For the last several years, unsuccessful attempts have been made by State dental associations to induce State and local authorities to allocate the funds needed to do the job that needs to be done. We are convinced, however, that earmarked Federal grants will supply the incentive needed to induce more adequate State appropriations. There is evidence already with the limited dental grant authority in existing law ($1 million for the 50 States) to indicate that the States and communities are expanding their support of dental services beyond the matching requirements. With a Federal grant of at least $10 million for State dental health services we could begin to build a prevention and control program to meet the Nation's dental need.

The CHAIRMAN. You would earmark funds for the dental services just as they are now earmarked for the mental health services? Dr. GALAGAN. That is correct.

The CHAIRMAN. You would make it 5 percent?

Dr. GALAGAN. That is the association's recommendation to the committee, yes, sir.

The CHAIRMAN. Is there anything you would like to add, Mr. Conway?

Mr. CONWAY. No, sir-just that I am glad to be here with Dr. Galagan. We have always been very proud of him as the head of the Dental Division of the Public Health Service, and now we are glad to have him as one of our instrumentalities in private dentistry. The CHAIRMAN. How long have you been in Public Health Service? Dr. GALAGAN. Twenty-nine years.

The CHAIRMAN. Anything you would like to add, Mr. Christensen? Mr. CHRISTENSEN. No, except thanks once more, Senator.

The CHAIRMAN. Well, the American Dental Association through the years has been mighty helpful to this committee. We appreciate it very much. We certainly appreciate your statement and your presence here this morning, all of you. We want to thank you very much.

Now, the Association of State and Territorial Mental Health Officers-Dr. Davis of New Jersey.

Good Morning, Doctor.

STATEMENT OF DR. V. TERRELL DAVIS OF NEW JERSEY, ON BEHALF OF NATIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS

Dr. DAVIS. Mr. Chairman, I would like to correct the recordI am representing the National Association of State Mental Health Program Directors. We are comparable in our interest and aims in the mental health field-it is just a technicality that our official organization name is the National Association of State Mental Health Program Directors, and this arises because there is a different pattern occurring State to State in the mental health program, more so than in the health programs.

As Dr. Hogan pointed out, 36 of the States have a separate mental health-a mental health program director outside of the health department, and in some of those the mental health program director is a commissioner of mental health in charge of a department. In other States, such as mine, for instance, I am the director of a division of mental health and hospitals within a State department of institutions and agencies, which also includes welfare, correctional programs, but does not include the health department.

The CHAIRMAN. I see. Well, as you know, my State of Alabama just passed legislation to give us a separate agency representing mental health.

Dr. DAVIS. A number of States have taken similar action in recent years.

I do not have a prepared statement to give you at this time, although I do have prepared remarks and I will have a prepared statement of these remarks to return to the committee later this afternoon.

The CHAIRMAN. We will have that appear in full in the record, and you just proceed now in your own way, Doctor.

Dr. DAVIS. Thank you, Senator.

I am a past president of the National Association of State Mental Health Program Directors, and served as a member of the Surgeon General's task force appointed by former Surgeon General Luther Terry to review the Federal public health grants program, and to make recommendations.

It has been particularly gratifying to me, in reviewing this bill to see that it was possible to incorporate in this legislation practically all of the key issues and problems with which this task force was concerned, and to which it addressed itself.

I am testifying on behalf of the National Association of Mental Health Program Directors, but I would like to tell the committee what I said in 1963 when I appeared here as a representative of the association in behalf of the community mental health centers construction legislation. At that time I said that the association does not speak officially for any of the States-"Our purpose is to attempt to present the facts and to permit each of the States to decide how these can be adapted to local needs within the local setting."

In fact, we have a phrase from the Latin, res ipsa loquitur, meaning that the facts speak for themselves.

However, I am speaking on behalf of the members of the association and I am happy to be able to tell you that most of the members of the association have been able to review provisions as the task force was working on these various provisions, and there is a united feeling in support of the purposes of this bill.

I was most pleased when I read S. 3008 and realized the potential that it had for providing a basis for significant improvement in public health administration throughout the country.

I emphasize the improvement of administration, because without administration people just do not get services. There has to be leadership.

Without good administration, we will have neither the manpower nor the money to do the job, because it will be dissipated.

The Government, at present, has a special responsibility to see that the vastly increased expenditures of tax money and other funds for health services are utilized efficiently, and with a minimum of dilution by bureaucratic distractions.

In some aspects this bill may be considered a move for the Federal Government to get its own house in order.

It is time to change some of the principles which have guided the appropriation of Federal funds in this field.

We need a partnership of Federal Government with the States and local resources in providing both the leadership and the financing of the essential services.

Seed money which is granted for a period and then withdrawn may be appropriate for demonstration projects, but not for the development of local leadership of public health services.

The CHAIRMAN. That is a continuing problem, it it not?
Dr. DAVIS. That is a continuing problem.

Categorical grants have helped to focus both moneys and efforts on the several areas of health needs, but the bureaucratic devices needed with such programs have fragmented local services and contributed duplication, to destructive competition, and have tended to have a divisive effect on the local organization of services for the people.

S. 3008 would implement such needed change.

In addition, this bill gives recognition to the fact of the vast increase in the Federal moneys available for the purchase of local services and for the construction of health facilities.

Unless State and local health agencies are adequally organized and staffed to provide leadership, our entire effort could lead to chaos.

An essential part of the local leadership is ongoing planning which establishes clear objectives, assesses the existing resources, charts unmet or anticipated needs, provides the effective coordination of services, and develops popular support for new services which supplement and complement the existing services in a practical and efficient

manner.

We have found that it is extremely difficult for anyone outside of the field to realize the amount of work which is involved in accomplishing just that.

Thus, when local governments are hard pressed to find sufficient tax moneys, it is natural that requests for additional staff for planning do not receive the essential top priority.

This bill addresses itself initially, I think, and principally to this very important need.

I believe that the efforts of this committee in connection with the Community Mental Health Center Construction Act of 1963, and also with the amendments of 1965, has contributed significantly to establishing a firm commitment among the professional as well as the public at large to the need for comprehensiveness in any health services. This has been long overdue, but it has been terribly encouraging to me, going around locally in the State, to have witnessed the change in the last 3 years-instead of people talking about their particular vested interests, there is a gratifying interest in how can we provide the comprehensive ranges. If we can improve this particular service without improving this one along with it, are we really doing a proper job?

The CHAIRMAN. In other words, we have got so much more teamwork now than we have had in the past, is that right?

Dr. DAVIS. That is right. I think that the concern and interest about the mentally ill and the Federal approach to this problem, and the public education that has been carried on in connection with the work of this committee, has been a significant factor.

It has been distressing to see so many separate plans develop within the State, each to meet Federal regulations for the allocation of Federal funds. We hope that the Congress will establish, through this legislation, a mechanism which will enable the States to develop a comprehensive plan for all of the health services which can be used

as a blueprint for the people in that State in operating their services as well as by the Federal Government to justify the continuing allocation of moneys to the individual State.

At present it is not possible to fully coordinate our State plans for the utilization of Federal community mental health funds with our State appropriations of local moneys because we do not have a commitment for Federal funds before we have to make decisions in connection with departmental budgets which we must present to the legislature.

What I am saying is that we set up our own State budgets, ask our legislature for State moneys, and then we develop our plan for the Federal moneys.

If the Federal funds for fiscal 1968, for instance, were appropriated by Congress early in fiscal 1967, our request for State appropriation could be effectively coordinated.

The State appropriations and Federal appropriations would t'i both be parts of a whole program within the State.

The CHAIRMAN. Doctor, in that connection-of course your Stat is one among 50, but how often does your legislature meet in New Jersey?

Dr. DAVIS. This is a pertinent point. Our State happens to have a legislative session and a budget on an annual basis.

The CHAIRMAN. Your legislature meets every year?

Dr. DAVIS. Right.

The CHAIRMAN. That is rather unusual. That is not true with most of the States, is it?

Dr. DAVIS. No, it is not true with most of the States.

The CHAIRMAN. All right.

Dr. DAVIS. So it makes it even a bigger gap in those States which meet only every 2 years, with no leadtime in the availability of the Federal money, so that they can anticipate this in planning, which presents an additional problem.

Now, we do note there is provision in this legislation to carry over Federal appropriations for planning into the subsequent fiscal year. We hope that Congress may see fit to enable the States, as I said before, to anticipate funds when their local moneys are budgeted.

We are also pleased to note the lead time which is proposed to enable at least one year of planning on the basis of Federal support prior to the effective date of the project grants and the comprehensive health grants. This will also provide congressional authorization a year in advance of appropriations, and this will thus enable the Federal Government to budget appropriation requests more accurately.

There was, as you are aware, a certain amount of confusion at the local level in connection with the community mental construction legislation in that money was available before we had adequately been able to complete the planning, and there were pressures to move before the program was sound.

The CHAIRMAN. Before the planning had been completed; is that right?

Dr. DAVIS. Right. Now, the impact of 2 years of Federal support for planning for comprehensive mental health services, which ended on last July 1965, as I indicated, has been most gratifying. In many areas, however, there is real danger of losing the momentum gained just at a time when we are beginning to see real gains in terms of

program. Gains in terms of benefits through better coordination of existing service this is a significant byproduct of our planning. There has been much improvement in the efficiency of existing facilities, even without the addition of new facilities as a result of the planning.

Again, gains in terms of convincing skeptics that this type of planning is essential and must be a sustained action. When we submitted our plans for planning, comprehensive community health service, and the word was reported back to our local press that Federal moneys had been granted for a planning operation based on this "plan for planning," we had some quips from the press. One I remember had something to do with about peeling an onion-"What are these bureaucrats going to think of next-not only do they want to plan, but before they plan, they want to plan to plan to plan."

I think they are older and wiser now, and with our experience behind us, there can be no doubt that you do have to have a plan for planning. I was not able to be here yesterday when the Association of State and Territorial Health Officers testified-but I did see a copy of their In their statement most of the important points that the task force addressed themselves to, which our association as well as that association has been concerned with, were highlighted and I will not repeat that, other than to say for your benefit that we are in full accord.

statement.

The CHAIRMAN. You concur pretty much with that testimony? Dr. DAVIS. Right.

The CHAIRMAN. The position of the State and territorial health officers.

Dr. DAVIS. Right.

Now, the only place that there has been any particular concern and debate in connection with this is the mechanism for developing the comprehensive planning, and the first provision, stating that the State shall designate a single agency, is going to provide a challenge to State government to establish such a single agency. In our judgment, this is going to have to be a commission. I cannot see a czar, one individual, having this ultimate responsibility, because it is too comprehensive.

The CHAIRMAN. You have too many facets.

Dr. DAVIS. Too many facets. And it seems to us that it is going to have to be an interagency health planning commission, with administrative decisionmaking responsibility made up of those individuals with direct operating responsibilities for health and mental health programs. Rarely do we think members of such a commission would be unable to agree. But in such an instance, there is always the Governor who has the ultimate responsibility for the program in the State, and it would be his responsibility to make these decisions, and it seems to us that there is nobody else in the State government who is this accountable to the people, who could carry the responsibility for making a decision in the event that those individuals directly responsible for these health services were unable to agree.

These are the main points, Mr. Chairman, that I had hoped to get before the subcommittee.

The CHAIRMAN. These are all good points, Doctor. We appreciate your very helpful statement.