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I think that no more telling tribute could be paid to the devotion of most county officials to the care, close to the home, of the mentally ill than a recent statement by a Minnesota county commissioner.

This commissioner said: “Our board would sooner reduce its county highway program than to cancel out our participation in our regional mental health center."

This, I think, Mr. Chairman, is the spirit of all U.S. county officials. They see this as a workable program of high priority for their constituents.

We not only ask you for its renewal; frankly, I would like to be humble enough at this point to say that we beg you to extend this program because county government to bring this kind of treatment into the neighborhood, to bring this kind of treatment into the home, does not have the financial resources to do it alone and they will never have them to do it alone.

We have to have the strong arm, the strong resources, of the Federal Government into the partnership that we are calling not only the Federal Government but the State, and in these 12 years that I talked to you about this in my own county when the mentally ill patient went to the State hospital in most cases he saw an imaginary sign on the gate that read “Abandon All Hope, All Ye That Enter”—but in his home, in his neighborhood, in his community, there is the hope, there is the friendship of his neighbors, there is the possibility of the total community involvement, there is the possibility of better professional involvement who shy away from the snakepits at the present time and who are waiting for decent community neighborhood facilities.

Congress, and particularly this committee, can open this door wider for the American people to get their treatment on a neighborhood level and almost on a home level with the kind of program that is envisioned here.

Gentlemen, I want to thank you for giving me this opportunity to testify.

Mr. JARMAN. We appreciate your being with us and the contribution you have made to this hearing.

Are there any questions?
Mr. Rogers?
Mr. ROGERS. Thank you, Mr. Chairman.

I would like to thank you for your testimony and for being here, and also for the initiative your area has taken. What is your problem with staffing? Do you have any staffing problem?

Mr. OTLOWSKI. Well, let me give you an example in our own county. With our clinics we haven't had a problem of staffing, and I like to believe it is because of the fact that we pay well.

I like to believe that our quarters are pleasant and I also like to believe that our professional people have a feeling of accomplishment, and for that reason, of course, we don't have the problem of staffing, but in addition to that we have done something else that was indicated by my predecessors who testified and that is the fact that we are now beginning to engage in the community nonprofessional people.

As I indicated in my testimony, we have the companion house that provides after-care people where nonprofessional people are engaged in helping these people.

Congressman, I would just like to say this, and it was so amply brought out this morning: That in many cases what is needed is the immediate warmth and the immediate sympathy.

Mr. ROGERS. I understand that. I don't want to take too much time of the committee.

Perhaps you would like to submit it for the record.
Mr. OTLOWSKI. We haven't had a problem with staffing.
Mr. ROGERS. This is in your county where you pay for all the care?

Mr. OTLOWSKI. We pay for all the care. The State provides 50 percent of our operating budgets.

Mr. Rogers. You anticipate using this program for staffing? Mr. OTLOWSKI. I am glad you asked that question, Congressman. We have two applications in at the present time. We are hoping that one will be approved by April 30.

Mr. ROGERS. Is this within your county?

Mr. OTLOWSKI. Yes, the two are within our county. One is for what we call the Raritan Bay area.

The other is for the Rutgers University area.

Mr. ROGERS. They have these county facilities?
Mr. OTLOWSKI. Right.

Mr. ROGERS. What is the average time for the inpatient treatment at your hospital? I understand you have a resident population there of 6,500?

Mr. OTLOWSKI. As a matter of fact, our county now is closely working with the State in our State hospital for which our county pays.

Mr. ROGERS. I am not thinking of the State hospital. I was thinking of your county mental health population. You may want to furnish this for the record.

Mr. OTLOWSKI. I would say on the average a year and one-half. Mr. ROGERS. For inpatients admitted ?

Mr. Orlowski. No, for outpatients. We do not have any in patient facilities in our county because the inpatient facilities are provided by the State for which the county pays the State.

Mr. ROGERS. I misunderstood your statement on page 2 where you say six counties have been operating comprehensive treatment mental hospitals and these have a resident population of 6,500. That is the statement.

Mr. OTLOWSKI. You are talking about the entire statement. In Bergen County and the other counties, we have these counties furnishing inpatient care and the average stay there, 40 percent of the stay there is 30 days as inpatient.

Nr. ROGERS. Thank you. I appreciate your testimony.
Mr. JARMAN. Are there any other questions?
Thank

you so much, Mr. Otlowski. Mr. OTLOWSKI. Mr. Chairman, may I present this to the committee? This is the national association's county platform.

Mr. JARMAN. Thank you, Mr. Otlowski" for taking the time to be with us this morning. Mr. OTLOWSKI. Thank you, Mr. Chairman.

(A series of articles on the psychotic child, from the Perth Amboy Evening News, and a letter from Dr. Samuel Breslow endorsing same, submitted by Mr. Otlowski, may be found in the committee files.)

Mr. JARMAN. Our next witnesses I am pleased to say are two prominent people from the State of Oklahoma, Dr. Albert Glass, director

of the Department of Mental Health of the State of Oklahoma, accompanied by Dr. Hayden Donohue, director of the mental health center in Norman, Okla.

In fairness to Mr. Kuykendall, I should add that they are accompanied by Dr. Nat T. Winston, the mental health commissioner of Tennessee.

Dr. Glass. May I also introduce Harry Schnibbe, the executive director of the National Association of Mental Health Program Directors, which group we represent here.

STATEMENT OF DR. ALBERT GLASS, DIRECTOR, DEPARTMENT OF

MENTAL HEALTH, OKLAHOMA; ACCOMPANIED BY DR. HAYDEN DONOHUE, DIRECTOR, MENTAL HEALTH CENTER, NORMAN, OKLA.; DR. NAT T. WINSTON, MENTAL HEALTH COMMISSIONER, STATE OF TENNESSEE; AND HARRY SCHNIBBE, EXECUTIVE DIRECTOR, NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS

Dr. Glass. As you may be aware the National Association of State Mental Health Program Directors is comprised of those directors who direct the programs for the mentally ill in the 50 States and the several territories.

As administrators for the vast majority of the mental health services in this country, we have a vital concern in these proposed mental health amendments of 1967 and our association unanimously urges its passage.

We have also here the messages from Governors and directors of mental health of some 24 States, including the States of Massachusetts, North Carolina, Illinois, Wisconsin, Kansas, Kentucky, Arizona, Arkansas, South Carolina, Connecticut, Delaware, Ohio, Vermont, Utah, New York, Washington, West Virginia, North Dakota, Pennsylvania, Louisiana, Missouri, Indiana, Texas, and Iowa, which I would like to submit to the committee.

Mr. JARMAN. They will be received.
Mr. ROGERS. You have no requests from Florida ?
Dr. GLASS. We are awaiting it.
Mr. ROGERS. I would be interested to know if Florida responds.

Dr. Glass. We are getting them in this morning and they are being added to the list. We expect a communication from the State of Florida.

Mr. SPRINGER. May I ask, have you heard from Illinois ?
Dr. GLASS. Yes, Governor Kerner.
(The material referred to follows:)

STATE OF ILLINOIS,

OFFICE OF THE GOVERNOR,

Springfield, II., April 3, 1967. The Honorable HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representatives, Washington, D.O.

DEAR CONGRESSMAN STAGGERS : On Thursday, March 4, 1965, I appeared before the Interstate and Foreign Commerce Committee, then meeting to consider H.R. 2985, and testified on behalf of the bill with the hope that it would allow our states to embark on a program which would make community-based Mental Health

services available to all citizens. At that time, I described the direction taken by the State of Illinois and the Illinois legislature which authorized the creation of Zone Centers throughout the State. Seven centers, at that time, were planned and programmed. Since that time, two centers in the Chicago area have begun operating. Also centers in Rockford, Decatur and Champaign have initiated programs of a comprehensive mental health nature. The remaining centers in Peoria and Springfield will be completed by mid-summer of this year.

The purpose of these centers is to provide intensive short-term care in an environment designed to keep the patient in his own community. These centers which, in terms of geographic catchment area, i.e., the numbers of population which they serve, are larger than those proposed under the Federal Construction Act. In part, this was because our planning for these centers was initiated in 1961, two years before the passage of the community Mental Health Centers Act and, in part, because of our program of decentralizing the Department of Mental Health in order for the regionalization of planning and services to be specific to the needs of the communities which they serve. The community Mental Health Centers program, therefore, is being used to set up a sub-network of community Mental Health Centers serving more discreet populations and regions as subzones which then relate to the zone center program in Illinois. In essence we are building a zone center complex in which state hospitals, outpatient clinics and community mental health centers are related in a network of services serring the population of relatively large geographic regions and sub-regions, providing a continuum of care and comprehensive services. This requires the highlyintegrated planning and organization between those agencies responsible for human services that is, the Department of Public Health, the Youth Commission, the Division of Vocational Rehabilitation, the Public Aid Department; the Division for Crippled Children, the Universities, and, of course, the Department of Mental Health. All these agencies have regional offices in the same zone cities where the Zone Centers have been constructed.

In Illinois, we have sought an enlightened approach to a partnership for planning and service. We welcome federal monies coming into our state, matched by state efforts and local community efforts. To achieve this partnership several progressive steps have been taken since my last appearance. Federal money for construction of Mental Health centers is not used by the Department of Mental Health, but rather is directed to local communities seeking to build resources necessary for providing services and reaching out in a service linkage to our new state facilities. In this legislative session, we have proposed an enabling act which would allow the state to implement the efforts of the Federal government by subsidizing local programs up to 30 per cent to match the 39 per cent provided by the Federal Mental Health Centers Construction Act. law was enacted in Illinois permitting local government units to tax themselves for mental health services subject to referendum. Eight such referenda have passed, and eight were to be voted on at the general election April 4. Therefore, you can see we are striving to truly effect a partnership between the Federal government, State government and local communities. The state sees its charge in this partnership for planning and service as stepping in only where communities are unwilling or unable to provide the resources and the services for their citizens.

We have reviewed, favorably, the budget proposals of the Department of Mental Health for this coming biennium to provide the expansion of those programs which we have initiated for comprehensive mental health services at the community level. Programs for the prevention and treatment of mental illness and retardation have expanded rapidly and have changed in concept during this decade. Today, we admit more persons to our programs than ever before in a greater number of facilities throughout the state. Through improved diagnostic and treatment methods we return a higher percentage of these persons to their homes and jobs in a shorter period of time. Our resident population in institutions for the mentally ill decreased 19 per cent from 31.912 patients on June 30, 1965, to 25,899 on December 31, 1966, and we are continuing to improve staffing at these institutions and zone centers to make them modern and effective treatment facilities. In all of our zone centers a substantial amount of community organization work has been completed. This work will be increased and intensified during the next biennium, and this has been a priority item budget request of all of our zone centers. Government must place as much emphasis on providing resources for the treatment and prevention of mental illness and retardation as it does on communicable diseases and physical impairments.

77-607-67-_-8

The Department's program is, therefore, to encourage communities to provide adequate front-line resources for the prevention, early diagnosis and treatment of mental illness and retardation. To this effect, we have requested a budget of $414,174,039, excluding reappropriations, for the coming biennium. This represents an increase of some 120 million dollars from General Revenue Funds over the last biennial appropriation.

I, therefore, request your support for the Mental Health Amendment of 1967 under H.R. 6431 which extends the construction and staffing of community Mental Health Centers under Public Law 88–164 and Public Law 89–105. diminish the serious, crippling effects of mental illness and retardation, and to increase the social competence and potential of our citizens, it will be through the efforts of these bills, providing service at the local level in conjunction with state efforts. In our ever-changing society, it will be those services provided by our staffs and our communities in the centers of populations where people live, trade, and congregate that will make the significant impact on our everchanging, ever-exploding society. Society, because of its size, because of its gross potential, because of the very nature of its technological explosion, creates a multitude of problems and stresses on its citizens. These stresses must be dealt with through treatment, prevention and rehabilitation. These services must be added to our growth as a nation and as a society which cares for its own on its own home front. Thank you. Sincerely,

OTTO KERNER, Governor.

STATE OF NORTH CAROLINA,

GOVERNOR'S OFFICE,

Raleigh, N.C., April 4, 1967. The Honorable HARLEY STAGGERS, Chairman, Interstate and Foreign Commerce Committee, House of Representa

tives, Washington, D.C. DEAR CONGRESSMAN STAGGERS : Adoption of S. 1132 (H.R. 6431) will enable North Carolina to continue implementation of its long-range plan to establish community-based services for the mentally ill and retarded.

Since the Facilities Construction Act (Public Law 88–164) was adopted in 1963, North Carolina has made considerable progress toward that objective. Under this act, Federal funds have been committed for construction of four comprehensive community mental health centers. Two of these will be in the eastern section of our state, one is in the Piedmont and one will be in the western section of our state. The latter is designed as a combination mental health-mental retardation facility to be housed in the same structure.

A number of other communities are in various phases of developing their plans for a comprehensive center. We estimate now that fifteen additional comprehensive community mental health centers can be established during the next biennium, provided funds are available.

Currently our recommended state budget, now before the Legislature and expected to pass, appropriate state funds sufficient to provide the state matching portion for construction of the fifteen new centers. Many of the communities already have their portion set aside. The state simply could not support its own and the Federal share of this

We are already putting about all we can afford into support of our mental health program. Currently, North Carolina is spending forty million dollars a year on its mental health program. For the next two years I have recommended an increase of 22.8 percent per year in mental health appropriations, the largest single portion of which will go to community mental health centers. I point this out to emphasize that we in North Carolina are not abdicating our financial responsibilities and shifting them to the Federal Government.

Our mental health program in North Carolina is in a very critical transitional period. We are making a concerted effort to build up our community programs with the resulting need for increased budgetary support, while still carrying the same responsibilities for maintaining a high standard of care in our state hospitals which currently receive over 12,000 admissions each year. Until we work through this period to the point that community programs are numerous enough to enable significant numbers of patients to be treated at home

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