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Mr. CASEY. About a year, isn't it?

Dr. YOLLES. I really do not know. I understand there was some difficulty with the application in terms of resubmitting it and modifying it but I do not know what the exact status is.

Mr. CASEY. I think you have some correspondence from me on that. I would like to know what the status of it is. If they cannot qualify I think you ought to tell them and tell me and let's get rid of it one way or the other.

COMMUNITY MENTAL HEALTH CENTERS

How many community mental health centers do you think you can take care of with the moneys you are asking for? That is, in the way of staffing and construction grants? Is this construction?

Dr. YOLLES. That is the total numbers funded because there is an overlap in many cases between ones that receive a staffing grant and the ones that receive a construction grant.

Mr. CASEY. When you fund them and give them a staffing grant is that for just 1 year or a period of years, or what?

Dr. YOLLES. No, sir; it is a grant for a period of 4 years and 3 months, and it is on a gradually declining matching basis, starting with 75 percent of the initial costs of staffing the first 15 months and then 60 percent in the following year after the first 15 months, and then 45 percent, then 30 percent, and then the Federal share is discontinued.

Mr. CASEY. The idea is that they are supposed to get on their own feet?

Dr. YOLLES. Yes, sir.

Mr. CASEY. This is to get them off the ground and prove their worth to the community?

Dr. YOLLES. Exactly.

Mr. CASEY. Whether it is a nonprofit organization or a State or local government operation?

Dr. YOLLES. Yes. We have seen a good deal of difficulty where a community has attempted to construct a facility and had to find the matching money to do so. When the facility is completed it finds it has exhausted its supplies of local funding. The community is then unable, really, to staff and to open as much of the facility as they thought they would like to. This program was deliberately designed to help communities to start their services right now when they are in need and gradually develop their local sources of support over 4 years and 3 months.

LITHIUM CARBONATE

Mr. CASEY. Lithium carbonate you say is very common or simple? Dr. YOLLES. It is a very common chemical substance which is used for the glaze on pottery.

Some 15 years ago in Australia a gentleman working with animals and animal behavior found that it reduced the excitement in animals and they experimented with the drug from time to time both here and on the continent in Europe.

They found that it has a very remarkable effect on the manic phase of manic depressive psychosis. The "high" phase, when the person is really excited. As a matter of fact, it really is the most effective drug

for this condition that we have today and is effective in somewhere between 60 to 85 percent of all cases versus something like 55 percent for the best tranquilizer used. Even more startling than that-and this is a startling fact in itself-it is the first drug which is available to us which will prevent the recurrence of a major psychosis. In one series of 88 cases that we know, Danish investigators with whom we have been collaborating have found that lithium increased the period between recurrences from an average time period of 8 months to somewhere between 5 and 7 years. This has been a remarkable achievement. The drug also offers us an unusual means of studying brain chemistry. It allows us to study some of the special substances in the brain which affect depression and elation as well as some of the other mental disorders.

So it has been, all and all, a very useful drug but it has been hidden somewhere for 15 years.

Mr. CASEY. Do you still use thorazine?

Dr. YOLLES. Yes, sir; and quite effectively in emotional disturbances. But for this specific type of illness, lithium carbonate is much more effective.

Mr. CASEY. I believe that is all.

Mr. FLOOD. Well, you had quite a workout and you did very well. It was an excellent presentation.

Dr. YOLLES. Thank you, sir.

JUSTIFICATION MATERIAL

MENTAL HEALTH RESEARCH AND SERVICES

Amounts available for obligation

1967

1968

Appropriation.....

Transfer to "Operating expenses, Public Buildings Service," General Services

Administration..

Comparative transfer to

"Community health services".

"Community mental health resource support"

"Comprehensive health planning and services".

Comparative transfer from "Hospitals and medical care'

Advances and reimbursements from

Other accounts..

Non-Federal sources..

Proposed for separate transmittal.

Total........

1 Includes reimbursements of $1,400,000 in 1967.

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Excludes comparatively transferred reimbursements of $1,400,000 in 1967, which are included under comparative transfer from "Hospitals and medical care," above.

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Transfer to "Operating expenses, Public Buildings Service," Gen

eral Services Administration (space rental)__ Comparative transfer to:

"Community health services".

"Community mental health resource support".

"Comprehensive health planning and services".

Comparative transfer from: "Hospitals and medical care".

1967 estimated reimbursements_.

Proposed supplemental_.

Unobligated balance, reserve_-_.

1967 total estimated obligations---

1968 appropriation estimate..

1968 estimated reimbursements.

1968 estimated obligations____

Total change----.

$264, 119, 000

-515,000

-8, 972, 000 —32, 081, 000 -6,750,000 1 9, 246, 000 1327,000 2, 000, 000 -156, 000

227, 218, 000

246, 741, 000

1, 731, 000

248, 472, 000

+21, 254, 000

1 $1,400,000 of the comparative transfer from "Hospitals and medical care" is reimbursements.

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Research Grants. The increase of $5,509,000 will provide for additional grants in the areas of behavioral sciences; clinical research; psychopharmacology research; narcotic and drug abuse; alcoholism; metropolitan mental health problems; and suicide prevention. An increase of $504,000 will support project grants under the provisions of the Narcotic Addict Rehabilitation Act of 1966. An increase of $100,000 for scientific evaluation grants is also provided. These increases are offset by a decrease of $767,000 in the general research support program and $500,000 in the study of children's emotional illnesses.

Training Grants.-An increase of $8,496,000 will provide for 13 new grants and $500,000 in undergraduate training, 96 grants and $5,252,000 in the graduate program; 31 grants and $1,150,000 for continuing education; 17 grants and $1,000,000 for experimental and special training; and 30 grants and $550,000 for the inservice training program. The remaining $44,000 is for an additional scientific evaluation grant.

Fellowships.-The $726,000 increase will support 116 additional grants in the predoctoral program and 5 new grants in the research career development program.

Planning, Development and Administration of Extramural Research Programs. Two positions and $83,000 will be used to strengthen the grants review activities of the extramural research program.

Intramural Research.-The 7 positions and $1,860,000 increase will provide: $500,000 for renovating Clinical Center space for psychiatric research; $450,000 for additional data processing and computer facilities; $210,000 for equipment for expansion of the laboratory of neurochemistry. The 7 positions and the

78-317-67-pt. 5-58

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