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APPENDIX IV

Admission of patients to Illinois State hospitals with a diagnosis of alcoholism

fiscal year 1953–66

Year

1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1969 1967

Number of admissions

3, 233 3, 287 3, 470 4, 247 4, 861 4, 283 3,937 4, 487 4, 695 4, 556 4, 499 4, 346 5, 140 15,906 2 7,059

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 V

NORTH AMERICAN ASSOCIATION OF ALCOHOLISM PROGRAM,

Washington, D.C., February 15, 1968.

NEWS MEMORANDUM

Re: The Administration Alcoholism Bill.
To: All members.
From: A. H. Hewlett, Executive Secretary.

Following through on President Johnson's alcoholism legislative recommendations contained in his recent Crime message to Congress, Representative Harley 0. Staggers (Democrat-West Virginia), chairman of the House Committee on Interstate and Foreign Commerce, has introduced the “Alcoholic and Narcotic Addict Rehabilitation Amendments of 1968.” This bill (HR-15281) would amend the Community Mental Health Centers Act to include three new titles-one for Alcoholic Rehabilitation, the second for Narcotic Addiction, and the third a general title relating to the funding of both.

Title 1--Alcoholism. The proposal would add "Part C—Alcoholism" to the Community Mental Health Centers Act and would provide :

A. Construction grants for facilities for the prevention and treatment of alcoholism. Such grants may be made only to public or nonprofit private agencies or organizations, the applications of which must meet the requirements for approval set forth in clauses 1) through 5) and clause (A) of Section 205(a) of the Community Mental Health Centers Act.

Applicants for such grants would be required 1) to show the need "for special facilities for the inpatent or outpatient treatment, or both, of alcoholics”; 2) to show satisfactory assurance that the services would be principally for persons residing in or near the particular community or communities in which the facility is to be located and that the facility services will provide at least those essential elements of comprehensive mental health services, and services for the prevention and treatment of alcoholism, including post institutional aftercare and rehabilitation that are prescribed by the Secretary of HEW; 3) to assure that the application has been approval and recommended by the single State agency designated by the State as being the agency primarily responsible for care and treatment of alcoholics in the State, and, in case this agency is different from the agency designated as the Mental Health authority, assurance must be shown that the application has also been approved and recommended by the Mental Health authority ; 4) to show that the project is entitled to priority over other projects for treatment of alcoholism ; 5) to show that adequate provision has been made for furnishing needed services for persons unable to pay in accordance with regulations of the Secretary under Section 203 (4) and for compliance with State standards for operation and maintenance; 6) the amount of any such grant may not be in excess of 66percent, as the Secretary may determine,

B. Staffing, Operation and Maintenance Grants under Section 261 of the Community Mental Health Centers Act may be made to any public or nonprofit private agencies and organizations for new facilities or for new services in existing facilities for prevention and treatment of alcoholism.

Grants under this section would be made only on applications meeting requirements under part B of the Mental Health Centers Act. In making such grants, the Secretary would consider relative need for services, population of the area to be served and financial need.

Federal matching funds would be available over a 10 year period, the first year of which the Federal percentage would not be more than 90%, 80% for the second year, 70% for the third, 60% for the fourth and 50% for the next 6 years.

C. Specialized Facilities. Grants from appropriations under Section 261 of the Mental Health Centers Act would also be made for projects for construction, operation, staffing and maintenance of specialized residential and other facilities, such as halfway houses, day care centers and hostels, for the treatment of homeless alcoholics.

Such grants would be made only for facilities which 1) are affiliated with a community mental health center meeting the essential elements of comprehensive community mental health services prescribed by the Secretary, or 2) are not so affiliated but with respect to which satisfactory provision (as determined by the Secretary) has been made for appropriate utilization of existing community resources needed for an adequate program of prevention and treatment of alcoholism.

D. Short Title. This part (everything outlined above) is to be cited as the "Alcoholic Rehabilitation Act of 1968."

Title II—Narcotic Addiction. HR-15281 would further amend the Community Mental Health Centers Act to include “Part D-Narcotic Addict Rehabilitation” which would provide :

A. Grants under Section 261 to assist in projects for constructing, operating, staffing and maintaining treatment centers and facilities (including post hospitalization treatment centers and facilities) for narcotic addicts within the states.

This grant program, as it deals with the kinds of activities authorized by parts A and B of the Mental Health Centers Act will be carried out consistently with the grant programs under that Act except to the extent that in the Secretary's judgment, special consideration would make differences appropriate.

B. Grants may be made beginning July 1, 1968 through June 30, 1970 to public or nonprofit private agencies and organizations to cover part or all of the cost in 1) developing specialized training programs or materials or in-service training or short-term or refresher courses with respect to the prevention and treatment of narcotic addiction; 2) training personnel to operate, supervise and administer such services; and 3) conducting surveys and field trials to evaluate the adequacy of the programs for prevention and treatment of narcotic addiction.

Title 111-General. HR-15281 would authoribe appropriations for both parts above-to begin July 1, 1968 through June 30, 1970, to provide such sums as may be necessary (to be determined by Congress) for project grants for construction, operation, staffing and maintenance of facilities described above.

Further, appropriations beginning with the years July 1, 1970 through the next eight years would be authorized to be made for continuance of those projects begun prior to June 30, 1970.

This title would further amend Part B of the Community Mental Health Centers Act to add a new section (Sec. 225) for "Facilities Relating to Rehabilitation of Alcoholics or Narcotic Addicts.” This new section would specify that alcoholism or narcotic addiction projects undertaken by community mental health centers would come under the requirements and provisions set forth in the new titles proposed for alcoholism and narcotic addiction outlined above.

Cost of Administration. This bill would also amend the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 to provide up to one half of the administration expenses annually except that not more than 2 percent of the total allotments for any one year, or $50,000, whichever is less, shall be available.

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First Day

Second Day

Third Day

Fourth Day

Fifth Day

DETOXIFICATION:

Room and Board
Nursing Care
Physician

36.00

36.00

36.00

36.00

36,00

BACK-UP SUPPORT

21,00

Lab
X-Ray
Pharmacy
Surgica)

10.00
14,00
Cost

14.00 Cost

3.00

3.00 Cost

3.00 Cost

Cost

$ 81.00

$ 50.00

$ 39.00

$ 39.00

$ 39.00

Actual Charges

$ 248.00

$ 60.00

$ 50,00

$ 30.00

$ 30.00

$ 30.00

Per Diem Charges

$200.00

Mr. ROGERS. Our next witness is Dr. Isadore Tuerk, commissioner of mental hygiene, State of Maryland, accompanied by Mr. Harry Schnibbee.

STATEMENT OF DR. ISADORE TUERK, REPRESENTING THE NA

TIONAL ASSOCIATION OF STATE MENTAL HEALTH PROGRAM DIRECTORS; ACCOMPANIED BY HARRY C. SCHNIBBEE, EXECUTIVE DIRECTOR

Mr. ROGERS. We are delighted to have you here, gentlemen, and appreciate your presence.

Mr. TUERK. I am Isadore Tuerk, M.D., commissioner, Maryland Department of Mental Hygiene.

I am here today representing the National Association of State Mental Health Program Directors, and I am accompanied by Mr. Harry C. Schnibbee, executive director of the association.

The members of our association are responsible for the administration of the major portion of the residential and outpatient public mental health programs in the United States. We administer 1,161 treatment facilities, both residential and outpatient. We have under treatment annually 1,500,000 persons.

Last fiscal year the State mental health program directors administered programs funded at $2.4 billion, which is 212 times bigger than all other State public health programs combined.

In 31 States the director of the State mental health program is also responsible for administering the treatment program for alcoholics, and virtually all major, public narcotic addict treatment programs are under the administration of our members.

It is from our experience in administering these vast public programs, and especially the alcoholism programs, that I wish to speak today.

Mr. Chairman, in general we endorse and support both the objectives and the specific approach of H.R. 15758.

Alcoholism and drug addiction are serious public health and social problems. The impact of alcoholism in terms of human suffering, physical illness and complications, financial and economic loss, disruption of family life, highway accidents, and suicides, is incalculable.

Physicians and psychiatrists and other professional personnel have only recently begun to involve themselves with the important problem, despite the fact that for some time the American Hospital Association and the American Medical Association have urged that alcoholism be considered a disease and that physicians and general hospitals provide treatment for the alcoholic.

There has been encouraging progress in the treatment of the alcoholic, but still much needs to be learned in coping with this grave disorder. Alcoholism is a chronic illness which cannot be treated exclusively in a hospital setting, and any attempt to evaluate the effectiveness of the treatment program must depend upon the availability of a wide variety of treatment facilities, programs, and resources.

Individual psychotherapy, group therapy, antabuse, Alcoholics Anonymous, tranquilizing drugs, general health management, churches, industrial counseling, family group therapy, utilization of family agencies, welfare departments, departments of education, schools, parole and probation, courts, labor, et cetera, are all valuable and necessary elements in a comprehensive approach to the treatment of alcoholism.

A comprehensive community mental health center program should include among its elements facilities and programs for the treatment of the alcoholic. The comprehensive community mental health center is in a strategic position to integrate the many resources and programs necessary for a coordinated comprehensive approach to this problem.

The elements of a spectrum of services in a broad approach to this problem would include detoxification centers, treatment of the acute phase of alcoholism in a general hospital, inpatient treatment for such complications of alcoholism as delirium tremens or acute hallucinosis, general hospital care for such complications as cirrhosis of the liver and peripheral neuritis.

Halfway houses, diagnostic clinics, outpatient long-term treatment resources, public health nursing, long-term rehabilitation centers for the chronic alcoholic who had little or no personal resources, shelters for those who have reached the point of chronic dependency with no capacity for rehabilitation, with our current knowledge of the treatment of this illness.

Many of these programs can be related to a community mental health center. Some should begin to develop apart from community mental health centers, particularly where such centers have not yet come into existence but could then become affiliated with, and integrated with, community mental health centers as they emerge.

The following motion was unanimously adopted by the members of the National Association of State Mental Health Program Directors in meeting at the Drake Hotel, Chicago, Ill., March 14, 1968:

The proposed Federal alcoholism legislation should provide mechanisms to strengthen services to alcoholics and drug addicts and encourage the development of these services as components of programs of comprehensive community mental health services rather than as separate autonomous units.

Federal support of such developments, both in terms of concept and in terms of financing, will go far in overcoming current resistances to developing programs, and will emphasize and stimulate the urgent desirability of including programs in behalf of the alcoholic in the community mental health services now taking shape throughout the country.

Another powerful factor at work is the judicial decisions which have already occurred and which are now in the process of being formulated by the Supreme Court making it illegal to punish the chronic alcoholic for public intoxication and requiring his treatment as a sick person instead.

Drug addiction and drug abuse have become significant in recent years as challenges to psychiatric and medical knowledge and enterprise and have provoked professional leaders to develop liaison with other innovating personnel in the antipoverty programs and the war on crime.

Drug addiction and drug abuse play salient roles in the perpetuation of poverty and in the incidence of crime.

Effective treatment programs and prevention programs in the areas of drug addiction and drug abuse should have an important impact

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