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It should be recognized throughout the country that there are many applications in various stages of preparation. The withdrawal of federal support at this time would make it virtually impossible to reestablish such favorable climate and interest in providing services for the mentally ill.
2. The substance and spirit of PL 88–164 strongly indicates that a continuing program was contemplated. For example, there is the insistance that the state plan "shall provide for adequate community mental health centers for people residing in the state” and shall "set forth a program for the construction of community mental health centers (A) which is based on a state-wide inventory of existing facilities and survey of needs."
3. It should be evident that the non-renewal of the Centers program would be discriminatory for those regions or communities in which approved applications for community mental health centers have not been completed. Often such a delay is due to the shortage of mental health professional manpower which frequently occurs in communities where there are the greatest needs for "Centers." In effect, only certain communities would enjoy federal support for their mental health programs, whereas other areas of need would be denied.
4. An example of what would occur in the event of failure to renew the "Centers” program can be envisioned in Oklahoma In Oklahoma, three approved or current applications for Community Mental Health Centers Construction will absorb most of the federal funds made available to the state under PL 88–164. However, these three centers will serve less than 14 of the state's population. But this excellent beginning has stimulated other communities who are now exploring ways and means of making application for community mental health centers. A denial of the "Centers" program at this time would not only eliminate planning, but also any future efforts to establish community psychiatry.
In summary, the state directors of mental health programs who are in daily and intimate contact with the mental health problems of the country strongly urge pasage of the Mental Health Amendments of 1967. Failure to enact this legislation will impede a decade of progress in establishing improved and modern mental health care.
Mr. JARMAN. Doctor, I think it would be well if you go ahead with your part of the presentation and then perhaps there will be some questions.
Dr. DONOHUE. This is a community mental health center. These are the essential services that are offered. As you may know, a community mental health center includes outpatient, inpatient, partial hospitalization emergencies, consultation and education services. These are the required. These are the ones that are recommended and in addition, diagnostic precare and aftercare, rehabilitative, research evaluation, and training.
These are the services that we have in the center which we will show you that we have now in actual operation. We began operation a month ago. We have both a staffing and construction grant and at this time I want to show the reason for the need for this.
Somebody asked a while ago about the number of patients. This yellow line shows the admission rate into the central State hospital in Norman, Okla., which serves a million population in density. 24 counties in central Oklahoma, but reflects what happens not only in Oklahoma but in most other States.
In 1953 and 1954 as Congressman Jarman is well aware, we were admitting about 1,000 patients. We were kind of in the snakepit area in 6 or so years after Mike Gorman but we started coming up and as you can see this is the way it is all over. Our number of patients in the hospitals is dropping down but this has only decreased the overcrowded and other things because if we had not decreased the census look at that admission rate which is now going up.
We started with 1,000 admissions a year and are now over 4,000. Personnelwise, in order to take care of these custodial patients we were using 880 some employees on a 48-hour workweek and now we have a 17-percent increase but they are professional people who came in to do this job.
Incidentally, we are estimating that the center now that we are operating is going to serve one section of this area which has 256,000 people in it. We estimate that out of that 256,000 that we will admit the same as we admitted out of this million. Why? Because we are there where these people can come and get this treatment and get it when they need it immediately.
The don't have to drive 40 or 50 or 100 miles. This is a cross-section of the proposed new mental health center. The plans are up here now and I was talking to the National Institute of Mental Health yesterday and we are ready to break dirt. This shows the whole new philosophy, not the old type mental hospital building.
This has all the latest things. This is, of course, showing the new type. These cupolas, for instance, are towers so that the patients know immediately where they are located in relation to these buildings.
If you notice, they are built in pairs and we will show you why.
This is the in-patient division. Notice that instead of having the great mammoth wards that you have in the mental hospitals throughout the country these are based on 16-patient units.
There are two patients to a room with a bath instead of having 40 or 50 sharing one bath if you were that lucky. When I went into Oklahoma we had 100 and maybe more to one bathroom. This has the facilities for emergency care and treatment. It has the lounge in here if you will notice.
There are no great massive areas. Incidentally, working with the National Institute of Mental Health, this is a 6-foot corridor instead of 8, which saved millions of dollars for the Government and us because we were able to design these things differently.
This has wall-to-wall carpeting to keep the sound levels down, and give you a softness in relation to your patients. It has a fireplace. It doesn't cost much more but it gives you a warmth and feeling for these people.
This is the new idea, a little privacy in their own little section for every 16 patients and a visiting room. In the old days in the mental hospitals the last thing they wanted was visiting.
Now here it is very important because we are doing family therapy. We are treating the whole family. So we want the visitors in.
We have 24-hour-a-day services in the offices. In the old days of mental hospitals there were no offices. This is the gymnasium
in which we can do psychodrama. These are music listening areas. This can be used as an auditorium but it is actually a gymnasium. You move the chairs and you have a gymnasium.
Here is the lounge where people can go. There is a fireplace here again. This is, as you can see, a place where patients can rest as in a lounge in a hospital. It has a warmth, and incidentally, there are no shadows in here. This is all top lighted with skylights and fluorescent lighting so that there are no shadows to frighten the patient.
This is what is called a day hospital. This big room here is for patient government. Incidentally, in order to economize and make the maximum use of these things, as you say, that gymnasium could be made into an auditorium.
This is the patient government room and here you pull this down and you have two group-therapy rooms. Each doctor and social worker has an office. The occupational therapists—all these people provide treatment and therefore must have facilities to provide it.
This is the occupational therapy area which we use in the day hospital as an ongoing therapy during the daytime. These patients come in at 9:30 in the morning and go home at about 4:30 in the afternoon. We don't keep them at night. They are back with their families where they belong in the evening and this helps us with the therapy.
In here is the kitchen. Here is the hairdressing facility for these patients because if they are here all day the girls can't get their hair fixed so we have facilities for it and also this is good therapy in the case of women.
Here is the out-patient area. These are the wonderful new things that we have. These are all treatment rooms, treatment for the patient.
Here is the group therapy room using group therapy so we can treat eight patients where we used to treat one. Not only are the doctors doing group therapy but under the supervision of our doctors and psychiatrists the OT's are doing it.
In the Army during the war we developed the mental health worker. Here are our two mental health workers and we are trying to work out a situation where they can go out on calls—actually house-tohouse calls in case of emergency like suicides and things—so that we get right on the situation immediately.
Notice here that we have gotten away from any long corridors getting away from this look of a hospital when the outpatient comes in here and knows that there are people in this area.
The banks have done this. They have come out from behind their grills and we ought to. This has television caremas with videotapes so that we can train people. This hospital is built jointly in connection with the Central State Hospital at Norman which is affiliated with the University of Oklahoma School of Medicine.
I met with 15 of the professors from the University of Oklahoma because we are going to work with the different types of people; the gerontologist and so forth, and they can come out of their ivory towers.
We took 40 of the honor students at the University of Oklahoma. Twenty of them stayed to the second year. Eight of them changed their courses and are going into the behavioral sciences.
They work together directly with patients.
Here is aftercare. This group doesn't go out and diagnose or work with an individual patient. They work with the judges and school systems and things like that so that this is a whole new day, a whole new area.
When I was in Arkansas in 1948, we had a clean up of their state hospital system and revised it and when I was in Texas in 1950 we were crying for this type of thing to be put in somewhere into the community, between the community and the hospital.
This building will start immediately. Its plans have been approved, as I said. It is a whole new area,
This last one shows the arrangement of these. This is the outpatient and the after-care. This is the day hospital here. That is occupational therapy.
Here is the recreational therapy, the lounge, and this is the emergency and in-patient service.
These things, as I said, were colored because they show the patient where he is. This is an ampitheatre. It is warm in Oklahoma a lot of the year so that we can have band concerts. This is a band shell in there. This is a whole new philosophy.
Incidentally, this is built about a half mile away on some ground that the hospital owns in proximity to the University of Oklahoma and to our hospital, the idea being that we can train people in this technique.
So these are our plans and what we are going to do. On the back you can see the actual picture.
What have we done? Let me give you an example of the first month's operation. Normally, we would admit into our hospital from this district about 84 people. In the first month we have already admitted 123. Of these, 55 of them have gone into our out-patient division.
We have 28 out of the hospital and we have 23 remaining but these were ones that cumulated. We estimate that only about 10 percent of these that will come in will go into the state hospital.
Speaking about personnel as we were asked: Within the first month I have been able to put together a staff of 50 composed of two psychiatrists, two residents in psychiatry, young psychiatrists in training, one psychologist and we now have another one since I left.
We have 6 social workers, 3 registered nurses, 1 vocational counsellor, 2 occupational therapists, 3 recreational therapists, and 21 psychiatric aides.
In addition to this we have a training person and the other administrative people like personnel clerks and others needed for backup services.
So that we now have within one month 51 people working. The question was asked what would it take to staff one of these. We propose to handle the 4,000 admissions that we estimate will come in here and probably will be nearer Dr. Ewalt's 6,000 eventually.
We estimate that that would take 8 psychiatrists, 6 residents in psychiatry, 4 psychologists, 2 psychological interns, 11 social workers and we are affiliated with the University of Oklahoma so that we would have about 10 student social workers, 16 registered nurses, and we are a training center for nurses so that we would have about 10 student nurses there, too.
We would have 2 vocational counsellors, 3 occupational therapists, 3 recreational therapists, 32 psychiatric aides, and in addition to that we would have the usual supportive services in administration.
We would actually have 146 people working, 87 professional and technical and 146 gross as against the 51 we now have.
The question was asked a while ago, what the States and the communities are doing. We presented the legislature our budget. Predominantly because this is going to be Oklahoma's teaching center and we hope here to train the cadres that will go out and supply the
professional personnel because the lay people are fine but this is a serious illness and somebody has to supervise them to make sure we are not going off on the wrong thing.
The budget presented was that the Federal Government the first year on the 75 percent match would give us $32,790 but the State would have to put up $678,974. Under our grant, we get $382,000 the next two, $92,000 the next, and $202,000 the next, and down to $14,000.
As that goes down the community and State share will have to go up. So these are the things that I thought you might be interested in. This is a going concern. I have been commissioner or assistant commissioner as the chairman is well aware in three States, in Arkansas, Texas, and Oklahoma.
Since 1948, I have been trying to see whether we couldn't get this thing going. Now that we have gotten it going, I think that it would be catastrophic to decrease in any way. In fact, I think it must be accelerated upward in order to meet the needs of these people.
Mr. Chairman, in Oklahoma we have them backed up now. We have done the foot work. We have gone out now and convinced people that this is the answer and people believe us and I am sure it is.
Now we can't say, "No, you can only have them over here and not over there. You can have one at Norman, Oklahoma. We will cover the lower third of Oklahoma County, Cleveland and McClain, but you can't have one in Osage County," and, incidentally, on that one we hope to take in a county in Kansas.
So you can't stop now. We are in it too far.
Mr. JARMAN. Thank you gentlemen for an excellent presentation.
Doctor Donohue what did you indicate as the target date for completion of your center?
Dr. DONOHUE. We are estimating 11 months for construction. Approximately a year from now we will have the opening. We didn't wait on this. We went ahead and took some of our State hospital area, dedicated it to this and broke it away from the State hospital and set up in business.
We could have done it downtown, but we had the buildings and the facilities and everything right there so that we just started there.
Mr. JARMAN. Do I understand that with the progress you have already made on the staffing problem that you anticipate no real difficulty in fully staffing ?
Dr. DONOHUE. It is not going to be a real gung ho thing. It is going to take a little time but we will do it. We are out 1 month and we are this far along. I don't see that it is going to be an extremely difficult thing.
We are having some difficulty getting residents in training because this calls for six residents in training even though we are getting more residents to go into training in psychiatry in this country they are just hard to come by but other than that I don't look for grave problems.
People are interested in going into these, Mr. Chairman.
Mr. JARMAN. As I understood your testimony, you now have nearly one-third of your staff selected?