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it is an understatement for us to say we "support” a concept which we in the counties virtually initiated in this country:

For example, 2 years before the enactment of Public Law 88-164 in 1963, the county governments were operating 392 community mental health treatment clinics-or centers in 36 States.

It is true that these 392 county facilities did not provide "comprehensive” treatment services. The were principally "out-patient” clinics. But they were in the community and part of the community, and we welcomed-in 1963—the chance to upgrade them into “comprehensive treatment centers” by adding “in-patient" and other essential services.

The Congress gave us that chance with Public Laws 88–164 and 89– 105. However, even before Public Law 88–164, the counties in some States were operating comprehensive mental health treatment programs, including in-patient care.

In my own State of New Jersey, six counties have been operating comprehensive treatment mental hospitals since the beginning of the century.

Let me say this about my own State, one of the greatly gratifying things that should be of interest to the committee: the States and the counties are vitally interested in this program, they are spending the money, they are willing to spend the money, they know the money has to be spent in this area.

For example, at this very moment, the New Jersey Assembly, the lower house, unanimously passed a bill, and the Governor has indicated that he is going to sign it, which would provide $712 million for contributions for construction, $712 million unanimously passed by the lower house without one dissenting vote.

I think this is the kind of indication that you want that indicates that States and counties want to spend this kind of money.

These hospitals today have a resident population of 6,500 patients. This means that county government in my State of New Jersey operates community mental health treatment programs larger than the mental hospital programs of 30 States.

In the State of Wisconsin, since 1881, the counties have operated their own local mental hospitals. Today in Wisconsin there are 35 county mental hospitals, serving 71 counties and covering 84 percent of the State's population.

In Iowa, the counties run 84 after-care facilities for aged ex-mental patients, and at present there are almost 3,000 patients in the Iowa county facilities. Also, in Iowa, the counties pay full cost of treatment of county residents who are committed to Iowa State mental hospitals.

Here, I think, that you can see that counties, and I am going to show more specifically, are becoming more engaged in this problem, more and more willing to pay the moneys that have to be spent here and, as has been indicated by the testimony that was given by my distinguished predecessors, frankly, the Federal Government has not been spending the kind of money that it should be spending in this area and the time has arrived now for a real partnership between the Federal Government, the States, and county governments in this area of mental health.

Thus, we see a clear record of interest on the part of the American county government in the treatment of the mentally ill in, or close to, their own communities. This is important, so very important, in their own communities. There is a big difference between a mentally ill person going to a State institution and going to his neighborhood community center the moment there is an indication of mental illness because he doesn't go to a State institution 9 times out of 10 until he is committed, until the mental illness is so progressive that, as the testimony indicated, after that it is a matter of years before he comes back to the community.

I would just like to point out this to the committee: I have been in this business for 12 years. I have had the good fortune to serve as chairman of the welfare committee in my county for 12 years and I distinctly remember when I first came on the board in my county and I started to advocate mental health clinics.

Most of my colleagues on the board 12 years ago thought I was talking about some kind of proposed retreat for retired politicians. They had no concept of what the mental clinics would serve in the county.

The amazing thing after 12 years in my county, which has 600,000 urban and suburban people, is that today the mental health clinics in that county vary in their concept of diagnosis and treatment for children and adults including additional alcoholic treatment centers, narcotic treatment clinics, crises intervention clinics, after-care clinics, and companion houses.

In 12 years, this has been accomplished in my county. The fantastic change that has taken place is not only amazing but pleasing, and here again is an example where Federal, State and county governments can form an effective partnership in the expansion of this kind of a program, and here again, we are talking about this bill that we are testifying about today because this is the beginning of that partnership.

This is the beginning of getting into the home, getting into the neighborhood, reaching out into the families. The great tragedy, Mr. Chairman, and members of the committee, with these clinics that we have established in my own community, is the wail and cry of the people who are on the waiting lists and cannot be treated. That is the great tragedy, when you sit there as an elected official and you have great big lists of people who are breaking the doors down to get into the clinics and you cannot take them because the clinics are not sufficiently comprehensive or sufficient in number to take care of the great needs that exist.

In 1963 and 1965 the National Association of Counties came before this committee in support of the proposed community mental health construction and staffing legislation. In 1963 the administration proposal called for a 5-year program

of $330 million starting on a 75-percent matching basis. The proposal was cut by 2 years and $180 million, with the matching formula reduced.

Now, we come back with 3 years of good, practical experience behind us and we ask for an extension of the program to get it moving at a pace originally envisioned.

Thirty-one county mental health centers are now underway. At this point, Mr. Chairman, I ask that a list of the 31 county projects be made a part of the hearing record. I am going to submit that.

Mr. JARMAN. Mr. Otlowski, how many States are those ? Mr. OTLOWSKI. They represent six or seven States, Mr. Chairman. They include such States as Florida, California, Kentucky, and so on.

Mr. JARMAN. Very well, without objection, at this point in our hearing record we will include those statistics.


(Submitted by the National Association of Counties) Olive View Hospital, Olive View, Calif..

$791, 627 County of Santa Barbara Mental Health Services, Santa Barbara, Calif

108, 915 Santa Clara County Community Mental Health Center, San Jose, Calif

378, 853 Panama City Memorial Hospital, Panama City, Fla--

269, 750 Mental Health Center of Manatee Memorial Hospital, Bradenton, Fla

331, 500 Escambia County Guidance Clinic, Inc., Pensacola, Fla_

185, 900 Community Mental Health Center, Athens General Hospital, Athens, Ga...

614, 962 Marion County General Hospital, Indianapolis, Ind.--.

545, 163 Hopkins County-Madisonville Hospital Corp., Madisonville, Ky.

223, 090 Prince Georges General Hospital, Cheverly, Md.

290, 931 Vista Larga Center, Albuquerque, N. Mex.---

504, 622 Cape Fear Valley Hospital, Fayetteville, N.C.-.

815, 220 Alamance County Mental Health Center, Burlington, N.C.

126, 000 Muskingum County Hospital, Zanesville, Ohio..

162, 669 General Hospital of Monroe County, Stroudsburg, Pa_

93, 170 Mental Health Guidance Clinic of Butler County, Butler, Pa.--

211, 464 Anderson-O'Conee-Pickens Mental Health Center, Anderson, S.C. 120,000 Whatcom County Outpatient Clinic and Psychiatric Day Center, Bellingham, Wash.-

171, 873 King County Hospital-Harbor View Center, Seattle, Wash -

1, 017, 049 Brown County Hospital and Community Mental Health Center, Green Bay, Wis.

664, 800 Adams County Comprehensive Community Mental Health Center, Adams City, Colo--

94, 763 San Luis Obispo County Mental Health Center, San Luis Obispo, Calif

112, 118 Franklin County Public Hospital, Greenfield, Mass.-

319, 691 Mental Health and Mental Retardation Center of Boulder County, Boulder, Colou

147, 591 Mental Health Center of Anderson and Roane County, Inc., Oakridge, Tenn

387, 547 Milwaukee County (6 centers) -

1, 040, 232 Total --

10, 902, 532 Mr. OTLOWSKI. In the next 5 years we would expect that, if this bill is enacted, the counties will develop 200 more mental health centers.

As President Johnson said in his 1965 health message, “Few communities have the funds to support adequate programs, particularly during the first years.” The key word here is adequate.

In order to develop adequate; that is, comprehensive, community mental health programs, the counties need financing help from State and Federal Governments.

In the 31 projects now underway we have demonstrated the intention of the counties. The Federal-State-county cooperative financing program is a demonstrable success.

I think that no more telling tribute could be paid to the devotion of most county officials to the care, close to the home, of the mentally ill than a recent statement by a Minnesota county commissioner.

This commissioner said: "Our board would sooner reduce its county highway program than to cancel out our participation in our regional mental health center."

This, I think, Mr. Chairman, is the spirit of all U.S. county officials. They see this as a workable program of high priority for their constituents.

We not only ask you for its renewal; frankly, I would like to be humble enough at this point to say that we beg you to extend this program because county government to bring this kind of treatment into the neighborhood, to bring this kind of treatment into the home, does not have the financial resources to do it alone and they will never have them to do it alone.

We have to have the strong arm, the strong resources, of the Federal Government into the partnership that we are calling not only the Federal Government but the State, and in these 12 years that I talked to you about this in my own county when the mentally ill patient went to the State hospital in most cases he saw an imaginary sign on the gate that read “Abandon All Hope, All Ye That Enter”—but in his home, in his neighborhood, in his community, there is the hope, there is the friendship of his neighbors, there is the possibility of the total community involvement, there is the possibility of better professional involvement who shy away from the snakepits at the present time and who are waiting for decent community neighborhood facilities.

Congress, and particularly this committee, can open this door wider for the American people to get their treatment on a neighborhood level and almost on a home level with the kind of program that is envisioned here.

Gentlemen, I want to thank you for giving me this opportunity to testify.

Mr. JARMAN. We appreciate your being with us and the contribution you have made to this hearing.

Are there any questions?
Mr. Rogers?
Mr. ROGERS. Thank you, Mr. Chairman.

I would like to thank you for your testimony and for being here, and also for the initiative your area has taken. What is your problem with staffing? Do you have any staffing problem?

Mr. OTLOWSKI. Well, let me give you an example in our own county. With our clinics we haven't had a problem of staffing, and I like to believe it is because of the fact that we pay well.

I like to believe that our quarters are pleasant and I also like to believe that our professional people have a feeling of accomplishment, and for that reason, of course, we don't have the problem of staffing, but in addition to that we have done something else that was indicated by my predecessors who testified and that is the fact that we are now beginning to engage in the community nonprofessional people.

As I indicated in my testimony, we have the companion house that provides after-care people where nonprofessional people are engaged in helping these people.

Congressman, I would just like to say this, and it was so amply brought out this morning: That in many cases what is needed is the immediate warmth and the immediate sympathy.

Mr. ROGERS. I understand that. I don't want to take too much time of the committee.

Perhaps you would like to submit it for the record.
Mr. OTLOWSKI. We haven't had a problem with staffing.
Mr. Rogers. This is in your county where you pay for all the care?

Mr. OTLOWSKI. We pay for all the care. The State provides 50 percent of our operating budgets.

Mr. ROGERS. You anticipate using this program for staffing? Mr. OTLOWSKI. I am glad you asked that question, Congressman. We have two applications in at the present time. We are hoping that one will be approved by April 30.

Mr. ROGERS. Is this within your county?

Mr. OTLOWSKI. Yes, the two are within our county. One is for what we call the Raritan Bay area. The other is for the Rutgers University area.

Mr. ROGERS. They have these county facilities?
Mr. OTLOWSKI. Right.

Mr. ROGERS. What is the average time for the inpatient treatment at your hospital? I understand you have a resident population there of 6,500?

Mr. OTLOWSKI. As a matter of fact, our county now is closely working with the State in our State hospital for which our county pays.

Mr. Rogers. I am not thinking of the State hospital. I was thinking of your county mental health population. You may want to furnish this for the record.

Mr. OTLOWSKI. I would say on the average a year and one-half. Mr. ROGERS. For inpatients admitted?

Mr. OTLOWSKI. No, for outpatients. We do not have any inpatient facilities in our county because the inpatient facilities are provided by the State for which the county pays the State.

Mr. ROGERS. I misunderstood your statement on page 2 where you say six counties have been operating comprehensive treatment mental hospitals and these have a resident population of 6,500. That is the statement.

Mr. OTLOWSKI. You are talking about the entire statement. In Bergen County and the other counties, we have these counties furnishing inpatient care and the average stay there, 40 percent of the stay there is 30 days as inpatient.

År. ROGERS. Thank you. I appreciate your testimony. Mr. JARMAN. Are there any other questions? Thank you so much, Mr. Otlowski. Mr. OTLOWSKI. Mr. Chairman, may I present this to the committee? This is the national association's county platform.

Mr. JARMAN. Thank you, Mr. Otlowski for taking the time to be with us this morning. Mr. OTLOWSKI. Thank you, Mr. Chairman.

(A series of articles on the psychotic child, from the Perth Amboy Evening News, and a letter from Dr. Samuel Breslow endorsing same, submitted by Mr. Otlowski, may be found in the committee files.)

Mr. JARMAN. Our next witnesses I am pleased to say are two prominent people from the State of Oklahoma, Dr. Albert Glass, director

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