disorders for children, adults and elderly exceeds twenty percent, or more than 40 million. of the U.S. population annually Mental disorders account for the majority of patients receiving clinical hospital care in the United States, yet research shows that only one fifth of those identified as having a mental illness are currently under treatment. It may be surprising to learn that of the one quarter of the U.S. population under age eighteen, at least twelve percent. or 7.5 million. of these children have a diagnosable mental illness: approximately 7.3% of U.S. adults have suffered from anxiety disorders; affective disorders -- including major depression, manic episodes, and dysthymia (a milder form of depression) affect approximately five percent of the adult population: schizophrenic disorders, which can be the most disabling of mental illnesses, occur in approximately one percent of the U.S. population, and approximately 40 percent of all hospitalized psychiatric patients in the United States suffer from schizophrenic disorders; an estimated four million elderly Americans suffer from Alzheimer's disease; an estimated 10.5 million United States adults exhibit some symptoms of alcoholism or alcohol dependence, and an additional 7.2 million abuse alcohol but do not yet show symptoms of dependence: nearly one-third of all new cases of AIDS are occurring in intravenous drug users; twelve percent of Americans have used cocaine, which is the leading cause of drug-related emergency room visits; nearly a third of the population of homeless single adults in the nation suffer from severe and disabling mental illness. As you can see, the ADAMHA mission to provide national leadership to America's mental health and substance abuse treatment and prevention efforts is extensive.

Despite the enormous challenges facing the nation, the scientific enterprise. clinicians and citizen communities are confident that with an adequate and sustained investment in ADAMHA-supported research you will yield economic and human dividends far in excess of the modest "down payment". The answer to the Congressional concern about clinical services and service systems also lies in the information obtained through ADAMHA's basic biomedical and behavioral research programs. The late Congressman Silvio O. Conte's "Decade of the Brain" plan for the neurosciences and the Senator Domenici-inspired National Plan for

Research on Schizophrenia are two important linkages to the future of mental health care delivery. So is the National Plan for Research on Child and

Adolescent Mental Disorders and the National Plan for Research to Improve Care for Severe Mental Disorders.

Mr. Chairman, you know better than I that the domestic discretionary spending cap requires tough appropriation choices. but I feel you would agree that the nation must forge a stable research investment and not have to bear the economic consequences associated with mental illness and addictive disorders hidden in our criminal justice system or alcohol and drug related injuries. Failing to make the necessary investment in ADAMHA-supported research will limit realization of immediate scientific opportunities and slows our national quest for new treatments, improved diagnostic techniques and better preventive measures for mental illness and addictive disorders.

Inadequate funding also threatens over the long term our national research capacity. The President's FY 1992 ADAMHA research budget, for example, will reduce the number of competing research project grants by nearly twelve percent. This reduction means that some researchers will not receive the necessary resources to carry their research forward. Increasingly, young researchers those 36 years of age or younger are the ones not being funded. The percent grant awards made to young investigations has declined from twenty percent in 1982 to thirteen percent in 1989. This trend is likely to frustrate talented young researchers and threatens the future base of our nation's scientific research pool.

In contrast to the President's budget, the APA and the Mental Health Liaison Group Coalition propose that the research budgets for the three ADAMHA institutes be increased to a level minimally appropriate to the quality of the science which merits support, as follows: $675.4 million for the N!MH: $378.0 million for the NIDA; and $201.0 million for the NIAAA. These recommendations include critical research training and research management and support

activities, as well as support for AIDS research. These recommended budgets

would allow the institutes to support high quality research project grant

applications at rates that will not dissuade excellent investigators from even applying for assistance.

History has repeatedly demonstrated the cost beneficial nature of this investment. For example, the introduction of lithium for the treatment of manic-depressive illness led to a $39 billion cost savings in reduced medical costs and increased productivity in the fifteen years since its discovery. This is ten times the total invested in research by NIMH since lithium's effects were discovered. We in the field have the capability to reap comparable benefits for patients with many other mental and addictive disorders by fully exploiting the strong scientific base which exists.

We are confident that with increased support researchers in the mental illness and addictive disorder field will be able to: clarify the underlying mechanisms of the major anxiety and depressive disorders through new imaging studies and develop more effective treatments for these disorders; evaluate the impact of clozapine on subgroups of schizophrenic patients who have not responded well to standard medications; undertake additional linkage studies to identify genes that underlie such severe mental disorders as schizophrenia, manic-depressive disorder, and Alzheimer's disease; discover that a series of biochemical. physiological and behavioral characteristics of an individual may be markers of individual predisposition to alcoholism; make more rapid progress in the development of new medications for the treatment of drug abuse; expand research on the identification of cofactors that affect HIV vulnerability.

transmissibility and disease course; expand research on the effects of maternal drug use on infant development; refine new diagnostic techniques for Alzheimer's disease; fully implement the National Plan for Research in Child and Adolescent Disorders. the National Schizophrenic Research Plan and the Decade of the Brain Research Plan; and, fully initiate the National Plan of Research for Improved Care for Severe Mental Disorders.

Mr. Chairman, these are only samples of the challenging research opportunities that lie ahead. The alternative, budget proposal developed for your

consideration has been thoroughly reviewed and assessed with full awareness of
the newly-enacted spending cap that confronts your Subcommittee. Our ADAMHA
research appropriation recommendations have been endorsed by the Ad Hoc Group
for Medical Research Funding and the Mental Health Liaison Group. In addition.
we agree with the Ad Hoc Group and the Coalition for Health Funding, that the
promise of research for reducing human and economics costs associated, as well
as for contributing positive benefits to the nation's international competitive
position, makes support for biomedical and behavioral research a high priority
investment in the nation's future.

The ADAMHA mission is broad. It contains many diverse but scientifically
related, interwoven and complementary programs. Briefly, we also propose for
your consideration:

$26 million for NIMH Clinical Training. $2 million for NIDA and $1 million
for NIAAA clinical training to better ensure the placement of personnel and
in shortage areas and in public facilities and to improve the quality of
training--in a field of exploding new knowledge from research

advances--provided to mental health and substance abuse specialists.

o $1.8 billion for the Alcohol, Drug Abuse and Mental Health Block Grant. There can be no overriding reason for holding at the current appropriation this program which provides critically needed services to the mentally ill and those suffering from addictive disorders.

$36.0 million for the NIMH CSP/CASSP. $10.0 million for the NIMH Prevention, and $14.4 million for the NIMH Homeless Demonstration programs.

O $381.0 million for the Office of Substance Abuse Prevention

$234.2 million for the Office of Treatment Improvement treatment improvement programs.

All of the above-mention appropriation recommendations are noted on page eight of my testimony. Thank you for the opportunity to testify before your Subcommittee. Mr. Chairman. I'd be glad to respond to any questions.

ADAMHA AIDS Budget (These numbers are included in the above figures unless

A

$7.1 million is not included in the NIMH figures listed above.