In Indiana, the 1973-75 biennial budget, before AFSCME encouraged amendments, called for a cut of $2.4 million in institutional budgets to provide community care with no phase-in period, minimal community facilities, and dramatic staff cuts in already poorly staffed State institutions. In California, the closure of institutions before community alternatives were prepared has finally been halted by legislative action over the Governor's veto. In Milwaukee, Wis., the budget of the county executive sought to mandate the administrative discharge of 400 mentally ill patients to make funds available for community facilities despite professional staff testimony that the patients were unready for discharge. In Arizona, the director of the department of mental health, Dr. Walter Fox, turned down a speaking engagement at an NIMH program at Scottsdale, Ariz., when the subject "The Arizona Plan" was assigned on the grounds that there is no "Arizona Plan"-there is a constant state of flux. This NIMH conference had no participants from the workers in mental health, despite requests on the part of AFSCME. Only in one State, Mr. Chairman, Massachusetts, is AFSCME aware of a public policy planning process for improving mental health care which has included all sectors of the public-professionals, workers, mental health organizations and consumers-in a program to utilize existing facilities and provide community alternatives for mental health. In a joint AFSCME-State of Massachusetts career development program, State institutional employees have been retrained for work in the community with patients. In view of the fact that State institutions have halved their populations in 5 years-in many cases with minimal or no followups of patients and are increasingly transferring institutional funds to community budgets without public planning processes or the development of standards or community care, AFSCME feels that H.R. 11511 should be amended to provide the following. First of all, a specialized program for outreach and services for persons in the catchment area who have been discharged from State institutions in the previous 5 years. Services in this case should mean specialized services or special adaptations of generic services directed toward the alleviation of a chronic psychiatric disability. From here we took the definition in the section of the bill dealing with the developmental disabilities because we felt that the need for services and standards went beyond the level of just what was provided in-house in the course of the community mental health center, but particularly reached into the boarding arrangements and domiciliary arrangements of these patients. Second, revision of section 201 (2) to mandate that services in a catchment area must be coordinated with States institutions servicing the same catchment area. Third, a revision of section 201(2)(c)(i) that the governing body of the community mental health center, the composition of the board should be itemized to include professional and citizen, mental health organizations, and organizations representing workers. The present definition of provider would prevent participation by many of the above groups. Four, clarification is required beyond the language in the bill calling for community health centers to make available a reasonable volume of services to patients unable to pay. This language which originally appeared in the Hill-Burton Act is not definite enough to provide services to those who need it, and will continue the burgeoning trend toward a dual mental health system. At a minimum, community health centers should be mandated to make their services available to medicare and medicaid patients in the catchment area. Most importantly, and finally, in section 223, "State Plans" and section 229, "Allotments to States," there should be revision to put emphasis on improved mental health services. Unless States, as a condition of receiving Federal moneys for community mental health centers are required to publicly plan for mental health services, there will never be enough community mental health centers. Discharges of patients from public institutions which are understaffed and underfunded to private profitmaking nursing homes and boarding homes which lack programs, staff, and facilities is being reported and repeated in many States. In many cases hospital staff members understand that a community mental health center will provide followup services but with lack of planning there is no followup. State plans must make this process clear for the thousands of recently discharged patients as well as those who may be discharged in the future. State plans must include manpower planning to utilize the skills of present psychiatric personnel-in no State can we afford to lay off skilled workers, such as the 101 AFSCME members at Chicago-Read Illinois Mental Health Center or the Harrisburg, Pa., State Hospital before AFSCME obtained court injunctions. The level of mental health care provided to our citizens must be enhanced and reasonable assurances must be made by States that the skills of present mental health workers will be utilized when new methods of providing care through community mental health centers are planned. In summary, Mr. Chairman, the American Federation of State. County, and Municipal Employees, AFL-CIO, representing 70.000 mental health workers supports the improvement of mental health services to our citizens and the orderly development of community mental health centers. The provision of improved mental health care through community mental health centers under the "Special Health Revenue Sharing Act of 1973," H.R. 11511, must be the result of careful public planning and coordination with utilization of existing facilities and staff and not the development of a dual-pay/no-pay system of mental health care. Thank you, Mr. Chairman. Mr. ROGERS. Thank you, Ms. Tarr-Whelan, for your very helpful testimony. I think it would be helpful to the committee if you could submit language that would carry out your suggestions. MS. TARR-WHELAN. Yes, sir. [The following proposed amendments were received for the record:] PROPOSED AMENDMENTS TO H.R. 11511 (1) On page 3, line 4, delete the word, "community." AFSCME feels that there is a shortage of mental health care resources, not limited to community mental health care resources, and therefore recommends removing the word, which has a limiting effect on this finding of Congress. (2) On page 5, following line 23, add the following new subsection: "(v) A specialized program for outreach and services for persons in the catchment area who have been discharged from state institutions in the previous five years, including diagnosis, evaluation, treatment, personal care, day care, domiciliary care, special living arrangements, training, education, sheltered employment, recreation, counseling, protective, information and referral, transportation, and legal and other socio-legal services directed toward the alleviation of a chronic psychiatric disability or toward the social, personal, physical, or economic habilitation or rehabilitation of an individual with such disability. AFSCME recommends that the protections are as important to mentally ill patients as they are to the mentally retarded. This language parallels that in the developmental disabilities section of the Act. (3) On page 6, line 2, following “(agen-)cies,” add the phrase, “including the state institutions." The purpose of this amendment is to bring state institutions into the catchment area coordinating process. (4) On page 6, line 20, delete the period following "body" and add the following new language: "including representatives of professional and citizen mental health organizations and organizations representing workers in mental health institutions." This amendment will insure that the governing body of the CMHC contains a broad cross-section of persons interested in the center's operations. (5) On page 9, lines 6 and 7, delete the words, "will make available reasonable volume of" and add the words, "may not deny". This amendment prevents centers from refusing care to people who cannot afford it. (6) On page 25, line 11, after the word, "for", add "mental health services including". This amendment is necessary to preserve the role of the state mental institution and to prevent states from ignoring their role in the state plan. (7) On page 37, Sec. 229 provides for allotments to states but does not specify what the states are to use their allotments for. We suggest that the section be amended to permit use of the allotments for planning as outlined in Sec. 223. This amendment would serve to give the states additional incentive to develop comprehensive plans for furnishing mental health services within their jurisdic tions. Mr. ROGERS. Dr. Carter? Mr. CARTER. Thank you for your statement. The point that we didn't plan sufficiently and there was inefficient or a total lack of coordination between discharges from our larger institutions, I thought that point was certainly well taken, because we have seen instances where patients so discharged got into difficulties immediately after that. In some cases, they committed murder. So, I think your point in that instance is well made. Would you discuss the Arizona plan? MS. TARR-WHELAN. Yes; this meeting was held in Scottsdale, Ariz., sponsored by the National Institute of Mental Health on the closures of State institutions, and Dr. Walter Fox, who is the director of the department was to be one of the speakers. He sent word to the conference to state that there has been no public plan in Arizona. They are in the process of hopefully formulating one, and that they were in the position of many other States that had not gone through a formal planning process, and, therefore, he could not accept any public speaking engagement that called on him to give a plan, because one did not exist. Mr. CARTER. Thank you. Mr. KYROS. Thank you, Mr. Chairman. I think the part of your testimony I heard is not only enlightening but I believe your union of State, county, and municipal employees has been in the forefront ever extending and making aware to all Americans the need for more help. I think your work is outstanding, and I appreciate the fact you want the spectrum of services. I met with some of the members of your union recently when I visited Pineland Hospital in Maine. One of the issues up there is decentralization and unitization and the problems that go with it. I was so impressed with the contribution those employees made to the policies in the hospital. So, I just want to commend you for your testimony and I am glad to see you here today. Thank you, Mr. Chairman. MS. TARR-WHELAN. Thank you. Mr. ROGERS. Mr. Hastings? Mr. HASTINGS. I join my colleagues in their statements regarding your testimony. I have no questions. Thank you. Mr. ROGERS. Mr. Symington? Mr. SYMINGTON. I congratulate the witness and have no questions. Mr. ROGERS. Mr. Hudnut? Mr. HUDNUT. No questions, same words of appreciation. Mr. ROGERS. Thank you. This concludes the hearing for today, and the committee's hearings are adjourned until 10 o'clock tomorrow morning. [Whereupon, at 3:47 p.m., the subcommittee adjourned, to reconvene at 10 a.m., Wednesday, February 20, 1974.] HEALTH SERVICES AND HEALTH REVENUE SHARING WEDNESDAY, FEBRUARY 20, 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. We are continuing our hearings on H.R. 11511 and other related bills to the Health Revenue Sharing and Health Services Act of 1973. This morning we are very pleased to have as our first witness Mrs. Baisinger of the PTA. I understand you would like to submit a formal statement on behalf of the PTA. STATEMENT OF MRS. WILLIAM C. BAISINGER, COORDINATOR OF LEGISLATIVE ACTIVITY, NATIONAL CONGRESS OF PARENTS AND TEACHERS Mrs. BAISINGER. I am here and I know you have a large list of witnesses, but I do appreciate the opportunity to present our written statement. We have brought copies for members of the committee. PTA has had a long interest in emotional health for children and we have supported children's emotional health projects. We are very concerned that this bill have provisions for mental health services for children in any facility that may be set up. I will just take a minute to tell you our national PTA president is here, Mrs. Lilly Herndon from South Carolina. There are some 200 of us here on a Congress for National Legislation. Mr. ROGERS. Mrs. Herndon, we are glad to have you. Mrs. BAISINGER. Mrs. Haddock came down with the virus today. Mr. ROGERS. We saw her yesterday. We are glad to have you. We know of your great interest in the mental problems of children, and this committee will, I am sure, try to be responsive to the needs of the Nation in this regard. We are grateful for your presence and your statement will be made a part of the record. [Mrs. Baisinger's prepared statement follows:] STATEMENT OF MRS. WILLIAM C. BAISINGER, COORDINATOR OF LEGISLATIVE ACTIVITY, NATIONAL CONGRESS OF PARENTS AND TEACHERS Mental health service to children and families has been of vital concern to the PTA since the first PTA meeting in 1897, and it continues to be a concern today. We recognize that sound mental health is essential to constructive family life and personal happiness and to the acceptance of civic responsibility. |