(4) Section 204 of the Act would be amended to require that-effective July 1, 1969-State plans for the construction grant program shall provide for enforcement of State minimum standards for the operation of such mental health facilities. In addition to these mental health amendments, the bill includes two other provisions of more general applicability: (1) Section 5 of the bill would add a new section 507 to the Public Health Service Act which would provide continuing (and somewhat expanded) authority for certain Public Health Service project grants which have heretofore been permitted under provisions of annual appropriations acts. The new section would provide that appropriations to the Public Health Service for research, training, or demonstration project grants shall be available, on the same terms and conditions as apply to non-Federal institutions, for grants for the same purpose to hospitals of the Service, of the Veterans' Administration, or of the Bureau of Prisons, Department of Justice, and to Saint Elizabeths Hospital. (2) Section 6 of the bill would establish in the Treasury of the United States a contingency account available to the Secretary of Health, Education, and Welfare to meet certain unforeseen needs relating to the program responsibilities of the Department. No new appropriations would be authorized for this purpose, since funds in the account would be accumulated through the transfer of unobligated general funds appropriated to the Department in annual appropriation acts. Both the accumulation of funds in the account and their expenditure to meet contingency needs would be subject to certain statutory limits and conditions, including a limitation to authorizations contained in annual appropriations acts. Full reports to Congress would be required. The provisions of H.R. 6431 embody legislative recommendations contained in a draft bill submitted by this Department to the Congress on February 28, 1967, to implement the mental health recommendations contained in the President's Message on Education and Health. We strongly recommend early enactment of the bill. We are advised by the Bureau of the Budget that enactment of this proposed legislation would be in accord with the program of the President. Sincerely, WILBUR J. COHEN, Under Secretary. OFFICE OF THE ATTORNEY GENERAL, Washington, D.C., April 5, 1567. Hon. HARLEY O. STAGGERS, Chairman, Committee on Interstate and Foreign Commerce DEAR MR. CHAIRMAN: This is in response to your request for the views of the Department of Justice on H.R. 6431, the "Menatl Health Amendments of 1967." The Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963, 77 Stat. 284, as amended, 42 U.S.C. 2661, authorizes the Secretary of Health, Education and Welfare to make grants to the States for construction of facilities for the mentally retarded and of community mental health centers. In addition, the Act authorizes grants for university-affiliated facilities for the mentally retarded and initial staffing grants for community mental health centers. The "Mental Health Amendments of 1967" would extend the appropriation authorization for the Community Mental Health Centers program from 1967 until 1972. Similarly, the program of staffing grants for Community Mental Health Centers would be extended from 1968 until 1972. The definition of "construction" in section 401 of the Act (42 U.S.C. 2691) would be amended to include acquisition of existing buildings and the Community Mental Health Centers program would be amended to require that, after July 1, 1969. States enforce minimum maintenance and operations standards for centers constructed with grant funds. H.R. 6431 would also amend the Public Health Service Act, 58 Stat. 682, as amended, 42 U.S.C. 201 et seq., to make research, training and demonstration project grants under that act available to various federal hospitals. H.R. 6431 would establish in the Treasury a contingency account for the Department of Health, Education and Welfare, limited to a total of $50,000,000. Unobligated appropriations of that Department would be deposited in the account and the Secretary of Health, Education and Welfare would be authorized to draw on the account whenever he determines: that such action is necessary to fulfill his responsibilities; that delay pending further appropriations would be contrary to the public interest; that the withdrawal is required to carry out a significant purpose; and that the need for such withdrawal could not reasonably have been anticipated at the time of the Budget submission. Individual withdrawals in excess of $15,000,000 in any one fiscal year would not be permitted, and no withdrawal could be made if Congress had refused to appropriate requested funds for the particular purpose or if withdrawals for the same purpose had been made in the two preceding years. Prior notice of withdrawals would be made to the Appropriations Committee and annual reports on the contingency account would be made to Congress. The Department of Justice recommends enactment of this legislation. The Bureau of the Budget has advised that there is no objection to the submission of this report from the standpoint of the President's program. Sincerely, RAMSEY CLARK, Attorney General. OFFICE OF THE ADMINISTRATOR OF VETERANS AFFAIRS, Hon. HARLEY O. STAGGERS, VETERANS' ADMINISTRATION, Washington, D.C., April 6, 1967. Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: We are pleased to furnish the following comments in response to your request for a report by the Veterans Administration on H.R. 6431, 90th Congress. The stated purpose of the bill is "To amend the public health laws relating to mental health to extend, expand, and improve them, and for other purposes." Section 5 of the bill is of direct interest to the Veterans Administration and our comments refer to that section. Section 5 would amend title V of the Public Health Service Act, effective July 1, 1968, by adding after section 506 the following new section: "GRANTS TO FEDERAL INSTITUTIONS "SEC. 507. Appropriations to the Public Health Service available for research, training, or demonstration project grants pursuant to this Act shall also be available, on the same terms and conditions as apply to non-Federal institutions, for grants for the same purpose to hospitals of the Service, of the Veterans' Administration, or of the Bureau of Prisons, Department of Justice, and to Saint Elizabeths Hospital." We understand that this section was developed and proposed by the Department of Health, Education, and Welfare to overcome a problem that became apparent after passage of Public Law 89-239, enacted October 6, 1965. This law authorized through the new title IX of the Public Health Service Act grants to be made from the Public Health Service appropriations for establishment and operation of cooperative regional medical programs designed to aid in research and transmission of new knowledge and technology on heart disease, cancer, stroke, and related diseases from the Nation's medical centers to the community hospitals. The grant provisions in title IX include "public . . . institutions and agencies" but this has not been considered by the administering department as broad enough in this context to include Federal facilities such as VA hospitals. It seems to us that to assure the effectiveness of the Regional Medical Program the same treatment should be accorded to Federal hospitals in providing grants for purposes directed to the health needs of the Nation as a whole as is afforded all other hospitals. The current exclusion of Federal hospitals works to the disadvantage of both the hospitals and various regions for it prevents an important segment of the national medical care system from fully and effectively participating in planning the regional programs at the formative stage. This is contrary to one of the major objectives of the Regional Medical Program, namely, to foster unified planning and utilization of regional resources. Under the bill the Public Health Service grants could also be made directly to VA hospitals for research and related activities apart from the Regional Medi cal Program. Generally, the VA has not been able to participate directly in such grants under existing laws. The Public Health Service has been making grants to Medical Schools or Universities affiliated with the Veterans Administration which in turn use the funds to support projects conducted by VA researchers who are also affiliated with the school or university. Enactment of this legislation would permit VA hospitals to deal directly with the Public Health Service rather than having to rely upon the indirect arrangements now followed. It is apparent to the Veterans Administration that cooperative efforts with HEW in research and related programs are mutually beneficial to both. addition to the obvious benefits resulting from coordination and more effective assignment of talent, the projects should receive greater recognition when supported by the prestige of both the VA and the Department of Health, Education, and Welfare. It seems entirely proper that the Veterans Administration's program in the area should be assisted by Public Health Service grants since our research and training activities make a large and continuing contribution toward meeting the health needs of the Nation. The importance of this proposal is emphasized by the recent action of the Congress in enacting Public Law 89-785 directly concerning the medical program of the Veterans Administration. Among other provisions, that law (38 U.S.C. 5054) authorized the Administrator to enter into agreements with medical schools, hospitals, research centers, and professional medical personnel for the free exchange of medical information and techniques. It also authorized grants to medical schools, hospitals, and research centers to support pilot programs for effectuating the arrangement for the exchange of medical information (38 U.S.C. 5055). Finally, this new law specifically directed that the Administrator and the Secretary of Health, Education, and Welfare "shall, to the maximum extent practicable, coordinate programs carried out under this subchapter and programs carried out under title IX of the Public Health Service Act." For the reasons stated, I strongly recommend favorable consideration of H. R. 6431 by your Committee. We are advised by the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the Administration's program. Sincerely, W. J. DRIVER, Administrator. Mr. JARMAN. We will start today's hearing with the statements of two of our colleagues, the Honorable Edward Patten, of New Jersey, and the Honorable Lee Hamilton, of Indiana. You may proceed as you wish, Mr. Patten. STATEMENT OF HON. EDWARD J. PATTEN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY Mr. PATTEN. Mr. Chairman, and members of the House Interstate and Foreign Commerce Committee, on February 5, 1963, John F. Kennedy became the first President to send a message on mental health to the Congress. He pointed out the challenge: that mental illness and retardation are "of critical size and impact." We heeded that challenge and passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963-and improved it in 1965. And in his message on education and health on February 28, of this year, President Johnson noted that "more community mental health centers are needed, and we must strengthen and expand existing services." This is another challenge we must meet and defeat. There have been notable achievements under this historic program: As of February 1, 1967, 147 community mental health centers have received Federal grants of $54.3 million $36.5 million in construction grants and $17.8 million in staffing awards. In the State of New Jersey, Newark has received a Federal grant of $1,504,924 for a community mental health center. Middlesex County, N. J., has applied for a Federal grant of $122,500 for the $350,000 Raritan Bay Community Mental Health Center in Perth Amboy. Other areas in the State have also applied and when I think of the valuable financial help this program will provide, it makes me particularly proud of the Congress that passed it. For years it was obvious that community mental health centers should be provided, but it took the 88th Congress and its successorthe great 89th-to convert hope to victory-and then, accomplishment. Federal construction grants ranging from one-third to two-thirds are provided. And Federal grants are provided for staffing the centers-as high as 75 percent for the first 12 months, to 30 percent for the fifth stage. When I was mayor of Perth Amboy, county clerk of Middlesex, and New Jersey secretary of state, I was greatly moved-and always will be-to see so many persons suffering from mental illness and retardation and not be treated effectively, either because of insufficient facilities, or obsolete and ineffective methods. One of the most important features of the community mental health center concept is that patients are treated close to their homes, thereby improving their morale and spirit, for as all of us know, love is the best "medicine" of all. In fact, I was informed that some persons who suffer from some forms of mental illness work during the day and are treated at night at some centers. Yes, significant progress has been made in these fields, but moremuch more—must be made before we can honestly say that we have conquered mental illness and retardation. So I strongly urge this committee to report the bill introduced by the able and respected chairman-the Honorable Harley O. StaggersH.R. 6431 and continue the attack against mental illness and retardation. By approving this bill, public health laws relating to mental health would not only be extended (5 years for construction and 4 years for staffing) and expanded, but improved. One of the most important improvements, for instance, would enable existing buildings to be acquired, instead of building only new units. This would considerably reduce the time required to provide a center, as well as decreasing the cost. Another improvement would establish a contingency account without a fiscal year limitation, increasing the efficiency and effectiveness of the programs. The proposal also includes other improvements. I voted for the 1963 act with deep happiness, because I knew it would help so many people and I voted for the 1965 amendments. I am also looking forward to voting for the Mental Health Amendments of 1967. Let us show the afflicted, our people, and even the free world our Nation leads, that compassion is not merely a word we speak-but a conviction we practice. Mr. JARMAN. Are there any questions? If not, we thank you for your testimony, Mr. Patten. Mr. PATTEN. Thank you for the opportunity, Mr. Chairman. Mr. JARMAN. We will hear next from Mr. Hamilton. STATEMENT OF HON. LEE H. HAMILTON, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF INDIANA Mr. HAMILTON. Mr. Chairman, I am pleased to testify in support of H.R. 6431 before this distinguished Subcommittee on Public Health and Welfare which in recent years has led the Congress in historic legislative breakthroughs to assist in the treatment of mental disorders. This committee is well aware of the enormous tragedy, personal and social, brought about by mental disorders. Mental illness afflicts about one out of every 10 persons in this country. It is often a significant factor in criminal behavior, delinquency, suicides, alcoholism, narcotics addiction, divorce, and accidents. The overall cost of mental health has been estimated to exceed $5 billion. The personal tragedy that attends each instance of mental illness is the highest cost of all. Americans spend more for chewing gum than for psychiatric research to get Americans out of mental hospitals. One out of every two hospital beds in the United States is occupied by mental patients. State mental hospitals are often overcrowded. There are more people in hospitals for mental illness than for polio, cancer, heart disease, tuberculosis, and all other diseases combined. Not a single community in this country provides an acceptable standard of service for mentally ill or retarded children. The Mental Health Centers Act, authored by this committee, has begun to meet the challenge of mental health in a most heartening way by providing for mental health centers. As a result of the Mental Health Centers Act, a trend has been initiated in the treatment of mental illness to move away from the State hospitals and toward an emphasis on the community-directed mental health center. In 1965 almost two in every three patients were not hospitalized. They received either private office psychiatric care or were treated in one of the 2,000 mental health clinics in the United States. The need for comprehensive community mental health centers is abundantly clear. The mental health center is a multiservice facility. It can provide easily accessible services for the early diagnosis and treatment of mental disorders, both on an inpatient and outpatient basis, and a resource for continued treatment for individuals returning to their home communities following periods of extended hospitalization. Services and training are made available to help restore a patient to his fullest mental, physical, social, and vocational abilities. Such mental health centers serve as a central focus for mental health services to the total community population. The Indiana State Department of Mental Health strongly supports H.R. 6431, as does the Indiana State Mental Health Association. I am persuaded that the enactment of H.R. 6431 can mean the difference between providing comprehensive care and service at the earliest practicable date to those afflicted with mental illness, and an indefinite delay in meeting these needs. The State of Indiana, prompted by the Federal legislation, has now begun to move aggressively into a comprehensive community mental health program. By June 30, 1967, Indiana should have five approved mental health centers, and at least three more applications are planned to be submitted during fiscal year, 1968. The presently approved center projects will need help in procuring staffing funds in the future. It is |