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Dr. Yolles. The staffing grant provided funds for the initial partial support of professional and technical personnel for emergency services, day and night services, inpatient services, as well as consultation and educational services. The totality of services provided by the stimulus of this grant was far greater. We have inpatient care being rendered to this total population, as well as for children and adults by the Western State Hospital. We have inpatient services rendered by the St. Joseph Hospital. We have child guidance services available to the total population.

The Department of Public Health has cooperated in providing aftercare services, and the community mental health clinic is now providing consultation and education services to the community, as well as outpatient services.

The Federal share on this project was $78,000 to provide 75 percent of the cost of initial staffing in the first year for St. Joseph Hospital, and the community health center. The others have provided their services without the aid of the Federal grant.

Mr. ROGERS. Mr. Chairman, may I ask a question there for a moment?

It is my understanding that when we passed this bill the concept was to put it all in one building, a community mental health center; to put all five services in one center. It appears that this is not the way you are administering the act. I thought the intention was to require that the services, all five services, be given in one area. I don't know how far it is between these hospitals. Does a person have to go across town? How do they know where to go for which service, and so forth?

Dr. YoLLES. The original intention was to have a single building which would have all of the services as well as for a number of individual services to join together to form a center. The act also calls for agreement by contract to show that the center will render all sery. ices to the individual.

The center itself will have a basie or central location in terms of a headquarters operation where patients can be referred. All of the units must be easily accessible to the patient and fairly close together. They may be in different parts of town. However, a patient who is in an inpatient service, and the stage of his illness now suggests that he be in outpatient service, can be moved without any redtape to the outpatient services that are available because of this contractual arrangement between these services. He can move easily and freely, and his records can move as well.

Mr. Rogers. If this can be arranged, then, anyone could do this with existing facilities and there is not much need for construction.

Dr. YOLLES. Some communities have a very definite need for appropriate facilities in which to house these services. A good example of this was in one of the counties in Florida, in your own State, where no services at all were available in a group of counties--no mental health services at all. The hospital had no inpatient psychiatric services. They have asked for and are receiving a construction grant to construct an inpatient psychiatric service. In addition, however, they have joined with other agencies in other communities to provide a totality of services over and above the inpatient services, which may be the only part constructed.

Mr. ROGERS. All right. Thank you.

Mr. COHEN. Might I add-because Mr. Rogers raised quite a fundamental question, and that is why I dealt with it in my testimony—that there was some discussion and perhaps some misunderstanding that the program was sort of a brick-and-mortar program, solely. Of course, the 1963 act authorized construction, and then the 1965 act authorized the staffing grants, but I think the main thrust that we tried to make in 1963, and that we are trying to make now, is that the comprehensive services ought to be available to the people. And if that takes construction, that is desirable. If it takes staffing, that is desirable. And if it takes both of them, of course, they would both be authorized by the law. But I think our concept is a much more flexible one, to adapt the center to the needs of the community.

If a community doesn't need construction but merely needs to broaden the scope of its services, then the staffing money would be available to the community without the construction money.

Mr. ROGERS. I think this is fine because this would cut a lot of construction money that would have to go in. I agree that this is logical but I am not sure that this has been gotten across to communities that are applying beeause I think many of them feel that all five services must be located in one central area. So you perhaps are getting applications to build because they don't have all of the facilities in one place which, if it were known, many areas might come in to qualify to provide the services that we are concerned with but presently don't think they can because of this concept that the legislation originally held of bringing them all in one central location.

I would hope that perhaps you could make this very clear in some informational bulletins perhaps to the States and societies that might be involved because I think there is a misconception in many areas that there they just can't qualify simply by tying some of their hospitals together.

Dr. YOLLES. We are attempting to do that through informational material as well as consultation through our regional offices.

Mr. ROGERS. I think this could be very helpful.

Dr. YOLLES. The last is the Muskingum County Guidance Center, in Zanesville, Ohio. (See fig. 5.) Here there were both a staffing and a construction grant. Three agencies were involved, the Good Samaritan Hospital, the Bethesda Hospital, and the Muskingum County Guidance Center.

The three joined together to set in motion the construction of the Community Health Center of Muskingum County. The staffing grant would provide for 75 percent of the initial cost of personnel for 12 inpatient beds in the Bethesda Hospital, and 24 inpatient beds in the Good Samaritan Hospital.

It would provide day care in the Community Mental Health Center, outpatient services in the Community Mental Health Center, and consultation and education to professionals and agencies in the community.

These three services would be housed within the new Community Mental Health Center to be constructed and would be provided to five counties in Ohio that have joined together for this purpose.

Dr. YOLLEs. The total population of these fire counties is 159,800. This third example is one of combining both grants where there was a need for a physical structure and for staffing as well.

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This table (fig. 6) shows the status of the program and the number of

grants that have been made for the 3 years that we have authorization. I emphasize the difference between grants made and centers funded, because in some cases the center receives both types of grants; so that the number of centers funded would be different from the number of grants made.

The white columns indicate construction. In fiscal 1965 we were able to fund 93 centers with 93 grants. The total is the same, since only construction grants were authorized.

In fiscal year 1964, 54 staffing grants were made and a cumulative total of 194 construction grants had been made. In fiscal year 1967 there will be a total of 131

staffing grants and 294 construction grants. Mr. ROGERS. Are those total?

Dr. YOLLES. They are not additive, Mr. Rogers, because of the overlap. These are the numbers of centers funded. (See fig. 7.) In fiscal year 1965 there were 93; in fiscal year 1966, 188 centers funded; and by the close of business this year in 1967 there will be 286 centers funded, serving a population of 47.2 million persons in the United States.

Mr. Brown. They do overlap but they are not additive, is that right?

Dr. YOLLES. The numbers of center grants added to the number of construction grants are not additive, because some centers receive both.

Mr. Brown. Does the 194 include part of the 93?
Dr. YOLLES. Yes, sir. The 194 is cumulative.
Mr. BROWN. It is cumulative?

NUMBER OF CONSTRUCTION AND STAFFING GRANTS UNDER PRESENT AUTHORITY

294 300

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FIGURE 7. Dr. YOLLES. Yes, sir. Mr. Brown. But in 1967 do some of your 93 work themselves out? Dr. YOLLES. In construction? Mr. BROWN. Yes.

Dr. YOLLES. Yes. These grants have been awarded. This is just a cumulative total of the grants that will have been made by 1967.

Mr. Brown. Some of your fiscal 1965 have been completed?
Dr. YOLLES. No; only one has been completed.
Mr. BROWN. Is that still included ?

Dr, YOLLES. We are including it in the total numbers that of grants have been made. It is still included. The 93 are included in this.

Lastly, this table (fig. 8) presents the status of the authorization, appropriations, and obligations of the program, both for construction and for staffing: You will notice that, in 1965 and 1966, we obligated $34.3 million of the $35 million which was appropriated.

By the close of business of this fiscal year we will have obligated the total $50 million authorized and appropriated for construction. At the present moment, about $22 million has been obligated, and by the close of business this year the rest will have been funded.

For 1967 we estimate that we will obligate the total funds that are available. In staffing, we obligated in the first year of the program some $15.2 million. We could have obligated the total amount; but the money became available in the last 4 months of the fiscal year, and we couldn't reach all of the applications that were in the institute.

In 1967, of the $19.1 million which has been appropriated we have pending applications totaling 104 percent of that amount, so that we will not be able to fund all of the applications.

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