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upon the reduction of illness and human suffering, but also in the reduction of crime and the alleviation of poverty.

Treatment of drug addiction is still a very perplexing and difficult problem. It requires more than an inpatient program. The experience of hospital programs alone has been that fairly prompt relapse into drug addiction occurs upon the release of the patient back to the community.

An effective spectrum of services would require treatment of addicts in the community with such measures as methadone, counseling by cured drug addicts, vocational rehabilitation, vigilant monitoring of urine for evidences of relapses, appropriate involvement of courts and probation officials, ministers, general practitioners, public health nurses, family agencies, and Narcotics Anonymous.

Facilities should include hospital programs, clinics, self-help groups such as Syn-Anon and related residential treatment centers and halfway houses.

Many addicts who are incarcerated after having committed a crime should be prepared for return to the community by appropriate programs in the penal institutions. Many addicts have concurrent problems with alcoholism, and both problems need to be treated by professionals knowledgeable in both fields.

It is imperative that research and evaluation be an important part of the approach to the treatment and prevention of alcoholism and drug addiction.

Education of industrial leaders and management is important in enabling both addicts and alcoholics to regain effective roles as citizens through appropriate employment.

As is the case with the alcoholics, the community mental health centers would be in a strategic position to coordinate and integrate a great variety of programs and resources in behalf of the addict. However, I would want to emphasize that many such programs for the addicts may need to start prior to the development of community mental health centers and then become integrated into the total program of the community mental health center as it evolves.

It is my hope and concern that facilities and programs for the alcoholics and drug addicts, which are a part of comprehensive community mental health centers, will not compete with the amount of money available to such centers, but will attract sufficient funds from the Federal sources to add to available financing for existing comprehensive community mental health centers and community mental health centers which will come into existence in the future.

As in the case for the alcoholic, so would it be in the case of the addict, that Federal support and stimulation of programs in behalf of drug addiction will encourage professional personnel, hospitals, community mental health centers, community mental health services, to bring to bear whatever talents are available in coping with a serious threat to the health and social well-being of this Nation.

I now wish to address myself, Mr. Chairman, to a particular section of the bill, page 6, section C, starting at line 6 and ending at line 14.

This matter involves the efficient administration of the new program.

The section on page 6 says that an application for a grant for construction of alcoholism facilities may be made only if it contains satisfactory assurance that the application has been "approved and recommended” by either:

(1) The single State agency designated by the State as being the agency primarily responsible for care and treatment of alcoholics in the State or

(2) The agency designated pursuant to section 204(a) (1) (of Public Law 88–164, which is the Community Mental Health Centers Construction Act of 1964).

It is the concern of the directors of mental health programs in the States that some confusion in the administration of the proposed alcoholism treatment program might result from the language on page 6 of the bill unless it is either modified or clarified.

The directors of State mental health programs have sole responsibility for administration of the alcoholism treatment programs in only 27 States. In four other States they have partial responsibility. And in an additional four States mental health is in an agency where another branch of the agency has responsibility for the treatment of alcoholics.

In 16 States the mental health agency of the State has no administrative connection at all with the State alcoholism program.

I might add that despite all the foregoing about "administrative responsibility,” alcoholics are treated in virtually every State mental hospital in this country and in some cases represent as much as 40 percent of the admissions to these State hospitals.

If the language of the bill starting at line 6 is interpreted by a State as requiring it to designate the agency presently "responsible for care and treatment of alcoholics," then it is possible that in 16 States the State mental health agency will not be involved in approving and recommending the proposed facilities.

If the language starting on line 10 (“in case this agency is different ***") is applied, then the agency designated under 204(a) (1) of Public Law 88-164 must approve or recommend the facility.

The 204(a)(1) agency is the “community mental health center construction authority.”

In 20 States the 204 (a) (1) designated agency is not the State agency that is responsible for the mental health program. I have a list of these States here, which I will not read at this point.

However, in 11 (out of the above 20) States the "alcoholism treatment program" is in the mental health agency. And out of the remaining nine States only four of the 204(a)(1) designees have any responsibility for an alcoholism program.

The defect in the substance of the "designated agency” paragraph on page 6 could be partially corrected by adding language to the effect that the “mental health authority” of the State will be consulted for construction and staffing of alcoholism facilities.

It is a matter of grave concern to me that there be a significant role provided the State mental health director. This is a matter of concern to the other State mental program directors, too. I hope it will be possible that the language of the bill can be modified to include this concept and that the legislative history of this proceeding call attention to my concern and the concern of other State program directors for preservation of their roles in developing effective, broadly based programs for alcoholics and drug addicts.

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Mr. Chairman, I now refer to section 305 on page 14 of the bill.

This section adds language to the Community Mental Health Centers Construction Act of 1963, providing for a set-aside of 2 percent of the construction money allotted to each State. This 2 percent, when matched 50-50 by the State, is to be used by the State, for "proper and efficient” administration of the State plan for construction of mental health centers.

This is a long-overdue amendment, and it was at the specific request of our association to HEW officials that this amendment was included in the draft bill sent to Congressman Staggers, which is now H.R. 15758.

Matching Federal assistance to State central offices for administration of Federal grant programs is an integral part of many existing laws. Thus, there is broad precedent for adopting section 305 of the bill before you. Actually, this provision should have been in the original law, and this association was derelict in not forcing this issue several years

go. A provision similar to the one we now have in the bill before you has been in the Public Health Service Act for years. Section 606 (c) (2) of the PHS act provides to the State Hill-Burton agency 2 percent of the federally allotted money for administration of the State plan.

Last year your committee initiated a bill, which became Public Law 90-170, which authorized each State to use for administration purposes up to 2 percent or $50,000, whichever is less, of the $30 million Federal allotment for construction of facilities for the mentally retarded.

In the Elementary and Secondary Education Act there is administration money available to the States under several sections of the act:

Five percent is available to the States for administration of the school library resources program.

Five percent is available to the States for administration of the education of handicapped children program.

One percent is available to the States for administration of the Federal school aid programs for education of children of low-income families. The maximum amount of money available to a State agency under this provision is $150,000.

Seven and one-half percent is available for administration of the supplementary educational centers and services program. The maximum amount of money available to a State agency under this provision is $150,000.

Under the Vocational Rehabilitation Act as amended, section 2, authorizing grants to States for rehabilitation services, provides that a portion of the State allotment may be used by the State agency for administration of the program. There is no limitation on the amount of money the State agency may request for this purpose.

You will note, Mr. Chairman, that in several instances the maximum sums available to the States for administration of the various Federal programs is $150,000. In the bill before you the sum, on line 20 of page 14, is $50,000.

We consider this an inadequate share, and we recommend that the sum be $100,000 per State. The Federal Government through this fiscal year will have granted about $125 million toward development

of community mental health centers in the States. The States are administering this $125 million with no Federal help.

In Public Law 90-170, extending the mental retardation centers program, the Congress allowed $50,000 per State for a $30 million annual program. The community mental health center program involves annual grants twice the size of the Public Law 90-170 program, or $60 million. The administration proportion should be $100,000.


We suggest a further amendment of section 305, Mr. Chairman.

We recommend the addition of language on line 19 following the word “part.” Strike the semicolon and all language through line 24 and add the following language:

and for evaluation of the programs, by the State agency, under Part A of Title II ; except that not more than 2 per centum of the total of the allotments of such State for a year, or $100,000, whichever is less, shall be available for the purpose of administration for such year, and not more than 1 per centum of the total of the allotments of such State for a year, or $50,000, whichever is less, shall be available for the purpose of evaluation of programs for such year. Payments of amounts due under this paragraph may be made in advance or by way of reimbursement, and in such installments, as the Secretary may determine.

Our proposed amendment would provide a small amount of money to each State central office, to be matched by the State, for purposes of evaluating the community mental health center program as it functions in each State.

Again, there is strong precedent in recent Federal legislation for provision of funds to evaluate a program to determine its efficacy and judge whether or not the congressionally authorized and appropriated money is being spent wisely.

In the Elementary and Secondary Education Act there are at least six separate sections of the law in which “program evaluation" money is made available. The Office of Education has asked the Congress for $14 million to fund these programs, most of which will be carried out by State agencies.

In the extension of the partnership for health program, Public Law 89–749, which originated in this committee last year and passed the Congress as Public Law 90–174, you included “program evaluation" money for several parts of the law, namely: 314(d), 314(e), 314(c), 304 and 309.

Your committee made the following comments about "program evaluation" in your Report No. 538 (August 3, 1967), and we heartily


As a basic tool of program implementation and development, evaluation is insurance that the health research, service, facilities, demonstrations, and related activities proposed in this bi-1 will fully accomplish their purposes.

Evaluation studies and analyses should be conducted to identify and extend the application of those program methods and approaches which show high success and to spot program weaknesses in time to permit steps to be taken to improve program performance.

Although the funds available for evaluation will be a small fraction of those available for the programs which are authorized, no more than 1 percent, the committee feels that making these funds available for evaluation will contribute substantially to the success of the programs proposed in the bill.

What we now ask is that everything you said about the need for program evaluation be applied to the community mental health centers program, and we respectfully request that your committee adopt the amended bill language we have provided today in this testimony.

Mr. Chairman, I thank you for your courtesy in hearing the testimony of our association today, and, as always, we stand ready to assist the committee and its individual members in any way that we can.

Mr. ROGERS. Thank you very much. Your testimony is most helpful, and we have, I guess, all of your proposed amendments now.

Thank you very much. Our next witness is Dr. Jacob Fishman, professor of psychiatry, Howard University College of Medicine, and director, Howard University Community Mental Health Center.



Mr. Rogers. We are delighted to have your comments.

Dr. Fishman. Thank you. I appreciate the opportunity to testify as an individual here on behalf of the bill, and in particular on behalf of the alcholism and narcotics addiction programs contained therein.

I would certainly like to lend my support for the alcoholism addiction components of these programs, particularly stress the importance of these programs in the poverty areas of our urban centers, since, as we all well know, alcoholism and addiction are a major problem in the mental health of the poor, particularly as they are related to the social, educational, employment, and psychological factors connected with poverty and the general problems of the urban ghetto.

However, I am here particularly to speak to one aspect of alcoholism and addiction programs as they relate to community health centers, and that is to urge the committee to stress consideration of the employment and use of local residents as nonprofessionals in new careers providing alcoholism and addiction services in these health centers.

In our experience in community mental health work, we have found that there are enormous advantages to the systematic recruitment, training, and employment of such persons in the delivery of services. They increase the effectiveness of services in these communities because of their unique backgrounds in connection with the community and experience. They provide an important link between the professional and the client population, with whom frequently the professional has had little real life experience.

They provide an important vehicle for helping people to help themselves in the community, and they also provide an important potential vehicle in these local health centers for meaningful employment and career development for the poor.

Now, this is true in general for community mental health programs. It is particularly true in addiction and alcoholism where we find that the use of ex-addicts and ex-alcoholics is a potential manpower resource of very significant effect.

Because of their previous personal experiences, contact with others in the community, and the knowledge of their own living situation, when they are given structured training, employment opportunities and career potential as nonprofessionals in these programs, they give

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