A group of 40 individuals will be available for assignment to States. A headquarters staff of 75, including professional staff skilled in medical care, hospital administration, nursing, statistics, and other specialties, together with clerical staff, will be available to provide overall program planning, direction, evaluation. conduct of special studies, staff work as needed with the advisory bodies, and other essential functions to help assure the successful undertaking and operation of this program. MIGRANT HEALTH-INCREASE OF $3 MILLION This proposal would increase the amount available for migrant health project grants from $2,500,000 in 1965 to $3 million in 1966 to continue support of medical care provided through family clinics or other arrangements, and to continue support of nursing, health education, sanitation, and other services. This amount would provide continued grant assistance to the 63 ongoing projects. In 1965 only slightly less than 1 out of every 10 migrants were reached through services offered under this program. The projects currently receiving grant assistance vary from one locality to another in the nature and scope of their service. The majority provide medical treatment for illness or injury, immunizations, casefinding and treatment of communicable diseases, prenatal and postnatal care, and other preventive and curative services. Family health service clinics to provide medical and, in some cases, dental care have been established in or near farm labor camps. Public health nurses have been employed to visit families in the camps on a regular schedule to find cases early, to see that care is obtained before cases become serious, and to teach migrants how to care for themselves and their children so that diseases and injuries are less likely to occur. Sanitarians have joined projects to work with migrants themselves and with property owners to upgrade housing and environmental conditions. Health educators have been hired to work with the migrants to develop better understanding of modern medicine and good health practices. The supplemental funds requested are needed to continue these essential services to the migrants. NATIONAL INSTITUTE OF MENTAL HEALTH WITNESSES DR. STANLEY F. YOLLES, DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH DR. STUART M. SESSOMS, DEPUTY DIRECTOR, NATIONAL INSTITUTES OF HEALTH B. J. SADESKY, EXECUTIVE OFFICER, NATIONAL INSTITUTE OF MENTAL HEALTH LELAND B. MAY, HEAD, BUDGET MANAGEMENT SECTION, NATIONAL INSTITUTES OF HEALTH DR. JAMES M. HUNDLEY, ASSISTANT SURGEON GENERAL FOR OPERATIONS HARRY L. DORAN, CHIEF FINANCE OFFICER JAMES F. KELLY, DEPARTMENT COMPTROLLER Mr. FOGARTY. Dr. Yolles, we will put your statement in the record at this point. It covers just one thing and that is staffing of these community mental health centers. (The statement follows:) STATEMENT OF DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH, PUBLIC HEALTH SERVICE Mr. Chairman and members of the committee, I appreciate the opportunity to appear before this committee as Director of the National Institute of Mental Health in support of the appropriation of funds necessary to implement part B of title II of the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 (Public Law 89-105). As you know, when the Congress enacted Public Law 88-164, it authorized $150 million over a 3-year period to provide Federal grants for support of up to two-thirds of the cost of construction of community mental health centers. The first $35 million of these funds was made available in January 1965. I should like to inform the committee, Mr. Chairman, that six States-Missouri, Minnesota, Kansas, New York, New Jersey, and Pennsylvania-have already received approval of their State plans for centers. Thirteen additional State plans are currently under review and others are still being completed by the States. The first grant to be awarded to a mental health center has been made to the Mid-Missouri Mental Health Center, which will be operated at Columbia, Mo., in association with the University of Missouri School of Medicine. While the Centers Act served as a stimulus toward establishment of a nationwide community-based program of services for the mentally ill, it quickly became obvious that a majority of the Nation's communities-especially the less affluent communities-would need help in financing the initial staffing of the new centers while local financing was being arranged to support continuing operations. The staffing authorization was passed during the current session of the 89th Congress, and the President signed the bill into law August 4. To implement this legislation, a supplemental appropriation is required. I should like to state, Mr. Chairman, that interest in the new law is already widespread, since it will make it possible for many communities, which would otherwise be unable to do so, to establish community mental health centers. Often, the law will make it possible to fill a critical need and make the difference between inaugurating a greatly needed program and having to postpone such a program indefinitely. Appropriation of these supplemental funds will have the effect of making the available forms of Federal assistance adaptable to a greater range of local circumstances. Staffing assistance will be available to centers applying for new construction, but centers already having physical facilities in existence also will be eligible to apply for staffing grants. In the case of existing centers, they may add services that meet the need for the essential elements required for a center program-inpatient and outpatient treatment, partial hospitalization, emergency services, and consultation and education through other community agencies, such as schools and the courts. Or they may apply for funds to support additional elements of service necessary to achieve true, comprehensive care. Public Law 89-105 will thus have the effect of rounding out the national mental health program in that communities will be able to apply for the type of assistance they need. One community, for example, will need to apply only for construction assistance. Another, where some mental health services are in operation, will need only staffing assistance to broaden its services to qualify as a community mental health center. Yet another, where neither facilities no services are now available, will be able to apply for both types of assistance. Given the broader range of available support, we fully anticipate an increasing number of applications and inquiries to the Institute. Even before enactment of Public Law 89-105, we were informed of 84 center projects for which Federal construction assistance probably will be requested; there are 248 additional inquiries from communities with a definite interest in making applications for construction assistance; and there were 259 other exploratory inquiries, expressing an interest in either construction or staffing assistance. This is a total of 691 inquiries. State action is also making such projects more viable. Of 26 States with community mental health service acts, 14 of them, representing 46 percent of the total population of the United States, have already appropriated funds from which communities can obtain assistance in operating centers as they are established. Because of their activities in mental health planning, the States now have an inventory of existing mental health facilities; they know what their long-term and immediate needs are; and they have, in many instances, already initiated improvement in certain mental health services. Liaison between the citizens of communities and the governmental officials involved has been improved and mental health planning has progressed in concert with other community planning. The prospects for the success of the national mental health program within the framework of the goals originally established by the Congress have been greatly enhanced by this legislation, Mr. Chairman. The law's implementation will, in fact, lead to the culmination of events set into motion by the Congress in 1955, when it enacted legislation authorizing establishment of what came to be the Joint Commission on Mental Illness and Health. The Joint Commission's report in 1961 stressed the need for a return of the responsibility for the mentally ill to the community. Implementation | of the staffing law will aid significantly in providing treatment to the mentally ill without sending them away from their home communities to State mental hospitals. With the wholehearted support of the Congress since that time we are well on our way toward achieving the goal set by the Joint Commission. As a final legislative step toward that achievement, I respectfully request your approval of a supplemental appropriation of $19,700,000 for support of part B of title II of the Community Mental Health Centers Act. STAFFING COMMUNITY MENTAL HEALTH CENTERS Mr. FOGARTY. The request for $19,700,000 includes $19,500,000 for grants recently authorized to assist in staffing the community mental health facilities and $200,000 for professional and technical assistance in connection with the same program. When this act first passed, no staffing was provided for. Dr. YOLLES. That is right. Mr. FOGARTY. After a year or two experience in the field it was definitely decided by those working in the field that unless they had some help in staffing these facilities, it just was not going to work. So Congress did remedy this mistake that they made previously. Dr. YOLLES. That is right. Mr. FOGARTY. By unanimous vote. Dr. YOLLES. Yes, it was a unanimous vote in the House and almost in the Senate. Mr. FOGARTY. This is the full authorization for the first year; is. that right? Dr. YOLLES. Yes, sir. AMOUNTS AUTHORIZED IN FUTURE YEARS Mr. FOGARTY. What is the authorization for future years? Dr. YOLLES. For fiscal 1967 it is a total of $40,575,000, made up. of $24 million for new grants and $16,575 for continuation of the first year's grants. In fiscal 1968 there is $30 million for new grant money and $33,075,000 for continuation of the preceding 2 years' grants. This continues on with fiscal 1969, $49,875,000; fiscal 1970, $32,250,000; fiscal 1971, $15,900,000; and then $3 million in fiscal 1972, which is the 4 years and 3 months after the last grant was awarded. METHOD OF ALLOCATION TO STATES Mr. FOGARTY. What is the allocation formula? Dr. YOLLES. This is a project grant program, although the legislation provides that we take into account the relative needs and population sizes in making a distribution by States. We intend to use as a basis for our original allocations the formula grant for construction.. So we could arrive at a top figure for each State. However, the individual project grants will be made on the basis of competition and excellence up to the total for each State as determined by thesame formula used for the construction allocation. FEDERAL-STATE PARTICIPATION Mr. FOGARTY. What matching is required? Dr. YOLLES. In the staffing program the Federal share in the first 15 months is 75 percent. After the first 15 months for the following year it is 60 percent Federal and then 45 percent and then 30 percent. Mr. DUNCAN. Do you want to bet? Dr. YOLLES. Yes; I will bet it works that way. STATUS OF VARIOUS STATE PLANS FOR COMMUNITY MENTAL HEALTH SERVICES Mr. FOGARTY. On page 1 you say you would like to inform the committee that six States-Missouri, Minnesota, Kansas, New York,.. New Jersey, and Pennsylvania-have already received approval of the State plans for centers. Dr. YOLLES. Yes, sir. Mr. FOGARTY. Thirteen additional State plans are currently underreview. RHODE ISLAND AND ILLINOIS What happened to Rhode Island? Did they get lost? Why are they so slow? Dr. YOLLES. At this point in time they are not very much slower than any of the other 27 States that are still expected to submit. Mr. FOGARTY. They should be first. It is the smallest State. They ought to be first. Why aren't they first? Dr. YOLLES. As you know from the planning that has been going on in Rhode Island, there has been some reluctance to approach the problem of community mental health without some assurance that there was Federal support beforehand for matching. There is a question of raising the local funds necessary. Earlier there were some differences betwen the various groups in the State but this has now been resolved. Mr. MICHEL. What about Illinois? Dr. YOLLES. We expect Illinois to submit their plan. As a matter of fact, we expect 27 others to be submitted this year, with the exception of 4 States or territories. DESCRIPTION OF STATE PLAN Mr. FLOOD. What do you mean by a State plan? Take Pennsylvania as exhibit A, what is a State plan? You approve the Pennsylvania State plan. What does that mean to us? Dr. YOLLES. It is a document prepared by the State after extensive! study of the need for community mental health services. It is the plan of the State to distribute on a public health basis these services throughout the State. It is a general proposal made by the State within the State's wisdom as it sees the need for providing services to the people in a State. Mr. FLOOD. And the State designates the communities in which these mental health centers will be established. Dr. YOLLES. The State plan, or the State, must approve the location of the construction of new centers since the allocations are made to the State. PROCEDURE FOR FUNDING CONSTRUCTION Mr. FLOOD. Who asks for the money for the bricks and mortar? Who is the applicant? Dr. YOLLES. An applicant may be any private, nonprofit organization or group, or it may be a city or a local foundation. Mr. FLOOD. This applicant files its application with the State. Dr. YOLLES. With the State. Mr. FLOOD. And it must have first the State's approval. Dr. YOLLES. That is right. Mr. FLOOD. What do you do, merely send them a check? Dr. YOLLES. We provide to the State on the basis of a formula the allocation for that State. Mr. FLOOD. Money? Dr. YOLLES. Yes, sir. Mr. FLOOD. And nothing else? Dr. YOLLES. We provide a good deal of consultation, occasionally irritation, but certainly a great deal of help in aiding a State to develop a State plan and an appropriate program. Mr. FLOOD. Do you help the community that is the applicant do the same thing? Dr. YOLLES. Yes, sir; but within the terms of the law as it is presently written. Mr. FLOOD. I understand. They have a right of access. |