ORGANIZATIONS REPRESENTED AT HEARINGS- -Continued National Congress of Parents and Teachers, Mrs. William C. Baisinger, coordinator of legislative activity. National Consortium for Child Mental Health Services, Virginia Crockford. Hunter, William F., Ph.D., chairman-elect, and area program director, Morris, Jonas V., executive director. National Easter Seal Society for Crippled Children and Adults, Maurice Newburger, Ph.D. National League of Cities, the U.S. Conference of Mayors, and the U.S. Conference of Health Officers, Dr. C. M. G. Buttery, director of Public Health, Portsmouth, Va. National Society for Autistic Children, Mary S. Akerley, first vice president and chairman, National Affairs Committee. Pennsylvania Migrant Health Project, Maria A. Matalon, R.N., field coordinator. Philadelphia Forum of Mental Health and Mental Retardation Centers, Anthony F. Santore, chairman, and chairman, West Philadelphia Community Mental Health Consortium, Inc. Planned Parenthood Federation of America, Frederick S. Jaffe, vice president. Population Council, Sheldon J. Segal, Ph. D., vice president and director, Biomedical Division. Range Mental Health Center, Virginia, Minn., William F. Hunter, Ph. D., area program director, and chairman-elect National Council of Community Mental Health Centers. Sound View-Throgs Neck Community Mental Health Center, Bronx, N.Y., Perry McFarland, demonstrations officer. U.S. Catholic Conference, Rev. Msgr. James T. McHugh, director, Family Life Division. United Cerebral Palsy Association, Inc., Paula B. Hammer, Governmental Activities Committee. United Methodist Church, Dr. McKinnon White, vice president of the Board of Church and Society. United Mental Health, Inc., Allegheny County, Pa., Alex T. Powell, Jr., president. Virginia Department of Mental Health, Dr. Joseph Bevalagua, director, Community Services. West Philadelphia Community Mental Health Consortium, Inc. Anthony F. Santore, chairman, and chairman, Philadelphia Forum of Mental Health and Mental Retardation Centers. Western Psychiatric Institute and Clinic, University of Pittsburgh, Ronald Forsythe, assistant executive director. Women's Lobby, Inc.: Burris, Carol, president. Pattin, Ellen, director, Health Research. Zero Population Growth, Inc.: Senderowitz, Ms. Judith, president. Tarnow, Mrs. Joyce, Miami Chapter. HEALTH SERVICES AND HEALTH REVENUE SHARING TUESDAY, FEBRUARY 19, 1974 HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON PUBLIC HEALTH AND ENVIRONMENT, COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE, Washington, D.C. The subcommittee met at 10 a.m., pursuant to notice, in room 2322, Rayburn House Office Building, Hon. Paul G. Rogers, chairman, presiding. Mr. ROGERS. The subcommittee will come to order, please. This is the third day of 6 days of hearings on H.R. 11511 and related bills. Today's hearing concerns title II of the bill which extends and substantially revises existing law with respect to community mental health centers. This title was written with substantial assistance from Congressman Heinz and his staff, who, I understand, worked closely with Pittsburgh and Philadelphia residents involved with community mental health centers. We are pleased to have some of these persons here today to testify. Our first witness this morning is Mr. Gregory Ahart, Director of the Manpower and Welfare Division of the General Accounting Office. The reason for Mr. Ahart's appearance is that the General Accounting Office is in the final stages of an exhaustive study of community mental health centers in several States. We will be particularly interested in GAO's assessment of the capability of centers to become financially self-sufficient after their staffing grants are terminated. Mr. Ahart, the committee welcomes you and your associates, Mr. Elmore, Mr. Fenstermaker, and Mr. Neuroth. We will be pleased to receive your testimony. STATEMENT OF GREGORY J. AHART, DIRECTOR, MANPOWER AND WELFARE DIVISION, GENERAL ACCOUNTING OFFICE; ACCOMPANIED BY WILLIS L. ELMORE, ASSISTANT DIRECTOR; CLIFFORD B. NEUROTH, SUPERVISORY AUDITOR; AND CARL FENSTERMAKER, SUPERVISORY AUDITOR Mr. AHART. Thank you, Mr. Chairman. We are pleased to appear here today to discuss the results of our review of the community mental health centers program which is administered by the National Institute of Mental Health (NIMH) of the Department of Health, Education, and Welfare. We have com pleted our fieldwork and have furnished a draft of our report to the Department for its review and comment, and have furnished a copy to this committee for its use. COMMUNITY MENTAL HEALTH CENTERS PROGRAM The community mental health centers program represented a new approach to the care of the mentally ill to make it possible for most persons suffering from mental illness to be treated in their own communities. The program began with the passage of the Community Mental Health Centers Act in 1963. This act, as amended, provides Federal grant assistance for the construction nad staffing of community mental health centers. SCOPE OF REVIEW Our review gave particular emphasis to the extent to which the centers had assessed community needs and developed programs responsive to such needs; second, the participation by local groups in developing the centers' programs and coordination of such programs with State and local organizations; third, the capability of the centers to become financially self-sufficient; fourth, the progress being made toward opening and/or constructing centers that received construction grants; and, finally the progress being made toward developing effective evaluation systems. We did not assess the effect of services on persons assisted by the centers. However, we did make observations on the quantity and range of mental services provided by the centers. At the Federal level, our review was made at NIHM headquar ters in Rockville, and the HEW Regional Offices in Chicago, Ill.; Boston, Mass.; Denver, Colo.; Dallas, Tex.; and Atlanta, Ga. We made a comprehensive review of the management activities of 12 centers and gathered information on the use of construction grants by nine other centers. These 21 centers were located in 11 States. PROGRAM STATUS AND ACCOMPLISHMENT As of September 1973, 392 centers were operational and another 148 were in the process of development. Federal funds totaling $793 million had been obligated for these centers-$216.8 million for constructionand $576.2 million for staffing. The operational centers have increased the accessibility, quantity, and range of mental health services available at the community level. Some success also has been realized in mobilizing State and local resources to further program objectives. The 12 centers reviewed have been able to establish the five services NIHM considers essential: inpatient, outpatient; partial hospitalization, emergency, and consultation and education. Although progress has been made in providing mental health serv ices at the community level, NIHM, the States, and the centers need to substantially improve performance in a number of program areas to enhance continued progress toward achieving program objectives. These areas include the need to improve, first, planning related to the area to be served and services provided; second, capability of centers to operate without continued Federal assistance; third, monitoring and evaluation; fourth, coordination of center activities; and finally, use of construction resources. IMPROVED PLANNING Federal regulations limit the size of the catchment area to be served by a center to no less than 75,000 and no more than 200,000 persons. Exceptions to this requirement may be authorized by NIMH. Adherence to the regulations and, however, created problems in the establishment and operation of centers. We found that adherence to these regulations could one, impede program performance by dividing existing planning areas and political jurisdictions; two, cause services and facilities to be duplicated in some areas, and three, cause spending for mental health services to be unevenly distributed within a political jurisdiction. We also found that a better job needs to be done in identifying mental health needs at the local level. State plans usually contain general demographic data, such as suicide rates, admissions to State mental hospitals, number of welfare cases and per capita income, which may be sufficient to justify initiating a program in a catchment area but not to justify continuing the same type of services year after year without assessing them in relation to community needs. In addition, data contained in State plans is not always current or of much value to individual centers in planning their programs. At the community level, most centers reviewed had not made specific studies of their catchment areas in support of their applications for a Federal construction or staffing grant. The availability of funds to match Federal grants and the interests of the professional staff of the center were often important influences in establishing program emphasis within a center. Although the needs met by programs established in this manner are probably valid, there is no assurance that they are the only needs or the highest priority needs of the catchment area. Also, once programs are established, they tend to dominate center activities in subsequent years. Our review also disclosed that community involvement in the activities of community mental health centers has varied considerably from area to area. In many instances, community representatives and advisory groups have had little voice in setting program priorities and direction or in determining how center funds were to be used. NIMH guidelines call for involvement of the community in the development and operation of the centers to assure that they will be responsive to the mental health needs of the community and have public support. CAPABILITY OF CENTERS TO OPERATE WITHOUT CONTINUED FEDERAL ASSISTANCE Our review disclosed that without continued Federal assistance a number of services, especially those which provide little or no revenue, would probably be curtailed or eliminated at many centers. We noted that the alternative financial assistance available cannot realistically replace Federal funds in total. 31-151 O 74 pt. 2 2 |