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Centers funded by State and locality as of Mar. 1, 1967-Continued

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Mr. Cohen. I would like now to permit Dr. Yolles to present the brief chart presentation on the mental health centers program.

Dr. YOLLES. Mr. Chairman, I would like to start by pointing out the status of patients in our mental hospitals around the country.

There are 289 mental hospitals in the country today. We have a very happy situation to report, in that over the past 11 years there has been a decreasing rate of patients resident in the mental hospitals at the close of each year. The numbers have been coming down in the hospitals, and this in the face of a very slowly rising rate of admissions to the hospitals. (See fig. 1, below.)

PATIENTS IN STATE AND LOCAL MENTAL HOSPITALS

STATE AND LOCAL GOVERNMENT MENTAL HOSPITALS ADMISSIONS AND RESIDENT
PATIENTS-RATES PER 100,000 POPULATION

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There are more admissions per year, but in the face of increasing admissions, there is still a declining rate of resident patients at the end of the year.

Mr. Brown. It is 226 per 100,000?
Dr. YOLLES. It is about 226 now.
Mr. ROGERS. In the hospitals?

Dr. YOLLES. Yes, in State and county hospitals in the United States.

Mr. ROGERS. 226 per 100,000 ?

Dr. YOLLES. Yes. Here are the actual numbers. This table (fig. 2) is in terms of numbers, rather than rates. From 1946 to 1955—and preceding that, you will note that there was an increasing rate of patients remaining in mental hospitals. Now this is a continuation of that rate projected to the present time.

If that rate had continued, we would have 702,000 patients in mental hospitals in the United States today. In 1955 a break in that upward trend occurred, due to a number of factors. Perhaps the principal factor involved was the introduction of the psychoactive drugs, but there are other factors. The actual numbers of patients remaining in hospitals at the end of 1955 started to come down.

You will note that the rate of decrease is much more rapid in the last few years. This is the result of the introduction of inpatient services in general hospitals, and the introduction of more community mental health approaches. We have over 1,000 general hospitals in the United States today that now accept mental patients who did not accept them before. The introduction of those services has caused the decrease in resident patients.

For this year, we are happy to report that the largest single decrease in the 11- or 12-year period involved an average per year rate decrease PROJECTED AND ACTUAL NUMBERS OF RESIDENT PATIENTS END OF YEAR, IN STATE AND COUNTY MENTAL HOSPITALS - UNITED STATES -1946-1966

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452,329

400 YEAR 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

FIGURE 2.

of 4.9 percent, and a decrease between the 2 corresponding months of December 1965 and 1966 of 7.2 percent. This is a very significant decrease. Mr. RogFRs. What year was the turning point? Dr. YollFs. 1955. Mr. Rogers. Thank you. Dr. Yolles. There is one other point. There has been a decrease from the projected number of 702,000 patients to 452,000. In terms of dollars to the State and local governments, this amounts to $4.4 billion of expenditures, both for cumulative cost of care of the patients over these years, as well as the capital improvements, that would have been built to take care of them. Those funds were used for other purposes during these years, and not used for mental hospitals. I would like now to present three examples of community mental health centers that have been funded under this program. The first of these is purely a construction grant, the second purely a staffing grant, and the last is a combination of both. This construction grant was awarded to the Swedish-Saint Barnabas Community W.o.o. Center. (See fig. 3.) Actually the joint applicants were the Saint Barnabas Hospital and the Swedish Hospital in Minneapolis, across the street from each other. These two hospitals joined to provide community mental health services. They closed off the street and plan to construct the community mental health center between them, uniting the two hospitals. This new structure will provide to central Minneapolis, which has a population of 200,000, all of these services which were not available to this population before except in fragmented or partial form. They will provide outpatient, inpatient, day and night or transitional services, consultation and education services to schools, courts, welfare departments, and other agencies as well. In addition, the St. Barnabas hospital and the Swedish hospital will provide emergency services to this total community and by contractual arrangement with private physicians, some patients will be given outpatient care. Further, through a backup arrangement, to be sure that they can serve all of the people in the community when demand is heavy; there is a backup service with the county general hospital to provide outpatient and inpatient services. The Federal share on this project was $828,000. The total, including local and private financing, was $1,700,000. This project was approved June 27, 1966, and the ground-breaking ceremony was July 10, 1966. The second example is of a pure staffing grant. This is the Tacoma Mental Health Center in Tacoma, Wash. (See fig. 4.) Prior to the award of this grant, there were some five agencies delivering mental health services within the city and counties surrounding Tacoma, Wash. None of these provided a total service. No total service was available to the city of Tacoma. By joining together these five agencies to set up the Tacoma Mental Health Center, a total program .# services was devised. This is what Mr. Cohen referred to as a program of services with these agencies joining together to provide total services to the city of Tacoma, with a population of 153,000.

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SWEDISH-ST. BARNABAS COMMUNITY MENTAL HEALTH CENTER

MINNEAPOLIS, MINNESOTA

FIGURE 3,

TACOMA MENTAL HEALTH CENTER TACOMA, WASHINGTON

FEDERAL SHARE $78,264 STATE AND LOCAL FUNDS (12 MOS $180,642

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