;

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-, .... f

ECONOMIC ASPECTS OF ALASKA'S · COMMUNITY MENTAL HEALTH MANPOWER

A Supplement to "Report on Comprehensive Community Mental Health Planning, 1963-1964 11

Juneau, Alaska October 1965

George w. Rogers; Ph.,,D. Research P~ofessor of Economics

Prepared for Alas lea Department of Health & Welfare, Division of Mental Health, Comprehensive Mental Health Planning Project under contract with Institute of Business, Economics and Government Research, University or Alaska·

J

\

..

TABLE OF CONTENTS

Chapter Page

I ECONOMIC ASPECTS OF COMMUNITY HENTAL

II

III

rv

H&'\LTH PROGRAMS FOR ALA.SI<A·.1;.,,;;.".· •• •'• ... .-.,.·.~\·.,..,~-~·.· •• ··.,. ~ l

Economic Implications of the Recommendations of the Governor's Committee on Mental Health Planning.... 3

\

Economic Elements in a Manpower Studies Model •••• •••.. 7

THE DE11\.ND SIDE OF Tifil EQUATION., .... •~.• ••••••••••••• •• ll+

Current Dema:pd........................................ 16 Population Base Served................................. 20

Projected Demands 1965-1985........................... 23 THE SUPPLY SIDE OF THE EQUATION••••••••••••••••••••••• 25 The National :Manpower Problem and Alaska.............. 27

Alaska's Competitive "Price" Position--The Salary Factor ••••••••••••• ·., ..................... I>·•.. 30

Alaska's Competitive "Price" Positinn--The Non-Salary Factors................................ 38

Calculation of a Hypothetical "Price" for One Mental Health Team.................................. 42

REQUIREMENTS FOR DEVELOPMENT OF A COi'l"-TINUING MA.NPOv,fER PROGRAM •••• • •••••••••••••••••••••• 45 Effective Demand--Determinate of Fiscal Capacity and Tax Effort........................ 45 (' V Studies 50

Alaska's Continuing Problems of Manpower Supply ..... '". 52 APPEND:Dc. ··~r.,~t.~ ...... :~,~.,.r~ .f• '•· .;·. ·,,/e:•'•'•i~·~~. ·• ·•· _,·.,1 ·i•'• r•'•"•f•"•'~'"~ ··• · •. t. , .. ,.·.~-. • 56

...

/

Table

1

2

3

4

.5

6

7

8

9

LIST OF TABLES

Page

Base Population to be Served by Community · · Mental Health 1965-1985 •••••••••• ,..g •••••••••••••••••••• 22

Community Mental Health Manpower Needs, 1965-1985 •••••• 23

Professional Mental Health Positions Currently Authorized and September 1965 Employment ••••••••••••••• 26

' Salary Ranges for Public Mental Health Hospitals in Alaska and Far West, September 30, 196',3 •••••••••••••••• 33

Salaries Reported for State Mental Health•••••••••••••• 34

Proi'essional Positions and Salaries Authorized in Alaska Regional Clinics, Fiscal Year 1963-1964 ••••••••• 37

Total Operating Costs of Regiortal Clinicsi Other Than Professional Salaries and Services, Fisca Year 1963-1964 •••••••••••••••••••••••••••• ,.. •••••••••••••••••••••• 39

Hypothetical 1963-1964 "Price 11 of One Community Mental Health Team••••••••••••••••••••••••••••••••••••• 43

State-Local Sharing of Hypothetical Cost of Community Mental Health Program,,•••••••••••••••••••• 48

I

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CR.tl.PTER I

ECONOMIC ASPECTS OF COMMUNITY MENTAL HEALTH PROGRl1.MS FOR AL.l\.SKA

Mental health and illness are prcxlucts of a myriad of indi­

vidual, social and economic factors--individual heredity, the

relation of the individual to family a.nd society, the economic

and moral climate of the community, the quality of the total

social and physical environmenta Programs to promote the mental

health and alleviate the mentals ills of the individual citizens

of a community cannot be isolated, but permeate all public pro­

grams designed to foster the improvement of the community and

the well-being of its citizens. The ideal community mental

health program has the same objective as that of the political

philosopher's ideal community, the development of the whole Man

and providing the conditions for achieving the good life.

In this broadest and most meaningful sense, community mental

health defies definition in terms precise enough for manageable

analysis and the formulation of specific programs of actiana To

make a start on planning community programs, therefore, it is

necessary to arbitrarily fragment the subject. This task is left

to the profess1-onals who look at reality through the special vie-wers

of their discipline. Hence, the fragmentation is along the defined

boundaries between established scientific and technical disciplines,

or comprises the jurisdictions claimed by the generally recognized

professions.

...

-2-

This is as it must be and is commented-upon merely to note

that the orientation of the resulting program reflects the pro­

fessional direction af its formulatior1,. If a community mental

health study committee were under the direction of an economist

or had 1an economic dimension to its membership, for example, its_

recommendations and program would have given particular attention

to the interaction among economic and mental health goals and

problems. Unemployment, economic uncertainty and instability

would be identified as being directly related to the incidence.

· af mental illness. Improvement of the community's basic economy

would be seen as an essential element in a total program to pro­

mote the highest mental well-being of its citizens. Conversely,

a satisfactory level of mental health would be a necessary con­

dition for providing a stable and productive labor force required

for further economic development and improvement.

It is not in this sense, however, that this monograph is

concerned with economic aspects of mental healthG The Governor's

Committee oper9-ted in accordance with the conditions set down by

Federal legislation dealing with a specific approach to achieving

mental health through community centers, the guidelines suggested

OH Healt11 Asso-

ciation, and the coordination provided by a professional psychi­

atrist. Economic c'onsiderations here will be limited to the

implementation of the resulting program for the provision of a

set of definable professional services organized in community

centers. (See descriptions in Appendix A.)

-3-

.Economi.c Imnlications of the Recommendations of the Governor~ s C ommi tt0e on Mental Hec1.l th Plan:n:Lng .

A review of the recommendations of the Governor's Committee

raises a host of specific economic problems and questions, not 1/

all oi~ ·which are clearly recognized or stated as such .. - Under

the "General" secti:on of the submission, the third item sums up

the over-riding economic implications of any mental health plan

as the establishment of priorities in implementing recommended

programs ubased on the needs for the services in any locality

and the ability of the State and the local government to finance

services and facilities to meet these needs~ 11 The importance

of economic aspects of planning were recognized in the original

grouping of the Committee into task. forces and in some of the

statements of their charges--manpcrwer and training (problems

of supply of professional manpower and cost of obtaining it),

financing (fiscal ability of State and local governments), and

community services (need vso local ability to pay)e The econo-

mic aspects, hcrwever, ·were not given any thorough technical

consideration in the operations of the Committee because of the

unavailability of economic consultation earlier and because of

the inadequate budgeting of funds for the payment of such pro-

fessional services.

!/Mimeographed memoranda presenting the final recommendations of the Govern?r's Committeel the sev~ral task forces a~ reports of the Commuru.ty Mental Rea th Plaruu.ng Groups made available August 20, 1965. · ·

~

·~,·>*"'" _,,--.,c,:.~~·~· . ··-~-.-,,-- ·--·- "

-4-

The more specific economic aspects of the recommendations

can be briefly revie,,red in terms of the task .forces which gave

some recognition to their existence~ The stated objective of

Task. Force One, the II optimal integration of existing services, 11

would clearly have a direct bearing upon the ef'ficiency and the

final cost of any total State plan. In the absence of a review

o:r such "existing services" and a plan .for their integration,

however, there is no basis f'or making an economic evaluation

beyond noting that the specific recommendations call for the

creation of two new State level positions in the Division

(Supervisor of Psychiatric Nursing and Supervisor of Psychia­

tric Social Work) which would provide a focus for integration

of mental health services with other social services ..

Task Force II was to "ascertain the nature and dimensions ·

of the problem" of meeting Native mental health needs.. The

determination ·of need was referred to a recommended program of

joint government and universtty research ·with an unmistakable

understanding that responsibility for meeting the needs of these

appr~~imately 45,000 Alaskan citizens should continue as a Fed-'

eral responsibility 11:ror as long as Alaska is to have a separate

f II 1\1.

recommending 11integrated mental health facilities for all popu­

latiop. groups," the Taslt Force makes it clear that ntreatment

of indigent Federal beneficiaries in racially integrated mental

---~-----·~- ______ ...... __ .... ___ - ··-~-····

~

-5-

health :facilities" should be on the basis of contracts between

the u ... SI> Public Health Service and State and local communities,

and that the Division of Indian Health 11acquire a psychiatrist

·with the same qualifications as are required by the state for

for a supervisory position, to work within its existing hospital

system .. 11

The recommended child and youth services of Task Force III

at the Alaska Psychiatric Institute would appear to be funded by

a federal grant program requiring no matching funds, but the ex­

tension of such services to children in community mental health

centers elsewhere was left "in the initial phases of planning .. "

The brief recommendations of Tas.-c. Force V on manpower and

training ·were given in broad generalizations urging "that Alaska

invest substantial sums in a recruitment program, 11 increased·

salaries and II other professional inducements" to attract quali­

fied person.i.--iel· and appropriate money for training seminars, in­

service training, etcv

Task Force VII dealing with the very specific economic

matter of determi:ni:ng "ho.·1 to establish the cost of new and

established programs and how to finance them" limited its recom-

L;u c on a practice or billing patients

11according to an agreed upon ability to pay," and establishment

of basic starting salaries at 25 percent above salaries o:r mental

health professional staff in the Western statesv It was recom-

-6-

mended that the "Western Interstate Commission of Higher Edu-·"'

cation be approached for i:nf'ormation on salaries .. 11

The combined reccmmendations of Task Force IV and III pri­

marily concerned ·with 11the feasibility of a corr.munity based and

oriented service, n are the most specific in terms o.f listing

additional facilities, contracts, personnel and a basis for

State-local financing ..

In addition to the recommendations of the Committee, there

has been released a detailed "Report on Comprehensive Community

Mental Health Planning. 11 The Report is not intended by its

authors to be taken uncritically as the final word on the me·ntal

health needs of' the State of Alaska.. In the words of the chair-

man of the Governor's Committee, it is presented with the hope

that it 11will serve Alaska as useful guidelines in the future

planning to. combat mental illness., 11 It is clear 1·rom a revie·w

of the Report that the statistical documentation of need for

mental health cent~ers and services and the translation of this

into manpower demand probably cannot be satisfactorily given,

particularly in an area as diverse and changing as Alaska. The

definition of mental illness beco~es reasonably precise only when

the condition which gives rise to the need has advanced to the

clinical stage. Planning for the programs ·which will include

preven:t;ion and identification of mental illness, as well as

diagnosis and treatment, therefore, of necessity is planning

1 .. or the unknown and can only be approached through

-7-

making inferences from general social, economic and demographic

data,through drawing upon experience and professional judgement.

The Report on Comprehensive Planning (hereafter and'in

footnotes referred to as the RepQI~) is a summary or a study

made of the social and economic environment with which the indi-.

vidual must cope in making a living and living in Alaska, includ­

ing the incidence of crime and other social disorders, the ex­

perience drawn from the several local committees of Alaskans,

and the professional advice sought. From this combination and

to the best or their abilities, the members o:r the Governor's

Committee had to make specific recommendations discussed above.

Despite the unavoidable shortcomings of the background studies

and the obvious gaps between this and the specii .. ic recommenda­

tions made, for the present analysis those recommendations ,

directly or indirectly relating to manpower needs will be arbi­

trarily assumed to be a reasonably accurate stat.ement ar current

. actual need. Future experience alone will determine the validity

of this assumpti·on.

EcQ;nomic Elements i;n a Manpqwer Stu.dies Model . .

Assuming fully adequate statistical data are available and

State and local goals and objectives are fully understood and

popularly accepted, there is a further and more basic· need for

the design of a schematic med.el for the study of professional

manpower supply available to Alaska, its need and derived demand.

·.,:~_·.{-

-8-

In the words or an American Psychiatric Association monograph 4,

on the subject of manpower research; "Without a systematic pro­

gram, little of value· is likely to be gained in terms of useful

information or action. A coordinated attack upon manpower prob­

lems cannot be launched by piecemeal tactics with any hope ·o:r . 11

winning progress beyond the transitory and illusory." ·

The methodology and model presented in the A.P.A. monograph,

which the author admits "were freely adapted from the President's

Committee on Scientists and Engineers" and hence have an impeccable

pedigree, suggest a general type or approach which might be used

in further research or Alaska's mental health manpower problems.

The A.P.A. model. itself cannot be adapted directly, hawever, as

it is nation-wide in orientation and focuses primarily upon short

and long range programs for r~pidly expanding the nation's actual

and potential pool of psychiatrists. The A.P.A. monograph pro-

poses to use II operations research or applied decision theory" as

its methodology for its·projected research and describes the logi­

cal underlying structure or 11model" as follaws:

"People can be viewed as the manpower resource together with other.social and physical components in a mental health 'system. i Then the goal is to maximize the con,-. · .-.,·,~ · gruence between their abilities and the requirements of'

j system~ Pers selection and classification (the distribution or assignment of person­nel throughout the system) can be conceived o:r as a subsystem which must take into account the administra­tive organism, mission, jobs involved, assessment of'

1/ Robert F. Lockman, "Development of' a Manpower Research Program :ror the American Psychiatric Association," (A.P.A. Washington, D. c., January 1965), p. 19.

-9-

human performance, selection procedures used, and flow of personnel through the total system. This systematic ecology is of great importance in providing a rational and comprehensive framework for studying manpower." 1/

From a reading of the re~ainder of the monograph and.a study

of the "schematic diagrams" af the research moie1 1 the above

quotation can be translated into more understandable and meaning­

ful language by simply saying that the A.P.A. model is analagous

to models which have been devised as guides in the :formulation

of natural resourc~s management programs and policies. In this

case, the objective is to provide guides for programs and policies

for the management of the nation's total "manpower r~sources 11

(later defined in'the model as "total population l4 years and

older") so as to provide sufficient "raw material" for the umanu­

facture" at· a desired supply of psychiatrists. "The programs pre­

scribed to divert a supply of manpower from the total "resource"

into the mental health fields include the discovery of individuals

with the required talents and capabilities, influencing career

choice am0i"1g the college-bound, provision or expanded technical

education and training facilities, etc.

If the orientation of manpower study is shifted from the

nation to the State of Alaska, it becomes clear that the change

in regional focus requires a different type of analytical model.

Although Alaska could conceivably malte some contribution to ex­

panding the nation's supply (i.e., inf'luencing some of its young

11 :Cbig., p. 8.

-10-

people to become psychiatrist!3, developing 11.J.oad-reducers" for

psychiatry, etc.), and thus indirectly ease its own supply prob­

lem, it would be a very min.or contribution indeed in the national

dimensions of the A.P.A. moo.el. It should be obvious that the

Alaska manpower supply problem cannot be met within the lini:L.ta­

tions of our own total "manpower resources" but must seek means

of recruiting from the national pool a greater share of profes­

sional manpower and seeking alternatives t_o the meeting of its

demand for the sort of services provided by these professionals.

In other words, instead ·or the "natural resource management" moo.el

appropriate to the study of national manpower, the Alaska man­

power moo.el must put the State in the position of a purchaser or

consumer of the services provided by this manpower. This can be

conveniently expressed in the form of the economist's classical

elementary supply and demand equation for determining the price

required to bring forth the output of services needed or the out­

put which the expenditure which can be made would call forth.

The combination of services embraced by a comprehensive com­

munity mental health plan aiming to promote mental health through

· prevention and elimination or the causes of illness, consultation

"economic producttt in the sense that a "product" is any goo:!. or

service or combination which gratifies wants and which people are

willing to pay m2nev ror either i:ridividually or as members or a

. ·'"'

-11-

group. There must be a recognized need for s .. uch a product and

it must be available at a price the consumer is able and willing

to pay. In economic terms, there must be "effective demand,."

The Report has attempted to establish the need for this 11product 11

and set forth a broad plan and recommendations for meeting this

need which can be expressed in terms of physical facilities,

professional manpower, supporting services, etc. Translating

this expression of need to monetary terms, effective demand can

be measured as that portion of the needed product which can be

purchased with State and.local revenues and private payments.

The size and the effectiveness of the resulting program will

also be determined by the sunply of the factors of production .,

which can be made available to Alaska. On the supply side of the

equation, some of the pertinent questions are: (1) to what· extent

can the inputs of professional manpower required by the "product"

be provided, and (2) what are the terms and conditions under which

these inputs can be made available to Alaska? Given national de­

mand for the factors of production required a1:1-d the output of new

trained _professionals, the supply ·which would be available to

Alaska may fall short of our needs and the proposed program would

Even if the physical supply can be called forth to meet the

full requirements specified by Alaska's needs, the cost of accom­

plishing this fully may be beyond our financial means. Demand

·,

-12-

must be translated, therefore, into "effective demand." The

pertinent questions would be variations on what can be paid for

through a combination of' available Federal aid and State and

local participation. The determination of the degree of possible

local participation becomes a particularly strategic factor in

this case as the underlying philosophy. of the program is that it

be based upon the maximum degree of de-cent~alization feasible,

including financial support. This will be determined by the tax­

ing capability of the local government units and areas and the

extent ·to which this is being exercised.

A comprehensive treatment of all of these matters is obvious­

ly beyond the limits of' this present study. Certain key data must

await the outcome of other investigations nav being conducted.

For example, the July 1965 Report notes: 11Mr. Richard Sassar_a,

o.f the Governmental Statistical Corporation, is preparing a report

on the possibilities of funding community mental health centers,

based on knowledge of financial resources in various communities.

This report will be a separate document available upon request."

Current data on professional salaries is not available. "The

Governor's Committee recommended that the Western Interstate

CommissiOJ,1 for Higher Education be asked for data more recent

than this .[J.96jJ on salaries. A reply was received July 8, 1965,

by Dr. Helen Whaley from WICHE, stating that current data for the

-l3-

nation or the western states alone, was not presently available" ~. 1/ At such time as this is available, it will. be sent to Alaska."

Finally, economic measuring devices generally available and

data available in Alaska are inadequate to assess fully the demand

and supply aspects of' manpower. For the present, therefore, the

approach can at best be· mainly descriptive with theoretical analysis

serving as a rough guide to a more ideal formulation at a later

date.

11 Renm:t,, 2 , pp. 71 and 78.

CHAPTER II

THE DEMA.ND SIDE OF THE EQUATION

In economic terms, demand for a product (goods or services)

is a reflection of' a recognized need on the part of the consumer,.

the income available for purchase, and the demand for other pro­

ducts. Need is reflection of a host of' socio-economic variables

and when the ttconsumer" is a comm.unity or other social group, this

can be approximated from the study or appropriate social and econo­

mic data. Looking at Alaska and its-major political entities as

consumers, a review of the background material contained in the

Report suggests a relatively high level of' need. Alaska's native.

citizens are in a strained pericd of transition between different

cultural and pbyisical environments. Alaska's non-Native citizens

on the whole are a highly mobile p opula ti on with all of' the un­

certainties ass·ociated with a footlooseness and lack of social

· cohesion. The resulting statistics on crime, suicide, divorce,

alcoholism, etc-., when related to total population in most cases

indicate abnormally high rates of social disorders. A sufficient

background of experience and knowledge does not appear to exist

statement of demand and manpower needs. As already stated, tor

present purposes the subjective judgement or those who were en­

gaged in the planning will be accepted. Upon the assumption that

-- ----·---- ---~---

-15-

the Committee's recommendations are an accurate reflection of ... need, a working definition of "demand" stated in terms of man­

power requirements can be made.

As defined in the A.P.A. monograph referred to above,

"Demand--effective demand is an aggregate of four components:

a. Mental health personnel currently employed as such (that is,

the current supply, as defined above); b. Established but un~

filled positions requiring mental health personnel; c. The need

for mental.health personnel not yet.formalized by the establish­

ment or positions but recognized by employers who are willing

and potentially able to provide accep~able employment conditions;

d. Manpower needs uncovered by the applications of standards of . "J:./ .

staff-patient ratios. 11 As already dis~ussed, the demand under

consideration here is for the services of mental nealth.personnel

employed -by the State and local governments. A tabulation can be

made of the Alaskan equivalents of the first two components from . .

current Bmployment records and the staffing authorized by the

Sta.teis mental health budget and the last t·wo components could be

inferred fr~~ the conclusions and recommendations or the Governor's

Committee and the Renort as· to further State staffing and proposed

th centers

J/ Lockman, ,on., cit(>, Pe 119 It should be noted that "effec­tive demandu as used here relates to the total United States and assumes that the Nation can afford and will pay for whatever it recognizes as a fldemand. 11

-16-

Current Demand

The pos:Ltions currently established in the O.f:fice of the

Director, Division of Mental Health included Director, Super­

visor of Psychiatric Nursing, Administrator and three clerical

positions. The first two positions are being filled on a part­

time basis by the Superintendent and Director of Psychiatric

Nursing at the Alaska Psychiatric Institute, respectively. The

Governor's Committee ~s recommended that every attempt be made

to recruit· additional professional persons to.eliminate the

present doubling up or A.P.I. staff, and the establishment at the

State level of two additional positions, a Supervisor of Psychia­

tric Social Work and a Supervisor of Psychology.. This would

appear to bring the Office of the Director up to the level re­

quired to meet present needs for overall supervision, direction

and coordination. Except for increases in clerical staff and

possibly additional administrative assistance, it will be assumed

that this reco.'Tlmended staffing ·would be adequate to meet the State

level administrative and supervisory manpm·rer requirements of a

considerably increased future State-·wide need for mental health

services ..

Under 11 11 the present State program

includes the operation of the Alaska Psychiatric Institute at

Anchorage, Harborview Nursing Home at Valdez, and Morningside.

The staff of the Alaska Psychiatric Institute according to the

Report consists of a Superintendent who is also serving as Director

-17-

of the Division, Director. of Psychiatric NurSii.ng who is also

serving as a Supervisor in the Division, Director of In-Service

Nurse Training, Director of Child Psychiatry, two staff psychia­

trists, one staff psychologist, 40 registered nurses and a Chief

of Services. The Governorts Committee. recommends the immediate

recruitment of a full-time Director for the Division (or Super­

intendent for A.P.I.), a full-time Supervisor of Psychiatric

Nursing· in the Office of the Director -to ·relieve the Director of

Psychiatric Nursing at A .P. I. oi' her present double duties and

"an increase in the staff of psychiatric social workers" (the

number is not given in the Renort). Again, it ·will be assumed

that the presently established programs under "Institutional

Services" and the recommended staff increases and the Alaska

Psychiatric Institute represent the present need or demand for

these services. Although the need for these services may expand

in the future a·s the need or demand for mental health services ·

generally increase, it is basic to the entire new approach being

considered here that much of institutional. care is outmo:ied. For

the present analysis, therefore, it 't·[ill be assumed that the j_I11-

,nlementation of the urono~rnd qommu,nity health.centers nror.:ram will

,tend to s,tab:Lli.ze t.he mano<;Jl:Te:r :cequirements :Ln Institutions ..

the com.~u...'1.ity health centers approach the national goal set by

President Kennedy in his 1963 speech of reducin~ the number of

patients nmv under custodial care by 50 percent by 1973-19$3, the

present manpa·1er needs may even decline.

-l8-

The present Communj_tv Mental Health Services program consists ...

of three State supported regio~~l clinics at Juneau, Anchorage

and Fairbanks. The position of Director of Commtu"'lity Mental

Health Services has never been filled. All three clinics have

suffered from an inability to recruit anq. retain professional

persons for many of their established positions. The currently

authorized positions are as follows: (l) Southeastern Clinic -

psychiatrist, psychologist, psychiatr~c social worker, psychiatric

nurse, two clerk-stenographers; (2) Southcentral Clinic - psychia­

trist, psychologist, two psychiatric $Ocial workers, four clerical

positions; (3) Northern Clinic - psychiatrist, psychologist,

psychiatric social worker, mental health nursing consultant, two

clerical positio~s.

To implement the community mental health program at a level

adequate to meet current needs, the Governor's Committee recom­

mends the establishment of six mental health teams (each to consist

of one psychiatrist, one psychologist, one psychiatric social work­

er, one psychiatric nurse and two secretarial-clerical positions)

to r.1eet the local community needs of the Juneau, Fairbanks, Sitka,

Koo.iak, Ketchikan and Anchorage areas, to be supported jointly by

the State and ·Borough governmentse The three existing State sup­

ported regional clinics would be freed for itinerant visits in

other communities of their respective regions. At Anchorage yet

a third team of four professionals is recommended to attend to

the matter of pre-care and after-care of patients admitted to the

-19-

Alaska Psychiatric Institute. Finally, a ps~chiatric social ·work­

er is reccxnmended for Nome, Cordova, Kenai, Seward and Palmer,.

In short, tha Co::nmittee appears to find that the mar;.prn,ter needs

of the State require a total of 10 psychiatrists, 10 psychologist.s,

l6 psychiatric social workers, 9 psychiatric nurses, and 22 steno-­

graphic-clerical positions.

As stated at the outset of this section, demand for mental

health services can be estimated from a study of a number of social,

economic and demographic variables which indirectly are indices of

both the mental health status of the community and its ability to

pay for services. Until the statistics reporting Tee ommendations

of the Governor's Committee (see Renort, pp~ 127-131) are implement­

ed and have been collected for a pericxl of time, it is not possible

to formulate any reliable theoretical relationships between the

level o:f care needed and the social, economic and demographic vari­

ables .. For the present analysis, it must be assumed that the above

described manpower program represents the level of present need ..

The only social-demographic data to which it is possible to relate

this manpower demand is the total present population to be served

by the programs. When this population base is established, it

possio~e maKe

manpower demand by assuming an approximately constant ratio be­

tween demand and future base population ..

-20-

Ponul2.tion Base Served

Members of the armed forces clearly should be excluded frcm

the total population to be considered in determining the need

for mental.health services. The Report on Comprehensive Planning

quotes a letter dated 20 July, 1965 from the Office of the Comma!l?,

Surgeon, Headquarters, Alaska Command which states in part:

11 .... Because of the unique and stressful circ:umstances of many of the military activities in Alaska a great deal of psychiatric screening is accomplished. Many of the patients seen would not under normal circum­stances of civilian living be the subject of any psy­chiatric care. Services rendered in military medical facilities to dependents of military personnel also do not contribute to the need for civilian plann:i,ng :r or mental heal th. 11 Y

Although the Command Surgeon states that "dependents of military

personnel also do not contribute to the need :for civilian plan­

ning, 11 this ·would appear to apply primarily to those dependents

residing in locations close to military medical facilities (South­

central, Southwest and Interior regions)" For example,· it is

doubtful that the dependent of a Coast Guardsman residing at

Ketchikan could be promptly cared for through or be eligible to

enter the appropxiate section of the main facilities existing in

so~thcentral Alaska~ In the absence of any clearer authoritative

f

the entire State and dependents estimated in the Southcentral,

Southwest and Interior regions should be excluded from the popu­

lation for planning purposes. The relationship of VoA. programs

1/ .Report ... "'..,, p. 44.

-21-

to State and comn1unity planning purposes cannot be assessed at

this time and will be ignored for the present.:.

Another important minority group in the total State popu-

lation requiring special consideration are the Native Alaskans~

The Governor's Committee recommends 11the State and Federal Govern-

ment should immediately formulate a cooperative program designed

to permit the state to assume all programs, over a period years,

consistent with the state's financial ability~ 11 The Report more

specifically suggests:

"It would, therefore, be consistent to request the Division of Indian Health to extend as many services in the United States Public Health Service Hospitals as the state hopes to extend in the other general hospitalsoooait is not re­commended. that Mt .. Edgecumbe Hospital and the Anchorage Mental Center do any more than provide psychiatric consul­tation on the basis o:r any other medical specialty consul­tation or se:eviceo., ... o It should be clearly noted that ·what is recommended here is an extension of community mental health se:rvices to the native a:reas where the state is not able to extend the servicei and where the local cormnunity has no funds to support a ocal service, even though the community may be of a size of Kcdiak or Sitka, and there is no recommendation to provide other services of a cus­tcdial nature that would compete wi.th Alaska Psychiatric Institute or Morningside· Hospitalr_ 11 Y It is impossible specifically to determine and measure the.

extent to which existing mental health services by the State are

being provi_ded its Native citizens, but it is clear that the in­

tegration of such services is in a pericd of transition and the

process is one ·which should be carried through to an eventual

completion "over a period o:f years" and "consistent with the

state's :financial abilitye 11 . In determin;tng the total population

1/ Reriort,, '.l '', PPe 103, lOlre

-22-

to be used for future State and local progra~ planning, there­

fore, a progressively increasing portion of the Native population

should be included in the planning basea In the absence of any

more reliable basis for doing this, it has been assumed that only

the Native population in the_Southcentral region is presently

integrated into the State programs, that the total Native popu­

lation in the Southeast region will be fully integrated by the

year 1970 and far the other regions by the year 1980~

The total population base for determining :future manpower

need for State and community mental health programs (total State

population less military personnel and dependents covered by ~li­

tary medical programs and less Alaska Natives covered by Ue S~ Pub­

lic Health Service facilities and service on the declining basis

indicated above) is tabulated belo·w for the State ar:d its five

major regions for the period 1960 through 1985 (refer to Appendix B

:far .full discus·sion of population component projections).·

TABLE 1 - BASE POPUT...ATION TO BE SERVED BY COM£.fLJNITY MENTAL HEALTH 1965-1985

Total South- South-Year Jltate J~a_s~tern western Southwest Inter:to:r _N_or.th1.·rest

(thousands of persons)

T5 1 24 2 1961 136 28 82 2 22 2 1962 · 144 30 83 3 25 3 196~ 150 30 87 5 25 3 196. 155 33 87 5 25 5 1965 160 33 90 7 25 5

1970 225 50 100 10 50 15 1975 ~20 80 120 20 80 20 1980 30 110 155 25 110 ~g 1985 520 130 200 30 120

-23-

Projected Demands 1965-198~

Only experience will determine whether the Committee's

initial manpower recommendations approximate the real current

need of the 1965 population base of 160,000. In estimating the

nation-wide needs for the services to be provided by community

mental health centers to the year 1970, the National Institute

of Mental ~ealth assumed that 26 professionals in the four core

areas listed above will be required to staff, on a minimum basis, . 11 a community mental health center serving a population of 100,000.

On the assun1ption made ~bove that the 1965 Alaska population to

be served is 160,000, this suggests an initial community mental

health program based upon the service of a total of 42 profession­

als in the four core areas which is very close to the Committee's

initial recommendation of ~~5 professionals.

On a population basis, the following manpower projections

can be made.

TABLE 2 - CO.MMuiiITY MENTAL. HEALTH MANPOWER NEEDS, 1965-1985

Year 1.2,gj l2ZQ 1212 1980 12fu Population Base Index (Rounded) 100 140 200 270 325

1t1, 27 Psychologists 10 14 20 27 33 Psychiatric Social Workers 16 22 32 ~~ 53 Psychiatric Nurses 9 13 18 29

1/ ~like Gorman, Executive Director, National Committee Against Mental Illness, "Mental Health Needs in the New Era of Community Psychiatry," Testimony Before House Appropriations Subcommittee on Labor-H.W.,W., on Fiscal 1966 Budget f'or National Institute of Men­tal Health, March 15, 196~ (Mimeo statement, p. 3).

-24-

The above does not include the adminis~rative and supervis­

ory positions at the State level in the Division of Mental Health

(one in each category) nor the supervisory and professional posi­

tions under institutional services (at the Alaslca Psychiatric

Institute - four psychiatrists, one psychologist, one psychiatric

nurse, 40 registered nurses).

Too much reliance cannot be placed upon the above as an accu­

rate projection of' future manpower needs. For one thing, over a

period of time as long as two decades it should be expected that

technological change and scientific advance will alter the methods

and effectiveness of treatment and preventative measures. There

also will be profound basic changes in socio-economic· factors which

condition and determine the need for mental health services. No

guides are available for anticipating these very strategic factors

in the determination of future need. Finally, the accuracy of the

estimates for the. future .are influenced by the accuracy of the

determination of current nee~ which serves as the base fro~ which·

to make the projections. The conclusion to be drawn is that

Alaska's demand for manpower in the four core areas will continue

to grow at an accelerating rate after 1970.

CHAPTER III

'l'1IE SUPPLY SIDE OF THE EQUATION

Returning to the work:l.ng definition of demand used in the

last chapter (the sum of personneJ. c'Ul'rentJ.y emp].oyed, estab­

lished but urtrilled positions, and need for which positions have ·

not yet been established) and applying this to the Alaska situ­

ation, it is apparent that a serious problem of manpower supply

exists. The last chapter indicated the degree to which presently

employed professioilc!.l personpel in the Division and at A.P.I. have

had to double up on their assignments. Beyond this, looking at

the currently authorized positions in the three regional· clinics,

of the 12 professional positions which have long been established,

only five are· filled as of this i.vriting (Table 3).. At Anchorage

this lack has been in part made up through contracting for pro­

fessional services with two local private practioners and at Fair­

banks through the part-time services of a milltary psychiatrist.

The number of current vacancies in positions which have been

established for several yea.rs indicates that either the available

supply of professionals is generally short or that the "price"

Alaska was willing or able to bid for a part of the available

supply was too low to result in an °effective demand" for manpower.

At pre·sent only a very rough indication can be given as to how

much of Alaska's problem could be attributed to each· of these

factors.

•,

-26-

TABLE 3 - PROFESSIONAL MENTAL HEALTH POSITIONS y CUR..."IBNTLY AUTHORIZED AND SEPTE.MBER 196 5 EMPLOYMENT

E · 1 c.,' · egi ona . .t .·. ~nc$.

Division API ~ BQ. B Total Ji ,Positions Authgr:t._~~d

Psychiatrist · 1 4 1 1 1 8 100 .. 0 Psychologist - 1 1 1 1 4 100.0 Psychiatric

4 Social Worker - - l 2 1 100.0 Psychiatric

Nurse _L 2 1 - 1 _s_ 100120 -· - - -Total 2 -2.... .l - 4· - .l 21 10020

Per:=u;mnel_Qur:rentl "'{ Empl oved.:

Psychiatrist -J:. 2 3t - 1 - 5 62.5 Psychologist - 1 - 1 - 2 50.0 Psychiatric

Social Worker - - - l - ·l 25.,0 Psychiatric

_L . 1t li-Nurse ...1.. - 1 80r:O - - -Total i_ -2- _L -3.... -L 12 iZ~l

1) Includes the- Commissioner and all supervisors.. Does not include 40 registered nurs-es at A,.P., I. or others at Harborview Home, although some of these are receiving in-service psychiatric training.

fl'.'

-27-

.JJ1e N2 tional Mano03,rer Problem and Alask 9

Alaska is .facing its mental health manpciwer problem in a

national context of short supply. The concluding statement of

a 1959 analysis of the national situation was pessimistic:

11our country will continue to be !'aced with serious shortages

in all fields related to mental illness and mental health for

many years to come. Barring _the possibility of a massive nation ...

al effort in all areas of education, with all of the social changes

such an effort would imply, or the possibility of a sharp break­

through in mental health research, the prospects are pessimistic

for significant improvement in the quantity or quality or pro-1/

fessional services in these fieldse 11

An American Psychiatric Association study of psychiatrist

supply-demand and salary data reported that of a total of 6,405.5

positions budgeted by the states, District of Columbia, Puerto

Rico and the Veteran's Administration, 5,418.5 or 84e6 percent

were filled as of Sept<.:_mber 30, 19630 For the pericd from April

1963 through Mar-ch 1961+ the A{>P.A. Classified Notices indicated

that the ratio of total positions offered in the u.s.A. to posi;_ y

tions wanted was 23 to l{> Although offering hope of a more

Jj G. Albee, ,Me;ntal Health Mannmver Trends, Monograph Series #3, Joint Commission on Mental Illness and. Health, (Basic Books, New York: 1959), p. 259~ .

iJ APA Manpowe~ Division, "Psychiatrist Supply-Demand and Salary :pata," June 1961+, Tables 2 and 4 ..

-28·-

effective approach to combating mental illn~ss than that of out­

mcded institutional care, President Kennedy's 1963 call f.or "a

new era of commu..-rd.ty psychiatry" and the resulting commun:Lty.

center legislation has compounded the manpower problem by the

additior...al problems of staffing planned new centers ...

More comprehensive studies of the. national manpower situation

are currently underway, but for the present the available scraps

of information will have to serve as guides to making some guess

as to how· much of Alaska I s problem might properly be assigned to

the more general supply situation. Table 3 indicates that of the

psychiatrist positions budgeted by Alaska, only 62.5 percent are

currently :filled as compared ·with the 84<)6 percent of positions

budgeted by all states, Puerto Rico, District or Columbia and the

Veterans Administration. If Alaska's vacancies were attributable

primarily to the nation-wide manpower shortage 1 the national and

the Alaska percentage would be more nearly equal,. This comparison,

therefore, suggests that in f\laska 1 s case the general manpower

shortage is only a co:Iltributing factor, not the primary factor.-

As has already been discussed, Alaska with its own "human

resources" can do little to improve the general supply, but ·will

ve t F ow:tng Wor1.d

War II, a number of high-level systematic attacks have been

launched on the manpower problem and in testimony before a House

appropriations committee on March 15, 1965, the executive direc­

tor o:r the National Committee Against Mental Illness could report

-.29-

progress in closing the gap bet·ween the demand for and the supply ~.

o:f mental health manpower. "In the decade from 1950 to 1960, the

number of people ·with approved graduate training in the four core

disciplines--psychiatry, clinical psychology, psychiatric social.

work and psychiatric nursing--jumped from 12,000 to 44,ooo~ Over

the past five years, we have been doing an even better job--the

National Institute or Mental Health estimates that, as o:f January

first of this year, we had approximately 64,ooo trained people in

these four core disciplines. But this is not enough ••• ~n the re­

port which it released last year, the NIMH estimated-that we would

need a minimum of 87,000 graduate trainees in the four core mental . 11

health professions by 1970~ 11

No predictions are available as to how· long this national

problem will continue, but in view of the grc,wing popular concern

for and support o:r efforts to combat mental illness and promote

mental health, .. the coordinated efforts being launched to meet man­

pa.,;er demands, and the recent encouraging results, it would not

appear out of line to suggest that another five years should see

the approximate closing oi' the gap,. After 1970, therefore, it

should be expected that the gra.vth of the national manpower pool

will eliminate this source o:r fact ors contributing to Alaska ts

mental heal th manp a.ver problems ..

1/ VJ.ike Gorman, op., cits., pp. 2 and 3.i. .

-30-

.A].as1rn rs Comnetitj.ve "Prtce 11 Position--the Sala-rv Factor J

From the previous section it can be concluded that if Alaska

had been meeting the competition of other states for professional·

manpower, its shortages would be comparable to the national average.

The difference suggests that the "price" being offered in Alaska

may not be competitive. Within the-workings of the classical

economists models, prices offered by consumers and accepted by

producers result in the optimal allocation of factors of produc-

tion. The interaction of supply and demand causes price movements

·which affect quanti:ties supplied and demanded until an equilibrium

price is reached at which supply and demand are in balance~ The

workings of the real economic world are not so simple 7 precise and

instantaneous, but the crude model does provide a logical frame­

work for understanding some of the basic problems .of calling forth

an adequate supply of professional manpower to meet Alaska's de­

mand. As has been already discussed, Alaska is not in a position

to "manufacture" or ."produce" additional supply, but is a consumer

and must bid through its price offerings for a share~ If its price

offerings are .too low, it will either call forth no supply or an

amount insufficient to meet demand. On the other hand, if the

offering price is above the acceptable

met but the consumer will be paying more than is necessary"

Ideally, Alaska will want to know for each position at just

what level the 11price is right," or ·what is.the equilibrium price

which will be sufficient to call forth the required output of

-31-

professional manpower ·without overpaying" This is an ideal, ...

o::: course, which can never be achieved with any certainty in

real life, but the process of seeking the ideal can result in

some approximation a.nd the mc<l.el does serve as a useful tool for

evaluation and analysis.

In the field of labor economics, ·where the 11commcdities 11

being bought and sold are the services derived from 11human re­

sources, 11 :Lt is recognized that 11price 11 is not simply monetary

payment in .the form of salary or ·wage,. A host of fringe benefits,

uorking conditions, etc~, are now well established as components

of the "price of manpower 1.1· and are reflected in the provisions of

labor contracts and agreements and in the recruiting programs of

employerso In the field of regional economics, it has recently

been recognized that the differences in living conditions in dif­

ferent parts of the country have a very important ef.fect up:on the

regional distribution o:f labor over and above any differences in

employer inducements" Formal theory is now including "amenity

factors 11 in its calculus and "amenity resources" are being included·

as part o:r a region 1s natural resource baseas they are capable of

"calling :rorth 11 labor resources in competition with other regions

f

A thorough evaluation of Ala.skat s current ·11price 11 situation

would require an examination of all of' these key components of

total 11price., 11 Although neither the Alaska data nor natio..rial data

are available for a proper consideration o:f .thi.s matter, we can

-32-

again draw a few tentative conclusions from the fragments of out .. of date information on hand.. Tables 4 and 5 su.rnmari.ze salary

range information reported in a Septeuber 1963 study of the Ameri-

can Psychiatric Association for positions listing Alaska and in

a January 1964 rep_ort for three of the core ~reas by the u .. s ..

Department of Health, Education and Welfare.., In addition to this

data, there was also available a June 1964 report of the A,..PJ.,. ..

Manpower Division w},..ich indicates that median starting salary for

72 full-time psychiatrist position vacancies listed in March 1964

A,..P,.,A" Classified Notices was ~~16,000 with a range of one position

listed at "less than $9,000 11 to two positions a.t 11more than $30,000~ 11

The 25th percentile was ~~14, 000 and the 75th percentile $18, 000.,.

This report also includes 11constructed yearly income estimates for

psychiatrists in full-time private practiceu which indicate gross

yearly incomes ranging from a median of $30,000 to a maximum median.

of ~?50,000, but these estimates cannot be compared directly ·with

the salaries reported in public positions because of the complex . 11 variations in f'ees· charged, hours worlced and office expenses ..

It has long been the practice of Federal agencies to reimburse

employees on the basis of the standard civil service salary scale

r 25 for

Alaska. T"nis has become a traditional factor in most salary deter­

mination in Alaska as generally most non-Federal employers simply

meet the competition by setting their salaries at approximately

1/ A-.PeA" Manpower Division, on,, cit,., Tables 6 and 7,..

TABLE 4 - SAT.ARY Rf\NGES FOR PUBLIC MENTAL HEALTH HOSPITALS IN ALASKA AND FAR WEST SEPTEHBER 3 0, 19631

Alaska Washo As -·-(Deflated* ---

.Q£§ Caltf ...._ _ _. .. ._...,:::,._. 119;:: Jiawaii

§..12-n,ey.) .. 11t.e nd qJJ:t 1'1inimum J.1'.aximu.m

Clinical Direct or ----Brniimim · · ~-

Hax1mum Staff Psvchiatrist ---yf(nrriiuin __ _

Maximum ~..:t.P.LQfJf:tJ.r.§j._ng-5._·!bl:I e

J,finimum Maximum

.fiQP..Qr.isJ.9; • ~B a.s eJ_

$21 600 2~.; 900

(~pl7 ,280) ( 21,600)

2o;ol+o · ( 16,000) 23,340 ( 18~672)

17, ol+o C 13,632) 20,640 ( 16,512)

9,720 ( 7,760) 11,520 · ( 9,216)

~pl8, 024 21,192

16 ,:52L1-. 19,500

12,4.08 15 ,24-o

7,860 9,372

~pl6, 500 · 18,500

15,4-20 17,700

12,i60 15 ,1+20

5,520 7,500

~~171880 20,L1,8l+

15,432 19,70+

125221 17,028

8,604 12,096

$16,176 19,6~J

16,176 19,656

7, 76L1-9 ~l+Ll-4

(Note: study also contains c cmparis ons f' or charge, head staff and other nurse 7 head and other occupational therapists, etco)

PSY:._QQ,Q+.c.Q£.b~-.t~: Minimum Maximmn

.Ptsy:_c_h...Q±S8i2.t ~ .. Pon~ clt:'.11-.9..@J Minimum Maximum

.§ oc i. a.,.~J:Lo.Kt: er ~ He..§..q_ Minimum Maximum

§s&tal W or_k_e_:(~af.f Minimum Maximum

----~----=---= ._. Ill" • ,,; • -

10,320 12,300

9,300 10,800

9,060 10,800

7,980 9, 5L1-0

( 8~256) ( 9,840)

( 7 ,44,0) ( 8 ,64-0)

( 7, 2Lr8) ( 8,640)

( 6 ,38Lr) ( 7,632)

9,372 11,184

7,860 91372

5,544 7,212

8,220 11~400

5,760 7,200

6,300 7,860

4,800 7~200

9,4·80 12$221

9,948 12,096

6,120 8,6d+

7 ,4oJ+ 8,988

7 ,4oLi-8,988

(Noto:· Maintenance and housing in addition to salary, etco, not fully reportGd or directly comparabl~)

*Reported figure divided by 1G25"

~pl.5, 561i. 16 ,31.:11-

13 ,1+t1.o 14,820

11 0611-7 12,Sol+

9,096 11,616

9,552 125192

8,256 105536

5,868 7,488

SOURCE: Dorothy M~ Richards on, 2£3,,1a.ry_Ba.r1~e.s .... ~.m;>,...12'..Qf§g,._ru_m.LJ:.?J:§..Q;n.neJ_B1DJ2.12Y.n§.J.11 fila.t~-1:i§ri,ta,l,..llsL2JZl:t?.-lE1.,.JlnLI:o~~~i-=,t1ttJQ.D/i ... J:m:...:tb§@J:1.@.n~.?l,ly_Ro~~~ii, Psychiatric Studies and Projects~ Noq 10, American Psychiatric Association, viashington, DoCv

! w L0 I

-34-

-T.i\BLE 5 - SA.L!\RIES REPORTED FOR STATE MEi>.'TAL HEALTH

Positi.ons, Januarv 1.,, 1964

?'.:?vc hia t-ri st::

United States - Mean Salaries

Alaska

Far West

Psychologist:

United.States - Mean Salaries

Alaska (As reported (Deflated base)*

Far West Washington Oregon California Nevada Hawaii

Psvchiatrj_c Sccial Worke,..:

United States - Mean Salaries

Al !'> c:,7~~ (As reported ..... -.>i\.C\ , ) · \Deflated base*

Far West l:.Jashingt on Oregon California Nevada Hawaii

* Reported figure divided by 1.,25.,

Minimum

~~13,145 . (B)

(B)

6,675

8?640 (6,912)

6,900 6,900 (B) 8,988 7,488

5,856 8' ()l{.Q

(6,432)

5,544 5,760 7,428 (B)

. 5,868

,Maximum

~~16,076

(B)

(B)

8,353

10,320 (8,256)

8,964 9,300 (G) (B)

10,956 Cc) 9.,552

7,372 9,720

(7,776)

7,212 7,860 9,036 (B) 7,488 (A)

(A) Longevity payments are added to this base pay range@ (B) No ccrrroarable class within scone of definition .. (C) Minimum qualifications in this ... state significantly higher<)

SOURCE: Department of Health, Educati,on and Welfare, Division of State Merit Systems, January 1, l96tt" ·

-35-

the federal level for equivalent positions ... A A realistic basis

for c 0w.paring A la ska z s c cmpeti ti ve salary position, the ref ore,

would require that the Alaska salary ranges in Tables 4 and 5 be

reduced on the assumption that a 25 percent .Alaska dirferential

is included above the base salaryo Comparing the deflated Alask~

salary ranges in Table 4 with the other Far West states, it appears

that on September 30, 1963, .Alaska was reasonably in line in almost

all cases with the prevailing minimum quotations* In almost every

position the deflated Alaska ma......:imum salary was significantly be­

low those reported for California and }Ia,;,;aii and the two psycholo­

gist positions and "social worker, head" appear generally lowo The

salary ranges as or January 1, 1964, summarized in Table 5 indicate

that on a deflated base salary comparison, the psychologist minimum

salary is in line with other states and the United States mean 1 but

the Alaska maximum falls short in every instanceo The psychiatric

social worker deflated base range is generally in line, with only

the California range being higher than AlaskaQ

The notes included on the two tables draw attention -to a num­

ber of fact-ors which cannot readily be translated into equivalent

dollar amounts (differences in minimum qualifications for positions,

l ur or

for, etc9) which preclude drawing hard and fast conclusions from

the above comparisons. The comparisons suggest, however, that

with a few minor adjustments, the Alaska salary ranges which were

-36-

surveyed in l963 and l964 could be consider~d to be generally in

line with a 25 percent differential above comparable ranges in

the Far West. The Governor 1 s Committee has recommended setting

the Alaska salaries at levels determined by WICHE to represent

those prevailing in the Western states, plus a 25 percent cost

of living increase. The fact of extensive vacancies in authorized

Alaska positions, however, further suggests that this attempt to

equalize dollar salary is not al.one surficient to put Alaska into

a c0t'D.petitive price position.

Before leaving the discussion of salary factors, we should

return t-o a consideration er the existing regional clinics as they

more nearly represent the problems which ·will be faced in the staff­

ing of an expanded community mental health program. The Rep9rt

refers to the fiscal year 1963-64 budgets in its discussion, and

the salaries which were used in their formulation are closer in

time to the available salary data referred to above. Table 6 pre­

sents the salaries for the professional positions. Because of the

wide variation in cost of living between points within Alaska, the

Bureau ar Labor Stat;J.stics indices for Juneau (November 1963),

Anchorage (October 1963) and Fairbanks (October 1963) were used to

t u

-37-

TABLE 6 - PROFESSIONAL POSITIONS AND SAIARIES AUTHORIZED IN ALASKA REGIONAL CLINICS, FISCAL YEAR ~963-1964

Position

Salaries, as buch;ete9i:

Psychiatrist

Psychologist

Psychiatric Social Worker

Psychiatric Social Worker

Psychiatric Nurse

Bn 1 9 Sa Cost of Liyin,g Inge;x; October and November 1963 (Seattle= 100)

Southeast

~~18,360

8,940·

8,640

--...

122

,Sala.ries at Seattle Dollar Equivalent

Psychiatrist

Psychologist

Psychiatric Social Worker

Psychiatric Social Worker

Psychiatric Nurse

15,ol;.9

7,328

7,082

South­Central

$17,ol+O

. n,100

10,020

8,820

123

13,854

9,024

. 8,146

7,171

Northern

$20,000*

12,720·

9,.540

8,460.

136

14,705.

9,353

7,015 .

6,220

* Actual budget included $107 000 ror half-time psychiatrist.

i!t\.\..., ~;:../Cf\/ yii. ).~ -~u.Pir;i ~.l4Y0~ 1J.... y ~ v vu.ui.p-~\-1...l-1,.,, v v .i.. .i...._._1..1.x:~-1- ).J..V~-.L. __::,it_~ i ,::3-~1..1.1.1 i J.l'?;,

-38-

Alas lea' 12 c omnetit~<ve "Price" P9si ti. on--the Jllon-Salgry fa.c;~ors

The Governor's Committee recognized that the "price 11 required

to call forth the desired amount of professional manpower includes

"not only increased salary where necessary, but also other pro­

fessional inducements." As a minimum, these must include. support

for the work of the professional staff member in the .form of ade­

quate operating budget, supporting staff, facilities, etc~ These

operational components are the 111.vorking conditions" without which

no quali.fied pro:ressionals will remain long in a position, no mat­

ter how adequate the salary. If he is frustrated in accomplishing

his work through lack of "tools'' there will be a loss or return on

the salary paid, or he will not tolerate this condition for long. A

full treatment of this subject requires a study of the supporting

budget required by the professional teams recommended by the Com­

mittee, operating conditions and facilities at the several loca­

tions, etc. Again, the 1963-1964- budget and expense experience of

the three State operated regtonal cl~nics can serve as guides to

the probable dollar amount of this component of manpower "price. 11

This is summarized in Table 7 as drawn from the appendix of the

,Renort ..

recognize the types of persons who will be sought and their need

II

tor continuing contact wLth their profession, their general prefer­

ence of urban living, etc. It is not only in mental health, but in

almost all professional recruiting that Alaska has defi.nite handi-

-39-

TABLE 7 - TOTAL OPER.ll.TING COSTS OF REGIONA.L CLINICS_, OTHER TFAN PROFESSIONAL SAIARIES AND SERVICES, FISCAL YEAR l9b3-1964

R e g i on· South-

,Sou.theast Central Northern

1. Clerical Salaries (incl. 10% fringe benefits) $11,682

2. Travel (Staff and patients) 6,500

3. pommcxlitie§ (drugs, supplies, etc.) 545

4. Contractual · -Rents, utilities,

Communications -Insurance, bonding, other

non-profit services

4,ooo 1,000

5 •. Short·-term Hospital Costs and Care; Attendant§, Guards . , 2,025

Total $25,752

$26,037

5,100

2,200

6,700

470

13 .. 335

$53,842

$13,134

9,060

2,900

n,300

750

15,770

$52,854

SOURCE: Data absbracted from Appendix H-63, H-64, H-65, Benort on Comnrehei;isive . o'11munity Memal Health Planning, 1963-1264.

-40-

meeting these components of price. Maintaining professional .. co.11petence and interest requires 11keeping in touch 11 ·with the

urofession in general and with other members of the pr. ofession .. to assure .exposure to new ideas and new knowledge, pericxlic

re~education and training, opportunities for study and career

evaluation, etc. Alaska unfortunately is remote from established

professional centers and for the foreseeable future its popula­

tion will continue to be too small and scattered to develop

completely satisfactory local means of meeting the need for a

variety of professional contact.

Professional isolation must be recognized as a very. real

factor in Alaska and special measures taken to combat it. This

might include the regular budgeting of travel to important pro­

fessional conferences outside Alaska and possibly some variation

on the academic sabatical leave or the "home leave" provided over­

seas federal emp~oyees.

As a minimum, considera~ion might be given to some form of

travel reimbursement such as that provided every two years to

employees and their families by the federal government to and

from points of original hire outside Alaska. There will be serious

practi"ca"L obj ons ta th'.ts as sett:tng Up for a

treatment of all State and local employees, but the provision of

such travel could be made contingent upon its being directly re­

lated to maintenance of professional standards, not as a special

vacation treat or other reward for staying on the job •.

-41-

The observable preference for urban liv~ng is in part a re­

flection of professional need (to be where research and treatment

facilities can be supported, etc.) and in part personal preference

(the urban amenities of culttiral activities, entertainment, etc.).

E..xcept for the extra individual psychiatric social worker positions

set up in Alaska's smaller and more remote communities, the C~~mit­

tee recommendations imply a recognition of this factor. The teams

are located in the larger communities and it is recommended that

there be a rotation of professional personnel bet'ween the urban .

oriented teams and the State supported itinerant teams to afford

an equitable sharing of the conveniences and rewards of urban living

and the inconvenience of travel within Alaska's rural areas.

It should al.so be recognized that there are some unusual pro-

fessional benefits as well as handicaps in the Alaska situation.

Alaska affords some unusual opportunities for original research, r

experiment and experience which should be made known to the pro-

fessional world outside the State. Not only should attention be

drawn to these opportunities, but professional staff should be given

inducements and support in taking advantage of what Alaska offers.

Such fa.ct ors should be exploited as a means of improving Alaska's

p on "price" to

its manpower needs ..

-1+2-

C91cn1 9ti on of a l]:vno:J:;hetical "Price' 1 for One Mental Health Team ~-

Given current information on the 11going salary 11 levels for

each pro:fessional position outside Alaska, an accurate cost esti­

mate of providing facilities and other support at each location,

and reasonably complete knowledge of additional professional and

amenity requirements, a calculation can be made of the "price"

which must be paid to call forth the desired amount of manpower ..

This is an idealized statement of one of the initial phases in

the normal budgeting process, the determination of what it will

cost t·o buy what we would like to have. It is an ideal which can

only be approximated, even under the best of circumstances, and

the state- of our information and knowledge on these factors as

they apply to mental health manpower is far from ideal. Drawing

upon the discussion in this chapter, hmvever, we can calculate a

very rough -hypothetical 1963-1961+ price which ·will be useful in 1

indicating the ·general magnitude of the probable price of the com­

munity mental health ·teams recommended by the Committee and as a

guide to futUI'-e study and analysis.'

Table 8 summarizes the three major elements in the calculation

of the price of a mental health team consisting of one representa­

tive of each o:f the fou:r core disciplines,. The four salaries are

guesses as to what would approximate the going level in the Far·west

adjusted upward .for Alaska cost of living. The operational compo­

nent is simply the average cost reported for the 1963-1964 opera­

tion of the three State operated regional clinics. This component

-43-

TABLE 8 - HYPOTHETICAL 1963-1964 11PRICE11 OF ONE COMMUNITY MENTAL HEALTH TEAM

1. Salarv Comnonent

-Psychiatrist

-Psychologist

-Psychiatric Social Worker ·

-Psychiatric Nurse

-10% Fringe benefits

2. Operational Comnonent

(Average cost of three regional clinics, see Table 7)

3. ,Professional and Amenities C omn onent

Professional leave travel

Additional employment or contract services to·cover staff on leave (average cost for two years)

Total "Price"

$18,750

10,500

9,000

8,750

4,zoo

$51,700

44,ooo

2,000

2,3.QQ

$100p000

-44-

is highly variable on a year to year basis. As rioted in Appendix

H-63 of the Reuort, in the current (1964-1965) fiscal year opera­

tions of the Southeastern clinic, the hospital costs of only one

patient have already exceeded the total hospital costs for all

patients during the 1963-1964 fiscal year. A review of other years'

experience would probably result in a much different figure for

this component •. The final "professional and amenities component"

is incomplete and merely to suggest the sort of calculation which

would have to be made. It assumes that every other year each pro­

fessional staff member will be provided with transportation and

travel funds to spend one month at some educational center, etc.

The calculation indicates that at 1963-1964 price levels, a

total price of ~~100,000 would have to be paid for one community

mental heal th team. vfnether or not offering this price on the

market would result in Alaska receiving the required supply depends

up.on the accuracy in determining the price of each of the compo-

· nents, the completeness of the factors considered, etce Because

this is a bid offered in a very competitive market, it also re­

quires that the orfering be accompanied by a recruiting and adver-

tising program.

Cl1'\.PTER IV .. REqUIREMENTS FOR DEVELOPMENT OF A CONTIMUING M.t\NPOWER PROGRAM

Fffe~tive Den<1nd--Determinate of Fiscal Cauaei.tv and Tax Effo1't

The discussion thus far has advanced only to the point of

considering factors which determine demand ( or need) for profes­

sional manpcr...;er and factors ·which determine the price required to

call forth a sufficient supply to meet demand. A further step in

the analysis is required which re-evaluates demand in.light of the

price which must be paid and the ability and willingness of the

consumer to meet this. The result is 11effective demand, 11 or the

recognized need the consumer backs up with a· firm ofi"ering price.

The felt demand for community mental health services has been ex­

pressed by the Committee in terms of a total of 10 mental health

teams and an additional five psychiatric social ·workers in smaller

centers .. Based upon the 1963-1961+ estimates, this has been assumed

in the previous chapter to require payment of a price of $100,000

per team and possible $10,000 per additional psychiatric social

worker (salary plus operational budget) or a total price :ror the

entire program of $1,060,000. Are the people of Alaska as they

are organized into their various political units able and ·willing

to pay thi.s price? If they cannot or will not pay this amount,.

what would they consider as being within their capacity? Aside

from an assessment of popular attitudes tmvard mental health, these

questions can be approached through evaluation o:r the fiscal capa­

city and tax effort of the State and local governments.

-46-

"Fiscal capacity 11 in the purest theoretical sense means the •.

potential amount of taxes which can be raised :from the economic

resources available to a taxing bcx:ly. As a practical matter,

however? the term has come to mean not absolute capacity, but

comparative ability of a governmental unit to raise funds through

taxation. The two commonest measures of fiscal capacity, or more

accurately comparative fiscal ability, are assessable tax bases

and in the case of state governments per capita persona~ income.

"Tax eff ort 11 is likewise comparative and generally is computed .

by relati:r1g total actual tax collections o:r a government unit to

the measure of its fiscal capacity to show the extent to which y

fiscal capacity is actually .used. The fiscal capacity and the

tax effort o:r the State of Alaska related to natior...a.l averages

and other states is commented upon in the ~eport, but the relative

fiscal capacity and tax effort of local government units must await . ?J further information in process of collection,. Based on what it·

1/ For- discussion of more sop:histicated and possibly more meaningful measures of capacity and effort, see Measures of State :'lnd Local Fl 8cal Canacitv and Tax Effort, a staff report, The Advisory Com.mission on Intergovernmental Relations, Superintendent of Documents, 1962. A proposed inccxue measure of fiscal capacity, for example, is a composite of several available income series in­tended to reflect the income base at the successive stages at which it is available for taxation (ioe,, as personal income it relates to personal direct taxes; as business income it relates to or,1e taxes; as corporate net income to corporate income taxes, etc.) Another sets up a hypothetical uniform or representative tax struc­ture or system which relates an individual state 1 s taxes to the uniform system of assessable tax bases. This study is suggestive of some useful approaches which might be applied to the problem of Alaska's.intergovernmental fiscal relations.

?J Renert ••• , pp. 60-73.

-47-

it believes to b~ the best fiscal capacity and tax effort in-,

formation available, the Committee has recommended that the cost

of operation of community mental health centers at Kcxliak, Sitka,

Juneau and Ketchikan be reimbursed by the State at a rate up to

50 percent, that. Fairbanks be reimbursed up to 60 percent, Kenai

ahd ~tanuska-Su~itna boroughs up to 55 percent; Nome up to 90 ;

percent and Anchorage up to 10 percE?nt. Using the demand and .

supply data and estimates made in the previous chapters, the cost

sharing or the recommended canmunity mental health program would

appear as given in Table 9.

Only a ve!Y rough token evaluation can be ma~e at present

or the financial feasibility or the proposed program and its

suggested form or joint financing. Expressing the local govern­

. ment shares .on a :per cauita basis or relating them to total wage , .

and salary income results in.rather high figures except in the

two largest communities and the token prog~ams in the smaller

towns. There are a number of sound objections that could be

raised to the comparisons made in.Table 9. The operational

costs per team will vary from one location to another as past

experience or the regional clinics has de!1'onstrated. With the

' or scale which would reduce average costs below that presented.

There also is the implication in· the Be:oru that some ·or the~

will be detrayed by private fees and insurance plans.· The list or ,.

,, .

-48-

TABLE,9 - STATE-LOCAL SHA.RING OF HYPOTHETICAL COST OF COMMUNITY MENTAL HEALTH PROGRAM

l'.2:t~l State L ...2 c a 1 ..... i .. ·:

(Per · ~Per ~;~1000

.Mental Health +~Ca.ID~ ($1000) ($1000) ($1000) capita)Jj income)g/

1. Southeast\ .100 100 -- -- --2. Juneau 100 50 50 . 4.71 1.36

~: Sitka 100 50 50 6.01 3.11 Ketchikan 100 50 50 4.48 . 2 05· . .

5. Southcentral 110 110 -- --~ --31 6. · A nchoraga 100 10 90·. 1.3 . · o.44: ·7. Kodiak 100 50 50 6.73 4.41· 8. A.P.I. 100. 100 --9. Northern 100 100 -- ·1:5~ 10. Fairbanks · 100. 60 40

£~y9hi~tric Social w~r~~I

1. Nome 10 9 1 0.15 2. Cordova 10 9 1 a.ii ~· Kenai 10 6 4 o. 7

• Seward 10 6 4 1.1+2· 5. Matanuska-S:usitna 10 6 4 .. o. 'ZO.. - -

Grand Total lo60 z16 ~.

Y On basis o.f 1963 election district population estimates, Employment Security Division, Cqrren;t PQpµl9tiQU$~t1me,tes.

Y On basis total civilian non-agricultural wage and salary election districts, Employment Security Divisi 1965

31 Excludes military personnel and estimated dependents and military income payments. · ·

~.50:V

0.-19 0.25 o.42 0.75 o .• 51:_

-49-

objections could be increased,. As with all .other discussions

in this monograph, however, this comparison is made merely to

indicate tha scale of the problems being dealt with and present

sooething of their nature, and to suggest the type of information

and analysis needed for a more adequate consideration~

The comparison indicates that the price of the full program

is such that the local u..rrl.ts of government could not make anything

beyond a token contribution. The only exceptions to this conclu­

sion appear to be Anchorage and Fairbanks. It also suggests that

there is ap. urgent need for the development of a series of local

economic indicators or "regional accounts" to provide a means of

assessing and c~nparing the economic condition of local areas and

local fiscal capacity.

There is need, the.refore, for the continuous collection,

analysis and publication of statistical series which will reflect

tl~, total economic health of each community or local area and its

ability to sustain a regular flcr, .. r of inccme and employment for its

residents.. A start has been made on breaking down the State per-

sonal income series into the five major units and the Employment

Security Division has begun to publish useful.economic indicators

on a labor a:cea ill

need to be augmented ·with further demographic and economic series

which would further pinpoint the relative differences. in inc~e,

basic employmen'c stability and diversification, ratios of ,;,,rorkers

. .

-50-

to non-workers, existence of' special groups 9f dependents, etc.,

and provide a continuously revised forward projection of the

t~ends in these factors~

Such basic i:rrformation or 11regional accounts 11 are required

not only i'or mental health planning, but for all areas of planning

involving State and local government financing relations.

[!pnt5_nu5.ni:; Mannower Dema;pd Informati o~ and Studtes

In its recommendations for study of' mental health manpower

needs at the national level, the A.P.,A., study suggests the follow­

ing basic -information as providing factors for a determination of

manpower demand:

l., P opula ti on gr cwth

2., Ee onomic growth and change

3<> Urban growth

4., Level,.content, quality of education

5.,. Research and development

6v Governmental policies

7., Changing practices in utilization of psychiatrists

8.io Attitudas toward mental illness and psychiatry

Under special studies required in determination of manpower demand

they list:

l. Identification, measurement, and evaluation of variables

involved

2e Analyses of interrelations of signif_icant variables

3o

~-..

-51-

Dimensional a~alyses oi' interrelationships 1/

Construction of predictive equations or methods-

Throughout the Renort and this monograph attention has been

called to the gaps in our knew ledge of and means of assessing

mental health needse Again, this situation could be significant~y

remedied through the collection and publication of demographic,

economic and social datao The GovernorVs Committee has made re-

commendations for the collection and uniform reporting o:r mental

illness and related statistics which must be implemented if we

are to be able to relate this to other demographic, econcmic and

social data and to construct equations and methcds for estimating y

and predicting the need for services and manpowero The "regional

accounts" recommended in the previous section should be expanded

· in scope to embrace the relevant additional basic data needed on

the economic and social conditions o:e local areas. Initially

special attention must be paid to definitions of terms ·used

(L,e., what is a "community" for mental health purposes, what are

the fu.i.victions to be perf armed or the problems to be dealt with,

etco) and need for comparability of data between reporting units.

There is need for special studies analyzing.demographic data in

t(} :::'p of the nature of Alaska 1 s popu-

lation (geographic distribution, age-sex composition, racial com-·

position, educational levels, etcQ) and past trends in levels and

characteristics and future projections (shifts in composition,

Y Lockman, on., cit., p. 200

Y Benort ••• , pp. 127-131.

-52-

movement of racial minorities, U.'1derlying ca;1ses of change, etc.,)

and the relation of demographic factors to mental health and ill­

r:ess,. T'.ne Renort presents evidence of the wealth of undigested

social data available from the various programs of the departments

of Health and Welfare, Public Safety, and Education (mortality,

crime and delinquency, welfare payments, sanitation and housing

conditions, etc~) and economic data available from the departments

of Labor, Revenue, Natural Resources and Commerce$

pi. la.ska vs C on,ti nuing Problems of Hanocrwer Suunly

In assuring itself of a chance to recruit professional staff

effectively from the national manpa1er pool, Alaska must keep

cUTrently in.formed on the availability of qualified persons and

the cUTrent going rates of paye The Committee and the author of

this monograph have been 11.andicapped in their ·work because the

latest available data on salaries and professional manpower was

for the year 1963 and January 1964~ More cUTrent, ccmplete and

reliable information are beginning to be published by such pro­

fessional and governmental organizations as the American Psychi­

atric Assooiation Commission on Manpower, American Public Health

Association, National Committee Against Mental Illness, National

Institute or Mental Heal th, etc <I, and the State · of Alaska must

avail itself of' the ini'ormation and guides provided in these

sources., As the Committee reccmmends, there must also be a

vigorous recruiting program which will keep the professional

-53-

r~roups i:nf armed of Alaska rs needs and the challenge and opp or-

tunity this affords their members~

The discussion in C_hapter III and at the opening of this

cho.pter describe the nature of Alaska q s problem of recruiting

the amount af manpower needed to staff the community mental

health program which the Committee believes is needed to meet

the State: s demands... When all the components of the total 11price"

required to bring forth this demand are considered (salary being

only one element) and related to State and local govern~ent fiscal

ability, it is clear that the amount of the supply ·which Alaska

can "effectively demandrr will undoubtedly i"'all short of what it

needs and probably will continue to~ The data and assumptions

used in the foregoing analysis have been inadequate to the task

undertaken and· the conclusi,ons reached are open to question» The

general indication, ho-wever, is that even if the na·tional man­

power supply situation were ideal (which it is not), Alaslca must

be prepared to face a continuing shortageo Accordingly, some

alternatives must be considered to providing services appraxi-

mating those which would be provided by the ideal program of

balanced professior~l teamso

The com~parisons in Table 9 suggest that only in the remote

· · areas and the communities of Anchorage and Fairbanks do the full·

recommendations appear feasible" The community of Kodiak might

be able to support part of a community-based professional team

(psychiatric social worker and nurse) and t:qe operating plant,

(:.;_: ~-~~-; J.. :, ' .. ,,.-~ \ .

. '

' .J._

-54-,.

but draw upon an augmented State operated Southcentral region

clinic for itinerant services of a psychiatrist and psychologist.

A sim:Llar alternative might be feasible for the communities of

Southeastern Alaska.. The State as a whole might also benefit

.from pericdic use of consultant services to review the effective-

ness of its programs and to recommend improvements and revisions9

Alask~ must keep abreast of progress in the development of

·what the A,..Pf/)A,.. study calls 11load reducers .. " The Committeets man-

power task .force was ·well aware of the realities being faced when

it recommended that "Alaska appropriate money and time .for staff

to engage in organizing programs of training for clergy, police,

teachers, doctors, general mases and welfare workers, under WICHE

and NIMH11 and when it reconm1ended that the Division staff be ex-

panded to make possible greater liaison and coordination with other

programs and groups with semi-annual meetings 11for purposes of

delineating areas of mutual responsibility and assistance, com­

munications, integration of services, and overall improvement of 11

mental health services.n

Alaska in promoting its general economic, social and politi­

cal development must seek new approaches and be willing to try

new experiments. Reliance upon copying of what has been done

elsewhere will put a serious limitation upon the achievement of

our full potentials., This generalization is particularly relevant

to the meeting of' Alaska's mental health needs. The new community

Jj Benqrt ... o, PPo 84-85 ..

. '

-55-

approach r-epresents an opportunity to explor_:e a ·whole range of

alternatives to the recruiting of a set :ratio of professional-

population as a means of meeting these needs~

XICTM:B:ddV

.. .

-56-APPENDJX A .... PROFESSI0?-:. 1\L CIASSIFICATION OF FOTJR CORE

l:IENTAL HEALTH DISCIPLINES

(Adopted 1 .. rom U., So Department of Healtrt, Education and Welfare? Division of State .Merit Systems 1 January 1, 1964)

l.. E_s_,r0.r·ri:1t'l'.':i st: This is responsible p:rof essior..al and adminis-

trative ·work involving the direction of a local or regional

mental health clinic or assisting in special services in a

State mental hospital or State agency., Duties may include

diagnosis and treatment of patients as well as supervision

and training of clinic personnel., This class usually re­

quires an MgD .. and a year 1 s internship supplemented by three

or four years of specialized training and/or experience in

the field of psychiatryo

2o Psych .. ol or:ist: Th.is is responsible professional psychological

wo-.rk in a clinic, hospi tal 9 or similar medical setting. An

employee in this class selects, adm.inisters 7 and interprets

psychological tests; assists in diagnosis and plan of therapy

as a member of a clinical team ,.,ith a psychiatrist and psy-

chiatric social worker; helps design and carry out research

projects; under supervision, gives individual and group psy­

chotherapy and participates in local and State mental health

Programs This is essentially non-supervisory ·work but may,

in soma cases, include the supervision of students and trainees •

The class usually requires a Master's degree with the major

emphasis on clinical psychology and some experience.

. .

-57-

3 o Psvc]1J_2,t,:-ic Social '\I o:rker; This is resppnsible psychiatric

social 1,,10rk performed in a clinic, hospital, or similar medi­

cal setting.. An employee in this class compiles case histories

for diagnostic study; assists in diagnosis and plan of therapy

as a member of a clinical team with a psychiatrist and psycholo­

gist~ assists in the supervision o:r trainees, and aids in the

development and conduct of co~~unity mental health educational

programs... This is essentially non-supervisory work, but the

duties may, in some cases, include directing social ·work ser­

vices in a.small clinic or hospital .. This class usually re­

quires a degree frcxn a gTaduate school of social work ·with a

major in psychiatric social work 7 or a major in social case

work plus some experience in psychiatric social work ..

l.i·o .P.syebiatrj.c 1'Iurse: This is responsible professional work per­

f'o:rmed in a clinic, hospital, o-r sim;Llar medical setting o An

employee in this class assists in treatment and therapy and

general patient care under the direction o:r a psychiatrist

or other medical doctora This class requires a degree from a

school of professional nUl'sing ·with additional training in the

field of psychiatry •

-58-

APPENDIX B

AL'\SKA POPUIATION ESTL\i.'\.TES AND PROJECTIONS, 1960-2000

•• ·- ' D . ,,·, J __ .; • -"' -'- 1 c•----t ~ ~.:i .; .;_ n, ~, Rarr-i r-ns ("' , 1 1) .r-)."1., GJ:_,_;_~:_._,.0('t _i~OI- l.,Xlf~ k1.t,?~,e ,:;._.:._1.i..1. ·~l,S ,~'.1-v2 _1.\_.,.~.\.1_ ..... ...L2.D e -

m, 1 ' · .,_ - · .l... 1 ~ · · f' 19/ Q th ' .Lne alli1.ua es-cima ... es OI. -cova poplllai:aon rem . o ... rouen

1965 for the State of Alaska are those made by the Uo S,.. Bureau

of the Census (Current PonuJ.ation Reuo-rts) and the regional break­

dc.·wn of these estimates from 1960 through 1963 is based upon the

current population estimates by election districts made by the

Alaska Employment Secu:rity Division (Current Population .Estimates­

J\l 2ska~,. by Election Districts, and Labffr:- Market Area Profiles,

June 1965)a The further regional estimates for 1964 and 1965

iJere made ·on the assumption that the regional distribution vrouJ.d

ba similar to that f'or 1960-19630 These sources ·were used as

they attempt to reflect the effects of net military and civilian

migration upon population change as well as net natural increase

(excess of births over deaths)o The estimates are given as of

July 1 each year, but represent the 12-month moving average figure

as of that date, not the estimated actual seasonal population~

Because of the a bnoI'mal Alaska seasonal pattern, they are a better

guide to the probable monthly average population than the official

census enur.;-iora G:i. ons ·i.;aken as of April o

A number of recent projections have been made of Alaska's

future population to serve a variety of purposes and utilizing

-59- y diiTerent methcdologies and basic assu,;1ptions., The projections

used in this analysis have been adapted :frori those made in the 2/

De:1artment of the Interior 1 s Rampart project study" - The choice

\:as mad.e because this is the most current authoritative projection

available, the regional units used within Alaska. are tha same as

those used in the 11Report on Comprehensive Community Mental Health

Planning, 11 the methodology used is the most appropriate to the

Alaska situation, and the economic development projections upon

which the population estimates ·were made reflect the kncr"rledge

and technical judgement of perhaps the most highly qualified

natural resource and ecox1cmic development talent available"

The simple projection of' past trends into the future, which

has been the methcd used in several other estimates, is.not appro­

priate to the Alaska caseo Except for the Native population,

natural increase (excess of births over deaths) is not the domi-

nant cause of population change in Alaska., Reviewing Alaska I s

past history, the major changes in total population reflect the

large in and out-migration of non-Native persons in response to

the ebb and flow of economic opportunities.. These have been too

erratic in behavi.or ·to serve as a basis for tr-end projection ..

Because they can be found to correlate with changes in the general

levels oi~ econcmiG employment, the projection o1· Alaska~ s f'utu:re

1/ For a fuller discussion and demonstration of the metho­dologies used and an analytical cc~parison of the results, refer to G., Wo Rogers and R .. Ao Cooley; ;1\laska!_s_P-9J)p.l,ati.on Economv, I_c:1.~ l (University of Alaska, l9o3), PPo 20l~235o

Y U., 80 Dapa:rtment of the Interior, R.amoart Pro:iect.., Alaska, J:::?:r.k.0-t lor :>c;~e-,:-2.nd Effect of Pro.iect on Natural Resources ... Vol., 2 ·c:Jun.eau, AlasIZa;:tanu.ary l9b5), P1h 573-602., .

-6c~

population should be made on the basis of assuraptions as to how

tha dynamic forces which ·will shape it are expected to differ

f:r-0..11 those of the past.. The Department of the Interior's pro-

jections utilize the basic employment-total population method ...

Basic employment projections for Alaska. and its five regions

·were made for five alternative projections of potential indus­

trial development made by the professional staff of the Depart­

ment's several technical bureaus utilizing all data available

on .Alaska's natural resources, world market conditions now and

in the future, etc~ The identified basic employment in each

alternative 1;ms inflated by a factor which varied over time to

reflect the expanding importance of the related but unidenti­

fiable development elements as the projections were pushed into

the future, expected technological changes, etco Total popula-

tion ·was then derived frcxn adjusted basic employment projections

by use of a factor expressing the normal relationship between

total population and basic employment (i~e9, total population ~

the sum of basic employment, supporting or derivative employment,

unemployment, dependents, and unemployables)o Implicit in this

computation is the assumption that in the future Alaska's growing

Eative population would participate in gainful employment afforded

by new economic development at the same rate as the non-Native

populationo If thi.s does prove to be true and the Native rate

of participation continues at its traditional low rate, the future

total population based upon this projected industrial development

..

-6..1--

would be higher (iQe., the unemployed and unemployable factor ~

·would be greater than that assumed). By the same token, social

problems, welfare costs, etc~, would also be greater.

,Native Population :for the State and its Five Regions (Tables 2-8)

The Native population projectio..."ls were derived from a study .

made for the Bureau of Indian Affairs. Because this study has

received only limited circulation, extracts from the narrative . 11

and the pertinent tables are reproduced here.

"Unlike Alaska 1 s highly mobile non-Native population, which

has increased and decreased mainly by migration to and from Out-

side in d~rect response to changed economic conditions, the total

number of Alaska's Native people has fluctuated as a result of

natural factors--the differences between births and deaths and

the underlying forces ·which determined the rates of each. There

has been some migration of Native Alasl\'.ans ·within and from Alaska,

but until recently this has been insignificant~ ••• Although of

historical importance, a revie,,1 of past population trends beyond

·the last decade are of limited value in understanding the current

and probable future growth of Alaska's Native population. The

economic and social factors which determined the past rates of

birth and death have been drastically altered or supplanted by

entirely different fa·ctors as Alaska advanced from its earlier

Y George W .. Rogers, 11Preliminary Comments on Alaskan Native Population and Employment Prospectsi 1960-2000 7 " (Mimeographed, Bureau of Indian.Affairs) December 964.

-62-

f o:rms of colonialism to statehocd. · A study of recent experience

covering a pericd in ·which social programs and similar factors

might be said to have assumed a status which ·will probably hold

into the foreseeable future is more relevant for our present pur-

poses .....

"Tables 2 through 7 relate annual statistics on Native births

and deaths to the 1950 and 1960 census benchmarks for the total

State and its five major regions. Vital statistics for earlier

. years are also available, but are lacking in ·consistancy and

coverage as compared with those ·which have been collected after

1950 when all collection and recording functions were centralized

in the Alaska Department of Health and Welfare, Bureau of Vital

Statistics .. A comparison of the 1950 and 1951 births gives an

indication of probable past under-reporting .. The 1950 figure of

1,376 births is consistent with the level of annual.figures ex­

tending back into the 191+01 s, but is 200 and more lower than the

eeneral levels extending forward into the 1950•s. The jump of

158 additional births in 12 months between 1950 and 1951 is in­

consistent ·with the annual increases reported during both the

1940 1 s and the 1950:slt

"The total natural increase (excess of births over deaths)

between l950 and l960 as recorded in vital statistics

a total increase of 12,465 Native people for the decade, but the

difference between the official 1950 and 1960 census enumerations

(which reflects other factors in addition to natural increase)

-63-

indicated a total increase of only 9,197 in Native population,;,

The 3,268 difference is not uniformally distributed among the

five regions. The census reports fe1.,1er Native people in three

of the regions (Southeast 1,585, Interior 972, and Northwest

l,l38) and more in two reeions (Southcentr~1 44 and Southwest

263) than vital statistics.

"It might be assumed that the 3,268 11missing 11 Native peopl~

represent the total out-migration from Alaska and three regions,

and an in-migration into two regions. No study has been made of

this, however, but it is generally assumed that Native migration

from the State as a whole is not nearly as large as this calcu­

lation would suggest. The rrmissing persons 11 might be accounted

for in part by differences in the reporting standards of the two

agencies involved, errors (the Census has frequently been criti­

cized as being understated by more chauvinistic Alaslrnns), etc ••• ,;,

"Whatever. the explanation for the differences, they were

redistributed to each year in the following tables as an adjust-

ment to a~..nual natural increases in arriving at an estimated

total Native population for each year (fourth column "adjustment

for other factors 11 ) .. "'~""

11The trends of crude birth and death rates in the five re-

gions over the past decade will be used as a starting place for

making future projections. Looking at the trends of birth and

death rates ·within Southeast, Interior, and Northwest Alaska,.

all present the general pattern of a rise in birth rates until

t~

..

-64-

tho late 1950's and evidence of a d0v1nward trend as they enter

the 1960 7s 1 while no real downturn is evidenced in Southwest and

Southcentral Alaska~ (The comparison of 1950-1960 increases from

census and vital statistics discussed above also indicates that

the first three regions may have experienced some net out-migration

and the last two some net 1n-migrati.on of Native population.,) In

all five regions the pattern of annual crude death rates has been

a widely fluctuating one, but a very general downward trend over

the total period can be found in all cases<» Relating ·the two sets

of factors produces a net natural increase pattern in each region

·which is a modified version of the pattern set by crude birth

rates (refer to Table 8)<»

It should be clearly understood that the projections made

of Native population beyond 1960 in Table 8 are not intended to

be J2Tedictions of ·what will happen or even what is likely to hap­

pen(jl They are P"oiections of what the population would be in the

State and its five major regions on the basis of the following

assumptionso It was assumed -that the only source of change would

be natural increase (the excess of births over deaths)e In other

words, net migration of Native people from Alaska and within

.Alaska would be zero. There ·would be no other means of ·loss from

the Native population sector, such as a on

racial groups,. Finally, it was assumed that over time, the rates

of annual natural increase in all regions would progressively de­

cline from the current levels to approach by the end of the cen-

-65-

tury the annual rates of 2.,0 percent to 2 .. 5 percent which the

United Nations has suggested as goals for underdeveloped areas

to achieve during the decade or the 19601 s ..

rrThe distribution of Native population among the five re-

gions and the levels projected :for the State, therefore, could

be and probably will be significantly mcdified by other factors

than those upon which the projections ·were based.. There are

strong indications, for example, that in recent years th~ Native

· population has· increased in its mobility throughout the entire

State ·and together with public programs fostering desirable popu-.

lation relocation will result in regional population totals dif­

ferent than those projected solely upon a consideration of net

natural increase .. The rates of natural increase themselves may

be lowered more rapidly, possibly achieving the 2@0 percent to

2 .. 5 percent goals in one decade instead of the assumed four

decades ...... <>"

J{i.Jitary Pe_rsonnel and Dependents for the State and its F:i.ve ,J1a j or Regions (Table 9) · ·

The annual estimates of current population by the U., s .. Bureau

of the Census·include a rounded count of military personnel in t:te

State as of July 1 provided by the Department of Defense .. From the

1960 census distribution of military personnel and other indica­

tors, the Employment Security Division in making its estimates of

current population by election districts estimates a regional dis­

tribution of military personnel .. These estimates are combined and \

,'/ ~

-66-

and summarized in Table 9, the Employment Security Division esti­

mates beiR~ rounded and adjusted slightly to tie into the Bureau

of the Census totals for the State.

The trend in military personnel stationed in Alaska dropped

from about· 50,000 during the first half of the 1950 1 s to about

33,000.during the first half of the 1960's .. This outmovement

has been the result primarily of changes in the technology of

warfare. It is difficult to predict the effect of the interplay

o:r future changes in technology, military concepts and inter­

national conflict upon the levels of Alaska based military per­

sonnel~ It appears reasonable to assume, hcswever, that future.

trends resulting from these several forces will tend to counter­

act with the result that the present level will continue. (It

can be noted that this level has held vlith very minor annual fluc­

tuations from 1959 through 1965~) The projections for 1970-2000

are those ·which were a component of the Department of the Interior

population projections.

In projecting the total.population to be serviced by a State

and local community comprehensive mental health program, some esti­

mate must be made of mili ~ary dependents who will be covered by

military programs. The ratio of dependents to personnel has flue-

tuated in accordance with official encouragement and availability

of transportation and housing., Assuming that present policies

and conditions continue, a conservative relationship ·would be one

dependent per military person~

'I

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,:.

TABLE 1 - ALASK1\ AVERA.GE :MONTHLY POPUIATION PTIOJECTIOHS BY H,\JOR REGIONS, 1960.-2000

X.ear %.Q.tf.4:L_,h;),a ajf§. Southeast .s 9ll.1Jl~G.ill..-T.?.~ .fu2llth:m~.rtt. Interi.or Northue~t ........ s:,,...,;.:~---··~· - .... -e.-..-~.-...- __ ..__.._...,_._,......,,-.r..-,

(Thousands of persons)

1960 228 36 109 21 ig 12 1961 ~~g 37 116 22 12 1962 38 118 ~~ 51 12 196~ 21+7 38 ·122 51 12 196 250 3.9 123 24 51 13 1965· 253 39 125 25 51 · 13

1970 306 55 132 25 75 19 1975 391 81 155 28 103 24 1980 fi.97 112 190 31 133 ~~ 1985 568 127 225 ~g 138 1990 664 152 257 16l1- 51 1995 868 213 335 53 200 . 67 2000 996 21+6 363 73 232. 82

Sourc_M: 1960-65 State totals from U" So Bureau of the Census, ..Qurrent Pcm_u:t-3.tion .Rerrorts (annual); 1960-63 by major regions computed from Alaska Employment Security Division, .~a~b.Qr Nar_ket A:f.:2.f}.l,r~o.U]&Jh (June 1965) and purr:,ent*Pop1,11a,t:lon Estirn~J.?.S. .hY.. E~e.ct,ion__J2;i_f!..E"ict

4s; 1970-2000 projection for State and major_ regions, Cnse V in

u.so Departm_ent of t];le Interior, J1am,p3I,_t. Prpj,ecj:;~;!:aska -Jg_rket for P9wcr_ fillg .Natura;L_Re.souT~Pl<!> 2 (January l9b5 5, PPo 57)-b02c , . ..

I

°' "'.J I

ESTIMATED TOI'AL NATIVE POPUL.1\TION AND COMPONENrs OF .AllNUAL CHANGE, 1950 - 1963

TABLE 2 - TO'fAL AL4BKA

Estimated Adjustment Total Crude · Crucle Rate of

Calendar Natural For Other Population Birth Death Natural Year Births Deaths Increase Factors April 1 Rate Rate Increase --- -- {Per 1,000 persons J

1950 1, 376-x· 574 802 (209) 33,863 40.6-x- 17.0 23-7* 1951 1,534 623 911 (237) 34,456 44.5 18.1 . 26.4 1952 1.,591 541+ l,o47 (273) 35,130 45.3 15.5 29.8 1953 1,582 497 1,085 (283) 35,904 45.1 13.8 30.2 1954 1,666 423 1,243 ( 32L~) 36,706 45.4 11.5 33.9

1955 1, 7·29 379 1,350 (352) 37,625 46.o 10.1 35.9 1956 1,908 446 1,462 (381) 38,623 49.4 11.5 37.9 1957 l,BL1-6 439 1,407 (366) 39,704 46.5 11.1 35.4 1958 1,953 394 1,559 (406) 40,745 47.9 9.7 38.3 1959 2,015 416 1,599 (416) 41,898 48.1 9.9 38.2

196o 2,059 4o4 1,655 (431) 43,081 47.8 9.4 38.4 1961 2,111 h32 1,679 (437) 1~4, 305 47.6 9.8 37.9 1962 2,170 li.29 1,741 (453) 45, 51~7 1~7 .6 9.4 38.2 ·1963 2,152 441 1,711 (446) 46,835 li-5, 9 9.4 g6.5 1964 N.A'B N.A. N.A. N.A. 48,100 N.A. N.A. N.A.

N.A. - data not available.

~-1950 figure r2flects under-reportinCT of births in Southwest, Northwest and Interior recions. Alaska Department of Health assumed full responsibility for recordine vital statistics in 1951.

Source: Births and deaths from unpublished worksheets of Alaska Department of Health and Welfare, Bureau of Vital Statistics •. Total population for 1950 and 1960 from U, s. :Bureau of the Census.

I

°' CD l

,. "'

ESTIMATED TOTAL NATIVE POPUIJ\TION AND COMPONENTS OF ANNUAL CHANGE, 1950 - 1%3

TABLE 3 - SOUTHEAST ALASKA

Estimated Adjustment Total Crude Crude Rate of

Calendar Resident Resident Nai..-ural For Other Population Birth Death Natural Year Births Deaths Increase Factors April 1 Rate Rate Increase

-c~-,-• (Per 1,oocf""Persons)

1950 343 93 250 (137~ 7,929 43.3 11.7 31.5 1951 347 111 236 (129 8,042 43.l 13.8 29.0 1952 348 94 254 (139l 8,149 42.7 11.5 31.2 1953 3 5 81 274 (150 8,264 43.0 9.8 33.2 1954 370 70 300 (164 8,388 44.1 8.3 35.8

l

1955 401 101 300 (164~ 8,524 47.0 11.8 35,2 Q'\ \.0

1956 408 80 328 (179 8,660 47.1 9.2 37.9 I

1957 399 94 305 (167l 8,809 45 .3 10.7 34.6 1958 404 87 317 (173 8,947 45.2 9.7 35.4 1959 419 85 334 (183 9,091 46 .1 9.3 36.7

1960 417 98 319 (174) 9,242 45.1 10.6 34.5 1961 438 97 341 (186) 9,387 46. 7 10.3 36.3 1962 426 93 333 (182) 9,542 44.6 9.7 34.9 1963 419 98 321 (176) 9,693 43.2 10.1 33.l~ 1964 n a. n.a. n.a. n.a. 9,838 n.a. n.a. n.a.

n.a. - data not available

Source: Birth and deaths adjusted to residence from unpublished worksheet of Alaska Department of Health and Welfare, Bureau of Vital Statistics. Total population for 50 and 1960 f-rom U.S. Bureau of the Census.

, i \

ESTTHATED TOTAL NATIVE POPULATION AND COHPONENTS OF ANNUAL CHANGE, 1950 - 1963

TABLE l~ - SOUTllCENTRAL ALASKA

Estimated Adjustment Total Crude Crude Rate of

Calendar Resident Resident Natural For Other Population Birth Death natural Year Birth~i ____ D~}~.§.. __ Increase Factors April 1 Rate Rate Increase

(Per 1,000 persons)

1950 165 46 119 2 3,788 43.6 12.1 31.l, 1951 16l; 61 103 4 3,909 42.0 15.6 26.3 1952 183 52 131 4 4,016 45.6 12.9 32.6 1953 179 40 139 4 4,151 43.1 9.6 33.5 1954 · 181 46 135 5 4,294 42.2 10. 7 31.4

1955 216 30 186 5 4,434 48.7 6.8 41.9 1956 259 l~4 215 5 ·4, 625 56.0 9.5 46.5 1957 238 42 196 5 4,845 49.l 8.7 40.5 1958 276 47 229 5 5,046 54.7 9.3 45.4 1959 268 39 229 5 5,280 50.8 7.4 43.4

1960 308 37 271 - 5,514 55.9 6.7 49 .1 1961 310 53 257 - 5,785 53.6 9.2 44.4 1962 329 49 280 - 6,042 54.5 8.1 46.3 1963 366 64 302 - 6,322 57.9 10.1 47.8 1964 N.A N.A. N.A. - 6, 62[~ N.A. N.A. N.A.

N.A. - data not available.

Sour~: Births and deaths adjusted to place of residence from unpublished worksheets of Alaska Department of Health and Welfare, Bureau of Vital Statistics. Total population for 1950 and 1960 from U. S. Bureciu of the Census.

I ~ 0 I

ESr::D-1,f.\.S:'ED TOTAL HA'I'IVS POPULATIOH AHD COMPOHEIITS OF AITNUAL CHANGE, 1950 - 1963

TABLE 5 - SOUTHWEST PJ..J\SKA

Estimated Adjustment Total Crude Crude Rate of

Calendar Resident Resident Nattu·8l For Other Population Birth Death Natural Year Births Deaths Increase Factors April 1 Rate Rate Increase __ ,__., __ ----- ----CPer 1,000 persons)

1950 32t 152 172 25 10,838 29.9 11~.o 15.9 1951 1~30 21+3 J.87 25 11,035 39.0 22.0 16.9 1952 41Vi~ 221 221 25 11,247 39.3 19.6 19.6 1953 41~9 19l 258 25 11,11-93 39.1 16.6 22.4 1951J. 11-93 161 332 25 11,T/6 41.9 13.7 28.2

1955 450 125 325 25 12,133 37.1 10.3 26.8 1956 569 177 392 25 12,11-83 45.6 14.2 31.4 1957 52~::c 156 385 25 12,900 41.9 12.J. 29.8 1958 55l;. 125 429 30 13,310 41.6 9.~- 32.2 1959 6lJJ;. 132 512 33 13,769 46.8 9.6 37.2

1960 66c~ 135 527 20 14,314 46.2 9.4 36.8 1961 70~? 155 547 -- 14,861 47.2 10 .1~ 36.8 1962 727 143 58h -- 15,408 47.2 9.3 37.9 ·1963 71 144 573 -- 15,992 411-.8 9.0 '.35. 8 1964 N N.A. H.A. -- 16,565 N.A. N.A. ILA.

N .A. - data not available.

Source: Births and deaths adjusted to place of residence from unpublished worksileets of Alaska Depart!:1.ent of ~Ie8lth a..."11.d Welfare, Bureau of' Vital Statistics. Total population :for 1950 and 1960 from u. s. B1.1.rcau of tne Census.

I "-.J }-l I

..

ESTI1ATT<..'D TOI'AL HA'I'IVE POPULATION AND COMPONENTS OF ANNUAL CF.J\NGE, 1950 - 19G3

TABLE 6 - IlIT'ERIOR ALP.BKA

Est:i.m.ated Adjustment TotaJ. ·Crude Crude Rate of

CaJ.endar Resident Resident HaturaJ. For other Population Birth Death Natural Year Births Deaths Increase Factors April 1 Rate Ro.te Increase ---··- ·- (Per 1,000 persons)

1950 186* 72 11h (53) 3,666 50.7* 19.6 31.1 1951 218 82 136 (64) 3,727 58.5 22.0 36.5 1952 247 60 187 (87) 3,799 65.0 15.8 49.2 1953 229 46 183 (85) 3,899 58.7 11.8 46.9 1954 237 38 199 (93) 3,997 59.3 9.5 49.9

1955 237 36 201 (94) 4,103 57.8 8.8 49.0 1956 249 36 213 (99) 4,210 59.1 8.6 50.6 1957 235 49 186 (87) l~, 324 54.3 11.3 43.0 1958 272 43 229 (lo8) 4,423 61.5 9.7 51.8 1959 229 53 176 (82) 4, 5li.4 50.4 11.7 38.7

1960 223 50 173 (81) 4,638 48.1 10.8 37,..3 1961 239 39 200 (93) 4,730 50.5 8.2 42.3 1962 249 46 203 (95) !~,837 51.5 9.5 42.0 1963 239 40 199 (93) 1: .• 945 48.3 8.1 40.2 1964 N .A. :N .A. N.A. N.A. 5,051 N.A. N.A. N.A.

* 1950 birtl1S probably tmder-reJ:)Orted.

N. A. - data not available.

Source: Births and deaths adjusted to place o:f residence from unpublished worksheets of Alaska Department o:f Hc2.l th and Welfare, 3urenu o:f Vital Statistics. TotaJ. population for 1950 and 196o from U. S. Bureau of the Census.

I ""1 [\) I

~~

ESTIMATED TOTAL NATIVE POPULATION AND COMPONENTS OF ANNUAL CH!illGE, 1950 - 1963

TABLE 7 - NORTHWEST ALASKA

Estimated Adjustment Total Crude Crude Rate of

Calenda:t· Resident Resident Natural For Other Population Birth Death Natural l Year Births Deaths Increase Factors April 1 Rate Rate Increase

. ' ----- (Per 1,000 persons5--

1950 3E,8 211 147 (591 7,663 46.7 27.5 19.2

1951 37 S 126 249 (100 7,751 48 .4 16.3 32.1 1952 371 117 254 (101 7,900 47.0 14.8 32.2 1953 3'70 139 231 · (92 8,053 45 .9 17.3 28.7 1954 385 108 277 (110 8,192 47.0 13.2 33.8

(135l I

1955 4 5 87 338 8,359 50,8 10.4 40.4 "'1

1956 4r,0 109 314 (126 8,562 49.5 12.7 36.7 Lu Lv I

1957 433 98 335 (134· 8,750 49.5 11.2 38.3 1958 447 92 355 (142) 8,951 49.9 10.3 39.7 1959 4 5 107 348 (139) 9,164 49.7 11.7 38.0

1960 449 84 355 (142l 9,373 47.9 9.0 37.9 1961 422 88 334 (134 9,586 44.0 9.2 34.8 1962 4 9 98 341 (136 9,786 44.9 10,0 34,8 1963 411 95 316 (126 9,991 41.1 9.5 31.b 1964 n,a. n.a. n.a. 10,181 n.a. n.a. n.a.

n a. - data not available

Source: Birth and deaths adjusted to residence from unpublished worksheet of Alaska Department of Health and Welfare, Bureau of Vital Statistics. for 1950 and 1960 from U.S. Bureau of the Census.

Total population

'i

I

I

I I,

' ,..,.

PROJECTIONS Olr AL-1\SK.ll:. I\..~TIVE POPUIATIOH~ 1960 ... 2000 ON BASIS OF l\1ET N.!\ TURAL INCREASE ONLY

1'..fil?JJE 8

Year Total Year Southeast Southcentral Southwest , Interior Northwest , _ _, ----Total Popul~t~~

1950 33,863 7,929 3,788 10,838 3,666 7,663 1955 37,625 8,524 4,434 12,133 4,103 8,359 1960 43,081 9,242 5,514 14,314 4,638 9,373 1964 48,100 9,838 6,624 16,565 5,051 10,181

1970 62,200 13,000 8,600 20,600 6,800 13,200 1980 86,100 17,500 12,700 27,700 9,600 18,600 1990 113,300 22,400 17,500 35,500 12,900 25,000 2000 141,500 27,300 22,400 43,300, 16,500. 32,000

Averate Annual Rate of Natural Increase (Per cent) !

1950-54 3.00 3,20 3,10 2.20 4 .50 , 3.15 1955-59 3,80 3.60 4.35 3.20 4.65 3 .8S 1960-63 3,75 3,50 4.65 3,70 4.10 3.55

1960-70 3,73 3.50 4,60 3.75 4.00 3.50 1970-80 3.20 3,00 4.00 3,00 3.50 3.50 1980-90 2.78 2,50 3 ,25 2.50 3.00 3.00 1990-2000 2.23 2.00 2.50 2.00 2.50 2.50

Ll Expressed as approximate average interest rate, compounded annually. To convert to rates used in previous tables multiply by 1,000.

I '3 + I

I;: ....

TABLE 9 - MILITARY PERSONNEL IN ALASJ:0.\, BY M\JOR REGIONS, 1960-2000

Xfilll: %9tg1l A la ska Southeast .fu,uthcentral Southwest llJ.terior Northwes~

1960 2,500 600. 17,100 3,300 10,800 700

1961 ,500 600 17,100 3,300 10,800 700

1962 33,000 600 17,400 3,300 10,900 800

1962 :13 000 ..... ' 600 17,400 3,300 10,900 800

1963' ·::e,3 000 -· ' 600 17,400 3,300 10,900 800

1964 ,ooo 600 18,000 3,500 11,100 800

1965 ,ooo 600 17,000 3,300 10,300 800

1970-2000 33,000 600 17,500 ·3,500 10,400 1,000

· Sources: Total State from u. s. Bureau of the Census, Current Population Estimates ·ca'nnual); Ma or regions, 1960-1963 from Alaska Department of Labor, Employment Security Division, Current Po ulation Estimates - Alaska b Elect·on Districts; Maj or regions, 1961+-190 estimated from State totals assumine major changes in · regional distribution occurred in Southcentral and Interior regions.

I "'1 \J1. I

. Jr.

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-76-

APPENDJX C - SUMMti.RY OF APA COlvIMISSION ON MA.NPOWER PROGRAM

I. Recruitment and Distribution

A. Objectives: Increase the number of psychiatrists and

and improve their distribution.

B. Proposed courses or Action

(None applicable to Alaska)

II. Utilization

A. Objectives: Improve utilization pf psychiatric manpower. :-

B. Proposed Courses or Action:

1. Study

a. organizational framework of mental health settings

b. functions of each professional mental health group

c. expanded patient coverage via

1) delegation of authority and responsibility

2) superv;i.si on

3) consultation

4) application· of skills at earlier stages

d. societal factors in

1) promotion of mental health

2) maximizing mental health potential of social groups

2. Develop 11load-reducers 11 for psychiatry

a. GP training in psychiatry

b. orientation of other MD's and specialists to

psychiatric problems

. }('

,,,

III. Training

-77-

c. psychologists and social scientists "'

d. nurses

e. social workers

f. rehabilitation, occupational and recreational

therapy personnel

g. c~'mllunity program administrators

h. non-mental health professions (law, clergy)

i. caretakers and attendants

j. individuals for self-help

k. volunteers

1. part-time personnel

m. leading citizens

A. Objectives: Improve psychiatric training

B. Proposed Courses of Action: Study

1. Improved methods of training

2.. Application of new knowledge from research by reduction

of time lag to implementation

3a Psychiatry departments, residency, post-graduate, and

"' in-service training programs; number, enrollments,

"' qua.1.ity, strength, on

4. Ways to adjust medical and psychiatric training to

meet special needs or women, Negroes, and Spanish­

speaking students.