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substantially greater not only in fiscal year 1968, but even more so in the years ahead. Because we think that the tooling up phase of this program will have been completed by that time, and that the necessary preparations and construction of centers can go forward more rapidly in the ensuing years.

Mr. JARMAN. Thank you very much.
Mr. Satterfield.
Mr. SATTERFIELD. No questions, Mr. Chairman.
Mr. JARMAN. Mr. Springer.
Mr. SPRINGER. No questions.
Mr. JARMAN. Dr. Carter.
Mr. CARTER. No questions.
Mr. JARMAN. Thank you very much for contributing to the hearing.

Our next witness this morning is Dr. Jack Ewalt, of the American Psychiatric Association; accompanied by Mr. Miké Gorman, of the National Committee Against Mental Illness.

I would like to comment that Mr. Gorman is a longtime friend, dating back to Oklahoma days when he was active in newspaper work and did a very comprehensive study of mental illness in our part of the country STATEMENT OF DR. JACK EWALT, AMERICAN PSYCHIATRIC ASSO

Mr. GORMAN. I thank the Chairman.

Dr. Ewalt. It is an honor, sir, to appear before the committee in support of H.R. 6431. I have a prepared statement which I shall not read. I will try to talk very briefly, at least for a psychiatrist, and try to answer any questions.

Mr. JARMAX. Dr. Ewalt, I also would like to mention the fact that you have served very efficiently as staff director for the Joint Commission on Mental Illness and Health.

Dr. Ewalt. Thank you.

Currently we have less than 200 of these mental health centers under construction across the country. If we are to give adequate service of a minimal sort to our 200 million citizens by 1975, we will have to have about 2,000 of these. It takes time and effort to plan these things and raise the local funds which represent about $3 for every Federal dollar expended. It takes time to make the plans that will meet the Federal criteria. The program should accelerate so that by 1970 we will be able to have about 500 of these centers and then double that number in the following 5 years, if we can get adequate support.

In the past years, we have made a great deal of progress. We have the Joint Commission Study, which was authorized under the Eisenhower administration and completed under the Kennedy administration. We have the Kennedy Mental Health Plan, and the States have made a lot of plans.

We have made much progress in the ways we treat patients. You have heard a lot about milieu therapy, the importance of the surroundings to patients; about the flexibility of care-not making them stay

all day or night if they only need part of the day or night to be cared for; the use of group therapy and the use of other professionals as well as psychiatrists.

I will just list one or two highlights. I think it is significant that now more patients are admitted to general hospitals than to all other hospitals combined. The number of mental patients admitted each year increases, but the number discharged also increases. So that over the last 10 years we have reduced the population of these hospitals by about 20 percent by the application of these new methods. That is a very significant figure, because if the hospitals had continued to grow at the rate they had before, rather than decreasing in population, figuring the construction costs of $20,000 a bed, it would have been $412 billion spent on brick and mortar that we are not spending today.

Mr. Seidman mentioned the Massachusetts Mental Health Center where I make my living. Last year in this hospital (where we admit about 900 a year to the hospital and between 4,000 and 5,000 a year to the clinic, and take the very acute, difficult patients as they come off the street) we certainly didn't "cure" everybody, but we only sent on for long-term hospitalization 1.7 percent of the patients we admitted. We were proud in years past that we have only committed 20 percent of our patients. So we have made a lot of progress in how to do our jobs better, and I don't think there is anything we do that could not be replicated by any well-staffed and well-run mental health center anywhere in the country.

A the end of June 1966 there were 93 centers in 43 States underway. We had spent most of the money made available. I think there are 125 centers under construction. We can't possibly go forward if we don't have authorization for the extension of these programs.

Mind you, the expansion will have to accelerate as the years go on, and we are not magicians, but with expansion I think we can very shortly cut down on the number of people cared for. And these people, of course, in some percentage, will become productive citizens and taxpayers rather than consumers of services.

I think at this time I would like to again emphasize that the money that we get from the Federal Government is really pump-priming money and it is essential. So far 1 Federal dollar has mobilized about 3 private dollars, and not all of this money has come from the States. Mr. Gorman has the figures, but I think about 40 percent of the matching funds comes from non-Government or private sources.

This is, indeed, a very important piece of legislation for the public welfare. I think I will stop at this point. I have submitted the written statement, and I will be prepared to answer questions.

Mr. Gorman might want to say something.

Mr. GORMAN. Mr. Chairman, I thank you for that gracious introduction. Mr. Springer, Mr. Satterfield, and Dr. Carter, after listening to yesterday's testimony by the administration on H.R. 6431, introduced by Mr. Staggers and others, I have decided to testify in an attempt to bring to this committee some sense of urgency concerning the legislation before it.

I want to address myself to your question about the moneys where the administration is vague about "such sums as may be required over the next 4 years.” I have some fairly precise ideas. I serve currently

as a member of the National Mental Health Advisory Council. This is the second time I have been appointed to that job. I don't know why. I was originally recommended by President Kennedy, and then by President Johnson. I would like to bring to this committee, if I may, our idea of the financial needs and potential of this program.

Now I speak from a background, if I may say so, of 22 years, going back to the sovereign State of Oklahoma when you and I were youngand you look young now, and I feel old, Mr. Jarman. I testified before this very distinguished committee as a newspaper reporter, in 1946, before Percy Priest on behalf of the legislation which created the National Institute of Mental Health:

1. The administration bill proposes $50 million for construction of mental health centers in the coming year and "such sums as may be necessary during the following 4 years.” When asked for the actual sum necessary to implement the program during the subsequent 4 years, the administration witnesses promised to supply figures to the committee at a later date. Under Secretary Cohen so testified yesterday. I know the reason for this. I have been in Washington 17 years, so that I have a suspicion that the Bureau of the Budget has put a clamp on these figures, and I understand the restraints under which Mr. Cohen had to testify yesterday and I sympathize. I am delighted that I don't have the same restraints.

Mr. Chairman, I don't see any point in coming before this distinguished committee with a 5-year bill which includes figures for only the first year. I submit that this is not being fully frank with the members of this committee, who want the fullest information. I am again not criticizing the administration, but I think, sir, I am stating a fact.

Let me recite a brief history of this legislation which you of course know, but I can recapitulate. All of you were members of the committee going back to 1963, when we first passed the legislation, except the gentleman from Kentucky.

In 1963 President Kennedy proposed a 5-year program for construction of mental health centers costing a total of $330 million. The funds were to be allotted as follows: $35 million in the first year; $50 million in the second year: $65 million in the third year: $80 million in the fourth year; and $100 million in the last year. These are the exact figures which he recommended. The Senate in 1963 passed a bill authorizing $230 million for centers construction, eliminating the fifth year of the program.

A few months later, the House passed a bill for 3 years eliminating both the fourth and fifth years. The final bill provided only $150 million over a 3-year period for construction of centers. I am not going into the staffing, because it is too complicated. I use construction as an example-$35 million for the first year, $50 million the second year, and $65 million the third year. These were the authorized figures under the 1963 legislation.

In actual fact, however, we have not even achieved the $150 million level. For example, although the Congress had authorized $65 million for the third year (fiscal 1967), the current year which we are now in, the administration asked for only $50 million and that is all we got.

In the renewal legislation, the first year requests $50 million as against the $80 million passed for that same year by the Senate in 1963. In other words, I am comparing the appropriations with our aspirations. Dr. Ewalt was the medical director of the Joint Commission on Mental Illness which proposed this program. I was a member, and these were our goals at that time. I don't know what is happening at the Bureau of the Budget, but I do know that the contemplated cuts in this program will emasculate it to the point where we will come nowhere near President Kennedy's announced goal of 2,000 centers by 1975.

I heard mention yesterday of this 2,000-center figure. I heard mention of it this morning, and I think that this committee deserves frankness from me and from every witness. We will not come anywhere near 1,000 centers if we drop the program back to $50 million and then "such sums as may be required over the next 4 years." I am a member of the Mental Health Council. I am privy to some internal figures that maybe I should not reveal, but I am going to, because my Irish glandular system is going to exceed my caution and wisdom. 'I will say that at the present time we have only 125 centers under construction, and this is not a result of a lack of State and local interest. I will come in a minute to the fact that it is a lack of Federal money.

As Dr. Ewalt pointed out, and as was pointed out yesterday, State and local money is outmatching the Federal money $3 to $1, and 40 percent of this money is coming from the private sector. People are ringing doorbells, holding barn dances, doing everything in the world legal or otherwise to match the Federal money. And in most of the States, the States are not putting up a nickel. In the State of Florida, Mr. Rogers, there are eight grants at the present time. There is not 1 cent of State money. Matching moneys have all been raised by localities, including one in Dade County, the only one in Dade County, the Variety Hospital. The other seven are construction grants. It is most impressive to me that the good people in Winter Haven, in Daytona Beach, in Panama City, in Pensacola, and elsewhere, have raised this money themselves to outmatch the Federal money.

I think there is no justification for saying there is a lack of interest, but there is some suspicion that the Federal Government is not meeting its obligation promises. I hear this, because I travel around the country and I was in some 26 or 28 States with my carpetbags last year. That is the thrust of our testimony when asked by the chairman about the figure.

I am not the only one who is worried about the relatively slow pace of the centers program due to inadequate Federal funding. Toward the end of 1965 the National Governors' Conference unanimously passed a resolution requesting the Council of State Governments to convene a conference of State and county officials to find out why the mental health center program was lagging and what could be done to speed it up. At a 3-day conference held in Chicago in December 1965 the delegates passed the following resolution:

I would like, if I may, to introduce into the hearings the text of the resolution and quote one or two paragraphs in this resolution which indicate what the problem is:

“Of the total annual mental health expenditures of $2 billion in this country"_which they used in 1965—"only $115 million, less than 4

percent, is available for ongoing local community mental health services. The share of the Federal Government in this funding is less than 10 percent." This was a 1965 figure in the first year of the actual program we are talking about today, so that the figure would be higher today. But I think what the Governors and the county commissioners said at the Chicago meeting was very important.

I am trying to get away from the idea that this is all "Big Daddy," that the big Federal impetus “Santa Claus” is slipping the money. “Santa Claus” is actually quite a cheapskate in this program. He is supplying less than 10 percent of the ongoing funds for this. I would like to introduce the full text of this resolution for inclusion at this point.

Mr. JARMAN. Yes.
(The resolution referred to follows :)


COMMUNITY MENTAL HEALTH, DECEMBER 15, 1965, CHICAGO, ILL. This national conference on community mental health programs was called as a result of a resolution unanimously passed by the National Governors' Conference in July, 1965, calling for a thorough “review and critical evaluation of the experience of states under the various kinds of community mental health services acts and other methods of financing community mental health services, and for thorough consideration of the future role of each level of government in multiplesource financing of community mental health programs.”

It is well recognized by this conference that in order to meet the pressing responsibilities and burdens in improving the mental health of this Nation there is critical need for an expansion of community mental health programs and of means to finance them, at all levels of government.

Of the total annual mental health expenditure of $2 billion in this country only $115,000,000, less than 4 per cent—is available for on-going local community mental health services. The share of the Federal Government in this funding is less than 10 per cent.

In order for the States and communities to make full use of the 1963 and 1965 Federal legislation, they must complete their plans and provide additional funds. To accomplish this, the enactment of new and expanded community mental health services acts which provide for State-local matching of funds is necessary.

But they cannot do the job alone—their limited tax base prevents many States and localities from responding to citizen demand for these services.

It is therefore imperative that the Federal Government, which receives the largest share of the tax dollar from our people, provide critically needed additional seed money for these programs.

It is the consensus of the conference that the national goal of 2000 new community mental health centers to be established by 1975 as envisioned by the landmark 1963 and 1965 Federal legislation will not be realized without expanded Federal, State and local support.

Mr. GORMAN. As a member of the National Advisory Mental Health Council which passes upon all policies and grants of the NIMH, I am privileged to see a great deal of documentation on community mental health center projections. I want to get to the heart of the matter. Late last year, I reviewed a document which indicated that the administration would recommend $175 million for centers construction, just talking about construction, during the next 5 years— $50 million for the first year; $95 million for the second year, and $110 million for each of the next 3 years. However, in listening to the administration witnesses yesterday, I gathered—and this is the understatement of the year—that these estimates have been chopped down considerably.

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