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SPECIFIC doMESTIC PROGRAMs
[In percent) Expand Keep Cutback | Not sure as is Expand: Program to curb air pollution------------------------------ 50 31 9 10 Program to curb water pollution----- ---- 50 35 5 10 Aid to set up mental health clinics-------------- ---- 47 39 5 9. Federal scholarships for needy college students.-- ---- 47 38 9 6 Federal aid to education------------------------ ---- 45 42 10 3 Medicare for the aged.--------------------- ---- 35 51 8 6 Keep as is: Federal housing for low-income families-- ---- 25 48 19 8 The Headstart program------------------ ---- 23 33 21 23 Federal aid in highway building--- ---- 22 51 19 8 The war on poverty---------------------------------------- 23 37 31 9 Cut back: Aid for welfare and relief payments - 16 46 31 7 Aid to cities--------------------------------- - 15 43 26 16 Aid to provide for adequate commuter trains - 14 24 29 33 The space program----------------------- - 13 38 42 7 Subsidy payments for farmers------------------------------ 12 34 37 17
Mr. BRANDT. To allow the comprehensive community mental health grants program to die out with the existing authorization would be to deny its benefits, in many cases, to those communities which need it most, those where it takes the longest to get started and where they have the farthest to go.
In one sense, it would reward those places which were already so far along that they could take advantage of the Federal funds with but a little extra effort, and would penalize those which need help the most.
We strongly favor, as we have previously testified, this system which places on the local citizens the burden of initiating the program and, once the Federal support has been phased out, the ultimate responsibility for keeping it going. The grassroots approach always takes longer. But the results are worth it.
The National Association for Mental Health urges this committee to favorably report H.R. 6431.
(Mr. Brandt’s prepared statement follows:)
I am Sandford F. Brandt, and I reside in Norris, Tenn. I am appearing today in behalf of the National Association for Mental Health. I serve on the legislative and public policy council of NAMH, and I am also first vice president and legislative chairman of the Tennessee Mental Health Association. In the past, I have served as board member and finance chairman of a community health center. I greatly appreciate the opportunity of presenting our views before this Subcommittee.
The National Association for Mental Health is a volunteer, non-profit organization with one million members and associated volunteers in 800 chapters throughout the United States. We speak for the more than one and a half million patients in mental hospitals, and for the uncounted other millions being treated as outpatients.
Mr. Chairman, it is our hope that by appearing here today we can, in some measure, alleviate the misery and suffering of the 1 in 10 of us who at one time or another in our lives fall prey to mental illness. I do not have to describe to this Committee the magnitude of the mental health problem in this country.
I would, however, like to submit for the record this fact sheet prepared by the National Association for Mental Health which more fully describes the problem. The record shows the need for comprehensive mental health services, and I think the fact that the need has been translated into demand for services speaks to the effectiveness of the program which the Congresss inaugurated in 1963, and which you are now considering for extension. The great demand for funds under this program continues. We anticipate that funds presently available will fall far short of the amounts ultimately required. 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 may 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 three years ending June 30, 1969. 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 that the State of Indiana has programmed $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. It should perhaps be made plain at this point that when we speak of 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 construction 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. 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. 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. The council said the 50-cent limit is no longer adequate and a substantial boost is needed to encourage the continued growth of community mental health programs. 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 an increase in the state aid formula would “assist those communities who have reached the maximum and it would give an added incentive to the communities who have not.”
Stressing that the mental health clinics not only provide direct services but also have an important preventive function, the report said: “The availability of these services often prevents hospitalization of people needing assistance in the early phase of a mental or emotional problem. Such outpatient services are also valuable to patients discharged from hospitals to prevent re-hospitalization.” Six community mental health centers have been established in Rhode Island. Two of them, in Newport and Washington counties, provides services on a countywide basis. A third serves both Woonsocket and Burrillville. Clinics also are in operation in Warwick, East Providence and Pawtucket. Barrington purchases services for children with mental and emotional problems. Providence and Cranston have established mental health boards but have yet to set up clinics. The report said that nearly $9 million was spent by state agencies in the past fiscal year for mental health services and that Blue Cross and Physicians Service paid out more than $1 million for the care and treatment of subscribers with mental and emotional problems. “There is little question,” the council said, “that the demand to increase existing services or implement new ones will increase mental health expenditures. This fact cannot be avoided.” 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 sub-divided 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. “In addition, state legislation has been proposed which would permit state funds to be used as matching funds against Federal construction funds, up to 30%. If enacted this law would go into effect this summer.” 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. The pattern of local financing varies from state to state. 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 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. 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. It has taken them more than two 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’ve got to get them out of your state legislature, your city council, your united fund, or wherever, takes 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. To allow the comprehensive community mental health grants program to die out with the existing authorization would be to deny its benefits, in many cases, to those communities which need it most, those where it takes the longest to get started and where they have the farthest to go. In one sense, it would reward those places which were already so far along that they could take advantage of the Federal funds with but a little extra effort, and would penalize those which need the help the most. We strongly favor, as we have previously testified, this system which places on the local citizens the burden of initiating the program, and, once the Federal support has been phased out, the ultimate responsibility for keeping it going. The grass roots approach always takes longer. But the results are worth it. We urge you not to penalize those communities which for one reason or anOther are just now beginning—or have yet to begin—to get this program moving. The National Association for Mental Health urges this committee to favorably report HR 6431. Thank you.
Mr. JARMAN. Mr. Brandt, in line with your testimony and your reference to the responsibility of local citizens, do you feel that somewhere down the line we can actually count on phasing out of Federal support and carrying this financial load by the States? Mr. BRANDT. Mr. Chairman, I think so. The evidence that I have seen personally is that the more the program goes, the more the local people get behind it. If I may cite my own State, since I am familiar with it, Dr. Winston pointed out this morning that the budget for his department in Tennessee for the coming biennum has increased more this year than any other time in the history of his department. My personal observation is once you get started the people won't let it drop. My own family physician said he doesn't know how he got along without our mental health center before we had one.
Mr. JARMAN. You mentioned in your statement Illinois has been divided or subdivided into 75 planning units each of which could reasonably be expected to maintain a community mental health center. Mr. BRANDT. That is under their State plan. Mr. JARMAN. That will be a real and continuing opol.) for the communities and for States and I want to get your opinion? Mr. BRANDT. I certainly think you can count on them. tit started and they will follow through. Mr. JARMAN. Mr. Nelsen. Mr. NELSEN. No questions. Thank you for your statement. Mr. JARMAN. Well, we thank you, and we appreciate your being with us very much. Mr. BRANDT. Thank you. Mr. JARMAN. Our next witness and our final witness in this hearing is Dr. Arthur Brayfield of the American Psychological Association. I would like to say, Doctor, two bells indicate a rollcall on the floor of the House and when they ring again we will be under pressure to go over and vote, but I did want to recognize you. I understood you felt you could abbreviate your statement?
STATEMENT OF DR. ARTHUR BRAYFIELD, EXECUTIVE OFFICER, AMERICAN PSYCHOLOGICAL ASSOCIATION; ACCOMPANIED BY JOHN J. McMILLAN, ADMINISTRATIVE OFFICER FOR PROFESSIONAL AFFAIRS
Mr. BRAYFIELD. Yes, Mr. Chairman, I had been informed you probably would be needed very shortly before the House and I will try to move right along. Mr. Chairman, I am Dr. Arthur H. Brayfield. I am executive officer of the American Psychological Association, the national organization of psychologists with 26,000 members, which has its headquarters at 1200 17th Street, NW., Washington, D.C. I am accompanied by Dr. John J. McMillan, administrative officer for professional affairs. I welcome the opportunity to testify before this subcommittee today in support of }}''. 6431. Psychology and psychologists are deeply involved in mental health services and programs. As a behavioral science discipline, phychology provides the fundamental basis for the work of all mental health professionals—psychiatrists, social workers, and nurses, as well as psychologists. As a behavorial science profession, psychology contributes a significant share of the manpower available to the field of mental health Based on data from the National Register of Scientific and Professional Personnel and from NIMH studies, we estimate that in 1964 approximately 8,000 psychologists provided some 13 million man-hours per year of direct clinical services, primarily the diagnosis and treatment of mental disorders, and another 7,500 psychologists spent another 13 million man-hours per year of psychological effort, primarily of and research, related to mental health. This total of 26 million man-hours compares, for example, to an estimated 27 million man-hours per year contributed by psychiatrists.