Public Health Service-with the balance of responsibility carried by the Department of Justice. Accordingly, in the early years of implementation of this legislation it will be necessary to continue to use the Fort Worth and Lexington facilities for the examination of alleged addicts and their institutional care.

Besides changing the legal criteria for eligibility for treatment at the Federal level, the legislation also authorized activities which the Public Health Service could not carry out before. The most important of these is the authority for the Surgeon General to provide supervised aftercare services (for those addicts in his custody) averaging 22 years following their release from inpatient treatment. It has been lack of aftercare facilities, many professionals in this area believe, which has resulted in the high rate of recidivism among addicts released from institutional care.

In keeping with community mental health concepts and to insure that close followup and supervision of the addicts will be maintained aftercare will be carried out on contract by appropriate facilities near the homes of the addicts. To maintain an overview of the performance of the contracts and insure a high level of professional performance in aftercare and rehabilitation, it is planned to locate Public Health Service personnel in the 11 metropolitan areas having the largest addict populations.

GOALS AND PROSPECTS

The outlook, then, is a positive and promising one-reflecting substantial progress in the community mental health center program itself, and in the allied programs of the Institute converging on that effort. This statement would be incomplete, however without an acknowledgment of the problems we must yet face.

We must continue our efforts to fill the enormous reservoir of manpower demanded by the center's program, without which our highest purposes will be frustrated.

Through careful research, we must continue to pursue the kinds of creative approaches to the treatment of the mentally ill that alone can give true meaning to the estabilshment of comprehensive services.

We must encourage close collaboration among the many professional disciplines working in the interests of the Nation's health, molding them into the kinds of compassionate staff that best serve the patient's interests.

We must assure that existing patterns in the financing of mental health services are maintained and strengthened in the States and communities across the Nation.

Despite our progress, we must be constantly aware that the Nation's need is still great-that nearly half a million Americans continue to reside in mental hospitals, and that a third of our citizens are significantly impaired at some time in their lives by symptoms of mental illness. We have made only a modest start in meeting the mental health needs of the American people; the great bulk of our population remains to be served through the 2,000 centers planned by

1980.

Difficult tasks and obstacles are still clearly before us, yet I have no reason to doubt that we will succeed. This conviction arises out of the confidence and strength we feel as partners with communities throughout the Nation. Ours is a cooperative venture embracing var

ious segments of society. Across the country we have stimulated a wave of rising hopes. We shall continue in our efforts to satisfy those hopes and thereby advance the well-being and productivity of our people.

COMMUNITY MENTAL HEALTH RESOURCE SUPPORT

The request for 1968 is $100,168,000 as compared with an operating level in 1967 of $125,173,000. There is a net decrease of $25,005,000. This decrease is discussed in detail in the budget justification. The request for 1968 is distributed as follows: Grants for construction of community mental health centers, $50 million; grants for staffing of community mental health centers, $46,168,000; construction and operation of narcotic addict rehabilitation facilities, $4,000,000. The total 1968 appropriation request is $100,168,000.

I would now like to present these charts.

SUMMARY OF RESEARCH PROJECTS

The NIMH program consists of a family of programs. Intramural research, where we do our own research at Bethesda and our field stations. Extramural research support, research grant support, training grant support, the construction of community mental health centers, the staffing of community mental health centers, scientific communication and public information, direct training of our own personnel, biometry programs to report on the extent of mental illness in the United States, grants-in-aid to the States for development of programs in the communities, and professional and technical assistance by NIMH personnel to States and communities.

Mr. FLOOD. How close do you bird dog the State grants on these things?

Dr. YOLLES. In terms of formula grants to the States for grantsin-aid, we maintain quite close liaison. In research grants, it is far less. In terms of the hospital improvement grants we make to State institutions, we have considerable followup.

Mr. FLOOD. I would be worried about the latter.

Dr. YOLLES. The State institutions or the followup?

Mr. FLOOD. State institutions.

Dr. YOLLES. We have been anxious to improve the level of care in these institutions as an interim program until the community mental health centers are ready to take over the burden of care. So, we have sent our personnel in to see that these programs are improving.

TREND IN NUMBER OF RESIDENTS IN STATE MENTAL HOSPITALS

PROJECTED AND ACTUAL NUMBERS OF RESIDENT PATIENTS

END OF YEAR, IN STATE AND COUNTY MENTAL HOSPITALS-UNITED STATES-1946-1966

400 YEAR

46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

This is a reflection of the changes that I mentioned before. This is the trend and the actual numbers of patients resident in State mental hospitals over the years starting in 1946 through 1955, with a steadily increasing upward rate, with increasing numbers resident in State hospitals at the end of each year.

In 1955, we have the first break in this upward trend. The introduction of the psychoactive drugs, the tranquilizers, plus the development of community facilities, the introduction or the expansion of the treatment of the mentally ill and emotionally disturbed in general hospitals, plus this new wave of hope that I was talking about before, have been reflected in this decreasing number of patients in the State mental hospitals.

If this trend had continued unabated, we would have about 702,000 patients in mental hositals today. Actually, we have as the year total for 1966 an average of 452,000 patients. This difference in number has resulted in the cumulative saving of $4.7 billion which was used by the States and communities otherwise than for the care of patients

These are the four major program areas of the Institute: The support and conduct of research, training of manpower, service activities, and the support of institutions and resources.

The value of the total program is that all of these program areas feed back into one another so that one becomes modified by the results of the other. The training of manpower is affected by the results of research. New findings from research can immediately be translated and incorporated into the training of new manpower. Likewise, the findings in training can be incorporated into the support of institutions and resources in the field.

Often in our service activities, new pragmatic findings in the field are fed back into the support and conduct of research for further refinement. A clear example of this is the treatment of families as a unit rather than a single individual.

We start it in practice first, and then feed it back into research to be refined as a treatment technique.

Mr. FLOOD. How does the AMA consider you? Respectable?

Dr. YOLLES. Yes, sir. The American Medical Association recognizes mental health as the No. 1 health problem in the United States. Mr. FLOOD. I know that, but I mean your operation.

Dr. YOLLES. Eminently respectable, Mr. Chairman.

All of these findings and their modifications by relations to other elements of the program are fed out from the Institute by means of our staff services, the setting of standards, not the enforcement of standards but aiding professional organizations in setting standards for care, planning, communications, and staff services of other types. Through our regional offices, and the liaison with other agencies,

these findings are disseminated to professional organizations, hospitals, scientists, the general public, and other Federal agencies such as the Food and Drug Administration, HUD, Peace Corps, and the Office of Economic Opportunity.

PROGRAM DISTRIBUTION 1967

This is the general distribution of the program in 1967 to show the rather equal distribution of the three parts of the program. We have been concerned that we have a balanced program between the training of manpower, the support and conduct of research, and the support of institutions and resources.