Mr. BURKE. I would like to point out to you that we really appreciate your appearance today.

I was on the committee when we had a fight to include mental health care in the medicare bill. At that time it did not go far enough. We were able to get up to 190 days in a mental hospital and also outpatient psychiatric treatment.

With the information you have given us today and with your active group I am sure we will be able to get more progress along this area. Mrs. ROBBINS. That is very encouraging.

Mr. SCHNEEBELI. Mrs. Robbins, you have been very specific in your recommendations. This will be very helpful to the committee. You do make one statement I would like to discuss. You say:

We strongly refute the misconception that mental health illness is prohibitively expensive and we are pleased there is now a sufficient body of reputable data to confirm this position.

Do you have any actuarial data that we could put in the record that would support this statement? I think the committee would be interested in what the costs are.

Mrs. ROBBINS. Yes; I can present to you some of the material which has been specifically taken out of Dr. Reed's book "Health Insurance and Psychiatric Care: Utilization and Cost," that will give more specific information about this.

Mr. SCHNEEBELI. If it is not too voluminous.

Mrs. ROBBINS. Not at all. I think this focuses on the very thing you are concerned about.

Mr. SCHNEEBELI. Thank you very much.

That is all.

[The information follows:]

HOSPITAL CARE FOR MENTAL ILLNESS-UTILIZATION/COST RATES, BY TYPE OF PLAN, 1968-69

1.1 30 days per year.

Washington Physicians Service

2.3

2.4

17.3

4.3

7.5

.89

(Federal).

Group-Practice Plans:

Kaiser Southern California (Fed

1.8

2.7

27.3

5.5

15.4

1.36

3.1 45 days per year.

30 days per year.

eral).

150 days per year.

2.8 45 days/5 months at 75 percent. 120 days per illness at $40 per

Source: Extracted from L. S. Reed, E. S. Myers, and P. L. Scheidemandel: "Health Insurance and Psychiatric Care: Utilization and Cost," American Psychiatric Association, Washington, D.C., 1972.

Not to be quoted without permission.

HOSPITAL CARE FOR MENTAL ILLNESS-COST RATES BY BENEFIT PERIOD, 1968-69

Source: Extracted from L.S. Reed, E.S. Myers, and P.L. Scheidemandel: "Health Insurance and Psychiatric Care:
Utilization and Cost," American Psychiatric Association, Washington, D.C., 1972. Not to be quoted without permission.

Mr. BURKE. Mr. Brotzman.

Mr. BROTZMAN. Thank you very much, Mr. Chairman.

I just want to tell you that I agree with your observation relative to community mental health centers. You probably heard me say this morning, in Colorado we had one of the pilot programs in Boulder where I live. I go down there frequently; in fact I was down there not too long ago. They are doing a wonderful job out there. They also have another one in another part of my district that I have been interested in, in Jefferson County. It is really working. It is keeping these cases out of the hospitals and I think the patients are much happier and they respond to treatment because they have the love and affection of their families and they can more nearly approximate a normal life. I could not agree with you more.

While I have been talking here I want to also compliment you in another sense. You used very good judgment some years ago to work for Congressman Herman Schneebeli because he is doing a wonderful job for this country.

Mrs. ROBBINS. I agree with you.

Mr. BURKE. I also want to commend you on page 5 of your statement for pointing out the reduction of patients in the State mental hospitals from 559,250. That represents a drop of 309,000 patients.

What is the average cost of a mental patient in a State hospital today?

Mrs. ROBBINS. I am not sure about the national figure. I know that in Pennsylvania the average cost today is between $35 and $40 a day. That is not for the complete kind of treatment that we would hope the patient in State hospitals would get in many cases, or not for all the patients at least.

Another thing that is important to realize about the reduction in hospitalized patients and the changing of this upward trend is the fact that just accommodations, just additional housing for that many more inpatient psychiatric patients would be a major consideration in all of the attendant expenses that go with giving inpatient service.

One of the advantages in the services that are provided in the community mental health center in addition to the fact that all but 18 percent of them are on an outpatient basis is the wide use of paraprofessionals and those other people who are in the helping and treating and helping professions that are not so terribly expensive and still can be used to great advantage in the therapy of the patient in an outpatient situation when they are returning to their homes at night rather than being on an inpatient basis.

Mr. BURKE. I just figured up roughly the savings to the taxpayers just per day will drop from 559,000 patients to around 250,000 patients, a drop of 309,000 patients, would figure out to almost a $12 million a day savings as regards the cost to our State mental hospitals. That is an impressive figure.

Mrs. ROBBINS. Indeed it is. It is very easy to see in terms of where comprehensive community mental health centers have been doing a job.

In Philadelphia there are some areas served by comprehensive mental health centers and some which are not but the whole city and country of Philadelphia would feed into one large State hospital, formerly