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This is an example of a center in Minneapolis that is being built with a construction grant, no staffing involved in this. St. Barnabas Hospital and Swedish Hospital were across the street from one another and serving that community. They decided to set up the community mental health center, and they closed the street between them and applied for a construction grant to build a community mental health center between them, joining the two hospitals. That Federal grant, the Federal share of which was $827,000, enabled the community to have outpatient services, inpatient services, day and night services, consultation and education services to schools, courts, welfare agencies, et cetera. Each one of the hospitals is providing emergency services. They have a backup arrangement with the county general hospital to provide additional services, if needed, to central Minneapolis with a population of 200,000, and they also have a contractual arrangement with local M.D.'s to provide outpatient services when needed.

These services were not previously available to central Minneapolis. There were no inpatient services available to the total population, for example. This has been the resultant of a construction grant for a community mental health center. The ground-breaking for this center took place on July 10, 1966.

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This, in contradistinction, is solely a staffing grant, no construction involved at all. Tacoma Mental Health Center, Tacoma, Wash., serves the city of Tacoma, with a population of 153,000.

There were five agencies operating independently in this area, Tacoma, providing a variety of services, but there was no continuity of care. The Federal share for the staffing grant was $78,000. The State and local funds in this case were $180,000 for the first 12 months. The grant enabled the St. Joseph's Hospital to add a number of staff. If enabled the community mental health clinic, which existed before, to add consultation and education services. Day and night services, inpatient services and emergency services were added at St. Joseph's Hospital.

The stimulus of this staffing grant brought all of these five agencies together to provide a totality of services which was greater than all of them singly had been providing before to the city of Tacoma. The grant stimulated the provision of consultation and education services which previously had not been provided by the community mental health clinic; the Department of Public Health, through its Division of Nursing, is providing aftercare to this population. The Western State Hospital joined with them to provide additional inpatient care for children and adults; the St. Joseph's Hospital now provides inpatient services; and the Child Guidance Clinic provides care on an outpatient basis for children.

This represents a center which was built and staffed with a combination of construction and staffing grants.

The Good Samaritan Hospital and the Bethesda Hospital joined with the Muskingum County Guidance Center [see p. 852] to set up a new community mental health center to serve five counties in Ohio with a total population of 169,800. The staffing grant

Mr. FLOOD. What would be the area in miles? It is right in the cen ter, is it not?

Dr. YOLLES. Yes. I am not quite sure of the exact distances. Certainly we expect that there would be no more than an hour's travel by road. Otherwise, we would consider the services as not being accessible.

The staffing grant provided for personnel, and the hospital provided 12 beds for inpatient care which had not been provided before. In this case, the Good Samaritan Hospital was able to provide 24 beds through the staffing grant, as well as emergency services by the addition of three professional personnel.

The new community mental health center was built with a Federal construction grant, and provides a total package of service to these five counties which did not have it before.

Mr. SMITH. When they put together a plan like this, they leave a small corridor down at the bottom without service. What possibility is there that those people will ever have this service available, or do you try to encourage them not to leave a little place like that?

Dr. YOLLES. I think this is the area of Cincinnati.

Mr. SMITH. You do try to get them to select a territory which would not leave a small area unserved.

Dr. YOLLES. Before we approved any specific application, the State must submit a plan for the provision of community mental health services throughout the entire State so as to assure that there is effective distribution.

Mr. SMITII. You would not leave some area uncovered?

Dr. YOLLES. No, sir. The State assigns priorities to the filling of the areas within in the State.

AUTHORIZATIONS, APPROPRIATIONS AND OBLIGATIONS

FOR CONSTRUCTION AND STAFFING OF COMMUNITY MENTAL HEALTH CENTERS

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