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In the renewal legislation, the first year requests $50 million as against the $80 million passed for that same year by the Senate in 1963. In other words, I am comparing the appropriations with our aspirations, Dr. Ewalt was the medical director of the Joint Commission on Mental Illness which proposed this program. I was a member, and these were our goals at that time. I don’t know what is happening at the Bureau of the Budget, but I do know that the contemplated cuts in this program will emasculate it to the point where we will come nowhere near President Kennedy’s announced goal of 2,000 centers by 1975. I heard mention yesterday of this 2,000-center figure. I heard mention of it this morning, and I think that this committee deserves frankness from me and from every witness. We will not come anywhere near 1,000 centers if we drop the program back to $50 million and then “such sums as may be required over the next 4 years.” I am a member of the Mental Health Council. I am privy to some internal figures that maybe I should not reveal, but I am going to, because my Irish glandular system is going to exceed my caution and wisdom. I will say that at the present time we have only 125 centers under construction, and this is not a result of a lack of State and local interest. I will come in a minute to the fact that it is a lack of Federal money. As Dr. Ewalt pointed out, and as was pointed out yesterday, State and local money is outmatching the Federal money $3 to $1, and 40 percent of this money is coming from the private sector. People are ringing doorbells, holding barn dances, doing everything in the world legal or otherwise to match the Federal money. And in most of the States, the States are not putting up a nickel. In the State of Florida, Mr. Rogers, there are eight grants at the present time. There is not 1 cent of State money. Matching moneys have all been raised by localities, including one in Dade County, the only one in Dade County, the Variety Hospital. The other seven are construction grants. It is most impressive to me that the good people in Winter Haven, in Daytona Beach, in Panama City, in Pensacola, and elsewhere, have raised this money themselves to outmatch the Federal money. I think there is no justification for saying there is a lack of interest, but there is some suspicion that the Federal Government is not meeting its obligation promises. I hear this, because I travel around the country and I was in some 26 or 28 States with my carpetbags last year. l | is the thrust of our testimony when asked by the chairman about the figure. I am not the only one who is worried about the relatively slow pace of the centers program due to inadequate Federal funding. Toward the end of 1965 the National Governors’ Conference unanimously passed a resolution requesting the Council of State Governments to convene a conference of State and county officials to find out why the mental health center program was lagging and what could be done to speed it up. At a 3-day conference held in Chicago in December 1965 the delegates passed the following resolution: I would like, if I may, to introduce into the hearings the text of the resolution and quote one or two paragraphs in this resolution which indicate what the problem is: “Of the total annual mental health expenditures of $2 billion in this country”—which they used in 1965—oonly $115 million, less than 4

rcent, is available for ongoing local community mental health services. The share of the Federal Government in this funding is less than 10 percent.” This was a 1965 figure in the first year of the actual program we are talking about today, so that the figure would be higher today. But I think what the Governors and the county commissioners said at the Chicago meeting was very important.

I am trying to get away from the idea that this is all o; Daddy,” that the big Federal impetus.“Santa Claus” is slipping the money. “Santa Claus” is actually quite a cheapskate in this program. He is supplying less than 10 percent of the ongoing funds for this. I would like to introduce the full text of this resolution for inclusion at this point.

Mr. JARMAN. Yes.

(The resolution referred to follows:)


This national conference on community mental health programs was called as a result of a resolution unanimously passed by the National Governors' Conference in July, 1965, calling for a thorough “review and critical evaluation of the experience of states under the various kinds of community mental health services acts and other methods of financing community mental health services, and for thorough consideration of the future role of each level of government in multiplesource financing of community mental health programs.” It is well recognized by this conference that in order to meet the pressing responsibilities and burdens in improving the mental health of this Nation there is critical need for an expansion of community mental health programs and of means to finance them, at all levels of government. Of the total annual mental health expenditure of $2 billion in this country only $115,000,000, less than 4 per cent—is available for on-going local community mental health services. The share of the Federal Government in this funding is less than 10 per cent. In order for the States and communities to make full use of the 1963 and 1965 Federal legislation, they must complete their plans and provide additional funds. To accomplish this, the enactment of new and expanded community mental health services acts which provide for State-local matching of funds is necessary. But they cannot do the job alone—their limited tax base prevents many States and localities from responding to citizen demand for these services. It is therefore imperative that the Federal Government, which receives the largest share of the tax dollar from our people, provide critically needed additional seed money for these programs. It is the consensus of the conference that the national goal of 2000 new community mental health centers to be established by 1975 as envisioned by the landmark 1963 and 1965 Federal legislation will not be realized without expanded Federal, State and local support.

Mr. GoRMAN. As a member of the National Advisory Mental Health Council, which passes upon all policies and grants of the NIMH, I am privileged to see a great deal of documentation on community mental health center projections. I want to get to the heart of the matter. Late last year, I reviewed a document which indicated that the administration would recommend $475 million for centers construction, just talking about construction, during the next 5 years— $50 million for the first year; $95 million for the second year, and $110 million for each of the next 3 years. However, in listening to the administration witnesses yesterday, I gathered—and this is the understatement of the year—that these estimates have been chopped down considerably.

2. According to the administration witnesses, by the end of the third year of this program they will have financed the construction of less than 200 community mental health centers. This is what Mr. Cohen said yesterday and what Dr. Yolles said yesterday. While this is a good beginning, it is a far cry from the goals of those of us who served on the Joint Commission on Mental Illness and Health from 1955 to 1961 and who participated in the drafting of the historic Kennedy legislation. We envisioned a broad network of centers bringing intensive psychiatric care to hundreds of communities, urban and rural, rich and poor, which were willing and eager to join in building and staffing these centers. We did not view this program as just one for Los Angeles or New York City or Chicago. #; was for all the people. Mr. Chairman, I heard little in yesteday's formal testimony about the needs of the individual mental patients. How long must they wait for intensive treatment while the Bureau of the *i; does its stretchout work? Does the Bureau of the Budget ever take their needs into consideration when it demands further and further stretchouts of the program? Let me be specific. For the last 22 years I have toured the wards of State mental hospitals. They have improved considerably in recent years, but there are still thousands upon thousands of patients confined in them who have been there 30, 40, and even 50 years, and this is true today. In fact, I read a report just the other day from a 5,000bed hospital in Alabama which estimates that one in every four young patients hospitalized today, and I quote from this report which we received at the advisory council, “can anticipate being permanently hospitalized for the next 50 years of their lives.” If that was my son, my daughter, my wife, my mother or father, would I want a Bureau of the Budget stretchout? No, thank you, sir. I saw another survey from the State of Washington, that patients who had remained in the hospital more than 1 year, because 1 year is kind of the magic figure, and if you can get them out in 1 year you can have a high 80-percent discharge figure. If they are in more than 1 year, it begins to get tougher and rougher. Patients in the Washington hospital system who had been there more than 1 year in 1956 remained an average of 12 years and 4 months. In 1965, they remained an average of 11 years and 9 months. In other words, the hard core of patients, many of whom we are still not reaching today. I read a report from another hospital, considered one of the finest in the United States—Camarillo Hospital in California—I consider it one of the four or five best, in which it was noted that only 4 percent of the patients in that hospital in 1965 received either individual or group psychotherapy. Yes, they got pills from the attendants and they sat in rocking chairs watching television, but there were not enough doctors for individualized therapy. That's their own report, not mine. . Yes, I worry about these people and I worry even more about 2 million Americans who sought psychiatric treatment but were turned away because of lack of personnel or facilities last year. Where did these 2 million people go who were sick enough to want to be helped? They were knocking on doors, but there was no room at the inn.

How do I tell these people about a Bureau of the Budget stretchout? I don't know how to tells them. Will they really understand? . I worry about children, because I have a few myself. The American Psychiatric Association estimates that there are about 4 million children who are in need of some kind of psychiatric help because of emotional difficulties. Of this number, anywhere from a half million to a million children are so seriously disturbed that they require immediate psychiatric treatment. - Very few of these children are getting the treatment which they need. More than 300,000 children were seen in mental health outpatient clinics last year—in most, cases the “treatment.” consisted of a single diagnostic interview followed by the admission that there were no facilities in the particular area for prolonged treatment. And I have heard it hundreds and hundreds of times, and parents are told that there are no facilities for long-term treatment. How about the other 3,700,000 children who seek treatment? I am just talking about people. Maybe people are out of style, but I am kind of partial to people. I think they are still in style and worth preServillno, I worry about 18,000 children who are still confined this very day in State mental institutions. I may be in the minority, but I don’t think one child should be in a State mental institution. I have said this for 22 years and every time"I walk through a ward and see a child in a ward with grownups, I say, “There, but for the grace of God, would be my child,” and it worries me to this day. Mr. Chairman, I have lived through the era of the snakepits and no one is more pleased with the fact that we are improving our State hospitals and that through increased personnel and drugs we have succeeded in reducing our State mental hospital population by more than 100,000 over the past decade. I am very happy about it but it is nowhere near President Kennedy's goal. He said that by 1963 we should reduce our population from 500,000 to 250,000, but our present census is 450,000, not 250,000. However, I would remind the committee of this fact. The State mental institution is no longer the primary source of psychiatric treatment. It is very important, but not the primary resource. Twenty years ago, State institutions handled three out of every four mental patients; in 1965, they cared for only one in every five SOnS. There is undeniable evidence that the American people are demanding that the mentally ill be treated in the community in the same way in which the psysically ill are. When asked what we want for the mentally ill, I put it simply: We want equal time with the physically ill. That is all we want, equal time. The average per capita expenditure for the mentally ill in a State hospital is $7 a day for all care. The average cost in the general hospital is $47.19. Is there that much difference between a physicallvill and mentally ill patient? I would refer that question to the distinguished doctor from Kentucky. The American Medical Association says that mental illness is America's most pressing and complex problem. If it is, why in something or other don’t we spend an equal amount of money on these people, when there are 6 million people in this country who are being treated for mental illness?

We cannot build this network of mental health centers on the

cheap. I ën't want to delude you. We cannot do it with 1-year estimates and “such sums as may be required over the next 4 years.” This was the trouble with the State mental hospital. We never had plans for it. When I was a reporter back in the forties when Mr. Jarman served in the State legislature and was so helpful to us in that program, they never had a long-range plan. #. total per diem cost then in Oklahoma and in Chattahoochee, that garden spot, Mr. Rogers, in Florida, was less than $1 a day. They were just trying to survive and keep their heads above water with thousands of patients and skeleton staffs. It is a little better today. Mr. Chairman, may I say this: I believe with all my heart that if we are to meet the promises we made to the American people in 1963, when we asked 30,000 citizens to cover this country and plan for a new era for the mentally ill and they did and they surveyed the State hositals and they interviewed people and developed the plans and every §. has submitted a plan and 30,000 citizens were involved in it, we must renew this legislation for at least 5 years at a cost in the neighborhood of $500 million. That to me is a minimum figure. We are operating now at a level of $50 million a year and we have built less than 200 centers. We have to at least double that. I am being conservative. I realize that there is a war going on. I read the newspapers, too, but so do the American people. I saw in the Washington Post on Monday of this week, and I don’t know if the members of the committee saw this, the Harris survey which polled the American people on our domestic programs. I always hear stories about how the American people want a big space program and want to spend $30 billion to get us to the moon but nobody asks the people. Lou Harris asked them and the answer was this: They wanted a lot of domestic programs cut, including aid to cities and I don’t disagree or agree with this. This is not my province, but the Harris survey of Monday said that they wanted to cut back aid to cities, cut back aid to welfare and relief programs and cut back the space program and so on but the three most popular programs which they wanted to increase are all within the purview of this committee: air pollution, water pollution, and running No. 3, mental health clinics or centers. If you want to go to the people and see what they think about it I think that a poll is vo, eloquent indication of it. Now, I conclude with this statement. is is no luxury item we are talking about. This is no matter of rifles and ruffles as the distinguished House minority leader puts it. Since when is the mental health of any human being a “ruffle” which we can dispense with at will in wartime or in peacetime. We are talking about what the American Medical Association has described as our most pressing and complex problem and I say finally that I hope to God that all of us here in this room, both members of this committee and all of us here, have the wisdom to act in commensurate fashion.

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