S. 2836-Section 2 NARC preference REQUIREMENTS FOR ELIGIBILITY OF FACILITY OR SERVICE (1) The facility must be public or non- (1) Same. (2) "Mental retardation facility" means (2) Same. (However NARC recommends that "custodial care" be amended to read "day and residential care.") (3) Services to be provided must be of a type or types deemed basic and necessary by the Secretary, but not all other elements need be already present. (4) Eligible facilities include but are not limited to mentally retarded facilities constructed under part B or C of title I; service need not be of a new type, but there must be an existing insufficiency in the community of the type or types of service to be funded. MAINTENANCE OF EFFORT Secretary must be satisfied funds will supplement and increase level of State, local, and other non-Federal funds, and in no event supplant them. Same. In addition, after July 1, 1969, preference should be given to facilities supported in part by State or local public funds. REGULATIONS (1) Secretary shall issue general regu- (1) Same. (2) Secretary must consult National (2) No formal consultation requirement. (NOTE.-Mentally retarded facility construction applications are now reviewed by representatives of all relevant HEW agencies, e.g., PHS, VRA, OE, WA.) COMMENTS ON COMPARISON OF S. 2836 AND NARC PROPOSAL PURPOSE Basic purposes are similar, but NARC position recognizes significant other costs incurred in cities and rural areas for bus transportation to daily programs. Items other than salaries to be controlled by regulation. FORMAT Mental retardation facilities and services reach more broadly into community than do mental health centers; hence requirement for strict affiliation between them is inappropriate, and was omitted in construction act. A consistent approach to operating costs requires different format in statute. ADMINISTRATION Mental Retardation Branch of U.S. Public Health Service has been coordinating reviews of program components of mental retardation facilities. Same agency should follow through on program assistance. CONFORMITY TO STATE PLAN In some States the State mental health plan includes the mental retardation plan, but in States where this is not true, difficulties would be created by S. 2836. DURATION AND EXTENT OF FEDERAL PARTICIPATION IN ANY ONE GRANT The sharply decremental pattern of the mental health staffing was predicated on availability of fees from patients through insurance, medicare, etc., and on increased Federal formula aid to State mental health departments as proposed in S. 3008. Such funds are not necessarily available for staffing mental retardation facilities under an agency other than mental health. Therefore flexibility in the project grant authority is needed, to accommodate different situations. In some States, State matching may already be available at 50 percent and a nondecremental grant at a lower percentage may be more suitable. NARC proposal is compatible with innovation grants in rehabilitation. Also experience with construction shows that even within a "wealthy" State, there are poor communities, where maximum aid may be needed to inaugurate new services. AUTHORIZED APPROPRIATIONS Appropriations are comparable in the two proposals except that the NARC recommendations are designed to peak at the time of estimated greatest need in relation to new construction. ALLOTMENTS Experience with allotting small appropriations in a largely untested field has shown that this is inefficient and unfair. We already know that different States are at different stages of construction of new facilities and hence at different stages of readiness for help with staffing and related costs. REQUIREMENTS FOR ELIGIBILITY OF FACILITY OF SERVICE (2) Both bills limit eligibility to specialized facilities and so not assist special programs in general facilities such as hospitals, public schools, etc. (3) See comment under Format; also the mental health requirement that all (five) essential services be present has cut out many communities which are trying to make a start with one or two. (4) Need in mental retardation field is not only for new types of service but for extending services now available on token basis only. MAINTENANCE OF EFFORT In mental retardation field even more than in mental health, there continues to be a need for participation by public agencies. We should combat tendency for State to bow out in favor of contributed funds to match the Federal dollars. REGULATIONS Regulations affecting mental retardation facilities should be developed in consultation with experts in all the various program areas, e.g., health, education, rehabilitation, child welfare, rehabilitation mental health, etc., since all these elements may be present in program to be aided. The CHAIRMAN. We want to thank you very much. Mrs. BOGGS. It has been a great pleasure, as usual, Senator. You are, you know, my favorite chairman. The CHAIRMAN. Thank you very much. The subcommittee will now stand in recess until 10 o'clock in the morning. (Whereupon at 12:55 p.m., a recess was taken until 10 a.m., Thursday, March 17, 1966.) PUBLIC HEALTH PLANNING AND GRANTS THURSDAY, MARCH 17, 1966 U.S. SENATE, SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON LABOR AND PUBLIC WELFARE, Washington, D.C. The subcommittee met, pursuant to notice, at 10 a.m., in room 4232, New Senate Office Building, Senator Lister Hill, chairman, presiding. Present: Senator Hill (presiding). Committee staff members present: Robert W. Barclay, professional staff member; and Roy H. Millenson, minority clerk. The CHAIRMAN. The committee will kindly come to order. We will hear from Dr. Bartholomew Hogan of Maryland, deputy medical director, Maryland Psychiatric Association. We are glad to have you, Doctor. We will be glad to have you proceed in your own way. STATEMENT OF DR. BARTHOLOMEW HOGAN, DEPUTY MEDICAL DIRECTOR, ON BEHALF OF AMERICAN PSYCHIATRIC ASSOCIATION Dr. HOGAN. Thank you, Mr. Chairman. I have a short statement here, if I may have the privilege of presenting it. I am representing the American Psychiatric Association this morning, Mr. Chairman. I am extremely grateful for this opportunity to appear before this subcommittee to testify in support of S. 3008-proposed by Senator Hill to amend the Public Health Service Act-for in the opinion of the American Psychiatric Association this amendment would result in very significant improvements in the funding and delivery of community health services. In the past few years, some of the most imaginative health legislation has originated in this committee and the proposal before you today is certainly one which, if adopted, will serve to promote the general welfare. The members of this subcommittee, the 89th Congress, and the administration, in considering this bill, indicate that we are no longer concerned merely with public health in its narrow sense but, rather, with the health of the public. Several things are at issue here. The proposal would result in the extension and improvement of comprehensive health planning and of health services. We would like to suggest, Mr. Chairman, that for the first time we have the opportunity within the provisions of these amendments to provide for more effective use of Federal funds in improving personal health services and environmental health services simultaneously. 105 This proposal provides for the establishment of a State health planning agency as the single agency for administering, or supervising the administration of State health planning functions. It does so correctly, we believe, Mr. Chairman. Such A single agency would be able to plan for personal health servicesincluding preventive services, treatment services, and educational services relating to the entire range of personal health needs. an agency would go far in coordinating treatment and services for illnesses whose causes are primarily physical, with treatment and services for mental illness. At the same time, by assuming administrative responsibility for planning a healthy environment, the single agency could, indeed assume a very significant role in implementing the modern concept of treating the "whole man" in his "total environment." We should like to speak to the kind of agency this might best be, Mr. Chairman, if it is to become the effective vehicle for both planning and delivery of funds in support of health services that the authors of the bill envisage. As the members of this committee are well aware, we do not, today, have the degree of coordination and collaboration among the major health agencies-both public and private-that we should have in most States. The CHAIRMAN. You need better teamwork, do you not, Doctor? Dr. HOGAN. Yes, sir. We must immediately secure such coordination in fact, if the States are to receive maximum benefit from the health legislation already adopted by this Congress, while planning ahead to improve future services. We who have been primarily concerned with the mental health needs of the people have had an opportunity to do this kind of coordinated and comprehensive planning, within the mental health field, in the past two and a half years. This experience leads us to strongly endorse the concept of a single planning agency for the health needs of a State. In establishing a single State health planning agency it is extremely important, we believe, that each State should provide for adequate representation and involvement within the proposed planning agency of those agencies having major health responsibilities. This will, in actuality, be a decisionmaking body, Mr. Chairman, for it is certainly to be hoped that grants for community services would be grants for services recommended through and by the proposed new planning agency. We would suggest that if effective planning is to be achieved, coordinate status in making decisions should be accorded the mental health agencies, the public health agencies, and other health agencies. We know that it is difficult to break with traditions in this matter, but the health of our people can only be improved if the public and private health agencies learn rapidly some new kinds of cooperation as well as some new degrees of cooperation. The second point to which the American Psychiatric Association would like to speak today is in support of a provision that a minimum 15 percent of the funds authorized in this proposal would be earmarked for mental health services and, of that amount, 70 percent would be available for community mental health services. This allotment of percentages, in effect, approximates the pattern of section 314c of the Public Health Service Act which these amendments would supersede. We believe, Mr. Chairman, that this provision is sound, particularly as the health services in most of the States are currently organized in separate health and mental health sgencies. This is the prevailing pattern of public health programing which has evolved over a period of time. In 36 States, the mental health authority is not a part of the health department. In 32 of these, the community mental health program is administered outside the public health program. In these States, there is no single department which has responsibility to allocate funds to or between either the health or mental health departments. In establishing a 15 percent minimum for mental health services, under the current proposal, the Federal Government makes a decision which allows for flexibility within each State, while assuring allotment of funds necessary to maintain mental health services at their present levels. Mental health services in the community must and in fact are being correlated with other health services, but mental illness brings with it special problems and considerations. Mental disorders, being disorders of the mind and the behavior of man, require special modes of treatment and special kinds of services. As more and more persons are treated in community mental health centers, the need for services will increase. We feel, therefore, that it is sound, both administratively and socially, to specify a minimum percentage of funds, under the proposed amendment, for mental health services. We feel strongly that the establishment of the single State planning agency along the lines suggested here would secure the most equitable and efficient assignment and use of Federal funds, and we respectfully urge that the regulations under which S. 3008 would be administered, specifically state such a composition for each health planning agency. Thank you, Mr. Chairman, for allowing me to present the APA's thoughts to you and also to thank this committee again for its continuing work toward improving the health of the people of this Nation. The CHAIRMAN. Doctor, as you know, there is a great variety among the States with respect to the supply of mental health personnel. Do you feel that this legislation would be of particular assistance to States in trying to meet their personnel shortages? Dr. HOGAN. Well, I think a single coordinating planning agency certainly will help improve all aspects of the mental health field including mental health personnel through the training grant projects. The CHAIRMAN. This bill earmarks some 15 percent of the formula grants for mental health services. About what percent of our total health expenditures are devoted today to mental health? Could you give us a figure? I realize you might not have the exact figure, but could you give us an estimate on it? Dr. HOGAN. I think approximately 15 percent of Federal funds for health services has been allotted, outside of the building and construction programs, to the mental health field in most States. The CHAIRMAN. Of course in 1955, when we set up the Joint Commission on Mental Health Illness and that is when the Federal 60-955-66-8 |