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All of us in mental health circles are aware that, despite "Action for Mental Health" and the community mental health centers program, we are still far from having efficient and effective mental health care, at any level national, state, or local. One of the elements still missing in our delivery systems is appropriate coordination of services. The term "coordination" has come to have some unpleasant connotations: it conjures up visions of superfluous bureaucrats busily engaged in shuffling papers, drawing up organization charts, trying to fit people and services into boxes on those charts, and generally accomplishing little of value. I should like to suggest, however, that coordination in the true meaning of the word "to bring into a common action, movement, or condition" is essential in our efforts to improve the delivery of mental health services. In today Ts slang phrase, it means "getting it all together" so that comprehensive, continuous care

This letter was written in criticism of the Correa-Beasly article entitled "Mathematical Models for Decision-Making in Population and Family Planning" published in the January 1971 issue of the Journal. The author believes that while that article claimed to have used linear and quadratic programming in connection with the acceptance of various contraceptives they did not specify an objective function which is the first principle of linear programming. They did not mathematically formulate their stated objective of minimizing the number of pregnancies through the use of direct contraceptive techniques. Another shortcoming of the paper is that its authors failed to recognize the possibility of substitution of one contraceptive for another. The author also finds fault with some mathematical formulations and their application. Finally he claims that he has recent articles in the same area which more clearly approach the problem although in a different way.

s. Sutpplement No. 3, 1968. Alencher, S. Poor Law to Poverty Program. University of Pittsburgh, 1967. Extensive bib)liography contained in this book. Mobilization for Youth, Inc. (Training Department). Bibliography on the Education of Socially Disadvantaged Children and Youth. New York, 1965. . Master Annotated Bibliography of the Papers on Mobilization for Youth. New York, 1965. Rosen, G., and Wellin, E. A Bookshelf oni the Social Sciences and Public Health. A.J.P.H. 49,4:441-454 (Apr.), 1959. Schlesinger, B. The Multi-Problem Family: A Reviewv and Annotated Bibliography. Toronto, Canada: University of Toronto Press, 1965. . Poverty in the United States and Canada: Overviewv and Annotated Bibli- ography. Toronto: University of Toronto

Families of 4 3 and 2 children are seen as significantly different both demographically and in terms of child development. The average num ber of children per woman in the U.S. was 8 in colonial days falling to 2.3 during the depression of the 1930s and rising slightly to 3 since then. A rate of 2.2. is needed if finite resources are to support the present standards of health and longevity. This paper presents the case for small families; benefits accrue to children as well as parents. Citing results of previously published studies in England and the U.S. the author mentions some effects of family size on children. The smaller the family the more intelligent the children. For example in 1964 70% of Selective Service mental rejects came from families with 4 or more children. Also the smaller the family the better the personality development of the child because of less maternal deprivation and/or more mother-child contact and warmth and therefore less prolonged dependency behavior in the child. Intersibling as well as parent-child relations have also been reported better in smaller families in studies carried out in Michigan and Ohio. Physical development also seems to be retared by large family size; a British study found the average height and weight for age decreased as family size increased despite the fact that birth weights increase with parity. It is true that not all studies favor small families; the advantages of adequate parental attention may be outweighed if too inten sive or too achievement oriented. Some studies find no significant diff erences that cannot be explained by factors other than size. It is noteworthy however that only 30% of children from large families themselves wholeheartedly endorsed the large family. Effects upon parents include: more illhealth both physical and mental was found among British parents of larger families especially among mothers. Oth er studies have shown that marital relations suffer and marital adjustme nt is adversely affected in large families. The phenomenon of "good marriages get better with parenthood and poor ones get more children" is a vicious cycle of maladaptation and should be researched further. Although the divorce rates in the U.S. have remained relatively constant the number of children affected now 1.18 per divorce has gone up significantly and reflects the proportion of couples with children. Good marital adjustment as well as contraception should come before childbearing because it is more rational and more responsible to have no children rather than unwanted children. An average number of 2 children per family given a very low infant mortality and perhaps even the possiblity of sex selection in the near future is seen as ideal.