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Dr. YOLLES. Mr. Chairman, there is one final chart that I would like to point out. That is the distribution of the community mental health center grants that have been made. (See fig. 9.) The little triangles indicate the construction grants and the circles represent the staffing grants.
There is good distribution across the country.
Mr. ROGERS. Have these charts been reproduced for the committee in the testimony?
Dr. YOLLES. They will be available.
Mr. JARMAN. Before general questioning starts, Mr. Cohen, would Dr. Stewart have any comment to make at this time or would you prefer simply to answer questions?
Dr. STEWART. I think it would be better to just answer questions. Thank
you very much. Mr. JARMAN. For the subcommittee we want to thank you gentlemen for being with us for what I think is a very good explanation of a very important subject.
There is one question that we would like to clarify for the hearing record : Last year, this committee passed legislation which was signed by the President as Public Law 89–749. This legislation establishes a State health planning agency which is to do comprehensive health planning for the entire State.
Under the mental health legislation which the Congress passed in 1963, a State plan is required for construction of these centers and this plan is required to be administered by a single State agency.
I wonder if you would clarify for the subcommittee the intended relationship between the comprehensive State health planning agency established under Public Law 749 and the operations of a State agency administering the mental health plan.
Mr. COHEN. I will ask the Surgeon General to reply to that, Mr. Chairman.
Dr. STEWART. Mr. Chairman, the intention is that the planning under specific plans such as the mental health planning agency would be complementary to comprehensive health planning. We have in each State in the country planning which is going on toward a specific target or health problem, or the provision of a specific set of services, or the development of a specific set of resources, such as hospitals.
We have planning for mental health services, for mental retardation services, for the development of hospitals. Many of the States have done planning toward the development of the number of physicians in their States and the number of nurses in their States, but nowhere do we have the information in such a way that one can relate all the plans together as to the total development of the services in the State and the total development of the resources in the State.
It is conceivable for a State to be planning the development of specialized services which, when combined, will exceed the State's ability to produce these services because it exceeds the number of physicians or the number of hospitals or the number of dollars available for capital or for operations, either private or public.
The intention of the comprehensive health planning agency is to provide a mechanism for pulling this information together so that the State can have some idea of what the long-range objectives are in the development of resources and services, what their capabilities are, what priorities they might have, what choices there are toward these priorities, given an assessment of their economic development, and of the development of their trained resources and of their facilities.
I think the best way to picture the relationship is to see mental health planning as vertical. It aims at a specific health problem and a specific target population, and it is one of many such vertical health planning functions being carried on simultaneously within a State.
On the other hand, the comprehensive health planning agency has a horizontal role, tying all the vertical plans into a single information sharing and evaluating system, and developing a plan for the total health needs of the total population.
The real function of the comprehensive health planning agency is to collect and then evaluate that information which shows what the health program choices are, whether the objectives are sound, whether they need to be changed.
In a given instance, the mental health agency may be overly ambitious or need some direction. This information would be available through the comprehensive planning agencies to the State government, to the Federal Government, to the private sector—such as Blue Cross—or any other group.
So this is the relationship between the specific planning and the comprehensive health planning agency.
Mr. JARMAN. Thank you.
Mr. Secretary, it is a pleasure, of course, to see you again with your associates here. I think the facts that have been presented on the reduction of mental cases actually occupying hospital beds are impressive.
I think we are beginning to make real progress, and this is encouraging, and I commend you and your associates and those from the National Institutes of Health.
There are two or three things I am concerned with in the new request. I notice that where we had previously, I believe, reached a level of $65 million for construction of community mental health centers you are now recommending a reduction of that figure in June 1968 of $15 million.
Could you give us some comment on this? Is it that you don't have enough applications or are we on top of the problem enough where we don't need to go into this program any more?
Mr. COHEN. I think that generally speaking, Mr. Chairman, and Dr. Yolles can amplify, what happens in a construction program in the early years is that the program progresses a little slower than intended as you said, there is a great deal of need for State and local consultation. I think that our original aspirations, projected to the fourth and fifth year from the submission of our original proposals, even somewhat above what we can carry out.
would have to quite frankly admit that during the preparation of our legislative program, when we had a number of other budget considerations, we were also influenced by a desire not to accelerate construction unnecessarily at a time when interest rates were higher than normal and when there were inflationary pressures.
I would hope now, though, with the program we have presented to you that we could modestly increase the amount of Federal funds in this program to get back upon our original schedule.
Mr. ROGERS. That resulted in this particular figure?
Mr. ROGERS. Then you think there are conditions that should be considered by the committee then that might change?
Mr. COHEN. Yes. I think that when you see our revision of our request for authorization for the next 5 years you will see that they will turn out to be a little bit more modest than those we originally submitted in 1963.
We all recognize that it is going to take quite some time to reach our ultimate goal and it is desirable for us to do it in a sound way, enlisting the full support of the communities.
I should also say one other thing: It isn't solely a matter of Federal funds involved here. Once a center is established it is anticipated that the locality will see that it is financed. That means substantial State and local money and money from individual patients and insurance premiums. The locality has to be doubly sure that it can support this operation in the indefinite future.
Mr. ROGERS. I will agree. You have constructed 286, I believe you stated. How many applications do you have on hand?
Do you have applications to warrant this additional appropriation? Is it sufficient? Is it insufficient? Could you give us facts on that?
Perhaps you could submit it for the record.
Mr. Rogers. Maybe you can comment quickly and then submit the details.
Dr. YOLLES. Our experience is to date that we have been able to use all of the funds available to us and we would expect that this would continue for the next year at least.
Mr. Rogers. The indications from the applications would indicate this?
Dr. YOLLES. Yes.
COMMUNITY MENTAL HEALTH CENTERS PROGRESS REPORT
During fiscal year 1966 a total of $32.4 million was obligated (FY 65 fundstwo year availability) representing 93 projects for the construction of community mental health centers. Additionally, $15.2 million was obligated (FY 66) representing 54 projects for the staffing of community mental health centers.
During fiscal year 1967 an additional 33 construction projects and 19 staffing projects have been approved respectively obligating $20 million (FY 66 fundstwo year availability) and 2.6 million. Based upon projects anticipated to be reviewed prior to the close of this fiscal year, June 30, 1967, another 68 construction projects representing $30 million and 58 staffing projects representing $16.5 million will be approved.
Based upon experience to date, we anticipate receiving during fiscal year 1968, 97 construction and 104 staffing applications. These would represent about $60
million for construction and about $30 million for staffing. With the current request for appropriations, $50 million for construction (1967 funds—two year availability) and $20 million for staffing, we would be able to approve approximately 83 of the requests for construction assistance and 66 of the requests for staffing assistance.
Mr. ROGERS. The Chairman has brought out the fact that this committee does not like to use language such as "appropriate such sums as may be necessary," so that I think we need language and specific figures as I think the Department knows.
Now, this contingency account, what precedent is there for setting up a contingency account like this by Federal departments other than for the President?
Mr. COHEN. I will ask Mr. Kelly, our Assistant Secretary, and Comptroller of the Department to handle that.
Mr. KELLY. Mr. Rogers, there are a large number of provisions throughout the Federal Government that either establish contingency accounts or that establish authority to transfer funds from one appropriation to another.
All told, I think we have accounted for about 36 of them.
Mr. Rogers. How many contingency funds have complete authority other than just notifying?
Mr. KELLY. The Department of Defense has several contingency funds. One that I am looking at now authorizes the Secretary of Defense to spend an additional $200 million if he determines that such is required in the public interest.
There is also a Department of Defense contingency fund which authorizes the Secretary of Defense to transfer research and development funds and to augment them.
Mr. ROGERS. From his contingency fund?
Mr. KELLY. Nr. I don't believe so. There is one in the Department of Health, Education, and Welfare and one in the Department of Labor that relates to the contingency of increased workload alone.
In the Social Security Administration we are authorized to augment our funds by $25 million in the event that the workload that is received from claimants exceeds that which the budget estimate was based on
Mr. ROGERS. I think it might be good to submit that into evidence. (The information requested follows:)
EXAMPLES OF CONTINGENCY FUNDS AUTHORIZED IN FISCAL YEAR 1967
1. Funds Appropriated to the President-Economic Assistance: "Contingency fund: For expenses authorized by section 451 (a), $35,000,000.”
2. Department of Defense-Contingencies, Defense: "For emergencies and extraordinary expenses arising in the Department of Defense, to be expended on the approval or authority of the Secretary of Defense and such expenses may be accounted for solely on his certificate that the expenditures were necessary for confidential military purposes : $15,000,000 : Provided, That a report of disbursements under this item of appropriation shall be made quarterly to the Appropriations Committees of the Congress.”
3. Department of Labor-Bureau of Employment Security, Limitation on Grants to States for Unemployment Compensation and Employment Service Administration : "* * * and of which $12,000,000 shall be available only to the