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Mr. ROGERS. I have been interested in the program carried out in my area by Dr. Carl Brumback, in the county of Palm Beach. He has made excellent headway. Let me ask you about the hospital funds that the committee authorized, I believe, in 1965.

Dr. LEE. First available in 1966.

Miss JOHNSTON. The first funds for hospital care became available in January of last year. Up to the present time, 55 projects have made application for hospital funds. They are scattered over 25 different States. They have agreements with about 170 hospitals at the present time.

Mr. ROGERS. Would you let us have a rundown on the ones that were approved, and what amounts, and the people involved?

(The following information was received by the committee:)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE STATEMENT ON MIGRANT

HOSPITALIZATION

As of January 1968, 55 migrant health projects in 25 States had added inpatient hospital care to their existing services in an attempt to provide as broad a scope of comprehensive health care as possible. The hospitalization component includes an intensified program of early casefinding, a referral system for medical care outside the hospital, and a system for predischarge planning.

State

Arizona

Arkansas

California

Delaware.

Florida...

Illinois....

Pinal County Health Department Florence, Ariz.
Yuma County Health Department, Yuma, Ariz.
Northwest Area Migrant Committee, Fayetteville, Ark.
California State Department of Public Health, Berkeley, Calif.
Delaware State Council of Churches, Dover, Del..
Florida State Board of Health, Jacksonville, Fla..
Dade County Department of Public Health, Miami, Fla.
Palm Beach County Health Department, West Palm Beach, Fla.
Jones Memorial Community Center, Chicago Heights, III..
Illinois Department of Public Health, Springfield, III.
Northwest Church Council for Migrant Aid, Inc., Rolling Meadows,

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$29,500 107, 445 2,400

1 14, 158

7, 200

125, 319

25,000

33, 176

1,900

7.359

4,500

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Mr. ROGERS. What are the needs now of the migrant program, any need that you have?

Miss JOHNSTON. Well, you ask for a rundown of the migrant health program. I could give it to you briefly right now.

At the present time we have 115 single or multicounty projects, They are providing personal health care in nearly 300 counties, personal health care plus sanitation services.

There are about 155 counties in which sanitation services only are being provided.

You have to realize that about 700 counties have a migrant influx during the year, so, roughly, we are providing personal health care in 300 of the 700 counties.

The personal health care is accessible to about 300,000 of the 1 million migrants. The level of care that we are able to support with the funds that we now have available is considerably less than that for the general population. The number of medical visits in the project areas for migrants is about one-fifth of the number for the general population. The number of dental visits is about one twenty-fifth of the general population.

The funds have been obligated to the last cent in every fiscal year since the program started. We started out this year with every cent obligated from last year, and as you will recall, our appropriation this year is exactly the same as last year's.

Mr. ROGERS. Thank you very much. If there are any additions you may want to make, the committee would like to have that. I think you have done a great job with the program.

Miss JOHNSTON. Thank you.

Mr. ROGERS. Is alcoholism a mental problem?

Dr. YOLLES. I think the experts in the field would say there is a large element of emotional problem in the alcoholic. I don't think all the experts agree as to the percentage of emotional problems in

each alcoholic, but for a long time it has been handled by the field of mental health.

Mr. ROGERS. For the confirmed alcoholic, would you say there is basically a mental problem involved, generally?

Dr. YOLLES. Certainly there is a basic mental and behavioral problem involved in the chronic alcoholic.

Dr. LEE. Mr. Chairman, I would like to add a personal comment on that because I had, when I was in practice, a particular concern with the problems of the chronic alcoholic, and I would agree with what I think is the general professional judgment. These patients often have serious emotional problems, and their families are also involved. It is a complex problem that doesn't just affect the alcoholic, but also affects his family and the interaction between the husband and wife and also the children, and they are all involved.

So it is a social behavioral problem, and there are many people who have sought for many, many years evidences of some physical cause, and we know there are certain biochemical derangements that occur with chronic alcoholism; but we have never been able to demonstrate any cause and effect relationship. You cannot treat the chronic alcoholic without assisting his family and mental health services are an important component in the treatment.

Mr. ROGERS. I assume that would apply to the narcotic addict as well. Dr. YOLLES. That is quite true.

Mr. ROGERS. Why aren't they now covered under the Comprehensive Mental Health Act?

Dr. YOLLES. They are covered, Mr. Rogers.

Mr. ROGERS. It was our intent to cover them when we wrote that law. Dr. YOLLES. Yes. The communities have been less than interested in providing treatment for alcoholics, and particularly for narcotic addicts. Their treatment has a lower priority than treatment for other patients. The cost of treating such patients runs high, and very often the patients cannot pay for it.

Dr. LEE. They are often discriminated against. An alcoholic often cannot be treated in a hospital because he is an alcoholic, so he is denied access to community health care institutions, and this just compounds the problem.

Mr. ROGERS. I would be concerned about increasing the percentage for staffing. Ninety percent, I notice you have changed it to in the proposal, 80 percent, 60 and 50, for each of the 6 years, which is a considerable change from the formula we had for the community health hospital, and also for the mentally retarded facilities.

Dr. YOLLES. Mr. Rogers, by raising the Federal matching in this level, and extending the length of the program from 4 years and 3 months to a period of 8 years, we are offering incentives to communities to pick up treatment programs that are vitally necessary. These communities at the present time are involved in supporting and financing general mental health services which have the first priority. To add another treatment program which, in their eyes, and which we have seen from evidence over the years has a lesser priority, at the same matching ratio, without any special incentive, does not encourage them to pick up those programs.

Mr. ROGERS. I think there is a growing concern on the problems of alcoholism and narcotics addiction, and the communities are becoming

more aware of that and the needs for treatment. I think the Supreme Court will probably make a decision soon that will affect this situation, as far as alcoholism is concerned.

If we are building community health centers now, I would like to see us get into this before we start building alcoholic centers and narcotic centers. I would think maybe simple additions-if it is necessary, and it may not be necessary in many areas-I would hope this could be tied in more rather than just setting up two new programs to start out with almost.

Dr. YOLLES. Mr. Rogers, this is exactly what we are trying to achieve in this legislation through the project approach. You see, only those communities which are ready to fund and ready to go with a new program such as this will be coming in for such project grant funds. These will be added to the community mental health center as an integral part of it, but it will allow those who are ready to do it now to come in and be supported at a higher rate, now.

Mr. ROGERS. I would like you to furnish us what your projection will be, your cost over the next 6 years, so let's give a projection of 6 years, if you can, if this is possible. And what it would require in personnel, money, and possible projected results.

(The following information was subsequently received by the committee :)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ESTIMATED NEW OBLIGATION AUTHORITY REQUIRED UNDER H.R. 15758 FOR FISCAL YEARS 1969-77

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Note: The projections contained in this table represent departmental predictions and do not represent the administration position on the future program or budget requirements. Personnel requirements will be dependent on program developments and budget factors which at this time cannot be fully predicted.

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