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NAMH knows that hundreds of communities are now planning new community mental health centers in contemplation of Federal support being available for their construction and/or staffing.

In my own State of Tennessee, Governor Ellington has asked the legislature to appropriate an additional $700,000 during the coming biennium to enable the Tennessee Department of Mental Health to help finance the operation of six comprehensive centers.

This amount is in addition to the State's contribution to existing community mental health clinics and also is over and above local funds which, in Tennessee, constitute more than half the operating funds of the community clinics. The total Tennessee budget for State financial assistance to local clinics-just operations; not construction-will more than double during the 3 years ending June 30, 1969.

We have in Tennessee 17 community clinics, and eight of them are planning on going comprehensives, three have already been approved for construction grants, three are in the pipeline, and two in the planning stage.

In Indiana, to cite another example, to date only one comprehensive center has qualified for construction funds under the Federal program. Eleven more centers are in the planning stage. We are informed by the Indiana Mental Health Association, a Division of the National Association, that the State of Indiana has programed $961,000 for comprehensive center construction this year, $1,370,000 in 1968, and another million in 1969—all with the anticipation that equal amounts of Federal matching funds will be available.

We also had a leter from the director of the Indiana Association the other day pointing out that the Indiana General Assembly in order to guarantee the implementation of the Federal program has just created a permanent dedicated source of funds to assist the communities in matching the Federal grants. This is a quarter of a cent of cigarette tax which will produce $3.37 million in the current biennium increasing to half a cent in the biennium in 1969 producing in the order of $6.7 million. That tax will be dedicated to community centers.

It should perhaps be made plain at this point that when we speak of a comprehensive community mental health center we do not necessarily mean a completely new building, built solely for the purpose of housing the essential services.

A most important feature of this program is its flexibility. The "center” concept does not require the housing of all the elements of service under one roof. On the contrary, so long as they are under a single administration, the various components may be separately housed.

We are informed that in only 5 percent of the centers for which construtcion grants have been awarded have the applicants requested funds for a single building to house all the services. The other 95 percent are taking advantage of the opportunity to achieve comprehensive community mental health services by requesting Federal grants to supplement existing services which are separately housed.

If you will pardon again the reference to my home State, the two centers I know most about are Oak Ridge and Knoxville. The Knoxville comprehensive center is being built on land adjoining the University of Tennessee Hospital in Knoxville. The land was con

tributed by the university. The Oak Ridge Center is on land adjoining the Medical Arts Building and the hospital operated by the Methodist Church.

Mr. JARMAN. You plan six such centers?

Mr. BRANDT. We have three for which construction grants have been approved and three for which we hope to get the grants and two which are in the planning stage.

Mr. JARMAN. Eight?

Mr. BRANDT. Eight altogether, yes. The present State budget is contemplating only six, so somebody is going to have to scrounge around for more money:

We have 17 local clinics and of those 17 eight of them are going comprehensive.

Mr. Chairman, our State and local governments are earnestly and conscientiously trying to do their part. Some are well along and others are just now beginning to set up the ways and means for accomplishing this program. This is understandable when one considers the wide diversity among the States in population spread, finances, geography, and level of development of mental health services. The following examples will illustrate these points.

In Rhode Island a recommendation that the per capita ceiling on State aid for community mental health clinics be raised from 50 cents to $1.50 was made by the Governor's Council on Mental Health in its annual report to the Governor and State legislature.

A Rhode Island law enacted in 1962 places two limits on State aid for these programs. State grants cannot exceed 50 percent of total expenditures for allowed items and they cannot exceed a per capita of 50 cents in the population of the area served by a program.

Until recently, the council said,

The 50 cents per capita sharing limit has been considered adequate to encourage communities to equally share the cost in providing local mental health programs. While some communities have not taken full advantage of matching the State's 50 cents per capita, other communities have enthusiastically responded.

Overmatching by some local communities currently exists, in one community by as much as twice the amount received from the State.

The council said that the 50-cent limitation is no longer adequate and a substantial boost is needed to encourage the continued growth of the community health programs in Rhode Island.

The Illinois Association for Mental Health, a division of the National Association for Mental Health, informs us that Illinois has only just begun to avail itself of the Federal assistance which is crucial to the extension of mental health care throughout the State. Illinois has received only two construction grants and no staffing grants to date although, according to that State's plan for comprehensive mental health services, Illinois has been subdivided into 75 planning units each of which could reasonably be expected to maintain a community mental health center. We are informed by our Illinois division that:

Illinois is just beginning to “tool up' to take advantage of these Federal funds. It took some time to educate communities as to the availability of Federal assistance and the requirements for eligibility. We have passed permissive legislation in Illinois which allows local governmental units to levy a one mill tax for mental health purposes. Eight counties and one village have successfully passed

this referendum and all, no doubt, are contemplating requests for Federal assistance now that they have a base for a source for matching funds. Three other referenda are scheduled for the month of April.

The State of Colorado has developed in recent years a statewide mental health program of real promise. Their State plan for an extension of comprehensive mental health services to all regions of Colorado has been formally approved. To date, Federal grants to aid in the construction and staffing of community mental health centers have been made to such populous areas as Denver, Boulder, Adams, Arapahoe and Jefferson Counties.

The Colorado Association for Mental Health, our affiliate, wrote us recently as follows:

Our concern is for the less populous and less financially able regions of the State, where restrictions on the development of facilities imposed by scant budgets and problems of geography make it unlikely that plans for mental health centers can mature into reality without continued Federal assistance.

For example, the first of the new centers in terms of priority is planned to serve Western Slope citizens from a site in Grand Junction. Without matching Federal funding it is doubtful that State and local resources can build and staff that center. On the other hand, with Federal aid for construction and initial staffing specific components of the Western Slope center and for other similar centers, their operation can be financed jointly until the expanding economy and population of Colorado make it possible to fund their operation from State and local revenues.

The foregoing are examples of progress that has been made to date—and progress anticipated in the future—under this farsighted program. It is important, I think, to consider some of the factors that have had the opposite effect, factors which have held us back, factors which explain why many communities are just now getting underway even though the program has been in effect for several years.

To begin with, no community will be given a construction grant or a staffing grant until it has proved to the satisfaction of NIMH that it can and will find the matching funds. This, of course, is essential. In some States, the State mental health authority, is able to help. In others, the centers are sponsored by county or municipal governments. In still others, non-governmental sources of funding predominate.

In my own State, the mix of State, county, city, community chest, patient fee, and private subscription sources of non-Federal funds varies from community to community. The broader the funding base, the longer it takes to round up the funds.

I would like to give as an example the Oak Ridge (Tenn.) Comprehensive Center's funding plan. This is their application for construction grant and it is 100 pages long and has been approved.

During the second year of operation, they expect a total operating budget of $478,000 of which Federal funds will amount to $142,000, State funds are $148,000, and county and municipal are $40,000. The Center will serve a five-county area. Two county courts and the city of Oak Ridge have agreed to put up some money; there are three counties which probably will not be able to contribute much. United Funds are $71,500 and patient fees are $124,000. Oak Ridge is very fortunate in that they have a fairly affluent population to draw on for patient fees. Then there is a balance of $5,000, for a total budget in the second year of $478,000.

So my point is the money comes from a variety of places and it takes time to line it up. Think how long it would take to get the governing

bodies of five rural counties to agree to put up $10,000 each toward the construction of a center. Yet I know a group of dedicated volunteers who have done just that.

I just learned from Dr. Winston, our State mental health commissioner, this morning in this hearing that not only have they agreed to put up the $10,000 each but the entire $50,000 is in the bank and drawing interest waiting for the Federal money.

It has taken them more than 2 years. They are now working on their application. They can't possibly, get it approved by the June 30 deadline. My point is simply this: lining up local matching funds, whether you have got to get them out of your State legislature, your city council, your United Fund, or wherever, takes a long time.

Furthermore, there is just plain inertia to be overcome. It is one thing to promote a comprehensive center in a community that already has a mental health outpatient clinic or a State hospital or general hospital with a psychiatric wing and a core of mental health professionals in the area.

It is something else to go into virgin territory, such as in parts of Appalachia, where the closest contact they have with a mental health program of any kind is a remote State hospital, known to the community only by its outdated but prevailing popular reputation as a place where they lock up crazy people and you never see them again. It is one thing to sell

a comprehensive center in a community with a live-wire mental health chapter, with informed and dedicated volunteers who can and will take the time to do the spadework. It is something else to stir the people up where there is not even a local chapter of the mental health association.

Popular acceptance of local responsibility for ministering to the mentally ill takes a long, hard, persistent educational program.

The National Association for Mental Health knows, however, from its affiliated associations that more and more the people of this country want and are willing to support this program.

Now, a witness who preceded me this morning cited the Harris Poll taken just the other day, 2 days ago, in which 47 percent of the people asked by the poll favored expanding Federal aid to set up mental health clinics.

Mr. Chairman, may I insert this newspaper article in the record on the Harris Poll?

Mr. JARMAN. Yes.
Mr. BRANDT. Thank you.
(The information referred to follows:)

[From the New York Post, Apr. 3, 1967]

HARRIS ON THE GREAT SOCIETY: MOST STILL WANT PLANS KEPT

(By Louis Harris) Public sentiment for cutting back President Johnson's Great Society programs has risen in the past year, but a majority of Americans still want to maintain or expand domestic programs despite the cost of waging war in Vietnam.

In-depth probing of the views of a carefully drawn cross-section of the adult population reveals a highly selective mood about which programs should be expanded, kept or cut back. The results reveal a new priority of domestic issues.

PUBLIC MANDATE ON DOMESTIC PROGRAMS
Expand

Program to curb air pollution
Program to curb water pollution
Aid to set up mental health clinics
Federal scholarships to needy college students
Federal aid to education

Medicare for the aged
Keep as is

Federal housing for low-income families
The Head-Start program
Federal aid in building highways

The war on poverty
Want cut back

Aid for welfare and relief payments
Aid to cities
Aid to provide for adequate commuter trains
The space program
Subsidy payments for farmers

The cutback list includes some new and some old sacred cows. The old New Deal standbys of aid for welfare and relief and subsidy payments to farmers have lost much of their luster. The new programs of aid to cities and commuter transportation simply do not yet command majority support. And the space program support appears to be fading.

In place of these areas the people lay heavy stress on resource and environment conservation (curbing air and water pollution), education (federal aid and an expanded college scholarship program) and health (more Medicare and mental health clinics).

In each of the six expansion areas the college-educated and higher-income people are far more in favor of expanding federal commitments than lower income, less-well-educated people.

A year ago and in the latest Harris Survey, cross-sections of the public were asked:

"In general, because of Vietnam, do you think President Johnson should or should not reduce the size of his programs at home, such as education, poverty and health?

GREAT SOCIETY PROGRAM AT HOME

[blocks in formation]

The cross-section of people in 1,600 homes was asked:

Besides providing for the military security of the country, the federal government conducts a number of programs in many different areas. For each, tell me if you think it should be expanded, kept as is or cut back.

In the following table, the key to the groupings of the areas is the relationship between the number wanting to expand or to cut back the program.

In analyzing this table the reader should keep in mind the direction of emphasis on the part of the public. In the case of air pollution there are over five times as many people who want to expand as want to cut back.

By the same token on the space program over three times as many people want to cut back spending on space as want to increase it. In contrast in the case of the Head Start program almost as many people want to cut it back as want to expand it, leaving the weight of opinion behind keeping the program as it is.

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