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In all the matters I have discussed here regarding the staffing of our institutions for the mentally retarded, the role of the superintendent is of course of particular import. As you know a controversy is going on at the moment in many states as to whether institutions for the mentally retarded should be exclusively administered by superintendents with a medical and often more specifically a psychiatric background, or whether different professional backgrounds are compatible with the function of such a superintendent.

In a recent debate in which he favored medical superintendents and therefore advocated change in the institution's name to "hospital," a medical superintendent said with reference to legislators: "When they think of a colony or home they think of housekeepers or caretakers, but when they think of a hospital, they think of physicians." The defect in this statement is that it does not sufficiently consider that a medical superintendent may greatly improve the medical services but by the same token the educational and rehabilitation facilities and services may be severely neglected. This is brought out very clearly here by contrasting the physician with housekeepers or caretakers, scarcely a comparison a non-medical person would have made.

Actually this very important debate as to the need for medical superintendents encompasses two quite distinct problems: the first one is to what extent medically oriented institutions should or should not be administered by a non-medical administrator. This is something that is an issue also in many general hospitals in the community and in our universities. There are appreciable factors on either side of this controversy.

The other problem seems to me of far greater importance. If we will develop, as I have suggested earlier, institutions specializing in the education and training of mentally retarded individuals who do not require nursing care or continuing medical observation and guidance, then indeed there is ample reason to raise the question why such an institution should be administered by a physician inexperienced and unacquainted with the educational and rehabilitative functions which form the main purpose of this type of institution.

In other words it seems to me that the heated arguments as to what kind of superintendent should be selected will become far less significant once we will have smaller institutions diversified in accordance with the type of program required to serve the particular type of patients assigned to such institutions.

One final comment needs to be made in this context: in some of our larger states a very respectable career system has been developed for the medical personnel in mental retardation institutions, with salaries sufficiently high to attract and keep in continuing service good personnel. If there is added to this a liberal program for educational leave and good and stimulating direction from a central state department, we indeed have a sound basis for medical staffing where it is needed. But unfortunately there are many other states where the medical staff is poorly paid, where there is no direction from a competent central department, no incentive for advanced training; indeed where there is hardly a medical journal in sight, let alone the specialized literature about new medical and psychiatric advances in our field. Therefore, whenever the issue of medical or non-medical superintendents is brought up there is a need to inquire rather specifically what kind of medical personnel is employed under what kind of circumstances.

I wish it were possible for me to relate in detail some of the thinking that is developing on the part of our progressive leaders in the field as to the specific aspects of programming for residential care. However, I will restrict myself to some general observations: First of all, the institution of the future must no longer be looked to as a catch-all facility, a stop-gap for all and sundry deficiencies in community planning. It must become a facility in its own right with a specific purpose of its own.

When I say that the over-all responsibility of such an institution is the development of the child or adult resident's fullest potential, I might easily be accused of making a trite statement. But do present ward programs actually do so? Just a few hours of observation on any one given ward will indicate that failure in achieving this purpose is by no means merely due to the inadequate present staffing but certainly as much to the mass housing, mass feeding, mass recreation (if any) and all the other negative attributes of traditional institution management in our field, so that it is often sheer mockery to speak of development of the person's fullest potential.

Certainly the institution of the future must take cognizance of recent findings both here and abroad regarding the possibility of a distinct upward movement in the performance level of many mentally retarded in their daily living activities, once a favorable and stimulating climate is provided. Thus, the institution will have to develop a meaningful program for all types and all ages of its residents and will have to rely on a highly skilled program staff, adequate enough in numbers, to provide continuing and effective guidance of the ward personnel.