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Dr. YOLLES. Of the 1960 funds we estimate that we will use all of the $19.9 million which has been appropriated.

Mr. JARMAN. I think it might be appropriate at this time to ask Mr. Cohen, now that you are on that chart, for a little more information as to funding for the future.

Of course, there is nothing new about the phrasing of the bill but the bill does provide a stated amount and then it says: and such sums as may be necessary for the next four fiscal years.

Could we get additional information on that, Mr. Cohen ?
Mr. COHEN. Yes.

I would be glad to submit for the record, Mr. Chairman, the proposed estimates that the Department has made with regard to the future funding over that 5-year period, both for the construction and for the staffing based upon, of course, the experience we have had up to date.

(The information requested follows:)

Proposed estimates for future funding for construction and staffing, 1968–72

Fiscal year Fiscal year Fiscal year Fiscal year Fiscal year Cumulative

1972 total

Construction: Authorization - $50,000,000 $60,000,000 $70,000,000 $80,000,000 $90,000,000 $350,000,000 Staffing: Authorization.. 30,000,000 26,000,000 32,000,000 36,000,000 38,000,000 162,000,000


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Thank you.

Dr. YOLLES. Mr. Chairman, there is one final chart that I would like to point out. That is the distribution of the community mental health center grants that have been made. (See fig. 9.) The little triangles indicate the construction grants and the circles represent the staffing grants.

There is good distribution across the country.

Mr. ROGERS. Have these charts been reproduced for the committee in the testimony !

Dr. YOLLES. They will be available.
Mr. ROGERS. Thank you.
Mr. Cohen. That completes our formal presentation, Mr. Chairman.

Mr. JARMAN. Before general questioning starts, Mr. Cohen, would Dr. Stewart have any comment to make at this time or would you prefer simply to answer questions?

Dr. STEWART. I think it would be better to just answer questions. Thank you very much.

Mr. JARMAN. For the subcommittee we want to thank you gentlemen for being with us for what I think is a very good explanation of a very important subject.

There is one question that we would like to clarify for the hearing record : Last year, this committee passed legislation which was signed by the President as Public Law 89–749. This legislation establishes a State health planning agency which is to do comprehensive health planning for the entire State.

Under the mental health legislation which the Congress passed in 1963, a State plan is required for construction of these centers and this plan is required to be administered by a single State agency.

I wonder if you would clarify for the subcommittee the intended relationship between the comprehensive State health planning agency established under Public Law 749 and the operations of a State agency administering the mental health plan.

Mr. COHEN. I will ask the Surgeon General to reply to that, Mr. Chairman.

Dr. STEWART. Mr. Chairman, the intention is that the planning under specific plans such as the mental health planning agency would be complementary to comprehensive health planning. We have in each State in the country planning which is going on toward a specific target or health problem, or the provision of a specific set of services, or the development of a specific set of resources, such as hospitals.

We have planning for mental health services, for mental retardation services, for the development of hospitals. Many of the States have done planning toward the development of the number of physicians in their States and the number of nurses in their States, but nowhere do we have the information in such a way that one can relate all the plans together as to the total development of the services in the State and the total development of the resources in the State.

It is conceivable for a State to be planning the development of specialized services which, when combined, will exceed the State's ability to produce these services because it exceeds the number of physicians or the number of hospitals or the number of dollars available for capital or for operations, either private or public.

The intention of the comprehensive health planning agency is to provide a mechanism for pulling this information together so that the State can have some idea of what the long-range objectives are in the development of resources and services, what their capabilities are, what priorities they might have, what choices there are toward these priorities, given an assessment of their economic development, and of the development of their trained resources and of their facilities.

I think the best way to picture the relationship is to see mental health planning as vertical. It aims at a specific health problem and a specific target population, and it is one of many such vertical health planning functions being carried on simultaneously within a State.

On the other hand, the comprehensive health planning agency has a horizontal role, tying all the vertical plans into a single information sharing and evaluating system, and developing a plan for the total health needs of the total population.

The real function of the comprehensive health planning agency is to collect and then evaluate that information which shows what the health program choices are, whether the objectives are sound, whether they need to be changed.

In a given instance, the mental health agency may be overly ambitious or need some direction. This information would be available through the comprehensive planning agencies to the State government, to the Federal Government, to the private sector such as Blue Cross or any other group.

So this is the relationship between the specific planning and the comprehensive health planning agency.

Mr. JARMAN. Thank you.
Mr. Rogers?
Mr. ROGERS. Thank you, Mr. Chairman.

Mr. Secretary, it is a pleasure, of course, to see you again with your associates here. I think the facts that have been presented on the reduction of mental cases actually occupying hospital beds are impressive.

I think we are beginning to make real progress, and this is encouraging, and I commend you and your associates and those from the National Institutes of Health,

There are two or three things I am concerned with in the new request. I notice that where we had previously, I believe, reached a level of $65 million for construction of community mental health centers you are now recommending a reduction of that figure in June 1968 of $15 million.

Could you give us some comment on this? Is it that you don't have enough applications or are we on top of the problem enough where we don't need to go into this program any more?

Mr. COHEN. I think that generally speaking, Mr. Chairman, and Dr. Yolles can amplify, what happens in a construction program in the early years is that the program progresses a little slower than intended as you said, there is a great deal of need for State and local consultation. I think that our original aspirations, projected to the fourth and fifth year from the submission of our original proposals, even somewhat above what we can carry out. I

would have to quite frankly admit that during the preparation of our legislative program, when we had a number of other budget considerations, we were also influenced by a desire not to accelerate construction unnecessarily at a time when interest rates were higher than normal and when there were inflationary pressures.

I would hope now, though, with the program we have presented to you that we could modestly increase the amount of Federal funds in this program to get back upon our original schedule.

Mr. ROGERS. That resulted in this particular figure ?
Mr. COHEN. Yes.

Mr. ROGERS. Then you think there are conditions that should be considered by the committee then that might change?

Mr. COHEN. Yes. I think that when you see our revision of our request for authorization for the next 5 years you will see that they will turn out to be a little bit more modest than those we originally submitted in 1963.

We all recognize that it is going to take quite some time to reach our ultimate goal and it is desirable for us to do it in a sound way, enlisting the full support of the communities.

I should also say one other thing: It isn't solely a matter of Federal funds involved here. Once a center is established it is anticipated that the locality will see that it is financed. That means substantial State and local money and money from individual patients and insurance premiums. The locality has to be doubly sure that it can support this operation in the indefinite future.

Mr. ROGERS. I will agree. You have constructed 286, I believe you stated. How many applications do you have on hand?

Do you have applications to warrant this additional appropriation? Is it sufficient? Is it insufficient? Could you give us facts on that?

Perhaps you could submit it for the record.
Dr. YOLLES. Yes, we can do that.

Mr. ROGERS. Maybe you can comment quickly and then submit the details.

Dr. YOLLES. Our experience is to date that we have been able to use all of the funds available to us and we would expect that this would continue for the next year at least.

Mr. Rogers. The indications from the applications would indicate this?

Dr. YOLLES. Yes.
(The information requested follows:)

COMMUNITY MENTAL HEALTH CENTERS PROGRESS REPORT During fiscal year 1966 a total of $32.4 million was obligated (FY 65 funds two year availability) representing 93 projects for the construction of community mental health centers. Additionally, $15.2 million was obligated (FY 66) representing 54 projects for the staffing of community mental health centers.

During fiscal year 1967 an additional 33 construction projects and 19 staffing projects have been approved respectively obligating $20 million (FY 66 funds two year availability) and 2.6 million. Based upon projects anticipated to be reviewed prior to the close of this fiscal year, June 30, 1967, another 68 construction projects representing $30 million and 58 staffing projects representing $16.5 million will be approved.

Based upon experience to date, we anticipate receiving during fiscal year 1968. 97 construction and 104 staffing applications. These would represent about $60

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