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State in preventive measures and has encouraged mental health workers to make better use of facilities already present in the community. With extension of this bill Kansas can look forward to additional comprehensive mental health services in at least four or five communities.
TALLAHASSEE, FLA., April 6, 1967. Hox. HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, Rayburn Office Building, House of Representatives, Washington, D.C.
The future of mental health treatment programs in Florida is contained in House bill 6431 which your committee conducted hearings on April 4, 1967. We have many porgrams awaiting additional Federal funds in this area and it would be a serious setback to Florida's mental health program if bill was not reported favorably and passed by the House of Representatives. I urge you to steer the measure to a successful conclusion, Sincerely,
CLAUDE R. KIRK, JR.,
Governor of Florida.
COLUMBIA, S.C., April 4, 1967. CONGRESSMAN HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.
South Carolina now has a number of comprehensive community health centers in the initial planning stage, therefore urges extension of the authorization for construction and staffing these centers as proposed in H.R. 6431.
ROBERT E. McNAIR,
LITTLE ROCK, ARK., Jarch 3, 1967. CONGRESSMAN HARLEY STAGGERS, C'hairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.
Hope you and your committee can see fit to continue community mental health center program for next five years.
GEORGE W. JACKSON, M.D.,
COLUMBUS, OHIO, April 13, 1967. BUREAU OF PLANNING AND GRANTS Attn: Dr. Wayne Chesso
On behalf of Governor James A. Rhodes I want to convey Ohio's support of H.R. 6431. Federal aid to construct and staff mental health centers vital incentive to communities to improve services for mentally ill. Detailed letter of Ohio position to follow.
MARTIN A. JANIS, Director, Ohio Dept. of Mental Hygiene and Correction.
ALBANY, N.Y., April 6, 1969. The Honorable HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign commerce, House of Repre
sentatives, Washington, D.C. P.L. 88–164 and P.L. 89–105 have led to greatly accelerated growth of community mental health and mental retardation services in New York State. A relatively small amount of Federal money ($15 M.) has led to applications for facilities with a total value of $55 million. Moreover these acts and the guidelines and regulations developed therefrom have directly assisted New York State in implementing the kind of broad range programs with continuity and responsibility which will provide definitive services for the mentally ill and retarded in the communities where they reside. The construction now planned will provide for only 16 mental health centers of a total of 112 needed according to State plan. Even a greater disparity exists in the field of retardation centers and the public has become keenly aware of the unmet needs. We have letters of intent for 21 additional mental health centers and 6 mental retardation facilities at a total cost of $76 M. Unless this legislation is extended as proposed in H.R. 6431 we fear loss of momentum in this great program.
ALAN D. MILLER, M.D.,
Commissioner, New York State Dept. of Mental Hygiene.
CHATTAHOOCHEE, FLA., April 6, 1967. Hon. HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.
The Florida Division of Mental Health is extremely interested in the prosposal to extend the present program of construction and staffing of community mental health centers, H.R. 6431. Under the present program Florida has made excellent progress by having nine projects approved for construction of community mental health centers. There are a number of other projects pending approval that will qualify should this program be extended. The staffing provision of the program is extremely important to these community mental health centers which will allow them to develop their program on a more comprehensive basis at a more rapid rate. Considerable State funds are presently involved in the staffing of the existing mental health clinics which will include future clinics under this program. Favorable consideration of H.R. 6431 by your committee will be appreciated.
W. D. ROGERS, M.D.,
Director, Division of Mental Health.
OLYMPIA, WASH., March 3, 1967. The Honorable HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.:
I would like to express my very strong support of H.R. 6431 (Mental Health Amendments of 1967). I believe this bill to be vital to the continued development of community mental health services in the State of Washington. At the present time enthusiasm is high among those responsible for planning at the community level. Within the past two years these individuals have invested enormous amounts of time and energy in the task of laying a foundation for local mental health programs. The withdrawal of Federal funds at this time would constitute a serious blow to this concern and morale which, as you well know, has been so long in coming.
Here in Washington there are several communities which are, quite literally, on the brink of submitting applications for Federal construction or staffing
monies. For example, the St. Luke's Hospital in Spokane wishes to include a psychiatric in-patient unit in its new construction program; the community mental health service of South King County has sent us a preliminary draft of a mental health center staffing grant; and there are many others. Our citizens have responded well to the challenges posed by the original Federal legislation. They gained acceptance for community based services in a State where the care of the mentally ill traditionally has been a State responsibility; they have developed reasonable and feasible plans even in the face of severe manpower shortages; they have, through the legislature, begun to make increasing amounts of public funds available to pay for local mental health services. This latter is all the more remarkable when one realizes that up until now Washington has invested only about 7 cents per capita per year in community mental health programs.
If Federal support is curtailed at this time, much of this effort will have been for nothing. Again, therefore, let me convey my support of H.R. 6431.
WILLIAM R. CONTE, M.D.,
Department of Institutions.
PHOENIX, ARIZ., April 4, 1967. Hon. HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.:
It is of utmost importance the community mental health centers program be extended, particularly as it will be the less affluent portions of the State_those most in need of helpwho will now be attempting to develop services.
Community acceptance of this program as evidenced by the rapid development of centers, plus the continuing need makes it most urgent that H.R. 6431 be supported and passed. We strongly request your support of this measure.
RAY LEWIS, M.D.,
Director, Division of Mental Health.
HARRISBURG, PENN., March 31, 1967. Hon. HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.:
I strongly support H.R. 6431, which extends the grant programs for construction and initial staffing of community mental health centers. I urge also increased funds for the construction program, since Pennsylvania program is hampered by low allocation. Strongly recommend that staffing grants be made through the States instead of directly to the community.
MAX ROSENN, Secretary of Public Welfare, Commonwealth of Pennsylvania.
FRANKFORT, KY., April 3, 1967. Congressman HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.O.
I am taking the liberty of forwarding to you the position advocated by the Kentucky Department of Mental Health with respect to the extension of the community mental health center program. I sincerely urge and hope that you
Governor Ellington was invited to be with us this morning and could not because the legislature was in session but he has asked me to express his regrets, and let me say as commissioner of mental health that he has given overwhelming support for our program and has given us the highest increase in our budget, hopefully which will be approved at any time, in the history of our department.
What I have done in my statement is to briefly outline the three revolutions that I have seen occurring in psychiatry, the first being the advent of Dr. Freud, the second revolution which is the tranquilizer in 1954, and third the comprehensive mental health center and I really see this as the most significant of all and I would like to confine my verbal testimony to my experience as the superintendent of Moccasin Bend Hospital, a small State hospital which opened 2 years prior to the comprehensive centers but which was run similar to the centers and just briefly outline our experience there because I think it is relative to the staffing questions which have been asked.
Mr. JARMAN. I think it would be appropriate to say that the Chair has announced that we will try to finish the hearing by 12 o'clock. Apparently we cannot do so. So, our intent is, in fairness to the witnesses who have come to the hearing, some from outside the Washington area, to ask for permission to sit this afternoon at 2 o'clock to conclude the hearing if we don't finish this morning.
Dr. WINSTON. Moccasin Bend Hospital, as I say, opened in 1961 actually. The results that we had there with this type of program similar to the comprehensive center we feel are almost miraculous. We cut the average first stay from 6 months to 5 weeks in the first year of operation
. We started new programs that were not capable of being started previously because of the small comprehensive concept that we envisioned and that is now in operation elsewhere, too.
We did this, I might add, with only one other psychiatrist serving an area of some 600,000 people. Let me make the remark that we rely heavily-in fact, solely, I should say—on the aid staff and the use of tranquilizers and not one patient there received the sort of treatment that I as a psychiatrist was trained to give; that is, the 1-to-1 psychotherapy relationship.
Yet we got these patients out, we kept them out and they are continuing to give what I think is a real testimony to the value of how these comprehensive centers can work without necessarily the staffing pattern that we have been accustomed to in the past and would like to have but cannot apparently have in light of short staff.
Let me read my concluding paragraph.
The impact of the comprehensive community mental health centers making treatment available to any aggregate population of 75,000 or more is indeed staggering.
It is my firm, sincere judgment that the farsighted thinking on the part of the National Institute of Mental Health in instituting this program will be by far and away the most significant of all of the three revolutions.
Although it will in no way eliminate mental illness any more than general hospitals eliminate physical illness, it will alleviate much of the suffering, the agony, and the despondency to which only those who have had mental illness can testify.
AUSTIN, TEX., April 12, 1967. Congressman HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.:
The Texas Department of Mental Health and Mental Retardation of the State of Texas is vitally interested in passage of H.R. 6431 which would extend for five years authorization for construction and staffing of community mental health centers. Texas has recently undertaken a comprehensive community mental health centers program and the financial assistance afforded by this measure would be of inestimable value.
JOHN KINROSS-WRIGHT, M.D.,
BATON ROUGE, LA., March 31, 1967. Congressman HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.:
I heartily endorse the bill, H.R. 6431, extending for five years the existing programs for construction and staffing of community mental health centers. Louisiana has 14 projects scheduled for construction, however, Federal funds will only permit 7 centers to be built. In addition the 1967 Louisiana State plan recommends the construction of 15 new centers and additions to 6 existing centers.
WILLIAM P. ADDISON, M.D., Louisiana Commissioner of Mental Health.
COLUMBIA, S.C., April 3, 1967. Congressman HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.C.
Extension of the Community Mental Health Center programs, as proposed in H.R. 6431 and S. 1132, would be most welcome in South Carolina. This State's comprehensive mental health plan leans heavily on the community center concept. Three applications for construction grants have been approved and two others are being processed, along with one staffing grant application from a sixth area which will submit a construction application later. It appears that virtually all, if not all, of this State's construction grant allocations will be used. All matching funds are being supplied by local communities, giving evidence of grassroots support.
Five other area mental health boards have expressed interest in expanding clinics into comprehensive centers but cannot meet current program deadlines. Two other clinics just getting underway would be prospects for centers later, as would one other area not now having a clinic.
If the program is terminated as scheduled, less than half of the need will have been met in South Carolina and the neediest areas, by and large, will be the ones left untouched.
Extension of the staffing grants is most important. The original deadlines for staffing applications were too close to the construction grant deadlines, so that many centers being constructed under current authorizations will not be completed in time to obtain a staffing grant. If construction grant legislation is ex tended, the need to extend the staffing grants will be even more imperative since many communities will not project centers without initial staffing aid.
WILLIAM S. HALL, M.D.,
South Carolina Commissioner of Mental Health. Dr. GLASS. Our first witness will be Dr. Winston.
Dr. WINSTON. I am Dr. Winston and I will briefly go over my written statement.