This is what is called a day hospital. This big room here is for patient government. Incidentally, in order to economize and make the maximum use of these things, as you say, that gymnasium could be made into an auditorium.

This is the patient government room and here you pull this down and you have two group-therapy rooms. Each doctor and social worker has an office. The occupational therapists-all these people provide treatment and therefore must have facilities to provide it.

This is the occupational therapy area which we use in the day hospital as an ongoing therapy during the daytime. These patients come in at 9:30 in the morning and go home at about 4:30 in the afternoon. We don't keep them at night. They are back with their families where they belong in the evening and this helps us with the therapy.

In here is the kitchen. Here is the hairdressing facility for these patients because if they are here all day the girls can't get their hair fixed so we have facilities for it and also this is good therapy in the case of women.

Here is the out-patient area. These are the wonderful new things that we have. These are all treatment rooms, treatment for the patient. Here is the group therapy room using group therapy so we can treat eight patients where we used to treat one. Not only are the doctors doing group therapy but under the supervision of our doctors and psychiatrists the OT's are doing it.

In the Army during the war we developed the mental health worker. Here are our two mental health workers and we are trying to work out a situation where they can go out on calls-actually house-tohouse calls in case of emergency like suicides and things-so that we get right on the situation immediately.

Notice here that we have gotten away from any long corridors getting away from this look of a hospital when the outpatient comes in here and knows that there are people in this area.

The banks have done this. They have come out from behind their grills and we ought to. This has television caremas with videotapes so that we can train people. This hospital is built jointly in connection with the Central State Hospital at Norman which is affiliated with the University of Oklahoma School of Medicine.

I met with 15 of the professors from the University of Oklahoma because we are going to work with the different types of people; the gerontologist and so forth, and they can come out of their ivory

towers.

We took 40 of the honor students at the University of Oklahoma. Twenty of them stayed to the second year. Eight of them changed their courses and are going into the behavioral sciences.

They work together directly with patients.

Here is aftercare. This group doesn't go out and diagnose or work with an individual patient. They work with the judges and school systems and things like that so that this is a whole new day, a whole new area.

When I was in Arkansas in 1948, we had a clean up of their state hospital system and revised it and when I was in Texas in 1950 we were crying for this type of thing to be put in somewhere into the community, between the community and the hospital.

This building will start immediately. Its plans have been approved. as I said. It is a whole new area.

This last one shows the arrangement of these. This is the outpatient and the after-care. This is the day hospital here. That is occupational therapy.

Here is the recreational therapy, the lounge, and this is the emergency and in-patient service.

These things, as I said, were colored because they show the patient where he is. This is an ampitheatre. It is warm in Oklahoma a lot of the year so that we can have band concerts. This is a band shell in there. This is a whole new philosophy.

Incidentally, this is built about a half mile away on some ground that the hospital owns in proximity to the University of Oklahoma and to our hospital, the idea being that we can train people in this technique. So these are our plans and what we are going to do. On the back you can see the actual picture.

What have we done? Let me give you an example of the first month's operation. Normally, we would admit into our hospital from this district about 84 people. In the first month we have already admitted 123. Of these, 55 of them have gone into our out-patient division.

We have 28 out of the hospital and we have 23 remaining but these were ones that cumulated. We estimate that only about 10 percent of these that will come in will go into the state hospital.

Speaking about personnel as we were asked: Within the first month I have been able to put together a staff of 50 composed of two psychiatrists, two residents in psychiatry, young psychiatrists in training, one psychologist and we now have another one since I left.

We have 6 social workers, 3 registered nurses, 1 vocational counsellor, 2 occupational therapists, 3 recreational therapists, and 21 psychiatric aides.

In addition to this we have a training person and the other administrative people like personnel clerks and others needed for backup

services.

So that we now have within one month 51 people working. The question was asked what would it take to staff one of these. We propose to handle the 4,000 admissions that we estimate will come in here and probably will be nearer Dr. Ewalt's 6,000 eventually.

We estimate that that would take 8 psychiatrists, 6 residents in psychiatry, 4 psychologists, 2 psychological interns, 11 social workers and we are affiliated with the University of Oklahoma so that we would have about 10 student social workers, 16 registered nurses, and we are a training center for nurses so that we would have about 10 student nurses there, too.

We would have 2 vocational counsellors, 3 occupational therapists, 3 recreational therapists, 32 psychiatric aides, and in addition to that we would have the usual supportive services in administration.

We would actually have 146 people working, 87 professional and technical and 146 gross as against the 51 we now have.

The question was asked a while ago, what the States and the communities are doing. We presented the legislature our budget. Predominantly because this is going to be Oklahoma's teaching center and we hope here to train the cadres that will go out and supply the

professional personnel because the lay people are fine but this is a serious illness and somebody has to supervise them to make sure we are not going off on the wrong thing.

The budget presented was that the Federal Government the first year on the 75 percent match would give us $32,790 but the State would have to put up $678,974. Under our grant, we get $382,000 the next two, $92,000 the next, and $202,000 the next, and down to $44,000.

As that goes down the community and State share will have to go up. So these are the things that I thought you might be interested in. This is a going concern. I have been commissioner or assistant commissioner as the chairman is well aware in three States, in Arkansas, Texas, and Oklahoma.

Since 1948, I have been trying to see whether we couldn't get this thing going. Now that we have gotten it going, I think that it would be catastrophic to decrease in any way. In fact, I think it must be accelerated upward in order to meet the needs of these people.

Mr. Chairman, in Oklahoma we have them backed up now. We have done the footwork. We have gone out now and convinced people that this is the answer and people believe us and I am sure it is.

Now we can't say, "No, you can only have them over here and not over there. You can have one at Norman, Oklahoma. We will cover the lower third of Oklahoma County, Cleveland and McClain, but you can't have one in Osage County," and, incidentally, on that one we hope to take in a county in Kansas.

So

you can't stop now. We are in it too far.

Thank you.

Mr. JARMAN. Thank you gentlemen for an excellent presentation. Doctor Donohue what did you indicate as the target date for completion of your center?

Dr. DONOHUE. We are estimating 11 months for construction. Approximately a year from now we will have the opening. We didn't wait on this. We went ahead and took some of our State hospital area, dedicated it to this and broke it away from the State hospital and set up in business.

We could have done it downtown, but we had the buildings and the facilities and everything right there so that we just started there. Mr. JARMAN. Do I understand that with the progress you have already made on the staffing problem that you anticipate no real difficulty in fully staffing?

Dr. DONOHUE. It is not going to be a real gung ho thing. It is going to take a little time but we will do it. We are out 1 month and we are this far along. I don't see that it is going to be an extremely difficult thing.

We are having some difficulty getting residents in training because this calls for six residents in training even though we are getting more residents to go into training in psychiatry in this country they are just hard to come by but other than that I don't look for grave problems.

People are interested in going into these, Mr. Chairman.

Mr. JARMAN. As I understood your testimony, you now have nearly one-third of your staff selected?

Dr. DONOHUE. That is right.

Mr. JARMAN. Mr. Rogers?

Mr. ROGERS. Thank you, Mr. Chairman. I have been impressed by the testimony here. What is the cost of this facility?

Dr. DONOHUE. Of the actual facility? When we get it all constructed it is going to cost approximately $900,000 as our estimates.

are now.

Mr. ROGERS. And what would be the Federal contribution? Dr. DONOHUE. The Federal contribution in that is $531,000. Dr. GLASS. The figure on Federal proportion in Oklahoma is 59 percent.

Mr. ROGERS. All one figure?

Dr. GLASS. Yes.

Mr. ROGERS. In establishing the facility, are you, in effect, raiding any other facility?

Dr. DONOHUE. We are taking some out of the mental hospital moving over there but we can afford to do this because we are going to be handling that portion of their patients.

Mr. ROGERS. So that you don't feel that it is a case of pulling people out of another facility where they would leave a vacancy that they have to fill? They don't have to replace those personnel?

Dr. DONOHUE. We wouldn't dare do that because I happen to have them both under my control and if I did that, I would be in trouble on the other side.

I am watching that closely but we are getting them from the outside, Mr. Chairman, and Mr. Rogers.

I think this is going to be a lot easier to staff than the State hospitals. People like to work there and these are going to be "in the community."

Mr. ROGERS. This is what I wondered about, some of these programs, for instance, some of the veterans hospitals. I think their pay scale may not match some of the suggested pay scales in this program and this may vary from State to State. I wonder what the impact will be, for instance, on the veterans hospital with their psychiatric program.

Dr. DONOHUE. I pay more than they do and I can't raid them right now because they have a lot of hidden benefits that we don't have in the state services. They have retirement programs and things so that you have to add this altogether.

Then, Mr. Rogers, I think there is another thing. This psychiatrist and other personnel who like to work in Federal and State, they pretty well stay in their own categories.

In the State service we move around much more than they do in the Federal.

Mr. ROGERS. Are your services paid for?

Dr. DONOHUE. If we can collect. I think this is a wonderful thing. We have never in the State of Oklahoma ever forced anybody. If they could under the law, I have to collect it and this would be the same here.

Mr. ROGERS. Let me ask you this question, and I may want to branch out to others, too. As to the theory, of course, of separating even here the Institute of Mental Health into a separate bureau and now talking

about building mental health facilities separate and apart from regular hospital overall care, is this a good trend over the long run, or don't you think eventually we are going to have to put all of the physical as well as mental care in the overall approach?

Dr. GLASS. What do you mean by long run? Do you mean a time frame of 1980 or something like this?

We do know that the facilities for the physical care are now located and pretty well set. We do know that a number of these general hospitals will elaborate community mental health centers as part of their activities and this is indeed going on now, as you know.

However, the problem is mental health can't wait for this. We need to get centers in now. It may well be that in time they may locate, but I want to point out that you don't have to have them actually together.

You can have an umbrella of services in the need to do is have a free passage of patients. tinuity of care, just as we have in the center. all phases of the center under one roof.

same area and all you The word here is conYou don't have to have

You can have the outpatient clinic in one place and the inpatient five miles away, so that we are not concerned with putting them altogether now.

Mr. ROGERS. What I want to know is this: From what I have observed, there seems to be a tendency to make a direct separation of the treatment of mental problems from physical problems.

I just wonder if some efforts should be given to tie the two together, but I would think that some of the physical patients have mental problems along with their physical difficulties because of the physical problem they have.

This doesn't seem to be the approach there and I was wondering if our philosophy is right here. Perhaps this program in itself is throwing us away from bringing comprehensive health care to the community.

Dr. WINSTON. May I comment?

Mr. ROGERS. Yes.

Dr. WINSTON. Of the three approved in Tennessee, two are in connection with general hospitals.

Mr. ROGERS. Do you think this probably is the approach that wẹ should take, to require this program to be put in with general hospitals?

Dr. WINSTON. Of course, some general hospitals do not have the space and cannot expand.

Mr. ROGERS. You are going to build a mental health center. If you are building for them is it advisable to build them with the general hospitals or isn't it?

Dr. WINSTON. It is not inadvisable. I think it is optional. Mr. ROGERS. Which is more advisable from your experience? Dr. WINSTON. Again, I don't have any experience because we haven't had any of these built yet. I think there would be testimony to both sides. I think keeping it in the medical stream is healthy, but in other ways it is crippling, too.

Mr. ROGERS. You said your staffing needs for a population of 75,000 has shown that you don't have to follow the old pattern that we had previously.