homes. We are finding jobs for former mental patients under a program we describe as our pinch-hitters' program, and we have met with a great degree of success with out pinch-hitters' program. Of course, we've always been engaged with voluntary services in St. Elizabeths Hospital. We engage in public education; we promote mental health through high school students. We have a youth council which is comprised of at least two to four high school students from every school in the Metropolitan Washington Area, be it private or public. We give assistance to public and private agencies in planning mental health programs. We monitor public budgets, laws, and administrative procedures affecting the mentally ill and their families, and we study the amount and quality of services and the desemination of facts.

Now, we have several demonstration projects currently in action, but the one that we are most proud of is a project that we are engaged in in conjunction with Catholic University that we entered upon last September, where we have taken ten foster children, together with their parents and they are attending classes at Catholic University every afternoon.

This involves not only education and treatment of children, but for the parents as well.

I think it would be well at this time if I introduce my associates here at the table, Mr. Chairman, and members of the Committee. This is Dr. Juliette Simmons, who is a noted psychiatrist in the field of mental health and co-chairman of our public affairs committee, and of course Cecil Camlin you know, and this is Sandra Bregman, who will be making the principal presentation to you this morning, and Mrs. Geraldine Davis, whom you will hear from in a few moments, and Dr. Eva Towns, who is another renowned psychiatrist in the field of child mental development, and Mrs. Robert Martin, who is cochairman of our public affairs committee.

I might add that Dr. Simmons and Mrs. Martin are primarily responsible for our being here today and for everything that you will listen to, because they and their committee have worked quite arduously for the presentation that you will hear very shortly.

We hope you will find our presentation interesting. We hope you will find it worthwhile, and we certainly hope that the Committee will see fit to respond to it.

So, without further ado, Mr. Chairman, I would like to introduce our spokeslady, I should say, who will make our main presentation this morning, Mrs. Sandra Bregman.

Mr. MCMILLAN. Thank you very much. I can assure you that every member of this Committee is very much interested in this subject and you will have our full cooperation.

Mr. FOWLER. Thank you, Mr. Chairman.

Mrs. BREGMAN. I am Sandra Bregman.

Mr. Chairman, first of all, I would like to thank you again for giving us this opportunity to come here and tell you about the plight of the mentally ill child in the city of Washington. We, as the Mental Health Association, speaking for all those who are presently mentally ill and those who might become mentally ill if the proper services are not available to them, but this morning we would like to specifically speak about the children and their needs, because that is where the need is the most acute and that is where the hope for change is the greatest.

There are thousands of children in the District of Columbia who are mentally ill and yet there is no public residential treatment facility for these children. There are fewer than 60 beds in the entire public sector, including St. Elizabeths.

What we need, specifically, Mr. Chairman, are three things-first of all, we need the creation of a system of four comprehensive care residential centers for mentally ill children and adolescents to be placed in the four mental health areas of the city.

Secondly, we need to enact a mandatory special education law for handicapped children.

Third, we need to create a system of early childhood education. This need is especially most acute for those children who live in foster homes.

I would like to state, Sir, that we speak only for the citizens. We do not speak for the City Government, nor for the Mental Health Administration. We have done everything that we could think of as a Mental Health Association to bring the attention of the public, of the citizenry, of the press to the plight of the mentally ill child in Washington, but we have had few results.

That's why it's necessary for us to come to you. There are 30,000 children in the city of Washington who are mentally ill. These figures were arrived at by using the figures in the Joint Commission Report on the Mental Health of Children, a study that was created by an act of Congress, and was published in 1969. By using the figures they projected and projecting them onto the population of children in the District of Columbia, the Mental Health Administration has arrived at this figure. We don't have the names and addresses of these children, but we do know they are there and both demographers at NIMH and the Mental Health Administration said this indeed is a conservative estimate.

If we just look at the figures of the Social Rehabilitation Administration, we find an estimated 14,000 children with serious emotional problems, and this does not count the children who have never come into contact with the Social Rehabilitation Administration.

I would like to stop for a brief moment and define the difference between mental retardation and emotional illness. When we use the phrase mentally retarded, we refer to sub-average general intellectual functioning which originates during the developmental period, prenatal or post-natal.

On the other hand, an emotionally disturbed child is one who cannot cope with his life. His personality development has been impaired and interfered with. It has been stopped by factors in his environment. He seems immature for his age and his intellectual endowment, which is frequently very high. He cannot interact in an acceptable way with his peers. Sometimes he has temper tantrums and crying fits. Some get down on all fours and think they are a dog. Others cannot relate with any human being and they withdraw inside of a shell and they cannot learn, they cannot control their impulses.

Those who are most severely depressed try to kill themselves.

I will never forget a meeting, Mr. Chairman, last spring, one of our committee meetings at the Mental Health Association, when a member of the Public Education Department came in and sat down and took her seat, and she said, "I hate to see spring come. We have so many suicide attempts in the schools each spring".

When we speak of mentally ill children, there's a vast range of severity in describing their condition and their needs, and that is why we need a vast range of treatment available for them. One thing is certain when a child becomes mentally ill, if he is not helped soon, then he can only get worse.

I would like to tell you about some of the calls for help we have received at the Mental Health Association, calls which leave us depressed and frustrated because there's really nothing we can recommend. There's no place for these children.

We had a school counselor call asking for help. She had a bright but uncontrollable sixth-grade girl who brought a pocket knife to school and threatened the other children. Did we know of a residential treatment facility she could put the child in? Two of our board members witnessed a thirteen-year-old girl screaming and banging the walls at the detention room at Juvenile Court for 45 minutes. At 5:00 p.m., when the Judge returned, the ladies asked him what was wrong with the child and he replied, "She's obviously psychotic." They said, "What will happen to you?" He said, "Well, she'll go back to the receiving home, and if anyone is there to help her, they'll probably give her a tranquilizer."

A private psychiatrist tells us that she's keeping four of her patients in her own home with her own children because there are no appropriate facilities for them, and she will not send them back to their homes, which is the primary cause of their illness.

The wife of a United States Congressman, an Urban Service Corps Public School volunteer, called asking us to recommend a treatment facility for a seriously disturbed 14-year-old girl. She talks and talks and walks around the town looking for her mother. who deserted her, or she sets herself up in closets. She will not stay in a classroom; she has no money.

We hear hundreds of cases like these each year, and there is nothing we can recommend because there is no place in the city of Washington. The most serious gap in the treatment facilities available within the public domain is the total lack of any residential treatment facility. And we have less than 60 hospital beds. There are seven fine private facilities. These private facilities have a total capacity of 300 beds. The cost ranges from $11,000 per child per year to $36,500 per child per year.

It's obvious that only an affluent family could afford to send the child to one of these institutions and even then, the waiting lists are tremendously long.

The Mental Health Administration operates two day-care centers which care for 44 children. They also have a therapeutic nursery caring for 17 children.

But what does all of this add up to when we have a least 14,000 children seriously ill within the Social Rehabilitation Services alone? Not much at all, as you can see.

Our Association was so distressed by the lack of treatment facilities that last year our children and adolescents committee did a very serious study of what was available in both the public and the private

sector.

Gentlemen, you will find it in your appendix, and it shows you what does exist and also what does not exist. We are now sending 505 children at the cost of $1,300,000 to facilities, some as far away as

Texas, for treatment, and we have a waiting list of 398 children waiting for that kind of treatment.

Perhaps you're wondering what kind of facility I am proposing. Working through a task force, including the D.C. Mental Health Association, the Mental Health Administration has put together a task force which has designed a plan for four comprehensive care residential treatment centers. Each one of these four centers would treat 100 children on a daily basis; 80 of them would receive day-care and there would be residential facilities for 20 of the 100.

When we speak of residential treatment, we're talking about what is called in the profession a therapeutic milieu. We are talking about a daily pattern of living which will be corrected and which will help these children learn how to interact in an acceptable way with their peers, with their parents, with their teachers, with figures of authority. There will be individual therapy and group therapy, education and play therapy. It will also be important at these facilities that these facilities be located in the neighborhood that the child is in because it's very important to bring his parents in for counseling.

It's very important that when he begins to get well enough, that he can return to the outside world, that he be near his local public school so he can return to his local school classes in the day and perhaps come back at night if that's necessary.

There will be a vast variety of programs available, tailored to the needs of the children and the particular severity of their illness.

Obviously, such treatment is expensive, In our local private institutions, as I have said, the cost ranges from $11,000 per child per year to $36,000 per child per year.

In the State of Massachusetts, where all children have been, by law, deinstitutionalized, residential treatment averages $7,000 per child per year. The cost of providing residential treatment service at the Episcopal Church Home for Children In York, South Carolina, is $9,000 per child.

Mr. Howie, the Executive Director of the Episcopal Church Home, has stated: "Without residential treatment, these children would spend their adult lives in institutions".

And Senator Waddell from South Carolina has estimated the cost of keeping a child institutionalized for his life expectancy at $1 million for six children.

But even more important than this, how can we measure the cost of salvaging a human life? The 92d Congress has already appropriated capital outlay funds to renovate or construct tow of these comprehensive care residential treatment facilities and the amount of $600,000 was appropriated for program money for this year.

What we are asking here today is that instead of two, that some time soon we would need four, one in each health area of the District. We are requesting, therefore, an additional capital outlay of $1.5 million and the yearly operating cost of running these four residential treatment facilities would run $4 million.

These figures are high. The benefits are incredibly higher. We would all agree, I think, that it is impossible to place a price tag on the saving of a human life, but we are also aware that Congress understandably wants to know what it's buying for every public dollar. Accordingly, if we assume-and this is a conservative estimate— that these centers will treat 400 children each every year, and that

perhaps half of these children will never, because of this treatment, have to undergo institutionalization, then, applying Senator Waddell's figure for the lifetime lockup, we would be saving $135 million for an annual expenditure of $4 million on the four centers. This works out to a savings of a $50 return on every $2 invested. I wonder, would any of us hesitate to make that kind of an investment with our own money, let alone the public's?

Secondly, I would like to turn your attention to special education. Because residential treatment is so expensive, because it is also expensive in terms of what it does to the children-in other words, if you let a child become so ill that he must be put in a residential treatment facility, then it's already very, very late in the game.

What we ought to be doing is helping these children when they're very young, when they're 3, 4, 5 or 6, and therefore, we turn to the public schools, to the Department of Special Education.

When we think of the Department of Special Education, we in the Mental Health Association speak for all children. First of all, we speak for those who are already mentally ill and we believe that they must not be denied their right to a free public education.

Secondly, we speak for children who are otherwise handicapped-the blind, the deaf, those suffering from dyslexia, from neuro-muscular diseases. These children run a very high risk of also becoming emotionally disturbed if they do not receive the right kind of education tailored to fit their needs.

In the city of Washington, the system works this way: when a child is noticed by his teacher, when he acts out in class, when he disrupts the classroom, the teacher decides that perhaps he needs help and she refers him to the Department of Pupil Personnel for testing. Then begins the long wait. Sometimes after the child is referred for testing, it's anywhere from 6 to 9 months before the child is actually tested. Finally, he is tested and if he is diagnosed as needing special education, the really long wait begins. We have had mothers tell us that three years after they were told their child needed special education, they were still waiting for that child to be placed in a special education class. And when this happens, everyone loses because when children who are ill disrupt the classroom, the children who are well can't learn either and everyone loses.

As of September 27, 1971, 1,501 children were on the waiting list for special education. They are still on that waiting list today.

When we deny these children their right to an education, we are denying them their future. We are literally giving up on them. To serve these children who have been identified, for whom we do have names and addresses, would cost $3.5 million, in addition to what is currently in the 1972 budget.

The United States Office of Education, however, has estimated that there are 18,000 children in the District of Columbia who require special education services. To provide services for all of these children would cost in the neighborhood of $40 million.

We do believe, however, that there must immediately be money made available to put the 1,501 children who have been identified in the necessary special education classes.

What we really need, sir, is a mandatory special education act for handicapped children. The reason why law is so important, I believe,