personally involved in making decisions. This isthe very healthy, democratic, decent, human side ofdecentralization. But there is another side, an ugly

34

side that cries out to weaken the central structuresthat are really trying to do things for people. This

side wants to weaken those central structures that havepolitical clout and knowledge to get money. Here thepolitics of the situation is critical. It influenceswhether individuals get the resources they want andwhether they deal with staff in the central office, inthe regional office or in their local community. In

the last few months, I am pleased to say that the de-centralization issue has settled down to where itreally counts. Citizen r:rticipation is occupying theinner sanctum of the decentralization issue. For ex-ample, here are some of the questions that are beingasked: What are the minimum requirements of citizenparticipation? In giving out money, what obligationdoes the Federal government have fo consider citizenparticipation? What are the rights of grantees? Whatare the rights of the community in dealing with therecipient of a grant? The decentralization issue isnow dealing with its basic, ultimate intent which isto involve citizens in their government and to listento their voices regarding programs affecting theircommunities.

I would just like to mention one other area, and thenI will entertain your comments and reactions. This

area is the issue of priorities. We are often vastlyadmired, or in some cases, laughed at because of ourmarvelous set of priorities. We seem to have prior-ities for all occasions. Vile have priorities for pro-fessors, priorities for citizen groups, prioritiesfor Congress. I =ten receive notes from DivisionChiefs who say, 'Please don't make me the number onepriority any more. Just give me the personnel I re-quest." Research has a history of being our numberone priority though we are quite sincere also abouttraining and service. Wheh I became Director, we setsome topical and opportunistic priorities which Ithink are important and with which I think everybodyhere is familiar. We said that meeting certain basicneeds in the area of child mental health was our numberone priority. With regard to our second priority wedecided to fly into the face of the devil and to ex-plore the mental health and behavioral science aspectsof law and order. We wanted to deal with the crime

issue head on. Our third priority concerned the mentalhealth interests of minority groups. This meeting is

an effort related to this priority.

35

Now, in making progress or not making progress on thesepriorities, we begin to get back to my basic point whichis that the name of the game is politics. Some psy-chiatrists and other professionals divide politics intothe politics of therapy, the politics of love, the poli-tiLs of human services and so on. If these divisionsare considered in terms of the allocations of resources,our priorities, child mental health, law and order,minorities, will be determined by how skillfully,knowledgeably and ethically the politics '17 the situa-tion is handled.

36

Demands of the Spanish Speaking Participants

1. Appoint Spanish speaking individuals to InitialReview Groups in proportion to the percentageof Spanish speaking people in the United States(9%).

2. Appoint at least one Spanish speaking represent-ative to the National Advisory Mental HealthCouncil.

3. Initiate affirmative action in implementing theCivil Rights Act by funding Spanish speakingprojects and by hiring Spanish speakingpersonnel especially at the policy-making levelthroughout NIMH.

4. Create a Center for Spanish Speaking MentalHealth Programs since the Center for MinorityGroup Mental Health Programs is irrelevant tothe needs of the Spanish speaking.

5. Include bicultural as well as bilingual conceptsin all NIMH programs and policies.

6. Fund specific geographical areas with Spanishspeaking populations in accordance with theirproblems and needs and allow each communityto define and designate these needs.

7. Recognize the Coalition of Spanish SpeakingMental Health Organizations (COSSMHO) as alegitimate Spanish speaking interest group andcommunity development organization which maybe funded by NIMH and to which NIMH is account-able.

8. Develop a comprehensive plan to establishdevelopmental funding for community based leader-ship training. Make available developmentalfunding for community based leadership training.

9. Revise the census figures to show the actualpercentage of Spanish speaking in the UnitedStates.

37

10. Establish equal opportunities for women to beemployed in NIMH policy-making and administrativepositions.

11. Focus attention on all geographical areas withheavy concentrations of Spanish speaking popula-tions not solely those in the southwesternUnited States.

38

Wet UtroupReports

Mental Health Services

The workgroup discussed a number of issues that relatedto the community's opinion of the mental health andmental health services. This discussion was the basisfor recommendations that were developed during thesecond session. The following is an outline of thediscussion. during the first work session.

1. Perception of mental illness among the Spanishspeaking.

a. Spanish speaking do not like to go tomental health facilities for fear of being labeled"crazy". The Spanish speaking cultures have cre-ated many terms and expresdions to indicate indi-vidual variations which avoid the stigma of men'-alillness.

b. There is need for a "service image" whichis broader than the treatment of mental illness.Mental illness in the Spanish speaking communityis often only a symptom of other problems outsidethe traditional domain of mental health. All ofthese problems must be understood and treated.

2. Adequacy of existing programs:

a. Many CMHCs have no out-reach programs andconsequently, cannot serve a number of Spanishspeaking who either do not know about the Centeror do not come to the Center for fear of beingtagged "crazy"

b. There is a need for an evaluative systemto measure the relevancy, extent, and effective-ness of services offered to the Spanish speaking.

c. The services do not incorporate theSpanish speaking individual's mental health per-ception.

d. The service programs should be monitoredby the communities. The community's opinionshould be considered in establishing and fundingprograms.

40

3. Establishing a service program.

a. Community groups do not know the mechanicsof applying for a CMHC grant. There is a needfor technical assistance in the development ofprograms.

b. Spanish speaking professionals and citizenrepresentatives should be included in the reviewprocess and used as consultants to NIMH to ensurethat the programs have relevancy for the Spanishspeaking. Community support of service programsshould be requisite for funding.

c. A percentage of the Initiations and Develop-ment Grants should be designated for Spanish speak-ing communities.

4. Training and utilization of personnel.

a. CMHCs should employ individuals represent-ative of the population being served. Centersserving the Spanish speaking need staff whci notonly speak Spanish, but who also understand thecultural background of the people.

b. A manpower and training program should bedeveloped to include the immediate employment ofcommunity workers to meet the current needs andto train professionals and paraprofessionals forlonger-range programs.

c. Provisions should be made available forexchange of personnel for training purposes. e.g.,travel funds should be available for planners tovisit service programs that are successful inmeeting community needs.

The workgroup participants compiled the following re-commendations to NIMH and to the Division of MentalHealth ServiCe Programs.

1. Designate a representative number of Initia-tion and Development grants for the Spanish speakingcommunity.

2. Earmark funds for training Spanish speakingprofessionals and paraprofessionals in the mentalhealth fields.

41

3. Offer technical assistance to the Spanishspeaking in developing grant proposals until the com-munity develops expertise in this area.

4. Demand that service grants in-progress in-corporate the mental health perspectives of the Spanishspeaking community and that funding be stopped if pro-grams do not comply.

5. Recruit the Spanish speaking for internshipsand fellowships within the Institute.

6. Provide incentive stipends to attract Spanishspeaking students into the mental health fields.

7. Fund pilot projects to

a. train Spanish speaking staff,

b. identify the types of programs needed,and

c. evaluate the existing Centers in terms oftheir relevancy to the community served.

8. Evaluate, considering the community's opinion,the existing CMHCs serving the Spanish speaking annuallyand every 90 days noting program direction, staffingpatterns, and service impact on the community.

9. Use participants of the MIMI Spanish SpeakingConference as resources for developing criteria for the90 day and annual site evaluations.

10. Provide funds for service center planningteams to travel to model Service Centers which aresuccessful in meeting community needs.

11. Utilize representative Spanish speaking lead-ers as consultants in planning programs serving Spanishspeaking communities.

12. Require that CMHCs provide more comprehensivemental health services by using preventive and multi-service approaches to treat a wide-range of problemsfacing the Spanish speaking.

13. Establish out-reach programs in the ServiceCenters to serve the Spanish speaking Who fear the

42

Center or are ignorant of the services offered.

14. Require that Service Centers employ staffthat are bilingual as well as bicultural.

15. Incorporate community solutions for curingmental illness, such as curanderas, spiritualists,and santerismo in CMHCs serving the Spanish speaking.

16. Initiate affirmative action to ensure thatprovisions of the Civil Rights Act are being carriedout.

17. Offer training to non-Spanish speaking indi-viduals working in mental health fields in order thatthey may understand the special problems and needsof the Spanish speaking.

Participants

Spanish Speaking ConfereesAmelia M. Castillo, ChairmanPedro RuizYolanda SanchezMilton N. Silva, ResourceAlbert VasquezRosa I. Vasquez

43

NIMH StaffEdward J. KeltyHumberto RosselliRalph C. Kennedy

Manpower and Training.

In addition to making recommendations to NIMH, the groupdealt with a number of training problems facing theSpanish speaking community. In general, the partici-pants felt that the Division of Manpower and TrainingPrograms and NIMH were not meeting the needs of Spanishspeaking Americans. A reorganization of the DMTP wassuggested so that programs -Could be made more relevantto the community being served. The group agreed thatthe splitting up of the training, research and serviceprograms destroys any comprehensive effort to improvemental health programs.

Specifically in the training fields, the Spanish speak-ing group members said that training money fails toreach the "ultimate client" or consumer. Trainingcurricula neglect programs addressing the specific needsof Spanish speaking Americans. In this area the work-group recommended that the community itself be givencontrol of the educational programs. It was furthersuggested that the Division develop new institutionaltraining models including bilingual-bicultural conceptsto improve the paucity of relevant training programs.

Following this general discussion the group developedset of specific recommendations to the Division ofManpower and Training Programs and to NIMH:

1. Develop a mechanism to insure compliance withthe 1964 CiVil Rights Act by June 1972.

a. Defund grants or demand refunding ofgrantees not complying with the Civil Rights Act.

b. Require that NIMH decisions and policyconcur with the Civil Rights Act.

c. Focus attention on the following inrelating the Civil Rights Act to the Spanishspeaking:

1) Develop training curricula relevant tothe Spanish speaking.

2) Recruit Spanish speaking faculty.

3) Recruit Spanish speaking students intotraining programs.

44

4) Develop a practicum relevant to theSpanish speaking.

2. Develop a two-pronged "crash program" to in-crease Spanish speaking manpower in mental health fieldswith 10 percent of the Manpower and Training budgetset aside for this purpose.

a. Establish a Crash Technical AssistanceService (CTAS) to:

1) Increase consultant staff to work onspecific assignments with the Spanish speaking.

2) Develop acmall contract program toseed manpower and training planning projectswith Spanish speaking staff.

3) Stimulate and develop conferences andworkshops for training planners, (possiblythrough the Continuing Education Branch).

b. Develop a specific crash recruitment andtraining program for the Spanish speaking withinDMTP.

3. Establish and fund two demonstration trainingcenters to serve as models for integrating training,service, and research aspects of manpower development.

Participants

Spanish Speaking ConfereesTeresa Aragon de SheproTomgs AtencioRaquel E. Cohen, ChairmanIsmael Dieppa, ResourceJ. Enrique Salinas

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NIMH StaffGeorge L. AdamsBernard SandlerWilliam H. DenhamWillie S. Williams

Research

The first meeting was spent mostly reviewing the pro-cedures of the Extramural Research Division for select-ing members for review committees, applying for researchfunding, and involving the community in research. Thequestion of technical assistance to Spanish speakingresearchers was discussed, and it was suggested thatNIMH staff could provide such assistance at workshopsheld at the various regional professional meetings.The Spring meeting of the Southwestern Social ScienceAssociation to be held in San Antonio was mentioned asa possible site for one such workshop. It was also feltthat action (i.e., applied) research was of more immedi-ate value to the Spanish speaking community than basicresearch.

The second meeting focused on the research priorities ofthe Spanish speaking community and a number of ways NIMHcould be more responsive to the research needs of theSpanish speaking community. The research priorities andrecommendations drawn up by the committee follow.

1. Investigations of uninstitutionalized ways thatthe Spanish speaking community deals with mental healthproblems and means by which these can be legitimized byinstitutionalized mental health service programs.

a. Intervention methods of dealing with crisissituations should be sought. It was noted thatmany of the problems which the Spanish speakingtake to the clinic are of multiproblem origin andintervention techniques must be sought, rather thanthe L11 too common referral to another agency oroffice.

b. Research on the utilization of mental healthservices should be undertaken. The differentattitudes of individuals within a group towardinstitutionalized mental health care should beexamined. Out-reach programs must be looked intofor their effectivess in meeting the needs of theSpanish speaking community.

46

c. Comparative research on therapeutic tech-niques with the Spanish speaking must be under-taken to select the most advantageous and effec-tive therapeutic model dealing with the Spanishspeaking (group vs. individual therapy, long termvs. short term therapy, crisis intervention vs. amore traditional kind of therapy).

d. Development of films on the mental healthproblems and'treitment of the Spanish speaking foruse as training devices to sensitize mental healthworkers.

2. Definition of normative behavior for theSpanish speaking.It was pointed out that what may be "abnormal" behaviorfor one group may not be so for another group. Accord-ingly, what constitutes psychopathology for the Spanishspeaking person, and ways to detect and measure it mustbe found.

3. Ecological studies of the barrio.The barrio as a social system must be better understood.Emphasis should focus on the crucial aspects of socialinteractions which take place in the barrio.

4. Mental health of the Spanish speaking child.It was felt that special attention should be given tocertain critical periods in the life of the Spanishspeaking child. Two critical periods mentioned were:

a. Age 5-6, when the child enters school andmay experience the cultural shock of not knowingthe language.

b. Late elementary school or junior high school,when the child begins to question his identity androle in life.

5. Distinction between social class difference andcultural and/or ethnic differences.Investigations here should include a wide range of socialbehaviors and should deal with the questions of valueswithin this area.

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6. The Spanish speaking individual's view of theworld as contributor to differences in behavior.The definition of normal behavior, individual valuesand life styles are of primary importance here.

7. Conflict generation and resolution in theSpanish speaking community.It is felt that this is vital to the mental health ofthe Spanish speaking community. Such research should

focus on:

a. Differences within a Spanish:sp.-Xing group(intra-group differences).

b. Contacts and relations between variousindividual groups (inter-ethnic relationships).

c. Process of change within the barrio as aresult of inter-ethnic contacts).

t. Consequence of the introduction of a newethnic group into a social situation.

8. New and/or improved methodologies for studyingthe Spanish speaking.-Attention should be given to research strategies andscreening instruments. These new methodologies should

be free of ethnocentric biases.

9. New screening and testing instruments whichare culturally sensitive not only to the Spanish speak-

ing as a whole but to the various' subgroups of Spanishspeaking across the country.

10. Coping styles of the Spanish speaking in deal-with grief, death and other crisis situations. Some

questions to be asked in this area include the following:

a. What are the safety valves for reducingstress?

b. What are group reactions to stress?

c. What are the linkages between copingstyles at different ages?

d. What are the linkages between coping stylesbetween family members?

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e. What are the adaptive strategies used bythe Spanish speakirj in functioning in an oftenhostile environment?

Recommendations for Action

1. NIMH should encourage more representativeSpanish speaking participation on Research Review Com-mittees, especially certain critical committLes:Clinical Research, Juvenile Problems, Mental He 'thSmall Grants, Personalit-/ and Cognition, and ScProblems Research Review Committee.

2. Mechanisms must be found to facilitate fundingof community based researchers. This can be accomplishedby increased dissemination of information on the processof research funding, technical assistance to Spanishspeaking researchers on grantmanship. In addition, waysmust be found to channel more funds into contractedresearch of immediate importance to the Spanish speakingcommunity.

3. An ad hoc committee should be formed to estab-lish mechanisms of monitoring research projects affect-ing the Spanish speaking.

4. With regard to research priorities, it is feltthat projects concerned with intervention and preventionof mental disorders of the Spanish speaking should begiven the highest priority.

5. It should be the responsibility of NIMr, tobetter define the guidelines of research funding andresearch monitoring by the Center for Minority GroupMental Health Programs.

6. NIMH should insist on the early and continuousconsultation of the communities in all research projectsthat involve them. Attempts should be made to see thatthe community is consulted in the design of the researchand in the construction of screening instruments, ques-tionnaires, and other measures taken during the projects.If at all possible, the researcher should seek communityparticipation in conducting the research. In addition,the researcher and the community should evaluate theresearch product.

49

7. NIMH, through the Center for Minority GroupMental Health Programs, should request that all research

published relating to Spanish speaking be coded in thesame manner as such by the National Science Information

Center for easy identification and retrieval of important

research.

Participants

Spanish Speaking ConfereesLupe AnguianoThomas Langner, ResourceAmado M. Padilla, ChairmanJulius RiveraJaime Sena Rivera

50

NIMH StaffLidia CraneAlvin E. GoinsMartin M. KatzAbel G. OssorioMiriam M. StaplesLorraine B. TorresLouis A. Wienckowski

Special Mental Health Programs

The workgroup discussed at length NIMH's method of op-eration and the various ways in which the Spanishspeaking should organize their efforts to affect changesin the Institute on their behalf. The group concentra-ted on the issues that had been introduced in thegeneral session prior to the first workgroup meetingrather than on programs dealing specifically with crimeand delinquency, child mental health, the aging, minor-ities and metropolitan studies.

Mr. Smith, however, did inform the group that his staffviews juvenile delinquency as a high priority and isinterested in receiving grants on the prevention andextent of delinquency. The group also discussed crimeand juvenile delinquency as a symptom rather than acause of other mental illnesses and problems. Treatingjuvenile delinquency with community care in lieu ofinstitutional care was suggested.

Mr. Vischi described the current planning project forthe aging. The Spanish speaking expressed interest inbecoming involved in this program.

In addition the following recommendations were proposed:

1. Designate program funds for specific problemsof the Spanish speaking via earmarking of funds and theuse of contracts.

2. Make funds available to community groups whichmay not be affiliated with some institution or univer-sity.

3. Develop guidelines for the IRGs specifyingminimum number of Spanish speaking as members. TheSpanish speaking in turn will supply NIMH with names ofqualified people.

4. Fund service programs at a constant minimumlevel for the duration of a grant and guarantee that themoney will not be reduced at will.

51

5. Extend the model being developed for fundingsmall demonstration projects (of less than $5000) spon-sored by the Section for Youth and Student Affairs tothe funding of small grants projects for Spanish speak-ing groups.

6. Study and document the cultural strengths ofthe Spanish speaking and not just the weaknesses, ill-

nesses, and handicaps.

7. Give special attention to the enforcement ofthe Civil Rights Act especially with regard to theequal employment of the Spanish speaking.

8. Increase the amount of contract money inrelation to grant money until the Spanish speaking com-munity groups are viable enough to compete for grantmoney.

9. Appoint Spanish speaking observer/consultantsto IRGs until Spanish speaking individuals are appointed

members of specific IRGs.

10. Consider the Coalition of Spanish speakingMental Health Organization (COSSMHO) as a communitydevelopment organization and interest group which may be

funded by NIMH.

11. Employ Spanish speaking staff throughout NIMH

program areas.

12. Provide technical assistance to the Spanishspeaking in applying for grants. One method could bethrough the preparation of a videotape in Spanish on thegrant process for use by community groups.

13. Establish a liaison between the AffirmativeAction Committee and COSSMHO to coordinate staffing ofSpanish speaking.

14. Request the Division Directors to submit toCOSSMHO the number of Spanish speaking staff in theirDivisions, the positions available and their GS level.

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As a final suggestion, it was proposed that COSSMHOfollowup on the recommendations made to NIMH at theConference.

-Group Participants

Spanish Speaking Conferees NIMH StaffRoger Chapa Roberto L. DuronRoberto D. Gonzales James R. RalphFaustina Ramirez Knoll Walter M. SmithMagdalena Miranda, Chairman Thomas R. VischiRobert Perla, ResourceTrinidad Pina, Resource

53

Alcoholism and Drug Abuse

The first session was spent discussing various alcoholand drug abuse problems as seen by the community. Ingeneral, discussion centered around the following points:

1. Drugs are a major problems for the Spanishspeaking. Mr. Acevedo reported that heroin and mari-juana are the primary causes of crime in California.

2. Alcohol and drug abuse services generallyaddress the needs of middle-class Anglos and not thoseof the lower class Spanish speaking.

3. The Spanish speaking must learn the proceduresfor applying for grants and for monitoring expendituresafter money is allocated. Lobbying NIMH on a regularbasis and working within the system are means of effect-ing change and ultimately obtaining funds for grass rootsprograms.

4. Of the 40 million dollars of Federal drug moneyvery little sifts down to the barrio.

5. Community individuals and professionals viewthe same drug and alcohol problems with different per-spectives. Professional treatment often fails to curethe problems in terms of the-community's viewpoint.

6. Drinking patterns of the Spanish speaking aredifferent from those of the middle-class or poor Whitesand should be accounted for in programs serving theSpanish speaking.

7. There are nc rehabilitation programs to helpthe ex-convict/ex-addict reenter society after hisprison term.

Staff from the Division on Narcotic Addiction and DrugAbuse and the Institute on Alcohol Abuse and Alcoholismattended the second workgroup session. Mr. Kisskodescribed the grant mechanism of NIAAA and the programscurrently in progress. In particular, he elaboratedon the state formula grants and the staffing grants.Dr. Scanlon and Mr. Leukefeld discussed the same pro-cedures in the Drug Division. Dr. Bunney later recom-mended that a liaison representative be designated fromDNADA to consult with Spanish speaking representativeson programs relating to the Spanish peaking. Karst

54

Besteman, Deputy Director, was designated to work withMr. Acevedo in drug programs. Mrs. Dulfano was, inturn, chosen by the group to work with Ruth Sanchez,Community Assistance Branch Chief, on alcohol programs.

The workgroup agreed on the following recommendationsto NIMH:

1. Employ community people including ex-addictsand ex-alcoholics in the alcohol and drug dbuse train-i:g centers.

2. Appoint Spanish speaking professionals andparaprofessionals with experience in the drug abuse/alcoholism fields to policy-making and evaluationcommittees.

3. Establish drug abuse and alcoholism trainingseminars throughout the nation.

4. Provide technical assistance to assist commun-ity individuals and organizations in writing grant pro-posals.

5. Establish rehabilitation services for ex-con-victs who are ex-alcoholics/ex-addicts.

6. Organize regional and national conferences tobring together Spanish speaking individuals involved inthe alcohol and drug abuse fields in order to shareinformation so that better services can be providednation-wide.

7. Require that services affecting the Spanishspeaking reflect the particular community drinking anddrug patterns and community perspectives which aredistinct from those of middle-class or poor Whites.

Participants

Spanish Speaking ConfereesJuan D. Acevedo, ChairmanErasmo AndradeSam BritoCelia Dulfano, ResourceRicardo GalbisGloria Lopez McKnightPedro Nel Saavedra

pum StaffWilliam E. BunneyRoberto L. DuronJames A. KisskoCarl G. LeukefeldSusan G. RileyJohn C. ScanlonE. Fuller Torrey

55

Fcsiptunsc:NMI Division

Division of Mental Health Service ProgramsClaudewell S. Thomas, Director

I would like to say that I am quite impressed by thework of the services workshop group. It brings to mindthe work of a very early ad hoc group that met inrelation to the Services Division and its activitiesabout a year ago. I see at least one face that waspresent in that group. The issue at that time wascultural pluralism and its meaning in terms of theservice delivery picture. My own personal belief,which I have been able to convert into action only ina limited way because of the very complex bureaucraticsystem Dr. Handler and others pointed out, has been toview the health needs of the nation, not in terms ofthose people who are most proximate to a cultural norm,that is an Anglo Saxon or Western European norm, butthose who are most distant. The former have a numberof alternatives within the health care system. Whatdefines the health deficit of the nation is those whohave no alternatives within the system. The work ofthat early ad hoc group reflected this problem.

Part of-that early discourse also involved an agreementthat the primary mechanism for solving such problemsmight be the Initiation and Development Grant. But asyou know, that depends upon the amount of money in thetotal program. HoWever, I thirik that the Division ofMental Health Service Programs is committed to use anyavailable I & D Funds in helping design Cervices thatare appropriate to minority groups and culturallydeviant groups. There is one other complication.That is that we are now the proprietors of a decentral-ized program where the administration and award ofservice grants is now the province of the regionaloffices. But those of you who are aware of what isgoing on in this area know that we have been goingaround the country talking to regional offices aboutthe potential of Initiation and Development Grants forminority groups, and in particular, for Spanish speak-ing groups.

Now, as I said earlier, we are the administrators of aprogram that started off relating to the needs of themajority groups in this country, and to some extentthis pattern is a little bit set in concrete. One ofour major tasks and commitments is to see how we can

57

unset that kind of commitment without doing a disser-vice to the majority groups, but to make sure thatminority groups are adequately represented and adequate-ly served. Part of that involves finding ways andmeans of transferring some of the monitoring respon-sibility to communities, and this, I note, is one ofthe questions and implied recommendations of theservices workshop. This process is a very difficultand complex task, partly because there is a historyto these grants and awards and to the evolution ofcertain structures within the Health, Education andWelfare DepartMent. And as other have indicated, thiskind of meeting is not.enough. We are going to requireconstant reminders as to your needs and constant inputas to your suggestions to meet them. To the limit ofour ability, and it is limited, we will try to see toit that the changes are brought about, but in order todo so, we are going to need your help.

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Division of Manpower and Training ProgramsBernard Bandler, Acting Director

First let me express my tremendous pleasure at the rec-ommendations made by the manpower and training group.

Before I comment on the recommendations I have severalgeneral points to make. The name of the game is power.The problems are institutional change, and the- distri-bution of power. Institutional change within NIMH re-sults from having a critical number of minority membersen masse on the staff and review committees. Only bythese steps can minorities be guaranteed the processof change in this institution. A second and equallyimportant factor in this game is change in institutionsoutside NIMH. I am rather sceptical about the possi-bilities of success with them, unfortunately. Thepower here lies the reallocation of money to dif-ferent types of decentralized institutions. Becauseof this somewhat pessimistic view of change withinoutside institutions, I am particularly committed toadvocating change in NIMH. A third item I would liketo mention concerns a report being' prepared by BillDenham and George Adams. For some time now they havebeen examining our Division's stance in relation tominorities and developing mechanisms by which the Divi-sion can implement that position. This process involveschange in Divisional staff and the carrying out ofestablished minority commitments.

Now I would like to respond to the workshop recommenda-tions. Of the three specific recommendations, thefirst was to develop mechanisms to ensure the enforce-ment of the Civil Right Act. This plan would affectcurriculum and practicum development, recruitment ofSpanish speaking staff, students and faculty, andinstitutions receiving NIMH funding. We have somefacts to put together in this area, and we will beginthis process. First, is this an area that necessarilyapplies to NIMH as a whole or can the Division ofManpower and Training act independently on it? Deci-sions governing such action, if indeed DMPT can act,cannot be made alone by me or other members of theDivision. The Institute would have to develop sucha policy taking into consideration the elaborateimplications of such action in terms of the reactionof a very important traditional constituency of the

59

Institute. However, on my part, I will move as fullyas possible to set up some compliance mechanism, andcertainly by July 1 we will have a report for you.Even if we cannot cease funding all grants or insti-

tutions violating the Civil Rights Act or rejectgrants not complying, there are many other methods of

persuasion. We will push for putting the maximumteeth into this program and refuse tb "alicibate funds or

else terminate grants.

The second recommendation for a "crash program" includes

two sections. The first section is a Crash TechnicalAssistance Service made up of three prongs. The first

part is the allocation of money to seed manpower andtraining programs with Spanish speaking staff. The

second involves technical assistance to the Spanishspeaking and the third concerns training workshops.It has been suggested-that the Continuing EducationBranch could be recruited to help with this last pro-

vision. Our Division will move on these suggestionsprovided we can kick off the horrible bureaucraticrestrictions. These restrictions include the dead-lines by which applications must be received, processed,reviewed by IRGs and finally funded. Many of ourprograms can receive applications only once a year,September 1. They are reviewed by IRGs-in January,considered by the National Advisory-Mental HealthCouncil in March, but not funded until the followingJuly. I think there may be some exceptions to this

schedule. I have not been here long enough to be ableto maneuver within our system or to manipulate it, butI will do my best to learn rapidly so that we caninitiate this part of the Crash Program.

The second phase of this'program is a request for in-

creased Spanish speaking people on our DMPT staff. By

the way, I met today with the people who keep.therecords for the review committee on Experimental andSpecial Training. They are recommending a Spanishspeaking person to the committee, so by next July youwill have a sixth Spanish speaking member on DMPTreview committees. We have only one job opening be-tween now and July 1, which is grade level 14, and wecertainly will do our best to recruit a Spanish speak-ing person for that position. I must qualify that

statement. We need a tremendous input from you interms of recommendations of personnel. It is abso-lutely crucial that we have a channel of communication

with you. With whom can we communicate in this group?

60

We are going to need some mechanism of communication tocarry out all of these plans and particularly meet theJuly 1 deadlines. An additional point in this samearea: for the following fiscal year, we have been askedto reduce further our manpower and q*:ade levels. Tomeet this limit we have been able to add only fiveminority members to our staff since last March. I

hope when people do leave, minority members will haveabsolute priority. I do not intend to be pessimistic,just realistic.

For these entire crash programs you have requestedthat we commit only 10 percent of DMPT funds. Sincemy goal is to have 50 percent of our funds set asidefor minority groups, I think 10 percent is too low.We have the Mental Health Career Development Programin the Division which trains an elite professionalgroup who then are recruited into N1MH. When thisprogram reviewed and accepted applicants for trainingbeginning this July 1, 50 percent belonged to minoritygroups.

j might also mention in relation to the Minority Centerthat of its $3 million over $1 million comes from theDivision of Manpower and Training. Of that $1 millionabout $450,000 is attached to grants which it is con-tinuing to fund, but another $550,000 to $600,000 isactually free, unattached money which is a gift fromour Division to the Minority Center.

The third and final workgroup recommendation was aimedto relieve racism in training institutions by estab-lishing training programs that are relevant to theSpanish speaking. The group requested that two train-ing centers be established which would integrate service,training, and research. I think this is a goal whichrequires, again, constant collaboration between us ifit -Ls to be met. There are enormous complexities in-volved if institutions training professionals must havesome accreditation from professional associations orfrom the state in order to recruit qualified students.But we will participate with you as much as we can inthis process. I doubt that you are going to get thechanges you want from the existing training institutions.You will have to develop new types of institutions,such as the training centers you have recommended.

And now let me express my own personal appreciation forthe privilege of working with you these last two days.

61

Division of Extramural Research ProgramsLouis A. Wienckowski, Director

It was gratifying to work with the research workgroupin establishing some of their research priorities andrecommendations. I am in wholehearted agreement with '

the list that was presented, partially because I thinkthat some of the suggestions are already being imple-mented in our program to a certain degree.

We are witnessing a new emphasis_in community researchthat is not peculiar to this Conference and ourInitial Review Groups are also aware of it. It isalmost a methodological necessity to involve thecommunities, either in planning research projects orin reaping the eventual benefits, if you will, of theresearch that goes on in their areas.

With regard to technical assistance, we, the ResearchDivision and I, pledge our utmost cooperation inwhatever way we can be of assistance with the re-sources available to us. I have already distributedwritten materials describing our programs and otherFederal government programs relevant to your interestsincluding some references to sources that can pro-vide you with literature on how to write proposals.Before this meeting, we submitted to the NIMHPlanning Branch a list of things we might do to helpthe Spanish speaking community in the research area.We suggested holding regional workshops and attendingvarious national meetings such as Spanish speakingsocial science meetings to assist people in thepreparation of proposals. A very interesting recom-mendation was made to set up an intermediary reviewgroup or consultant body to screen preliminaryproposals. This group would look at pilot proposalsand feed back information that would be helpful toinvestigators in preparing proposals in final form forformal review. These seem to sum up my positivecomments.

On the negative side, because of my research bias, Imust confess that I was bitterly disappointed to notethat the word research was not mentioned in connectionwith any of the recommendations from the other work-groups, The problems there are equally researchable,

62

and there are research components within each of thoseDivisions. Some attention was focused on research ofservice delivery in Dr. Thomas' Division. Unfortu-nately, Dr. Howard Davis was not able to be here. If

he had been present, he would have spent more timediscussing this area, I am sure.

In addition, I think it is a serious omission to setup training programs or delivery programs withoutsome kind of built-in evaluation component. I thinkthat any new enCeavors should automatically includean evaluation component from the start.

Similarly, I felt a kind of disappointment becausevery little emphasis was placed on the problems ofchildren. You are not going to solve the problemsof the Spanish speaking people in this generation oreven the next to or three generations. You wouldhave a double advantage if you focused on.childrenbecause, as Dr. Brown said, NIMH is already veryheavily committed to the problems of children. Ifyou focused on the combined needs of children andminorities, you would have two points of advantageto begin with.

In regard to the possibility of acquiring an in-creased amount of contract money o'er: grant money,I regret that no one from the budg,, office ispresent bedause they could acquaint you with thegreat difficulties involved in the Institute'seffort to-increase the availability of contractmoney. We have not had a long history of access tocontract funds, unlike some other parts of theDepartment such as NIH, and it is very difficult tochange the modality of support. But I am sure thatHEW will hear yourpless, and per1v.r something canbe done by way of involving us in more collaborativecontract supported efforts.

In conclusion, I have several comments. We hear youloud and clear. We will be discussing, at leastwithin the Division of Extramural Research Programs,the varLous recommendations mady by the researchworkvoups. I have regular meetings with the chair-men of our Initial Review Groups twice a year and Iplan to bring the Conference and workshop summariesto their attention this March. I want to urge youto approach other agencies within the FederalgovernMent, particularly within the Department of

63

HEW. I think because of greater accessibility, NIMHis usually in the forefront of these kinds ofactivities. The Office of Education, the Office ofEconomic Opportunity, and the Department of Housingand Urban Development should be tapped as potentialresources to meet your needs and interests. I mightpoint out finally, that we are traveling on a two-way street, and in exchange for our willingness toprovide you with financial support, we in turn needhelp from you to supply us with needed informacionto achieve quality in all programs.

64

Division of Special Mental Health ProgrtmsWalter M. Smith, Deputy Director

I want to commend you on your demands, particularlythe items concerning Spanish speaking members appoint-ed to Initial Review Groups and the hiring of Spanishspeaking staff throughout NIMH. The IRGs play a veryimportant part in relation to the Institute. But Iwant to caution you. Solutions to your problems andfulfillment of your desires will not automaticallyflow from having Spanish speaking individuals on theIRGS and on the-NIMH staff. Other channels must befound.

Now, to respond to the comments and complaints aboutthe appointments made to the Minority Center InitialReview Group. Perhaps it was our fault that weneglected to consider the subgroups of the Spanishspeaking in our selection. Instead of consideringChicanos, Cubans, and Puerto Ricans, we looked at thebroader ethnic division of Spanish speaking Americans.In the past, we have chosen members for the IRGsbecause of their competence. This was, for example,the case with the Blacks we appointed and with theSpanish speaking "ember we selected. If we have madeerrors, we will correct them as we go along.

Another important point I want to stress is that younot think that this meeting alone is enough. Youmust keep alive the contacts you are establishing atthe working level in each division. Your concerns,your desires, your questions, your priorities andyour complaints are all perfectly legitimate. We area public agency and stand ready to hear your feelings.But as I told the workgroup that I was in, I have beenamazed at the lack of interest in the Minority Centerwhich was created especially to take care of minorityproblems. I expected hundreds of proposals to comein saying, "This is what we want to do. Can you helpus?" So far we have received five. After this meetingthe staff will probably regret my saying this becauseI am sure you will inundate us with work. But up tonow you have not taken advantage of the services wecan offer.

Admittedly, the Minority Center is just a beginning,and it is working with a limited staff, but there are

65

other resources to be tapped. Dr. Goodman, who regretsthat he cannot be here due to an IRG meeting in Florida,is asking us in the Division to develop a comprehensiveprogram to utilize the staff and resources of all thecenters rather than to allocate resources to each semi-autonomous center. By not dividing funds between de-linquency, minorities, metropolitan problems and so on,

- we will be able to increase our resources for use inareas that concern you.

Let me point out one other pitfall we should avoid. Ido not mean to discredit Ken, but I do not put greatfaith in the liaison scheme. It is just that I haveseen these relationships established before, thoughnot necessarily in the Institute, and after a month ortwo they tend to fade out. People lose interest becausethey see no immediate results from their coming in andmeeting with us one or two. times. They get discouragedbecause they do not get what they want or we misunder-stand their needs. These relationships simply taketime to develop and to work out. So, I caution youhere not to expect great changes in the first monthsafter you visit us once. After all, this process isnew to us also.

We lc)k backward and point with pride to where we havebeen and to what we have done. What you are askingus to do now is to plan ahead with some intent to dosomething that you want done in your own particulararea. We hear your message and will, I am sure,act accordingly.

66

National Institute on Alcohol Abuse and AlcoholismKenneth L. Eaton, Deputy Director

First of all I would like to convey the personal re-gards of my boss, Dr. Morris Chafetz, who is himself aSpanish speaking persor4 though not of Spanish ethnicdescent. He specifically asked me to be with youtoday and respond to your recommendations in the areaof alcoholism programs.

My reaction to such issues as placing Spanish speakingpeople on our staff is very positive. We are recruit-ing staff and ask that you submit nominations forpositions. We are tightly committed to the employmentof minority people. In fact, we are presently in theprocess of recruiting for .several high level positions.Dr. Chafetz and I have begun the recruitment processabout three times but have stopped each time becausewe agreed that we did not have adequate informationfrom minority groups, and we did not feel that ourrecruitment was extensive enough for- selecting thestaff that we need. I share this with you only toaffirm an unalterable commitment on our part to appointSpanish speaking individuals in our offices. In addi-tion, I assure you that we are suffering from thi:understaffing at some very high levels. But eventhough it means that those of us who are there nowmust fill in the gaps, we are not going to.let ourcommitment weaken.

In response to the repeated recommendation to appointSpanish speaking members to the Initial Review Groups,we invite your specific recommendations and nomina-tions. We have three IRGs corposed of about 40-45people, and like all initial review groups, there issome turnover each year. We welcome your participationin helping us recommend Spanish speaking individualsto fill the vacancies.

I am pleased that the group this morning and yesterdayafternoon, settled upon a liaison person with whom wecan consult. We are delighted with this decision andlook forward t%., working closely with Celia Dulfano,as closely fact, as her time permits.

67

Now I would make a basic challenge to you, not a dis-agreement, but a challenge, of the efficacy of some ofthe points of emphasis that have been repeated thesetwo days. Specifically, a great deal of emphasis hasbeen places upon staff appointments to Spanish speakingindividuals and the appointment of Spanish speakingmembers to IRGs and NINE advisory councils. I agreethat this is an important step toward influencingchange on behalf of the Spanish speaking, and I com-mit the full cooperation in the Alcohol Institute tocarry out these recommendations. However, my challengeis to question whether these appointments in themselveswill really satisfy your goals. I guess what I amdoing is introducing a little fear that sometimes ouracute concentration on these selective processes mightcause us to ultimately overlook our mutual goal ofhelping people. I hope our self-interest does notblur our vision of the total picture. We must notlose sight-of the important problems we have beforeus. The Alcohol Institute is engaged in dealingwith them, and we need your help to guide us.

We must guard against focusing on only one area insolving our prdblems and consider additional avenuesof approach. I think there was a particularlypointed remark made yesterday morning by TomisAtencio about the-need for counter-institutionalmethods. There could not be a truer statement.Looking at the history of many Federal programs, Irecall the development of institutions at the Federallevel and almost immediately, the development ofcorollary institutions at community levels. Forexample, the Economic Opportunity Act served as thecatalyst for the creation of local institutionsdealing with the same issues at a different level.The same is true for the NIMH local community mentalhealth services which sprang up after the passage ofthe Mental Health Centers Act. I do not think thatseparate local institutions need to be created toaffect change in the Alcoholism area, but I do feelthat we need some counter institutional methodswhich will permit the resources of our national, state,and local governments to be deployed in a more effec-tive and responsive fashion. The existing institutionssimply cannot carry all of the responsibility forcuring the ills of the Spanish speaking instantly.

I do not know an easy answer to improving thissituation. I do not know how to surmount the

68

bureaucratic problem of channeling funds and resourcesand knowledge to a population of people who are tryingto live with their problems without creating institu-tions for those specific purposes. But I am convincedthat there must be a way, and I think that by workingtogether, we can find that way. This cooperativeeffort is my commitment to you.

I recall another pointed remark from Tomgs' addressthat applies to this same commitment: "knowledge isderived from experience:. Because Dr. Chafetz and myexperience working with you is limited,-our knowledgeis also limited. _In spite of the deep commitments ofour entire staff, we need more experience, with youto guide our decisions. This conference is a goodbeginning-for us to learn about you and also for youto find out how we operate. But this is only abeginning. I invite you all, and especially Celia,to consider additional methods-to bring us togetherto share our experiences and knowledge.

I can offer one for you to learn what to expectfrom the IRGe and the National Advisory Mental HealthCouncil. I invite you to be our guests during thesemeetings so you can draw your own conclusions aboutthe powers and responsibilities of these committees.From such an experience you can then determine howmuch effort you should devote to being appointed tothese committees.

I would like to offer a final suggestion for you toimprove your knowledge about the Alcoholism programs.We would be very interested in having a small, capableand committed group'to work formally with us to takea look at our budget, our priorities, our policies,our grant mechanisms, and our review processes andto make specific recommendations about the kinds ofprogram changes needed to make our services re-sponsive to the problems of your people. I commitour staff time as necessary for this undertaking andhope ycu can organize a knowledgeable group to workwith us. This is the way to get something done.You need to confront us with wrong judgements on ourpart, and we need to understand the reasons for thoseconfrontations. I am suggesting we get to the busi-ness at a very serious and, in fact, a detailed level.I commit my full cooperation in seeing that whateverneeds to be done on our half of this partnership isindeed done, and is done in the way most responsiveto your interests.

69

Division of Narcotic Addiction and Drug AbuseNarcotic Addict Rehabilitation BranchRobert W. Carrick, Assistant Chief

Federal funding for drug abuse programs is diverse andspans many agencies. The President, in the newly ex-panded effort to curb drug abuse, proposed legislationto establish a Special Action Office for Drug Abuseprevention. This office is presently operating underan Executive Order. This new office is to establishpriorities, and direct the coordination of the Federaleffort in the field of drug. abuse.

Within the National Institute,of Mental Health, theDivision of Narcotic Addiction and Drdg Abuse is theprimary agency responsible for the administration ofresearch, education and-training, and prevention andtreatment -of drug abuse. The Federal funding forprevention and treatment programs administered by theDivision are authorized under Part D of the CommunityMental Health Centers Act as amended. The funding isthrough grants-in-aid availabld to any public orprivate non-profit agency.

The following is the response of the Division ofNarcotic Addiction to the recommendations of theconferees:

1. Representation on Initial Review Groups

The Initial Review Groups of the Division hasqualified individuals from minority group's. TheDivision is committed to ensure continued re-pit.sentation.

2. Hiring Spal.ish Speaking Personnel

The Division is committed to the search for quali-fied professionals from minority groups. TheNarcotic Addict Rehabilitation Branch has recentlylost to Regional Offices two such professionals,Recruitment is often difficult because of the re-luctance of the Spanish speaking professional touproot his family to move to Washington, D.C. Atthis time there are staff vacancies, and theDivision is looking for Spanish speaking personnelto fill these openings.

70

3. Employment of Community People including Ex-Addictsin Drug Abuse Treatment and Training Centers

The Division started to use and has encouraged theemployment of ex-addicts and community people inthe civil commitment program established estab-lished by the Narcotic Addict Rehabilitation Actof 1966 and in the first grants program establishedby Title IV of the Act.

The spedial "expertise" of the ex-addict continuesto be utilized by agencies receiving grants.

The newly organized Education and Training Sectionof the Division has established in the trainingprograms being developed the special role'for theex-addict to be used as-a teacher and is alsoplanning for special training for the ex-addict andparaprofessional from the community..

4 Community Participation in Grant Application andProgram Development

Effort is being 'made to ensure community partici-pation in the grant and program development throughthe consultation provided by staff program develop-ment specialists. This process ensures that theprogram developed will be accepted and used. Com-munity participation is always a major item con-sidered by the Initial Review Group in theirevaluation of grant applications.

5. Development of Liaison with the Spanish SpeakingConference

Dr. Bunney, Director, Divisior of Narcotic Addic-tion and Drug Abuse' has designated Mr. Karst J.Besteman, Deputy Director as the liaison personfor the Division. It is understood that Mr. JuanAcevedo is to be the liaison for Spanish speaking-groups.

71

ri

Summaryof

Uccurnuncinclaticrs

Summary of Recommendations

General Recommendations and Demands

*1. Appoint Spanish speaking individuals to InitialReview Groups (IRGs) in proportion to the percentageof Spanish speaking people in the United States (5%).1/

2. Assign Spanish speaking observer/consultantsto IRGs until Spanish-speaking individuals are appoint-ed members of'specific IRGs.

*3. Appoint at least one Spanish speaking indiv-idual to the National Advisory Mental Health Council.

4. Provide technical assistance to the Spanish'speaking in applying for.grants.

a. Prepare a videotape in Spanish on the grantprocess for use by community groups.

b. Create en ad hoc committee to advise theSpanish speaking on their grant and program pro-posals in preparation for review by the IRGs.

c. Make funds available to community groupswhich may not be affiliated with h-some institutionor university.

5. Develop a plan to ensure compliance with theCivil Rights Act by June 1972.

*a. Initiate affirmative action in implementingthe'Civil Rights Act by funding Spanish speakingprojects and by hiring Spanish speaking personnelespecially at the policy-making level throughoutNIMH.

*b. Establish equal opportunities for women tobe employed in NIMH policy-making and adminis-trative positions.

I/ Asterisk indicates that the recommendation is oneof the eleven demands presented to Dr. BertramBrown by the Spanish speaking caucus at theConference.

73

c. Defund grants or demand refunding of grant-ees not complying with the Civil Rights Act.

d. Require that NIMH decisions and policycomply with the Civil Rights Act.

*6. Recognize the Coalition of Spanish Speaking- Mental Health Organizations ( COSSMHO) as a legitimateSpanish speaking interest group and community develop-ment organization which may be funded by NIMH and to-which NIMH is accountable.-

*7. "Include bicultural as well as bilingual con-cepts in all NIMH programs and policies.

*8. Create a Center for Spanish Speaking MentalHealth Programs since the Center for Minority GroupMental Health Programs is irrelevant to the needs ofthe Spanish speaking.-

9. Request the Division Directors to submit toCOSSMHO the number of Spanish speaking staff in theirDivision and the positions currently available withtheir 'GS level.

10. Establish a liaison between the AffirmativeAction Committee and COSSMHO to coordinate staffing ofthe Spanish speaking.

11 Fund pilot projects to train Spanish speakingstaff for positions throughout-NIMH and recruit Span-ish speaking individuals for internships and fellow-ships within the Institute.

12. Increase the amount of contract money in re-lation to grant money until the Spiriish speaking commu-nity groups develop expertise in applying for grants.

*13. Focus attention on all geographical areas withheavy concentrations of Spanish speaking populationsnot solely those in the southwestern United States.

*14. Fund specific geographical areas with Spanishspeaking populations in accordance with their problemsand needs and allow each community to define and desig-nate these needs.

*15. Revise the census figures to show the actualpercentage of Spanish speaking in the United States.

74

Division of Mental Health Service Programs

1. Designate a representative number of Initiationand Development grants for the Spanish speaking commu-nity.

2. Demand that service grants in-progress incor-porate the health per6pectiVes of the Spanishspeaking community and that funding be stopped if pro-grams do not comply.

3. Evaluate, considering the community's opinion,the existing CMHCs serving the Spanish speaking annu-

- ally and every 90 days noting program direction,- staff-ing.patterns, and service impact on the community.

4. Use participants of the NIMH Spanish SpeakingConference as resources for developing criteria forthe 90 day and annual site evaluations.

5. Provide funds for CMHC planning teams totravel to model CMHCs which are successful in meetingcommunity-needs.

6. Utilize representative Spanish speaking leadersas consultants in planning programs serving Spanishspeaking communities.

7. Require that CMHCs provide more-comprehensivemental health services by using-preventive and multi-service approaches to treat a wide range of pkoblemsfacing the Spanish speaking.

8. Establish out -reach programs in the ServiceCenters to serve the Spanish speaking who fear theCenter or are ignorant of the services offered.

9. Require that Service Centers employ staffthat are bilingual as well as bicultural.

10. Incorporate the community methods of curingmental illness such as curanderas, spiritualists, andsalitefismo in CMHCs serving the Spanish speaking.

11. Fund pilot projects to identify, with communityparticipation, the types of programs needed for specificlocations and to evaluate existing Centers in terms oftheir relevancy to the community served.

75

12. Fund service programs at a constant minimumlevel for the duration of a grant.

Division of Manpower and Training

1. Earmark funds for training Spanish speakingprofessionals and paraprofessionals in the mental healthfields.

2. Provide incentive stipends to attract Spanishspeaking students into the mental health fields.

*3. Develop a comprehensive plan for establishingdevelopmental funding for community based leadershiptraining.

4. Focus attention on the following in relatingthe Civil Rights Act to the Spanish speaking:

.a. Develop a training curriculum relevantto the 'Spanish-speaking.

b. Recruit Spanish speaking faculty.

C. Recruit Spanish speaking students intotraining programs.

d. Develop a practicum relevant to theSpanish speaking.

5. Develop a two-pronged "crash program" to in-crease Spanish speaking manpower in mental healthfields with 10 percent of Manpowei and Training budgetset aside for this purpose.

a. Establish a Crash Technical AssistanceService (CTAS) to:

1. Increase consultant staff to work onspecific assignments with the Spanish speaking.

2. Develop a small contract program toseed manpower and training planning projectswith Spanish speaking staff.

3. Stimulate and develop conferences andworkshops for training planners, (possiblythrough the Continuing Education Branch).

76

b. Develop a specific crash recruitment andtraining program for the Spanish speaking withinthe Division of Manpower and Training Programs.

6. Establish and fund two demonstration trainingcenters to serve as model' or integrating training,service, and research aspects of manpower development.

7. Offer training to non-Spanish speaking ind!vid-uals working with the 'panish speaking in mental healthfields in order that they may understand the specialproblems and needs of the Spanish speaking.

Division of Research

Recommendations

1. Include Spanish speaking on research, reviewcommittees, especially Clinical Research, JuvenileProblems, Mental Health Small Grants, Personality andCognition, and Social Problems Research ReviewCommittees.

2. Establish research priorities along the linesof intervention-prevention which is multi-thrust innature, to include a-number of the research areas.

3. Define guidelines for the Center for MinorityGroup Mental Health Programs for research funding andresearch monitoring.

4. Use community par' _Jipation in the design andimplementation of research programs.

5. Code all research published relating to theSpanish speaking in the same manner as the NationalScience Information Center to ensure easy identification

and accessibility.

6. Study and document the cultural strengthsof the Spanish speaking and not juLt the weaknesses,illnesses and handicaps.

Recommended Research Priorities

1. Uninstitutionalized ways in which the Spanishspeaking community deals with mental health concernsand means of applying these mechanisms to institutional

77

mental health service programs.

a. Intervention research especially in thearea of multi-problem crises.

b. Utilization of community mental healthservices with specific reference to the differentattitudes of individuals within a group towardinstitutionalized mental health care.

c. Utilization of community out-reach programs.

d. Studies comparing therapeutic techniques,group vs individual therapy; long-term vs

short-term therapy; crisis intervention therapyvs a more traditional kind of therapy.

e.',Development of films on mental healthprobleMS and treatment of the Spanish speaking.

2. Definition of normative behavior for theSpanish speaking.

3. Ecdiogical studies of the barrio as a totalsystem relating to Spanish speaking mental health.

4. Critical periods in the life of the Spanishspeaking child.

5. Distinction between social class differencesand cultural and/or ethnic differences.

6. World view of the Spanish speaking and howthis factor contr!_butes to differences in life experi-ences.

7. Conflict generation and resolution withinthe barrio.

a. Differences within a Spanish speakinggroup (intra-group difference).

b. Relations between various individualgroups (inter-ethnic relationships).

c. Process of Chan' s within the barrio asa result of interaction among ethnic groups.

78

8. Methodologies for studying the Spanish speaking.

a. Development of research strategies used

cross-culturally.

b. Development of screening and testing in-struments that are culturally sensitive not only

to the Spanish speaking as a whole but to the

various Spanish speaking groups across the country.

9. Coping mechanisms of the Spanish speaking in

dealing with grief, death and other crises.

10. Studies and documentation of the culturalstrengths of the Spanish speaking and not just their

weaknesses illnesses and handicaps.

Division of Special Mental Health Pro)lems

1. Extend the model being deveLoped for funding

small demonstration projects (of less than $5000)

sponsored by the Section for Youth and Student Affairs

to the funding of small projects for Spanish Speaking

Groups.

Other recommendations are incorporated into Section on

General Recommendations and Demands.

National Institute on Alcohol Abuse and Alcoholism

Division of Narcotic Addiction and Drug Abuse

1. Employ community people including ex-addicts

and recovered alcoholics in the alcohol and drug abuse

training centers.

2. Appoint Spanish speaking professionals andparaprofessionals with experience in the drug abuse/

alcoholism fields on .ralicy-making and evaluation

committees.

3. Establish drug abuse and alcoholism training

seminars throughout the nation.

4. Establish rehabilitation services for ex-

convicts who are recovered alcoholics/ex-addicts

79

5. Organize regional and national conferences tobring together Spanish speaking individuals involvedin the alcohol and drug abuse fields in order to shareinformation so that better services can be providednation:wide.

6. Require that services affecting the Spanishspeaking reflect the particular community drinkingand drug patterns and community perspectives which aredistinct from those of middle-class or poor Whites.

80

CentclcumVirticionts

SPANISH SPEAKING CONFERENCE

NATIONAL nIST/TUTE OF MENTAL HEALTH

HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION

January 11-12; 1972 Bethesda, Maryland

PARTICIPANTS

Mr. Juan D. Acevedo

Dr. George L."Adams

Mr. alum Andrade

Executive Director

Narcotics Prevention Program

Boyle Heights Center

507 Echandia Street

Los Angeles, California 90033

(213)

223-4017

Special Assistant

Division of Manpower and

Training

NIMH,'NSMHA

..N

AN

Nab

Nab

5600 Fishers Lane


(301)

443-4257

Director

Mental Health Planning Project

Hogg Foundation for Mental

Health - South Texas Project

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

NN

MN

Mrs. Lupe Aeolian°

Civil Rights Specialist

omen's Action, Program

DHEW

Mr. Tomis Atenclo

Coordinator

La Academia

NO

ON

AN

IN

P. O. Box 550

Crystal City, Texas 78839

(512)

374-3342

330 Independence Avenue, S. W.

Roos 3427

Washington, D. C.

20201

(202)

962-5151

P. O. Box 148

Dixon, New Mexico 87527

(505)

579-4349

CO

Dr. Bernard Sandler

4111

11.1

4111

1

Acting Director


Training Programs

NIMM, =NBA

5600 Fishers Lane


(301)

443-4257

Mt. Samuel Brito

Mental Health Program

Specialist

Region VI, MIMS, =MBA

.001

09

Dr, Bertram S. Brown

610

Dr. William E. Bunny

Director

NUM, ERMA

Federal Office Building

1144 Cbumerce Street

Dallas, Texas 75202

(214)

749-3426

I MIN

IM

Acting Director

Division of Narcotic Addiction

NUM, MSMSA

Dr. Marry P. Cain II

5600 Fishers Lane


(301)

443-3673

5600 Fishers Lane


(301)

443 -4227

AssistantDirector for

Planning and Evaluation

NIMM, ISMMA

5600 Fishers Lane


(301)

443-3175

Assistant Chief

5600 Fishers Lane

Narcotic Addict Rehabilitation


Branch

(301)

443-4666

Division of Narcotic

Addiction and Drug Abuse

MIMS, MSNBA

Administrator

Father Rahn 'Information and

Referral Center

419 South Virginia Street

81 Paso, Texas 79901

(915)

532-5949

Narcotic Specialist

Mental Health Field Program

615 Peres Street

San Antonio, Texas 78207

(512)

225 -4241 act. 47

Associate Director

Laboratory Community

Psychiatry

H arvard University Medical

School

58 Fenvood Road

Boston, Massachusetts 02115

(617)

232-6951

Secretary

Center for Minority Group

Mental Health Programs

Division of Special Mental

Health Programs

IISMMA

5600 Fishers Lane


(301)

443-3724

Acting Associate Director for

Parogras Coordination


Training Programs

NINE, =BMA

5600 Fishers Lane

Rockville, Mhryland 20868

(301)

443-1278

IDirWctor

741 South Atlantic Boulevard

last Loi Angels. Chicano

Los Angeles, California 90022

Mental Health Training

(213)

263-9694

Center

Director

,

Social Work Training Program

in Alcoholism

New York State Training

Programs

105 East 22nd Street

New York, New York 10010

(212)

254-9400

Mental Health Program


Specialist

50 Fulton Street

Region IX, NIMR, =NBA

San Francisco, California 94102

(415)

556-2215

Mr. Kenneth L. Eaton

Deputy Director

3600 Fishers Lane

National Institute on


Alcoholism and Alcohol Abuse

X301)

443-3851

RIMS, MINA

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Dr. Ricardo, Calais

President,

1707 Rhode Island Avenue, N.W.

Aidromeda Incorporated

'

Washington, D. C. 20036

Community Mental Health

(202)

347-1676

Project

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Dr. Alvin E. Gains

Chief

5600111shere Lane

co

Personality and ortition

.kville, Maryland 20852

Research

SectioCn

Roc(301)

'443-3944

Behavioral Sciences Research

Branch

Division of lxtranural

Research Programs

MIMS, ISM

mimmummmmm

40411.

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Mr. Roberto D. Gonsalfs

Program Monitor

State Department of Urban

Affairs

a last Long Street

Columbus, Ohio 43215

(614)

469 -3488

Dr. Martin M. Eats

.111

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ON

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'Dr. Edward J. Kelty

Ralph, C. Kennedy

Chief

5600 Fishers Lane

Clinical Research Branch


Division of Extramural

(301)

443-4524

Research Programs

MIME, =MBA

Chief

5600 Fishers lane

Planning and Allied Systems


Branch

(301), 443-3667

Divisionl)f Mental Health

Service Programs

NIMMOUNDIA.

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chief

5600 Fishers Lane

Community Mental Health


Services Support Branch

(302)

443-3623

Division of Mental Health

ServicmProgrims

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oMr. James A. Mask°

Health Services Officer

1,5600 Fishers Lane

Spy:Jai Projects Branch

Sockville, Maryland 20852

Nutlanal Institute on

"(301)

443-2954

alcoholism and Alcohol Abuse.

RIM, EMMA

,

rs. Faustina Ramirez Knoll

Dr, Thomas Langner

.11.

0.11

Mr, Carl 0. Leukefeld

011.

Supervisor - Youth Services

Catholic Social Services

of Wayne County

111

9851 Hamilton Avenue

Detroit, 'Itchiest, 48202

(313)

883-2100

Professor of Epidemiology

Division of Epidemiology

Columbia University

OE

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6111

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800, West 188th Street

New Fork, New York ,10032

(212)

925-7300

Program Development Specialist

Narcotic Addict Rehabilitation

Branch

Division of Narcotic Addiction.

and Drug Abuse

RIMS, NSMBA

:500 Fishers Lane


(301) ,443-4547

Mr. Ralph Littlestone

Chief

Planning Branch

Office, of Program` Planning

and Evaluation

SINN, MINNA

5600 Fishers Lane


(301)

443 -3476

Mrs. Gloria Lopes McKnight

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INN

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11.M

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Public Welfare Worker of

,640 Tenple,Street

Employment Related Services

Detroit, Michigan 48201

Wayne County Department of.

(313)

222-2785'

Social Services

Miss Mamdalena Miranda

MO

INI1

011M

1010

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Assistant Professor

Livingston College

Rutgers University

NO

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Mew Brunswick

Mew Jersey 08903

(201)

932 -3954

Mr. K

,,...1.- lc Omura

Executive, Assistant to the

5600 Fishers Lane

Director


m'

MIME, BMA

,(301)

443-4297

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Dr. Abel G. Ossorio

Associate Regional Health,


Directorfor Mental Health.

1961 Stout Street

Region VIII, MIME, BMA

Denver, Colorado 80202

(303)

837-3177

Dr. Jerry Osterweil

Deputy Director


Training Programs

NUB, RSMMA

5600IPisheis Lane


(301)

443-4259

Dr. Ado M. Padilla

Assistant Professor

DepartMent of Psychology

University of California

Santa Barbara, California 93106

(805)

961-2210

.......

--------- ........... --__-----

r-

fr. Robert Pena

Public School Social Worker

414 - 14th Street

Denver Public School System

Denver, Colorado 80202

(303)

623-7193

Mr. Trinidad Pifia

State Coordinator for Chicano

P. O. Box 907

Studies

San Juan, Texas 78589

Colonise Del Valle

(512)

787-9901

......

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MID

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Miss Maria Poinsett

Management Intern


Office of Spanish Surnamed


Americans

(202)

963-6952

Office of the Secretary

DREW

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Mrs. Marion Primas

Social Science Analyst

Planning Branch

Office of Program Planning

and Evaluation

MIME.' USIMIA

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5600 Fishers Lane


(301)

443-3476

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11.

IMP

Dr. James R. Ralph

Chief

5600 Fishers Lane


RoCkville, Maryland,20852

Mental Health Prograis

(301)

443-3724


Health Programs

NIMH, HSMHA

Dr. Juan Ramos

Special Assistant to the

5600 Fishers Lane

Director


Office of Program Coordination

(301)

443-3823

NIMH, HSMHA

-Mr. Arthur R. Raya

Special Assisitaii)for Spanish

Speaking AMOS to the

Assistant Secretary for

Health and Scientific

Affairs

DREW



(202)

9628411

Miss Susan G. Riley

NUR Contractor

Planning Branch


and Evaluation

NIMH, HSMHA

5600 Fishers Lane


(301)

443-3476

Dr. Julius Rivera

Dr. Humberto Rosselli

Dr. Pedro Ruiz

Professor

Sociology Department

University of Houston

411M

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110

Houston, Texas 77004

(713)

748-6600

Ext. 1085 or 1075

President Elect

Sociedad Colombians

de Psiquiatria

.1N

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11.0

*

Carrera 18, Number.84-87

Apartment #406

Bogota 8, D.E., Colombia,,

South America

Director

Lincoln Hospital Community

MentalHealth Center



(212,

993-4376'

Dr. Pedro Nel Saavedra

11.4

10

Mr. J. Enrique Salinas

EXperimental, Health

Specialist

Mental Health Education

Area "B" Mental Health

Community Center

1125Spring Road, N. W.


(202)

629 -5404

Regional DirectOr for 15

,County Area

State Department of Public

Welfare

111

P. 0. Box 2410

San Antonio, Texas 78298'

(512)

CA 3-2661

111

Miss Yolanda Sanchez

Director

Office of Puerto Rican

Program Development

City College of New 'York

Administration Building

Room 3068

138th Street k Convent, Avenue

New-York, NeW 'York 10031

(212) 62142425

Dr. John C. Scanlon

1Associate Director for

Program Planning

Division of Narcotic

Addiction and Drug,Abuse

NINE, "LINEA

5600' Fishers Lane

Rockville,, Maryland 20852

(301)

443-3629

ke,me. Jaime Sena Rivera

Acting Assistant Professor

Sociology and Chicano Studies

Department of Sociology

University of California

Riverside, California 92502

(714) 787-3543

mm

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Mrs. Theresa Aragon de Shepro

Dr. Milton N. Silva

Vice Provost for Special

Programs

University of Washington'

Seatile, Waehinetn 98105

(206) 543-9210

'

Associate Director

Mental Health Unit

Ruitspointlultiservice

Corporation



(212) 993-3800

Mr. Walter N. Smith

Deputy Director


Health Programs

NIMH, HSMHA

5600 Fishers Lane

`Rockville, Maryland 20852

(301)

443-3533

Mrs. Miriam Malavet de Staples

NIMH Consultant

Office of Communications

NIMH, HSMHA

5600 Fishers Lane


(301)

443-4276

Dr. Claudewell S. Thomas

Director

Division of Mental Health

Service Programs

NIMH, HSMHA

5600 Fishers Line


(301)

443-3606

Mrs. Lorraine B. Torres

Chief

Social Sciences Research

Branch

Divieton of Extramural

Research Programs

NIKE, HSMHA

5600 Fishers Lane


(301)

443-3942

Dr. X. Fuller Torrey

Dr.,, Albert Vasquez

.014

1HI

Special Assistant to the

Director for International

Affairs

HSMHA

Staff

New Careers Program


Training Programs

NUR, HSMHA

5600 Fishers Lane

Robkville, Maryland 20852

(301) 443-4233

411 11

1

5600 Fishers Lane


(301) 443-4233

DirectOr

Pilsen Mental Health Center

1624 West 18th Street

Chicago, Illinois 60608

(312) 341-8535 -36-37

Mrs. Rosa I. Vasquez

Director

Accion Community Center

452 S.W. 12th Avenue

Miami, Florida 33135

(305) 649-2400

Mr. Thomas R. Vischi

Social Science Analyst

Planning Branch


and Evaluation

RIME, HSMHA

5600 Fishers Lane

Rockville,, Maryland'20852

(301) 443-3476

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Dr. Louis A. Wienckowski

Director

5600 Fishers Lane

Division of Extramural


Research Programs

(301) 443-3583

MIMI, HSMHA

Dr. Willie S. Williams

%o

Executive Secretary


Mental Health Programs


Health Programs

RIMS, HSMHA

5600 Fishers Lane

RoCkvillei Maryland 20852

(301) 443-3724

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