« PreviousContinue »
any combination of a variety of facilities--clinics, general hospitals, mental hospitals, remodeled space, or halfway houses.
The program of a community mental health center is designed primarily to provide an adequate range of services to meet the mental health needs of the community as a totality, irrespective of the type of building or facilities that are provided.
To provide all the services in a center which has none of them available, the center would need about 100 professional and technical personnel. The average center, however, already has some of the services, and needs about 50
professionals made up of psychiatrists, psychologists, social workers, nurses, rehabilitation and occupational therapists, and such technical personnel as technicians, dieticians, laboratory technicians, orderlies, et cetera.
At the conclusion of my testimony, Mr. Chairman, this report which Dr. Yolles, the Director of the National Institute of Mental Health, has made, will be appended. It gives you a full report on the program to date, including the number of centers that have been provided with grants, a full listing of all of those by States, and something about the goals and the ways that we went about developing this program. Dr. Yolles will later point out that so far to date we have funded 173 projects, 100 of them for construction, 47 for staffing, and 26 for both construction and staffing, and we hope by the end of this fiscal year to have funded 286. He will develop this further in his presentation.
The neighborhood community mental health centers being built and staffed with Federal assistance under the Community Mental Health Centers Act are providing care which will reduce both the severity and duration of disabilities resulting from mental illness. This goal is being achieved in communities across the Nation through an alliance of Federal, State, and local governments, professional groups, hospitals, and welfare agencies, both public and private. They are working more closely together than ever before on the basis of two principles: continuity of care for the patient, and partnership in responsibility on the part of all those who can help.
A center plan is inherently local; it must be designed by the community, which alone can assess its needs and resources. A center serving a large section of Harlem, for example, will have space and staff for treating narcotics addicts and special techniques for reaching disadvantaged people in emotional trouble. A center in western Kansas will face a number of different problems. There the problem is geographic accessibility of services, and establishing services on a scale which can be supported by a small and very scattered population. In a suburban California center, people may be able, in general, to pay for the services they need; but in a deprived Appalachian area, they may not. The centers may be located, as is one in Philadelphia, where a medical school has long prepared the way; or it may be located, as is one in Florida, where the local general hospital has never before had a psychiatric unit.
The point is this: there is not, and we do not intend that there shall be, a single, inflexible model for a community mental health center. Every one of these communities needs a center of its own design and making. This diversity makes the early success of the centers program, in my opinion, all
the more impressive.
Indeed, diversity has been reflected in the type of applicants receiving grants for both construction and staffing support. For example, over half of the sponsoring agencies have been private, nonprofit groups. Also, well over one-third of the center grants have been made to rural areas, that is, cities or towns serving 50,000 persons or less.
As of March 27, 1967, more than $54.5 million in Federal funds had been obligated to assist the construction of 126 centers. State, local, and private matching funds of $109 million brought the total to $163.5 million-$17.8 million has been obligated for 73 staffing grants under the 1965 legislation, an additional $16.5 million is available for fiscal 1967 and we anticipate the approval of another 58 staffing grants by July 1 of this year. In all, more than 173 communities in 43 States have provided the initial enthusiasm and the community support to establish community mental health centers under the existing legislation.
The authority for the construction grant program expires June 30 of this year. The legislation before the subcommittee would extend the construction grant program through fiscal year 1972, with an authorization of $50 million for fiscal 1968, and such sums as Congress may appropriate for succeeding years. The authority for staffing grants, which expires at the end of fiscal 1968, would also be extended by H.R. 6431. The bill would continue the staffing grant program in its present form for an additional 4 years, through fiscal 1972, with the authorization remaining at $30 million for fiscal 1968, and for such as Congress may appropriate for succeeding years.
The bill also makes two changes in the substantive provisions relating to mental health construction. First, it amends section 401(e) of the act to allow the acquisition of buildings, as well as new construction. This amendment would give a further measure of flexibility to the program; in many cases, the program may be able to move forward more quickly and economically, and to provide services closer to the people who need them, if suitable existing facilities can be acquired, and adapted where necessary, for use as part of a community mental health center. New construction would not be required in every case; this amendment would widen the possibilities for local initiative in designing center programs, and would help assure that all available resources will be brought into play.
Second, H.R. 6431 amends section 204 of the Act to require State plans for construction of community mental health centers to include provisions for enforcement of minimum standards of operation of the centers. This means that the State must show that it has considered and adopted measures which will secure compliance with its own standards. This could involve regular inspection, licensure or financial restrictions. A choice of an effective approach would be up to the State itself.
Mr. Chairman, to achieve the goal of making essential community mental health services available to as many people in our country as possible as soon as possible, continued Federal concern and support is essential. Our goal is to provide these services in every part of our Nation; but our enthusiasm is tempered with realism. Speed and quantity alone, without the careful development and utilization of sound professional and administ rative procedures are insufficient, and ultimately self-defeating. Our request for continuation of these programs and our plans for further implementation are based upon such realizations. We mean to build a program in which numbers and novelty will not replace soundness of purpose and design. A community mental health center can only rise from firm foundations: from systematic priorities in the allocation of resources; from convincing evidence that service will in fact reach the people for whom they are intended; from a certainty that care will be comprehensivethat the continuum of human needs will be met by a continuum of responsive services.
Mr. Chairman, I am here today to ask the support of the committee in continuing this approach, and to urge early action on H.R. 6131. The first communities ready to establish a center program on the basis of sound planning have sought and received Federal assistance. Neighboring communities have been carefully laying their own plans. The States have been helping them lay this groundwork for comprehensive mental health programs. Some will be ready to apply for Federal funds next year, and I believe many more in the years which follow. We ask that they be given the same opportunity which more than 173 communities have now had—to take local responsibility for mental health care.
Amendments dealing with mental health take up the first four sections of the bill, Mr. Chairman, and I would now like to go on to section 5 of the bill, dealing with project grants to Federal institutions. Federal hospitals are a valuable resource for training, research, and demonstration projects. They offer a diverse array of patients and treatment settings.
Section 5 of H.R. 6431 authorizes research, training, and demonstration grants to Public Health Service hospitals, Veterans' Administration hospitals, and to St. Elizabeths Hospital.
Actually, this merely confirms in substantive terms in the statute a policy that has existed in a limited way through “point of order” language since 1960.
In that year, "point of order” language made St. Elizabeths Hospital eligible for research training, or demonstration grants.
In 1963, the hospitals of the Public Health Service were also made eligible, along with the medical facilities of the Bureau of Prisons in the Department of Justice. The 1966 language in the appropriation act is as follows:
[Public Law 89–787] SEC. 204. Appropriations to the Public Health Service available for research grants pursuant to the Public Health Service Act shall also be available, on the same terms and conditions as apply to non-Federal institutions, for research grants to hospitals of the Service, the Bureau of Prisons, Department of Justice and to Saint Elizabeths Hospital.
We are now asking that this policy-which has demonstrated its value-be made statutory and that hospitals of the Veterans' Administration be included among those Federal institutions eligible for the same kinds of grants. The language makes very clear that grants must be awarded under the same terms and conditions that apply to non-Federal institutions.
Our reasons for requesting this lie partly in our experience and partly in our recognition of the research, training, and demonstration potential offered by Federal hospitals.
Since the original"point of order” authority in 1960, a wide range of projects has been carried on in Federal hospitals, from studies of specific behavioral problems to experiments in new treatment methods and drugs. The diversity of patient population and treatment conditions make Federal hospitals no less valuable than non-Federal institutions for such study and research purposes.
In addition, the Federal hospitals have attracted physicians and scientists with valuable research, training, or demonstration ideas. They should be given the same opportunity to apply for grants that a physician or scientist in non-Federal institutions now has.
To put it another way, this section of the bill is an invitation to the physicians and scientists in our Federal hospitals to compete on the same terms with their counterparts in non-Federal institutions for Public Health Service research, training, and demonstration grants.
I would now like to turn to section 6 of H.R. 6431, which would authorize the establishment of a contingency account in the Treasury, giving the Secretary of Health, Education, and Welfare what we believe is needed flexibility to act promptly in extraordinary situations.
In an enterprise of such scope and complexity as the Department of Health, Education, and Welfare, it is inevitable that opportunities to accelerate the achievement of program objectives in these three areas, as well as new problem areas will arise during the course of a fiscal year. As much as we try, these breakthroughs and emerging problems cannot always be anticipated during the preparation of the President's annual budgetary plan. In certain instances, the need is met through requesting congressional enactment of a supplemental appropriation. On other occasions, the critical nature of the situation demands immediate action through a realinement of already available resources.
Let me give you some illustrations:
An emergency situation occurred in fiscal year 1964, when outbreaks of botulism poisoning from fishery products focused public attention on this longstanding public health problem. This incident was the first time a significant outbreak involving commercially processed foods had occurred. Investigations disclosed a new type of botulism of alarming severity (22 cases, 9 deaths). At the same time, prevention of the so-called type E botulism from smoked fish and other nationally distributed products was hampered by inadequate information concerning such matters as sources of the organism in food products.
You can well imagine that the Congressmen and Senators from those districts that were affected, as well as the businessmen, were really quite concerned about this situation, and asked us for immediate action. Because of the urgency of the problem, adjustments had to be made to provide funding for emergency research and training activities. A total of $315,000 was allocated within existing appropriations for the award of research contracts and purchase of necessary research equipment to develop necessary control measures. The availabilitv, however, of a contingency fund would have made it unnecessary to reduce or discontinue other necessary health activities in order to carry out the emergency activity.
Another illustration: In March 1961, a chlorine-laden barge sank in the Mississippi River seven and a half miles below Natchez, Miss. To avert any possibility of endangering the public health, the President directed the Office of Emergency Planning to initiate and coordinate a broad-scale plan to insure safe removal of the barge and its cargo. Public Health Service was asked to assume responsibility for the public health and public information aspects of the project.
As part of this effort, the Division of Air Pollution rendered technical assistance by sending meteorological observers and chemists to the scene. Since no funds were available from the Office of Emergency Planning, $45,000 had to be diverted from other air pollution activities to support this emergency effort.
At any time there may be a breakthrough in any one of a number of targeted research and development programs in the whole field of health, education, and welfare. This could require the immediate availability of additional funds during the course of the fiscal year. If an effective German measles vaccine should be at the threshold, of development, we would certainly want to move as quickly as possible to move into the stage where there could be wide public use.
In the past, as in 1957, when there was a serious Asian flu epidemic in this country, the Division of Biologics Standards, National Institute of Health, worked for about 6 months assisting in the effort to get an effective vaccine on the market. This work, costing some $50,000, was done at the expense of the Division's regular activities related to the quality and safety of biological products coming within the jurisdiction of the Public Service.
In 1961, because of frequent polio outbreaks in local areas, large numbers of previously unvaccinated individuals were seeking polio vaccination. In such cases, however, it was usually too late for the Salk vaccine to be effective in combatting the epidemic. Accordingly, the Surgeon General's Advisory Committee on Poliomyelitis Control recommended that the Public Health Service maintain reserve stocks of oral poliomyelitis vaccine for use during epidemics. A supplemental appropriation of $1 million was required for the establishment of such an epidemic reserve.
We believe, particularly with the many new breakthroughs coming to our attention, that a new approach is required to cope with situations of this kind-an approach which affords the Secretary of Health, Education, and Welfare greater flexibility in the administration of a myriad of programs without at the same time infringing on the constitutional responsibilities of the Congress. The mechanics of our proposal, Mr. Chairman, are relatively simple.
A contingency account of indefinite duration would be created on the books of the Treasury with a monetary ceiling of not to exceed $50 million. Into this account would be deposited those amounts provided in any general fund appropriation of the Department which remain unused at the end of their period of availability. Prior to withdrawing money from this contingency account to supplement appropriated funds, the Secretary would be required to make a determination that
Such action was necessary to fulfill his responsibilities;
Delay pending further appropriations by the Congress would be contrary to the public interest;