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Whether this is a new building or he would take over an existing building, he would include the alcoholics.

Mr. ROGERS. Would you have a detoxification center, in effect?

Dr. Cook. We don't want a separate, large detoxification center. We would like each medical center to accept and treat the alcoholic. We are providing funds for detoxification. We will pay on a contractual basis, or we could establish a unit with funds from some source in a medical or mental health center.

Mr. ROGERS. Would you let us have a rundown on how you would do the operation of this?

Mr. BECKER. We have recently submitted a proposal for a grant, and approximately $350,000 from the State legislature for this program of buying medical care for the indigent alcoholic. Funds would also come from public aid to purchase medical coverage.

The idea is to contract for these services on a per diem basis. Particularly in the city of Chicago, we have a problem. In any one given day, we would have anywhere from 150 to 200 patients coming in. This could soon inundate a single program, so we are in the process of continuing to develop citywide programs in concurrence with the comprehensive health program services. Each of these programs will utilize the hospital in that area.

We will contract with them for their medical services in any one year.

Mr. Rogers. What is the estimate of your population of alcoholics?

Mr. BECKER. Using the information we have, our public health statistics indicate we have in excess of 500,000 alcoholics in the State of Illinois. Over 80 percent of these reside in the Greater Chicago area.

During 1967 we admitted on a voluntary basis something like 7,000 alcoholics, and over 4,500 of these were in the Greater Chicago area. So we have been involved in the detoxification process for a long time.

We do need the opportunity for some comprehensive backup support that this comprehensive bill would supply.

Mr. ROGERS. Are you having any success with bringing about abstinence?

Dr. Cook. We are having a good deal of success in our State hospital programs, but what we are trying to do is keep the alcoholic in his local area, in his community for detoxification, and refer him there for followup care, and save our State hospitals for special treatment centers for the alcoholic who needs 30, 60, or more days of continued treatment.

Mr. Rogers. Do you get into the treatment of narcotics?

Dr. Cook. In our State we have a council on narcotics, which is established by the legislature and appointed by the Governor.

Mr. ROGERS. Do you handle this in your program yet?
Dr. Cook. Not yet.

The pilot project is being established to try to determine what would be the best statewide program for narcotics.

Mr. Rogers. What is your narcotics population?
Dr. Cook. About 60,000 would be an estimate.
Mr. Rogers. Thank you very much.
If you would, let us have a breakdown on your operation.
Dr. Cook. Yes, sir.
(The following information was received by the committee:)

STATE OF ILLINOIS DEPARTMENT OF MENTAL HEALTH,

Springfield, Ill., April 1, 1968. Hon. PAUL G. ROGERS, Committee on Interstate and Foreign Commerce, U.S. House of Representativcs, Washington, D.C.

DEAR CONGRESSMAN ROGERS : First may we extend our appreciation for the privilege of appearing before your Committee. We hope that our contribution may help in soine small way to assist you in reaching your decisions.

As you recall, during the Committee Hearings you requested information on our General Hospital Detoxification Program which I am enclosing.

Again, our deepest appreciation, and should you feel that we can be of assistanc to you in any way, it will only be necessary for you to so advise. Sincerely yours,

WILLIAM N. BECKER, Jr.,

Assistant Chief, Division of Alcoholism. Enclosure.

PROJECT

Section on alcoholio programs, Department of Mental Health, detoxification program

PROPOSAL

To provide emergency care for acutely intoxicated indigeat persons in general hospitals. In this proposal the main emphasis is on a situation which involves the Chicago metropolitan area but it is our intention to include the entire state in our plans to offer care to acutely intoxicated patients.

RATIONALE

During the past five years it has become increasingly apparent to the Sertion on Alcohol Programs of a need for a program of mass management of the acutely intoxicated person at the community level. It is common knowledge in the field of alcoholism that the federal government, and the Nation as a whole, is becoming vitally aware of the need for more adequate care and treatment of the acutely intoxicated person. It is equally known that (a) the Supreme Court of the United States will issue a decision regarding compulsory care of the inebriate, the acutely intoxicatel, and the chronic alcoholic; (b) that the American Bar Association and the American Medical Association are jointly sponsoring model legislation to assure the appropriate medical management of the alcoholic; (c) that the President of the United States recommended the "Alcoholic and Narcotic Addict Rehabilitation Amendments of 1968" (HR 15281) (Appendix V) to the 90th Congress.

With full knowledge of the above, the Section on Alcohol Programs strongly proposes the immediate establishment of a pilot project for the mass management of the acutely intoxicated and/or inebriated and/or the chronic alcoholic. In addition to preparing for the effect of the inevitable legislative action, this proposal will have a marked effect on the management of our present problem with acute and chronic alcoholics.

During the last nine months of the last fiscal year, 1,830 persons were assigned to the Department of Mental Health facilities through the hospital referral service for chronic alcoholics. (Appendix I) It is estimated that, as of 1967, there are in excess of 500,000 alcoholics in Illinois with the majority of them residing in Cook County. Utilizing 1967 statistics provided for us on February 13, 1968, by the Department of Mental Health Data Processing Division, there were 7,059 admissions to the Department of Mental Health for alcoholism, representing 30.3% of the total admissions to thirteen state hospitals and four zone centers. (Appendixes II and IV)

Our experience with this increasing number of alcoholic patients, particularly in the metropolitan Chicago area, indicate the following: (1) that the majority require medical management; (2) a large number of these patients do not want, will not, or cannot accept or benefit from treatment or rehabilitation in the alcoholism programs provided in our state hospitals; (3) a substanital number of this group could benefit more by being treated for the acute phase of intoxication and then referred to a variety of ancillary programs for appropriate care; (4) a reasonable number require no emergency medical or psychiatric care but do require direction for the above mentioned ancillary programs; (5) that once these patients are inappropriately assigned to our state hospital alcoholism programs (a) they will continue to return, (b) they are inclined to leave before medically discharged or recommended discharge, (c) they tend to interfere with more effective programming for those who are more able to benefit from the programs.

OBJECTIVE

To establish a cooperative program between the Department of Mental Health, Section on Alcohol Programs, the Illinois Department of Public Aid, and the Cook County Department of Public Aid;

To provide emergency psychiatric care of indigent persons in general hospitals for acute intoxication ;

To short-circuit the general flow of the alcoholic patient away from the state hospital alcoholism programs to the community agency programs.

PROGRAM

In response to this situation, we have developed a program which provides medical treatment for acutely intoxicated patients in certain acceptable general hospitals. (Appendix VII) Hospitals, where this care can be given, are available. Aside from the money requested by this grant, the cost of this care will be covered by payment from the Department of Public Aid and its county representatives in situations in which patients are eligible for coverage for medical expenses. We believe that some category of assistance will compensate for this service in a majority of cases. In other instances the cost will be paid by the patient's insurance, family, or by the patient himself. However, funds requested in this grant are vital because there will be a significant group of patients unable to pay from personal resources and yet not eligible for payment through any of the categories of assistance available through Public Aid. Funds from this grant request, also, enable us to assure each participating hospital against loss incurred through caring for our indigent patients. This program will include the entire state, depending upon where this programming is indicated and where local arrangements permit its development. The present most pressing situation is in metropolitan Chicago.

It is our expectation that this program will be a solution, or a very substantial step toward a solution, of the three conditions which we have long recognized as needing correction. This innovation of service is much more far-reaching in its implications. First, it is a step toward anticipating the tremendous demands, previously mentioned, which these changes will make on our health services. A second significant point is that this program is very much in keeping with the current decentralization of health services in general. We believe that it makes much better sense to treat the alcoholic patient in his own community and in existing health facilities or in those facilities which are being planned than to direct further effort toward establishing special installations for the care of the acutely intoxicated at this time.

The providing of medical treatment in general hospitals for acutely intoxicated people is only one phase of our plan. The question of intake is highly relevant. At the outset, patients would be admitted chiefly from the Hospital Referral Serivces and from the admitting service of other to be designated programs, but our chief mission is to pick up patients before they arrive at state hospitals. Since our program includes several general hospitals, we include a "clearing center" which would keep carefully compiled information regarding the movement of patients in and out of beds set aside for acutely intoxicated patients. This clearing center would serve all sources of referral, both in and out. Also, our network of ancillary programs will be expanded to permit referral for ongoing aftercare. (Appendix VI)

At the outset, this program would not be sufficient to deal with all patients seeking hospitalization because of acute intoxication. For example, this program would have to be greatly expanded before it could accommodate the hundreds of intoxicated patients who are now jailed daily until they recover from the acute stages of intoxication.

The criteria for admission for medical treatment of the acute intoxicated would involve the following: (1) acute intoxication with or without complications; (2) indications that the patient cannot be restored to a nontoxic state in his home; (3) acceptance of hospitalization on a voluntary basis; (4) behavior compatible with admission to a general hospital.

The period of hospitalization would be brief, three to five days, in as many instances as possible. Screening and diagnosis would be done before discharge as much as practicable, but this could be completed at the clearing center, Based on the screening and diagnosis, an aftercare plan will be made on each case with appropriate referral to existing facilities in the area closest to where the patient resides. Referral could be to outpatient clinics, state hospital programs, halfway houses, missions, service centers, vocational rehabilitation, Veterans Administration, employment agencies, and public aid. Emphasis will be on follow-up from the very outset, although this is a very challenging task.

We visualize this program as a model for future expansion into both existing and planned medical services.

IMPLEMENTATION Tentative plans have been made with three Chicago area general hospitals to initially involve themselves in this project. (Appendix VI) An attempt has been made to determine a per diem cost for each of the participating hospitals based on the latest cost analysis, as published by the Department of Public Health. Pending the approval of this grant, we have received a firm agreement with the Martha Washington Hospital (Appendix VII) tentative per diem amounts from Alexian Brothers and Grant Hospitals. As indicated in Appendix VII, the per diem rate for Martha Washington would be $50 and it would appear that the other two hospitals would vary between that amount and $60. The per diem amounts that we are attempting to establish with the participating hospitals include all charges excepting surgical and psychiatric services. Where it can be readily assessed that the patient requires either prolonged or intensive care for conditions other than detoxification, he would not be referred to this program.

Realizing that over 3,000 patients were admitted to Chicago area state hospitals in 1967, and that the rate of alcoholism admissions across the state rose 2,000 patients in 1967 over 1966, it would be extremely difficult to immediately meet the obvious needs, rather it is our intent to establish a pilot program with whatever funds are available and to extend the program as additional funds become available from other sources.

REQUEST

In view of the above, the Section on Alcohol Programs requests your consideration of funds in the amount of $250,000 for the remainder of the present biennium. These funds augmented by funds from the Department of Public Aid and the cost shared by third parties, in behalf of our patients, will enable us to establish a pilot program for the management of the indigent alcoholic patient in the metropolitan Chicago area.

Recognizing that the same problems exist in other areas throughout the state, we further recommend consideration of an amount of $100,000 to seed these programs where other funding and programs are not available.

ADMINISTERING AGENTS

That the Section on Alcohol Programs be responsible for the administration and supervision of the funds requested.

APPENDIX I

(Following paragraph extrapolated from Department of Mental Health Annual Report-July 1966-June 1967.)

The number of persons with a primary diagnosis of alcoholism continue to comprise more than one third of the non-emergency applications processed through this Unit. During the last nine months of the past fiscal year eighteen hundred and thirty (1830) persons were assigned to Department of Mental Health facilities as chronic alcoholics. Many had previous records of hospitalization. This group of patients demand services, and all too often misuse available facilities. Many are in need of medical attention, which is often denied at the only medical resource available to them. Many are undomiciled, estranged from families, and unemployed. They see in Department of Mental Health facilities

a temporary room and board situation as well as a place where medical attention is available if needed. It is felt repeated request for readmission may be due to a lack of adequate services for the alcoholic in our facilities, as well as a lack of motivation for change on the part of the patients. This writer is aware of the shortage of staff and space, however, a more concentrated effort to coordinate our present resources may prove definitive in the care and treatment of the alcoholic.

APPENDIX II

Estimated number of alcoholics in Illinois according to the Jellinek estimating formula, calendar years 1952–66

Estimated

number of Year:

alcoholics 1952

308, 150 1953

333, 450 1954

322, 250 1955

303, 100 1956

331, 350 1957

358, 600 1958

341, 750 1959

360, 750 1960

371, 250 1961

372, 800 1962

392, 650 1963

404, 850 1964

413, 200 1965

403, 650 1966

1 460, 150 1967 (plus)

2 500,000 1 Subject to revision pending reporting of new facilities. 2 Pending Revision.

Source : Department of Mental Health, Division of Planning and Evaluation Services, Statistical Research Section, June 30, 1967.

APPENDIX III

MALE ADMISSIONS TO ILLINOIS STATE HOSPITALS, FISCAL YEARS 1954-66

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1 Subject to revision pending reporting of new facilities. 2 Pending revision. Source: Department of Mental Health, Division of Planning and Evaluation Services, Statistical Research Section, June 30, 1967.

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