Since they have a separate mental health authority they have not been able to determine the total effect on their State of fiscal 1956 over fiscal 1955. KANSAS Approves in principle in spite of the projected loss of $18,000 a year in Federal funds. Disapproves of the extension and improvement or type 2 grant until it is more clearly spelled out. Feels that the basic services which are not adequately nourished at the present time would need this additional support. KENTUCKY Is not familiar enough to make detailed comments but believes it has some disadvantages for their State. LOUISIANA Approves of the latitude given by block grants and the additional latitude to State health authorities in determining fiscal policy. MASSACHUSETTS Trying to ascertain whether funds received under the terms of the proposed law will be subject to reappropriation by their State legislature before their department can actually use its share. If so, feel that they will fare at least as well as under the old categorical allotment policy. Dislikes the application of the new formula. MISSOURI Approves opportunity of developing a health program suited to the individual State. Sees no disadvantages if the State is allowed to use 95 percent of the total according to the determinations of the State health authority in accordance with recommendations of the A. S. T. H. O. executive committee and the A. M. A. Would lose $22,000. NEVADA Approves the advantages of flexibility. Disapproves in (2) the squaring of the per capita income factor and changes in matching formulas. Most Public Health Service grants are now 50 cents State to $1 Federal and this bill changes it to $2 State and $1 Federal. Believes $1 State to $1 Federal would be fair to all with 85 percent, 10 percent, 5 percent distribution. NEW MEXICO Approves block grants provided for in S. 2778 as funds will be more wisely spent at State level. Would prefer 85 percent, 10 percent, 5 percent distribution. NORTH CAROLINA Approves S. 2778 in principle and likes the increased flexibility and adaptability for State and local health department areas. Would prefer only small amount, say 10 and 5 percent, respectively, under (2) and (3) with main portion going to support (1). Special projects should be approved by State health department or mental health authority. Federal support continuation in the Federal-State-local partnership is of greatest importance. OHIO Approves flexibility of S. 2778 as compared to categorical grants. Advantages and disadvantages depend entirely on amounts appropriated and distributed among the three types of grants. OKLAHOMA Approves single grant-in-aid fund instead of categorical grants. Disapproves of allowing the Department of Health, Education, and Welfare to earmark large funds to type 2 extension and improvement and type 3 special project grants at the expense of established health programs. Another disadvantage would be the reductions of Federal funds available to the State. Feels that the bill should provide specific ratios of amounts to be appropriated in the three types of funds. OREGON Approves of the flexibility in the use of funds. Does not approve the lack of assurance in each type of fund for a certain percent of the grant and does not feel that one can commit States 6 years in advance in the type 2 grants. Loss of 20 percent to the State, comparing fiscal 1956 to fiscal 1955. is disapproved. TENNESSEE Is going to leave the decision concerning testimony for this and other legislation to the judgment of the executive committee of the association. Approves the block grant in principle but realizes that this depends upon adequate publichealth appropriations. TEXAS Opposes grants being made to other than official State health agencies. WEST VIRGINIA Approves flexibility in administration of basic public-health services. Disapproves that less money is available for basic general-health services and would approve an 85 percent, 10 percent, 5 percent distribution. WYOMING Approve of the individual flexibility allowed in the States by a block type of grant. Feel that the specific percentages of funds going into each of the three types of grants should be spelled out in the legislation and at least 90 percent should be made available for general support. Disapprove of the fact that we are losing $10,000 in fiscal 1956 as compared to fiscal 1955 but feel that adequate appropriations for public-health services could remove this objection. Senator PURTELL. Thank you, Dr. Norton. Senator Cooper. Senator COOPER. I addressed the question to Mr. Rockefeller of the perhaps insistence of local health officers on more funds for support. Do you think there would be too much emphasis placed on just the operating facilities in this new program, or would you be interested in the other parts of the program, like the extension and improvement program? Dr. NORTIN. I can say that most of us feel, as is true apparently for the Federal appropriations, that it is possible there will be a leveling off of State and local appropriations which have up to now been going up. Since 1950 as was brought out the Federal appropriations have been coming down, particularly this fiscal year which we are in now. But I can say as an administrator of the Public Health Service in the State, and having talked with a good many of the others, that we do not feel that we can put too much emphasis on support at this time. We feel that is the most important part of it: although we are very much interested in the other two categories. Senator HILL. Doctor, I have listened to your statement with interest. I note emphasis on two matters. One is the matter of adequate financial support, which you just referred to in regard to the drop in the Federal appropriation from $43 million in 1950 to $22 million this year, and $19 million next year. Is that right? Dr. NORTON. That is right. Senator HILL. As I said before, unless you have the gas in your car you are not very dynamic. Dr. NORTON. That is very true. And unfortunately this most drastic cut came after 34 of the State legislatures had adjourned for 2 years, which left us in a particularly difficult situation. Senator HILL. The other point is that instead of a 65-25-10 percentage ratio, your association believes it ought to be 85 for the support program, 10 percent for extension and improvement, and 5 percent for special projects. Dr. NORTON. That is right. Senator HILL. That is from your experience operating in the State health departments, and the experience of other State officers? Dr. NORTON. I would say this: If Federal and local appropriations were on the increase, as they were for many years, then we would favor a larger percentage of extension and improvement, and special projects, because we would have enough for support; but with appropriations leveling off we felt the most important thing is continuing support where we have well-trained and experienced personnel, and where we know how to do the job, rather than extending too much into new fields and employing new specialists in those fields. That is why we feel support is the most important thing. Senator HILL. You would write these percentages into the law? Dr. NORTON. The executive committee would like for it to be written into the law, but we are so unfamiliar with just how these things come out eventually, that we wanted to express our opinion here and leave it to you gentleman to work it out the best way you could after you know how we feel about it. Thank you very much. Senator HILL. Thank you, Doctor. Senator PURTELL. Senator Lehman. Senator PURTELL. Thank you very much, Doctor Norton, for appearing and helping us. Is Dr. Joseph E. Barrett, commissioner of the Department of Mental Hygiene and Hospitals of the Commonwealth of Virginia here? (No response.) Senator PURTELL. He is not here. Without objection his statement will be included in the record at this point. (The prepared statement of Dr. Barrett is as follows:) STATEMENT OF JOSEPH E. BARRETT, M. D., COMMISSIONER, DEPARTMENT OF MENTAL HYGIENE AND HOSPITALS, COMMONWEALTH OF VIRGINIA, RICHMOND, Va. I am most appreciative of your indicated willingness to hear my personal comments regarding S. 2778. I have been working in the field of mental health for more than 30 years and know something of the problems. I refer here to the overall problems, including the care and treatment of the mentally ill in public-supported hospitals, as well as the so-called preventive efforts as exemplified by mental hygiene clinics, public-education programs, research and personnel-training programs. I am sure each of you is familiar with the problems of securing adequate financial support for an active-treatment program in the mental hospitals. An unprecedented impetus was given to the so-called preventive program, etc. when the Congress passed the National Mental Health Act and made specific appropriations for its operation. Specific provisions were made for categorical grants for (1) community services (clinics, etc.), (2) research, (3) training personnel, etc. Mental-health authorities were established in each State. In those States without an organized mental-health program the State health officer was named the mental-health authority. In other States, such as mine (Virginia), where there was an organized mental-health program, the mental-health commissioner or director was named mental-health authority. Under these conditions the categorical grants were made to the mental-health authority. Now this bill S. 2778 would eliminate these categorical grants for mentalhealth work and make lump sum grants as follows: 1. Grants to assist States generally in meeting the costs of their public-health services (including mental health). 2. Grants to assist States in initiating extension of, and improvements in their public-health services. 3. Grants to assist in meeting the costs of projects directed toward the solution of public-health problems of regional or national significance. It is my understanding that these several types of grants would be made to the State health authority and then any money he considered appropriate for mental health would be made available. In the case of those of us who head separate departments of mental health this would be most unsatisfactory. It must be realized that the preventive mental-health program is still in its formative stages. It is not well enough established to be able to survive without positive, identifiable, and continuing financial support. I do not believe it will get this if it is left to the decisions of a State health officer. On this basis I urge you to continue categorical grants for mental health in its various phases as mentioned above, until such time as you can be reliably advised that the mental-health programs in the several States are stable in all respects. Senator PURTELL. Is Mr. Mike Gorman, executive director of the National Mental Health Committee here? STATEMENT OF MIKE GORMAN, EXECUTIVE DIRECTOR, NATIONAL MENTAL HEALTH COMMITTEE Mr. GORMAN. Yes, sir. Senator PURTELL. Is that Michael or Mike? Mr. GORMAN. That is Mike, sir. It is legal. It used to be Thomas Francis but I did not like it so it became Mike. Senator, if I may I do not think I will read the full statement which I have prepared. Senator HILL. All of Dr. Norton's statement went in the record, did it not? Senator PURTELL. Yes. I so noted, I think, when the doctor started his testimony. Senator HILL. I bring that up because he has an exhibit attached to his statement about State reactions which he wanted in. Senator PURTELL. Yes. He mentioned he has some sheets appended to it and I said they would be included in the record here. Mr. GORMAN. If I might just introduce a statement in the record which is our position on the bill and to make note of one thing, I would appreciate it. Senator PURTELL. Without objection your statement may be received and included in the record. (The statement is as follows:) STATEMENT OF THE NATIONAL MENTAL HEALTH COMMITTEE ON H. R. 7397 BY MIKE GORMAN, WASHINGTON, D. C., EXECUTIVE DIRECTOR, NATIONAL MENTAL HEALTH COMMITTEE (Mr. Gorman is a former newspaperman and magazine writer who has specialized in the mental health field for the past 10 years. In 1948, his book, Oklahoma Attacks Its Snake Pits, was condensed as a book supplement in the Reader's Digest. He has written numerous magazine articles on mental health) Mr. Chairman and members of the committee: I appear here today on behalf of the National Mental Health Committee, an organization dedicated primarily to the promotion of State and local efforts to prevent mental illness through research, training and clinical services. In this endeavor we have worked very closely with the National Governors' Conference and the Council of State Governments. We are proud of the 40 State governors who serve as honorary chairmen of our organization. From the point of view of mental health, H. R. 7397 is an exceedingly dangerous bill. It would turn the clock back 10 years and it would tear at the very foundations of the mental health preventive structure we are trying to build across this great land. Let me recite a few of the facts in the matter. Ten years ago, when I started writing about mental illness as a newspaper reporter in Oklahoma, mental health was at the foot of the table when funds were passed around each year by State health departments. At that time, those of us who were active in the mental health field realized there would be no solid advance against this problem until mental health activities were taken out from under State health departments and assorted types of welfare boards, and placed in a separate department operated by certified psychiatric personnel. We convinced the people of the States of the soundness of our position, pointing out to them that, in most States, expenditures for mental health exceeded those for all other health problems. Prior to our reform movement, the mental health division was usually low-man on the State health totem pole. And we newspapermen who had covered State legislatures knew this-the mentally ill had no lobby, nor were they able to speak for themselves. We would have to push for unambiguous legislation which would protect their interests. The battle to get mental health activities out from under existing boards and departments was a fierce and often unsuccessful one. However, in 1949 the National Governors' Conference ordered a study of the mental health programs of the 48 States. That massive study, published in 1950, was the first great blow for liberty. It came out foursquare for separate State mental health departments administering all mental health activities, including those aided by grants-in-aid from the Federal Government. In 1951 the National Governors' Conference ordered a second study of the problem, this time concentrating on research and training. That study, published in August 1953, reemphasized the need for strong, separate departments of mental health. As a climax to all these activities, the governors of the 48 States held a special National Governors' Conference on Mental Health in February of this year. They adopted a 10-point bill of rights for the mentally ill which again included emphasis on separate, nonpolitical mental health departments. As a result of these activities, more than half of the 48 States now have separate departments of mental health. In 10 of them-Massachusetts, Pennsylvania, New York, Tennessee, Kentucky, Virginia, South Carolina, Illinois, Minnesota, and Wisconsin-the State mental health department is the recipient of the Federal mental health grants-in-aid. Paralleling the action of State governments, which are now spending more than half a billion dollars a year on this problem, the Congress of the United States moved into the picture. In 1946 the National Mental Health Act was passed, authorizing grants-in-aid to the States to help combat mental illness. In the first few years of the Federal program, the Congress was appropriating $2 for every State and local dollar for clinic and preventive activities. In the short period of 7 years, the picture has changed completely. Today, for every $2 the Congress appropriates for these activities, the States and localities appropriate approximately $10. During the year ending June 30, 1954, the States and localities will spend more than $12 million for clinics and community services while the Federal Government will contribute a little more than $2 million. Why this dramatic change? The answer is very simple. I was in Oklahoma at the time the first Federal grant-in-aid came to our State. Previous to this 46293-54-pt. 1-20 |