We ask the committee to report this legislation out as soon as possible and to report it out favorably.

Sincerely,

DR. DEBORAH P. WOLFE, Legislative Program Chairman.

P.S. Mr. Chairman, we hope that this letter can be submitted into the record. Thank you.

COUNCIL FOR THE ADVANCEMENT OF THE PSYCHOLOGICAL

PROFESSIONS AND SCIENCES, Washington, D.C., March 20, 1974.

Hon. PAUL G. ROGERS,
Chairman, Subcommittee on Public Health and Environment, Committee on
Interstate and Foreign Commerce, U.S. House of Representatives, Washing-
ton, D.C.

DEAR MR. CHAIRMAN: The purpose of this letter is to express the support for H.R. 11511, the "Community Mental Health Centers Amendments of 1973" by the Council for the Advancement of the Psychological Professions and Sciences. Several features of this proposal merit specific comment.

1. The listing of comprehensive services mandated by Section_201 (b)(1) is commendable for its completeness, especially for its emphasis on follow up care for individuals who have been discharged from a State mental health facility and on programs for children, the elderly, alcoholics and drug addicts/abusers. The aforementioned provisions of Section 201(b) (1) are reenforced in Seetion 223(a) (5) requiring State Plans to program all community mental health center facilities to "provide services for the prevention and treatment of alcohol abuse, alcoholism, and other drug abuse and drug dependence problems."

Too often, community mental health centers have avoided addressing the needs of individuals in the aforementioned categories; the cited provisions of H.R. 11511 offer promise that such no longer will be the case.

2. In some areas, the centers have lacked a representative community body with any governing authority, leaving real leadership (beyond advisory input) largely in the hands of medical professionals, especially phychiatrists. The provisions of Section 201 (c) (1) should substantially improve this situation by requiring CMHC governing bodies to include representative residents of the catchment area (at least one-third being non-providers of health care services); and sub-section (2) requiring an organized quality assurance program which includes utilization-review and peer-review mechanisms.

3. Section 201(b)(2) calls for the coordination of CMHC services with "the provision of services by other health and social service agencies in the center's catchment area to ensure that persons receiving services through the center have access to all such health and social services as they may require." It also provides that the services may be provided at the center or satellite centers through the staff of the center or through appropriate arrangements with health po fessionals and others in the catchment area. We endorse the intent of these provisions; the Chairperson of our Committee on Governmental Relations, Dr. Herbert Dorken, has commented as follows on the implications of these provisions, especially as they relate to the terms of Section 222 regarding the priority of projects for CHMC's "closely associated with a general hospital":

"... Placing mental health in the sickness-hospital orbit with a strong tendency to be isolated from grievous community health problems and the essential coordination with other health and social service agencies was, in my view, one of the great setbacks in the original federal impetus to development of comprehensive community mental health centers. H.R. 11511 would now coordinate these programs with better emphasis on community planning, environmental accommodation and ambulatory care and treatment. The predominant proportion of CMHCs can and should be in a community setting; that is, not an institutional complex."

Mr. Chairman, for the reasons set forth above, and for other reasons, we endorse your proposal and urge the enactment of H.R. 11511. In separate testimony at the appropriate time, we plan to speak in support of adequate funding for community mental health centers in the fiscal year 1975 HEW budget.

We commend you and your colleagues and the Subcommittee staff for developing this proposal to ensure adequate mental health services in the community to all the people who need and deserve them.

We would ask that this letter be made a part of the legislative record of H.R. 11511.

DEAR MR. ROGERS: I am sure that by this time the hearings on the Proposed Migrant Health Bill have come and gone-which is a major complaint I have: those people most affected by a piece of legislation usually are the last people to hear about it. In case the matter, is still unresolved, however, I would like to bring the following comments to your attention.

"Comprehensive Health Services", as defined in the Bill, are an ideal for which we all strive. However, there are a few impediments.

(1) The appropriation allocated to Migrant health is insufficient to purchase these services.-Mandating the provision of inpatient hospitalization costs while not providing significantly more funds (2 or 3 times the present appropriation) means the reduction of other services and/or the reduction of persons served. (2) In addition to the financial crunch of providing more services with the same amount of money, the mandated inclusion of environmental services forces many of the projects into a collision course with the local health department. Most non health department projects have historically been at odds with the establishment groups and this provision.enhances the possibility of conflicts. (3) No where in this proposed legislation is the entity, "National Reporting Requirements for Migrant Health Projects", an expensive ($20-30,000/year) burden of extremely questionable utility which has been laid on the Migrant 3 Projects this year.-Again, without increasing the appropriation. While I recognize the Congressional need for information on which to base its decisions, I feel that this is an unnecessarily expensive method of producing grossly erroneous data. Cost, utilization and quality evaluations done on site to gather specific information will yield more dependable and comparable (and probably less expensive data). Separating this evaluation expense and making a separate ap propriation for it will: a) insure that limited funds will not be mandated to be spent on non health care services, and b) will put some kind of a financial lid on the tendency of the H.E.W. evaluation section to create a paper empire for themselves.

I thank you for your time and trouble in reading through these comments and for your sincere interest in watchdogging these programs to insure that bureaucratic politics do not alter the intent of Congress to provide health care to those who need, but cannot afford it.

Sincerely,

KATHRYN HEALEY,
Project Director.

[Whereupon, at 1:10 p.m. the committee adjourned.]

О

HAWAII AND WESTERN ISLANDS SURFACE COMMERCE

PROTECTION ACT

HEARINGS

BEFORE THE

SUBCOMMITTEE ON

TRANSPORTATION AND AERONAUTICS

OF THE

COMMITTEE ON

INTERSTATE AND FOREIGN COMMERCE HOUSE OF REPRESENTATIVES

NINETY-THIRD CONGRESS

FIRST AND SECOND SESSION

ON

H.R. 7189

A BILL TO AMEND TITLE II OF THE RAILWAY LABOR
ACT TO PROVIDE FOR THE NORMAL FLOW OF OCEAN
COMMERCE BETWEEN HAWAII, GUAM, AMERICAN SAMOA,
OR THE TRUST TERRITORY OF THE PACIFIC ISLANDS
AND THE WEST COAST, AND FOR OTHER PURPOSES

JUNE 5, 1973 AND SEPTEMBER 27, 1974

Serial No. 93-88

Printed for the use of the Committee on Interstate and Foreign Commerce

97-548

U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON: 1978

COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE

HARLEY O. STAGGERS, West Virginia, Chairman

TORBERT H. MACDONALD, Massachusetts SAMUEL L. DEVINE, Ohio

SUBCOMMITTEE ON TRANSPORTATION AND AERONAUTICS
JOHN JARMAN, Oklahoma, Chairman

JOHN D. DINGELL, Michigan
BROCK ADAMS, Washington
BERTRAM L. PODELL, New York
RALPH H. METCALFE, Illinois

4 Appointed to Subcommittee on May 1, 1974.