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cal Program. Generally, the VA has not been able to participate directly in such grants under existing laws. The Public Health Service has been making grants to Medical Schools or Universities affiliated with the Veterans Administration which in turn use the funds to support projects conducted by VA researchers who are also affiliated with the school or university. Enactment of this legislation would permit VA hospitals to deal directly with the Public Health Service rather than having to rely upon the indirect arrangements now followed.

It is apparent to the Veterans Administration that cooperative efforts with HEW in research and related programs are mutually beneficial to both. In addition to the obvious benefits resulting from coordination and more effective assignment of talent, the projects should receive greater recognition when supported by the prestige of both the VA and the Department of Health, Education, and Welfare. It seems entirely proper that the Veterans Administration's program in the area should be assisted by Public Health Service grants since our research and training activities make a large and continuing contribution toward meeting the health needs of the Nation.

The importance of this proposal is emphasized by the recent action of the Congress in enacting Public Law 89–785 directly concerning the medical program of the Veterans Administration. Among other provisions, that law (38 U.S.C. 5054) authorized the Administrator to enter into agreements with medical schools, hospitals, research centers, and professional medical personnel for the free exchange of medical information and techniques. It also authorized grants to medical schools, hospitals, and research centers to support pilot programs for effectuating the arrangement for the exchange of medical information (38 U.S.C. 5055). Finally, this new law specifically directed that the Administrator and the Secretary of Health, Education, and Welfare “shall, to the maximum extent practicable, coordinate programs carried out under this subchapter and programs carried out under title IX of the Public Health Service Act."

For the reasons stated, I strongly recommend favorable consideration of H. R. 6431 by your Committee.

We are advised by the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the Administration's program. Sincerely,

W. J. DRIVER, Administrator. Mr. JARMAN. We will start today's hearing with the statements of two of our colleagues, the Honorable Edward Patten, of New Jersey, and the Honorable Lee Hamilton, of Indiana. You may proceed as you wish, Mr. Patten.



Mr. PATTEN. Mr. Chairman, and members of the House Interstate and Foreign Commerce Committee, on February 5, 1963, John F. Kennedy became the first President to send a message on mental health to the Congress. He pointed out the challenge: that mental illness and retardation are “of critical size and impact.” We heeded that challenge and passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963—and improved it in 1965.

And in his message on education and health on February 28, of this year, President Johnson noted that "more community mental health centers are needed, and we must strengthen and expand existing services.” This is another challenge we must meet and defeat.

There have been notable achievements under this historic program:

As of February 1, 1967, 147 community mental health centers have received Federal grants of $54.3 million-$36.5 million in construction grants and $17.8 million in staffing awards.

In the State of New Jersey, Newark has received a Federal grant of $1,504,924 for a community mental health center.

Middlesex County, N.J., has applied for a Federal grant of $122,500 for the $350,000 Raritan Bay Community Mental Health Center in Perth Amboy. Other areas in the State have also applied and when I think of the valuable financial help this program will provide, it makes me particularly proud of the Congress that passed it.

For years it was obvious that community mental health centers should be provided, but it took the 88th Congress and its successor the great 89th—to convert hope to victory-and then, accomplishment.

Federal construction grants ranging from one-third to two-thirds are provided.

And Federal grants are provided for staffing the centers—as high as 75 percent for the first 12 months, to 30 percent for the fifth stage.

When I was mayor of Perth Amboy, county clerk of Middlesex, and New Jersey secretary of state, I was greatly moved—and always will be-to see so many persons suffering from mental illness and retardation and not be treated effectively, either because of insufficient facilities, or obsolete and ineffective methods.

One of the most important features of the community mental health center concept is that patients are treated close to their homes, thereby improving their morale and spirit, for as all of us know, love is the best "medicine" of all. In fact, I was informed that some persons who suffer from some forms of mental illness work during the day and are treated at night at some centers.

Yes, significant progress has been made in these fields, but more much more—must be made before we can honestly say that we have conquered mental illness and retardation.

So I strongly urge this committee to report the bill introduced by the able and respected chairman-the Honorable Harley O. StaggersH.R. 6431 and continue the attack against mental illness and retardation.

By approving this bill, public health laws relating to mental health would not only be extended (5 years for construction and 4 years for staffing) and expanded, but improved.

One of the most important improvements, for instance, would enable existing buildings to be acquired, instead of building only new units. This would considerably reduce the time required to provide a center, as well as decreasing the cost.

Another improvement would establish a contingency account without a fiscal year limitation, increasing the efficiency and effectiveness of the programs.

The proposal also includes other improvements.

I voted for the 1963 act with deep happiness, because I knew it would help so many people and I voted for the 1965 amendments.

I am also looking forward to voting for the Mental Health Amendments of 1967.

Let us show the afflicted, our people, and even the free world our Nation leads, that compassion is not merely a word we speak—but a conviction we practice.

Mr. JARMAN. Are there any questions? If not, we thank you for your testimony, Mr. Patten.

Mr. PATTEN. Thank you for the opportunity, Mr. Chairman.
Mr. JARMAN. We will hear next from Mr. Hamilton.


CONGRESS FROM THE STATE OF INDIANA Mr. HAMILTON. Mr. Chairman, I am pleased to testify in support of H.R. 6431 before this distinguished Subcommittee on Public Health and Welfare which in recent years has led the Congress in historic legislative breakthroughs to assist in the treatment of mental disorders.

This committee is well aware of the enormous tragedy, personal and social, brought about by mental disorders.

Mental illness afflicts about one out of every 10 persons in this country. It is often a significant factor in criminal behavior, delinquency, suicides, alcoholism, narcotics addiction, divorce, and accidents. The overall cost of mental health has been estimated to exceed $5 billion. The personal tragedy that attends each instance of mental illness is the highest cost of all.

Americans spend more for chewing gum than for psychiatric research to get Americans out of mental hospitals. One out of every two hospital beds in the United States is occupied by mental patients. State mental hospitals are often overcrowded. There are more people in hospitals for mental illness than for polio, cancer, heart disease, tuberculosis, and all other diseases combined. Not a single community in this country provides an acceptable standard of service for mentally ill or retarded children.

The Mental Health Centers Act, authored by this committee, has begun to meet the challenge of mental health in a most heartening way by providing for mental health centers. As a result of the Mental Health Centers Act, a trend has been initiated in the treatment of mental illness to move away from the State hospitals and toward an emphasis on the community-directed mental health center. In 1965 almost two in every three patients were not hospitalized. They received either private office psychiatric care or were treated in one of the 2,000 mental health clinics in the United States.

The need for comprehensive community mental health centers is abundantly clear. The mental health center is a multiservice facility. It can provide easily accessible services for the early diagnosis and treatment of mental disorders, both on an inpatient and outpatient basis, and a resource for continued treatment for individuals returning to their home communities following periods of extended hospitalization. Services and training are made available to help restore a patient to his fullest mental, physical, social, and vocational abilities. Such mental health centers serve as a central focus for mental health serv. ices to the total community population.

The Indiana State Department of Mental Health strongly supports H.R. 6431, as does the Indiana State Mental Health Association.

I am persuaded that the enactment of H.R. 6431 can mean the difference between providing comprehensive care and service at the earliest practicable date to those afflicted with mental illness, and an indefinite delay in meeting these needs.

The State of Indiana, prompted by the Federal legislation, has now begun to move aggressively into a comprehensive community mental health program. By June 30, 1967, Indiana should have five approved mental health centers, and at least three more applications are planned to be submitted during fiscal year, 1968. The presently approved center projects will need help in procuring staffing funds in the future. It is projected that Indiana will need to build and staff approximately 20 comprehensive mental health centers in the future to begin to meet the needs of its population.

Daily, I receive letters from Indiana's Ninth Congressional District which ask for advice on how to acquire mental health services for family members. The tragic fact is that at the present time I can only refer these people to the State hospitals where the waiting lists for admittance are discouragingly long. Public interest to provide facilities to combat mental illness and retardation in the Ninth District is high. Clark County Memoral Hospital has been approved for a construction grant of $530,000, and comprehensive community mental health centers are in the planning stages in Bedford and Columbus, Ind.

Important measures passed by the 95th Indiana General Assembly show Indiana's willingness to participate as a solid partner with the Federal Government in developing community programs to meet the needs of the mentally ill and retarded. One act provides a permanently dedicated source of funds to assist communities in matching Federal grants for the construction and operation of mental health centers. A portion of cigarette tax revenues will provide approximately $10 million in matching funds over the next 4 years. These funds will be available in the event that some committee find it impossible to provide adequate matching funds through local tax sources.

Another measure enacted by the Indiana General Assembly broadens the definition of community health centers for the mentally ill and retarded, gives counties permission to issue bonds as well as levy a 10-cent property tax to finance facilities, and provides that counties may support a center in a neighboring State that serves Indiana residents.

Indiana is beginning to meet the challenge of mental health. However, continued progress in Indiana's efforts to control mental illness and retardation is predicated on the continuation of Federal support. The passage of H.R. 6431 is essential to the success of Indiana's program.

Mr. JARMAN. Thank you for your presentation Mr. Hamilton.

Our next witness today will be the Under Secretary of the Department of Health, Education, and Welfare, Mr. Wilbur Cohen.

Mr. Cohen, we are pleased to welcome you and your associates here today, and you may proceed with your statement in your own fashion.


Mr. COHEN. Thank you, Mr. Chairman.

Accompanying me today is the Surgeon General of the Public Health Service, Mr. William Stewart; the Director of the National Institute of Mental Health, Dr. Stanley F. Yolles, on my right; and the Assistant Secretary, Comptroller of the Department, Mr. James Kelly.

My plan this morning, Mr. Chairman, would be to read my testimony, my prepared statement, and insert some materials in the record, and then at the conclusion of that, Dr. Yolles will make a brief chart presentation of the charts that are here which will attempt to illumi. nate some of the more important points. And at the conclusion of that, of course, all of us will be available for questioning.

Mr. JARMAN. That's fine. You may proceed.

Mr. COHEN. I am pleased to come before this subcommittee today to support H.R. 6431, the Mental Health Amendments of 1967 introduced by the distinguished chairman of the full committee, Mr. Staggers.

I should like to add, Mr. Chairman, that I wholeheartedly concur in the observation you made about the very significant contributions that this committee has made in the development of mental health legislation and mental health program over the last 20 years. We wouldn't be where we are today if a great deal of other legislation had not preceded this which came out of this committee.

H.R. 6431, recommended by President Johnson in his February 28 message on health and education in America, will carry forward landmark legislation recommended by this committee and enacted in 1963 and 1965.

Under this legislation the kind and quality of mental health services available to the people of the Nation is rapidly being transformed. The heart of the program is the concept of providing care to the mentally ill in the communities where they live-where they will have the support of family and friends.

That concept may seem perfectly logical and ordinary to the members of the committee. This, in itself, is a mark of the tremendous progress we have made in the mental health field.

The last half century in particular has seen a revolution in our attitudes toward the treatment of the mentally ill, and in our ability to deal meaningfully with mental illness.

Consider how great a distance we have traveled in a remarkably short time:

It is 113 years since Dorothea Dix succeeded in her fight to have Congress pass a bill appropriating 10 million acres of public land for the benefit of indigent insane, only to have President Pierce veto the bill.

It is 59 years since Clifford Beers, graduate of Yale and a former mental patient, really broke open the whole development in the field by writing book entitled "The Mind Which Found Itself," which really gave spirit and substance to what has become the mental health movement in America today.

Then, of course, the tranquilizing drugs, which greatly expanded the number of cases which could be managed outside of hospitals, have been available only since the early 1950's.

Today, by no means do we have guaranteed cures for mental illness. Indeed, the history of the treatment of mental illness has been all too full of overenthusiastic devotees of one "cure” or another. But we do have far better means of dealing with mental illness than ever before.

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