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of the Department of Mental Health of the State of Oklahoma, accompanied by Dr. Hayden Donohue, director of the mental health center in Norman, Okla.

In fairness to Mr. Kuykendall, I should add that they are accompanied by Dr. Nat T. Winston, the mental health commissioner of Tennessee.

Dr. Glass. May I also introduce Harry Schnibbe, the executive director of the National Association of Mental Health Program Directors, which group we represent here.



Dr. Glass. As you may be aware the National Association of State Mental Health Program Directors is comprised of those directors who direct the programs for the mentally ill in the 50 States and the several territories.

As administrators for the vast majority of the mental health services in this country, we have a vital concern in these proposed mental health amendments of 1967 and our association unanimously urges its passage.

We have also here the messages from Governors and directors of mental health of some 24 States, including the States of Massachusetts, North Carolina, Illinois, Wisconsin, Kansas, Kentucky, Arizona, Arkansas, South Carolina, Connecticut Delaware, Ohio, Vermont, Utah, New York, Washington, West Virginia, North Dakota, Pennsylvania, Louisiana, Missouri, Indiana, Texas, and Iowa, which I would like to submit to the committee.

Mr. JARMAN. They will be received.
Mr. ROGERS. You have no requests from Florida?
Dr. GLASS. We are awaiting it.
Mr. Rogers. I would be interested to know if Florida responds.

Dr. GLAss. We are getting them in this morning and they are being added to the list. We expect a communication from the State of Florida.

Mr. SPRINGER. May I ask, have you heard from Illinois ?
Dr. GLASS. Yes, Governor Kerner.
(The material referred to follows:)


Springfield, IH., April 3, 1967.
Chairman, Interstate and Foreign Commerce Committee,
House of Representatives,
Washington, D.O.

DEAR CONGRESSMAN STAGGERS : On Thursday, March 4, 1965, I appeared before the Interstate and Foreign Commerce Committee, then meeting to consider H.R. 2985, and testified on behalf of the bill with the hope that it would allow our states to embark on a program which would make community-based Mental Health

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services available to all citizens. At that time, I described the direction taken by the State of Illinois and the Illinois legislature which authorized the creation of Zone Centers throughout the State. Seven centers, at that time, were planned and programmed. Since that time, two centers in the Chicago area have begun operating. Also centers in Rockford, Decatur and Champaign have initiated programs of a comprehensive mental health nature. The remaining centers in Peoria and Springfield will be completed by mid-summer of this year.

The purpose of these centers is to provide intensive short-term care in an environment designed to keep the patient in his own community. These centers which, in terms of geographic catchment area, i.e., the numbers of population which they serve, are larger than those proposed under the Federal Construction Act. In part, this was because our planning for these centers was initiated in 1961, two years before the passage of the community Mental Health Centers Act and, in part, because of our program of decentralizing the Department of Mental Health in order for the regionalization of planning and services to be specific to the needs of the communities which they serve. The community Mental Health Centers program, therefore, is being used to set up a sub-network of community Mental Health Centers serving more discreet populations and regions as subzones which then relate to the zone center program in Illinois. In essence we are building a zone center complex in which state hospitals, outpatient clinics and community mental health centers are related in a network of services serving the population of relatively large geographic regions and sub-regions, providing a continuum of care and comprehensive services. This requires the highlyintegrated planning and organization between those agencies responsible for human services—that is, the Department of Public Health, the Youth Commission, the Division of Vocational Rehabilitation, the Public Aid Department; the Division for Crippled Children, the Universities, and, of course, the Department of Mental Health. All these agencies have regional offices in the same zone cities where the Zone Centers have been constructed.

In Illinois, we have sought an enlightened approach to a partnership for planning and service. We welcome federal monies coming into our state, matched by state efforts and local community efforts. To achieve this partnership several progressive steps have been taken since my last appearance. Federal money for construction of Mental Health centers is not used by the Department of Mental Health, but rather is directed to local communities seeking to build resources necessary for providing services and reaching out in a service linkage to our new state facilities. In this legislative session, we have proposed an enabling act which would allow the state to implement the efforts of the Federal government by subsidizing local programs up to 30 per cent to match the 39 per cent provided by the Federal Mental Health Centers Construction Act. In 1963, a law was enacted in Illinois permitting local government units to tax themselves for mental health services subject to referendum. Eight such referenda have passed, and eight were to be voted on at the general election April 4. Therefore, you can see we are striving to truly effect a partnership between the Federal government, State government and local communities. The state sees its charge in this partnership for planning and service as stepping in only where communities are unwilling or unable to provide the resources and the services for their citizens.

We have reviewed, favorably, the budget proposals of the Department of Mental Health for this coming biennium to provide the expansion of those programs which we have initiated for comprehensive mental health services at the community level. Programs for the prevention and treatment of mental illness and retardation have expanded rapidly and have changed in concept during this decade. Today, we admit more persons to our programs than ever before in a greater number of facilities throughout the state. Through improved diagnostic and treatment methods we return a higher percentage of these persons to their homes and jobs in a shorter period of time. Our resident population in institutions for the mentally ill decreased 19 per cent from 31.912 patients on June 30, 1965, to 25,899 on December 31, 1966, and we are continuing to improve staffing at these institutions and zone centers to make them modern and effective treatment facilities. In all of our zone centers a substantial amount of community organization work has been completed. This work will be increased and intensified during the next biennium, and this has been a priority item budget request of all of our zone centers. Government must place as much emphasis on providing resources for the treatment and prevention of mental illness and retardation as it does on communicable diseases and physical impairments.


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The Department's program is, therefore, to encourage communities to provide adequate front-line resources for the prevention, early diagnosis and treatment of mental illness and retardation. To this effect, we have requested a budget of $414,174,039, excluding reappropriations, for the coming biennium. This represents an increase of some 120 million dollars from General Revenue Funds over the last biennial appropriation.

I, therefore, request your support for the Mental Health Amendment of 1967 under H.R. 6431 which extends the construction and staffing of community Mental Health Centers under Public Law 88-164 and Public Law 89–105. If we are to diminish the serious, crippling effects of mental illness and retardation, and to increase the social competence and potential of our citizens, it will be through the efforts of these bills, providing service at the local level in conjunction with state efforts. In our ever-changing society, it will be those services provided by our staffs and our communities in the centers of populations where people live, trade, and congregate that will make the significant impact on our everchanging, ever-exploding society. Society, because of its size, because of its gross potential, because of the very nature of its technological explosion, creates a multitude of problems and stresses on its citizens. These stresses must be dealt with through treatment, prevention and rehabilitation. These services must be added to our growth as a nation and as a society which cares for its own on its own home front. Thank you. Sincerely,

OTTO KERNER, Governor.



Raleigh, N.C., April 4, 1967. The Honorable HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representa

tives, Washington, D.C. DEAR CONGRESSMAN STAGGERS : Adoption of $. 1132 (H.R. 6431) will enable North Carolina to continue implementation of its long-range plan to establish community-based services for the mentally ill and retarded.

Since the Facilities Construction Act (Public Law 88–164) was adopted in 1963, North Carolina has made considerable progress toward that objective. Under this act, Federal funds have been committed for construction of four comprehensive community mental health centers. Two of these will be in the eastern section of our state, one is in the Piedmont and one will be in the western section of our state. The latter is designed as a combination mental health-mental retardation facility to be housed in the same structure.

A number of other communities are in various phases of developing their plans for a comprehensive center. We estimate now that fifteen additional comprehensive community mental health centers can be established during the next biennium, provided funds are available.

Currently our recommended state budget, now before the Legislature and expected to pass, appropriate state funds sufficient to provide the state matching portion for construction of the fifteen new centers. Many of the communities already have their portion set aside.

The state simply could not support its own and the Federal share of this program. We are already putting about all we can afford into support of our mental health program. Currently, North Carolina is spending forty million dollars a year on its mental health program. For the next two years I have recommended an increase of 22.8 percent per year in mental health appropriations, the largest single portion of which will go to community mental health centers. I point this out to emphasize that we in North Carolina are not abdicating our financial responsibilities and shifting them to the Federal Government.

Our mental health program in North Carolina is in a very critical transitional period. We are making a concerted effort to build up our community programs with the resulting need for increased budgetary support, while still carrying the same responsibilities for maintaining a high standard of care in our state hospitals which currently receive over 12,000 admissions each year. Until we work through this period to the point that community programs are numerous enough to enable significant numbers of patients to be treated at home

instead of entering our state hospitals, continued Federal support for community mental health development is essential if we are to continue to move forward.

Many of our communities in North Carolina are just now moving into the final phases of the rather long and involved process of community organization through which an application for construction funds is developed. This has been a time-consuming process in North Carolina for two reasons. First, it has involved bringing together multi-county groups for joint planning and negotiati Secondly, because we decided to tie in our comprehensive community mental health centers with general hospitals, our center construction plans have had to be phased into the long-range plans (under Hill-Burton) for hospital development. In some cases it is possible to do this quickly but in many others it may involve a period of several years.

Let me emphasize that the process of community development and involvement which has come about as plans for a community mental health center take shape has been very healthy and stimulating for our state. The people of our communities have responded to this challenge by working together to a degree that has been inspiring. So, while North Carolina has used only a portion of the Federal construction funds originally allocated to us, there has been no lack of interest or work by our people. And now many of our communities are ready to move forward. The funds simply must be made available so that the plans and hopes for a comprehensive community mental health center may become a reality.

Equally as important as the "bricks and mortar” part of this Act is Section 3 of S. 1132 which extends the staffing grant program (P.L. 89–105) through fiscal 1972. This is absolutely essential in order to help the new community mental health centers bear the initial burden of employing the new personnel which their effective operation requires. Recruiting and hiring of professional mental health personnel cannot be done quickly. They are in great demand and in scarce supply. While we are committed in North Carolina to meeting the manpower shortage through expanded training programs and opportunities, it again takes a period of several years before these training programs can begin to bridge the gap.

Our long-range mental health plan in North Carolina envisions the eventual establishment of thirty-two comprehensive community mental health centers. Each of these is going to require a full staff of qualified personnel. I can think of no more productive and creative way for Federal tax dollars to be used than in helping these communities meet some of the initial financial strain of acquiring the staff needed to carry out our responsibilities toward the mentally ill and retarded.

May I sincerely urge your favorable consideration of S. 1132 which will do so much to help our state through this very crucial period in its mental health program development. Sincerely,

DAN MOORE, Governor.



Bismarck, N. Dak., April 3, 1967. The Honorable HARLEY 0. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce, House Office Building, Washngton, D.C.

DEAR CONGRESSMAN STAGGERS : It is my understanding that hearings will be held soon on extension of the Community Mental Health Centers Construction and Staffing Acts and the grants authorizations as provided for in H.R. 6431 and a companion bill S 1132. This is to inform you that I strongly support this proposed legislation.

North Dakota has been able to provide care, near their home, for many patients suffering from mental illness through two new Centers, located in Grand Forks and Bismarck, during the last several months. Two other Centers, located at Fargo and Minot, will open within the near future. These four centers eventually will provide care for patients for approximately 60% of our state's population.

This marked progress could not have been accomplished without the assistance from federal funding through the Community Mental Health Centers Acts. In addition, construction funds have been made available for the St. Michael's

Hospital in Grand Forks and for the Neuropsychiatric Institute at St. Lukes Hospital in Fargo.

I believe that a continuation of this program, as embodied in H.R. 6431 and S. 1132, will be of great benefit to North Dakota and to all other states in the nation in meeting the mental health needs of our citizens. I respectfully request your Committee's favorable consideration. I appreciate this opportunity to submit my views. Sincerely,

WILLIAM L. GUY, Governor,

Olympia, Wash., April 1967.
Chairman, Interstate and Foreign Commerce Committee,
House of Representatives, Washington, D.O.:

As Governor of the State of Washington I want to convey to you my wholehearted support of H.R. 6431 entitled the "Mental Health Amendments of 1967." I have observed closely the salutary effects of the original federal laws providing financial support for the construction and staffing of community mental health centers. I think it is fair to say that the concepts embodied in those laws, and the opportunities they have made possible, have stimulated degrees of interest, enthusiasm and support at all levels which would have been long delayed, if forthcoming at all, in the absence of a national posture and national leadership.

While our state and its several communities have moved a great deal, it would be unfortunate, indeed disastrous, if federal support were to be withdrawn at this time. Community mental health programs are quite costly. As a result they require the assurance of substantial amounts of public funds from state and local sources to supplement those from the federal government. Because ours is a biennial legislature, only now have we reached the point where these monies might be made available. With combined federal, state and local funding, I expect to see considerable progress in the years just ahead. To the extent that any part of this funding is diminished, we may expect a set back in our programs. We are not yet ready to carry the entire program alone.

DANIEL J. EVANS, Governor.


Montpelier, Vt., March 31, 1967.
Chairman, Interstate and Foreign Commerce Committee,
House of Representatives, Washington, D.O.

DEAR MR. STAGGERS: I understand that your committee will hear testimony on April 4th and 5th on H.R. 6431, a proposal to extend authorization for construction and staffing of community mental health centers. I urge you and the members of your committee to support the utilization of this beneficial program.

The Mental Retardation Facilities and Community Mental Health Centers Act of 1963 has had direct and indirect effects on many facets of mental health programs in Vermont. It has stimulated program development which would otherwise have been difficult if not impossible.

The northeastern part of our state, a sparsely populated and economically undeveloped area, has been the recipient of both construction and staffing grants to develop a comprehensive community mental health program, the scope of which would have been unimaginable and unrealizable without the provisions and funds available through this federal legislation. This has been brought about by citizen interest within the area and by the stimulation of professional imagination which the act has made possible.

Under the terms of Public Law 88-164 the Bennington area has received a grant for construction of additional facilities to their existing clinic building which is presently being strained beyond its capacities. These funds will not only enable an expansion but will strengthen the program and bring it even more closely into the orbit of comprehensive mental health services to meet the needs of the people in this area.

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