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Mr. KELLY. I think that we could have gained from the availability of the 4 months in launching the exploitation of this finding. It turned out to be a long-range investigation that has resulted from this finding including the development of new facilities which had never been developed before.

Mr. Brown. But with this kind of early commitment by Congress, in other words, this willingness to take testimony in advance of the actual presentation of the request for funds and so forth, isn't it true that you can also

go ahead and begin to presume your plans and frequently do perhaps up to the point where you take the legal steps to put them into effect; in other words, sign a contract or in effect commit yourselves?

This is what I am trying to find out. How important is it that the cash be on hand, and how important is it that we presume that the Congress is going to act fast enough?

Mr. KELLY. I think your point is well taken and necessarily, in order to carry out any amount of work, you have to do some planning.

The very presentation of a budget constitutes this planning, that you have identified the problem, how you will approach the problem and what the next steps are; but by and large, this is the planning which was done prior to being able to present the estimate and prior to being able to present testimony with respect to it so that this loss of time is really occurring to a marked degree after this initial preliminary planning has been done.

Don't misunderstand. You know, and I know, that we do divert staff resources to try and get as far along as we can in moving down the road. I thing that we have had examples in the past that indicate the extent to which a greater degree of flexibility would have been useful.

I think that you can foresee this problem occurring in the future that makes this an important piece of flexibility for the Secretary. We are not asking, however, in any sense as I see it for a blank check.

One, we are asking for the legislative committees to authorize the use of a contingency fund. We are asking for the appropriations committees to then implement that provision and tell us each year that we are authorized to use it and the extent that we can use it.

We are suggesing that we give to the Congress a report 10 days in advance of its use of our intention to use it and an annual report on our use of the fund.

Mr. JARMAN. The Chair hates to interrupt, because this is an important and, perhaps, maybe a controversial part of the bill before us, but I might point out that we do hope to finish with this part of the hearing by 12 o'clock this morning, since we have a full agenda of witnesses for tomorrow. If that deadline can be kept in mind with several other members of the committee yet to ask questions, the Chair would appreciate it.

Perhaps this matter can be developed more completely from the Secretary and Mr. Kelly, and others, in the materials which you submit to the committee.


Mr. KELLY. We would be glad to submit data on the time lag involved in receiving supplemental appropriations.

(The information follows:)

Chronological history of Department of Health, Education, and Welfare supplemental

appropriations, fiscal years 1962-67

[In thousands of dollars

[blocks in formation]

Recently, I received a letter from Dr. Vail, of Minnesota, dealing with the question of flexibility in the program and here is what he said:

I would bring you up to date on some of the problems we are having in implementing the Federal provisions at the state level, at least here in Minnesota.

The simplest way to do this, it seems to me, is to send you copies of the letters that I have written to Senator McCarthy and Representative Rogers, together with the stock answer received from the Department of Health, Education, and Welfare.

There is nothing to add to this point. I think our quarrel is not with the theory of the Federal concept of community mental health centers, but with the administratives practice, especially the requirement to prepare cumbersome plans for mental health centers in addition to the regular mental health plan which we write each year in order to qualify.

Generally, I would have to say that I favor the categorization of the welcoming of the correction of one comprehensive plan to the state of mental health programs that would require one plan for the entirety of the state mental health program.

I recall a meeting at the White House a couple of years ago in which it was the declared intention of HEW to move in the direction of giving the State more flexibility in the use of the funds. In some of these community health centers the facilities are there, and the staffing problem is more important than the bricks and mortar. In other cases the opposite is true.

I wonder if you wish to comment on this particular complaint !

Mr. COHEN. Yes. Let me make a brief statement and then I will ask Dr. Yolles to talk about it.

I also received a letter from Dr. Vail and I suppose I gave him what he refers to as a “stock answer. But I do wish to say that at the time I received his letter, I immediately communicated with Dr. Yolles, who is in charge of this program, to study the points that Dr. Vail made.

I established, at least to my own satisfaction, though perhaps not to Dr. Vail's, that we were trying to do two things that make it very difficult to carry out what Dr. Vail had proposed.

On the one hand, it is the professed objective both of the President and the Department, to give the States and the localities a greater degree of discretion in the use of Federal funds. But at the same time both the substantive committee-(this committee)—and the Appropriations Committee hold us responsible for making an account of our stewardship in terms of what the money was appropriated for. Many of the so-called provisions and restrictions or requirements in the submittal of information, particularly those of which Dr. Vail has sometimes been critical are an attempt to be able to supply the substantive committee and the Appropriations Committee with all the information that they think is necessary to assure that Federal funds have been spent for the purpose for which they were appropriated. That requires us to collect a good deal of information to assure ourselves that the money has not been misspent, that is, misspent in the sense of not having been directed toward the primary purpose for which Congress appropriated the money.

I do think that there is a basis for giving the States more flexibility in programs once the program has been started. You will recall, for example, that we came in here 4 or 5 years ago requesting that the

States be given greater flexibility in the Hill-Burton program for modernization.

The committee very seriously restricted our ability to give the States that flexibility because they said, “We want to see this primary objective retained." I would say, Mr. Nelsen, that while the objective is sound, I think that also our administrators feel that we must be very carefully responsive to the congressional will. We want to be sure that we can account for the money in terms of the authorization that Congress has given us.

Perhaps Dr. Yolles would like to amplify on that in terms of Dr. Vail's points.

Dr. ÎOLLES. I would like to comment briefly, Mr. Nelsen.

I might say that I have commented on this point before regarding Dr. Vail. Dr. Vail's principal concern is with the “minutiae” as he calls them, of the State plan which must be submitted.

There are certain requirements in Public Law 88–164 which I consider to be very wise provisions of the Congress.

Before one sets up a program, especially in a field like mental health where there is such a tremendous need for services throughout the United States, the State must take into account which of its own areas have the greatest need. It needs to divide the State into areas which set forth the relative need for services.

It must also provide in the State plan an inventory of resources and services that presently exist so that these can be built into and not be duplicated by the new service to be rendered. It is this type of requirement which is in the law that Dr. Vail objects to.

Perhaps my last point is not entirely germane. However, it is that Dr. Vail has been the most outspoken objector to this requirement for providing such information and yet he was the first to submit a State plan in excellent form.

Mr. NELSEN. I appreciate the problem you face and might also mention that obviously, you are moving in the direction of attempting to provide for greater flexibility which I think is the direction in which all of us would like to move.

At the same time, I understand your concern. Getting to section 401(e) of the bill, this, of course, will also provide for the mental retardation centers; would it not?

Dr. YOLLES. Section 401(e) provides for altering the definition of the term of construction to allow for the acquisition of existing buildings.

Mr. NELSEN. Yes. Getting back to my problem of mental retardation day care centers and training centers, this has been an obvious area where attention is needed.

Out in my district we have under the poverty program one day care center and staffing is a tremendous problem. We have another one, using the little school building that I have talked about so many times, now under operation largely through voluntary subscription.

As far as acquisition of buildings is concerned, this seems to be the lesser of the problems. We find many hospital buildings that are vacated because they need new and larger facilities.

We find many school buildings vacated, very good centers with playgrounds and what-have-you. Looking to the future, is there a

possibility that we may be able to move not in the area of spending money on acquisition but more with the idea that we can give some help to staffing? Certainly there is a very, very crying need in many of our communities.

I believe other legislation may touch on that.

Dr. STEWART. Yes, Mr. Nelsen, there is legislation before the Congress for consideration of the staffing of the mental retardation centers, modeled very much like the initial staffing in the mental health centers.

In the amendment of section 401(e) by inserting the word "acquisition” after "new buildings," it would apply to both the mental retardation and the mental health legislation.

Mr. NELSEN. Now, in your statement, on page 9, you say that H.R. 6431 “would continue the staffing grant program in its present form for an additional 4 years."

In this staffing grant program you presently have, would money be available to a day care center, a mental retardation day care center?

Dr. STEWART. No; this money is for the staffing of the comprehensive mental health centers. There is other legislation before the Congress which proposes the staffing of mental retardation centers.

Mr. NELSEN. Thank you.

And the money that was spent on the Tacoma and Minneapolis centers was not in bricks and mortar but more altogether in staffing, almost altogether in staffing?

Dr. YOLLES. A good part of it.
Mr. NELSEN. Thank you.
I have no more questions, Mr. Chairman.

Mr. JARMAN. The chairman of our full committee is with us this morning and I would like at this time to call on the chairman.

Mr. STAGGERS. Thank you, Mr. Chairman. I would like to ask Mr. Cohen just one or two questions because I don't want to take up the time of the committee.

What is the National Institute of Mental Health doing to improve the care available to patients in the existing State mental hospitals?

Dr. YOLLES. Mr. Staggers, as you may recall, at the time that the socalled new national mental health program was devised in 1963 as a complement to the Community Mental Health Centers Act, we made funds available for demonstrations of improved care and treatment of the mentally ill in hospitals.

This was a grant program available to all institutions for the mentally ill and mentally retarded in the United States. Each could apply on a competition basis for a grant of $100,000 each year for a period of 10 years to improve care and treatment.

These grants have resulted in some of the most interesting and constructive types of treatment programs and have aided in the release of many thousands of patients from mental hospitals. This is an interim program until the community mental health centers can take over the burden of the treatment of the mentally ill.

Mr. STAGGERS. Are there any of the States that do not have an approved plan for community health centers?

Dr. YOLLES. At the present time there is only one State that does not have an approved plan but we expect that before the fiscal year is out that that plan will have been approved.

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