NUMBER OF RESIDENT PALLONES AT END OF YEAR AND EXPECTED NUMBER (BASED 400 Source: 1946 1948 1950 1952 1954 1956 1958 '1960 1962 1964 1966 National Institute of Mental Health, Patients in Mental Institutions, Part II CONSTRUCTION OF COMMUNITY MENTAL HEALTH CENTERS Mr. FOGARTY. Also will you place in the record your opening statement on Construction of Community Mental Health Centers. STATEMENT BY DIRECTOR, NATIONAL INSTITUTE OF MENTAL HEALTH, PUBLIC HEALTH SERVICE ON "GRANTS FOR CONSTRUCTION OF COMMUNITY MENTAL HEALTH CENTERS" Mr. Chairman and members of the committee, when historians of the future review 20th century mental health efforts, they will undoubtedly point to our own day as a time when major and revolutionary tides began to form. Just over 2 years ago, the Congress passed the Community Mental Health Centers Act, providing for the construction of centers to encompass comprehensive and coordinated programs of mental health services within the community. And, more recently, an amendment to that act has given our States and communities the basis for staffing the centers. Together, these two legislative milestones have provided the physical and professional foundations-the bricks and the brains-for ushering in a new era in the care and treatment of our mentally ill. President Johnson has described these efforts as "an important beginning." I would like to report to you today that our task is indeed well begun-as we pursue our responsibility for assisting the States in making the new approach a reality for those among us in need of help. In spite of the short time since the centers construction program was begun, I am happy to report tangible progress. PROGRAM PLANNING AND DEVELOPMENT Procedures for implementation are functioning well-as Institute staff members join with professionals and volunteers in States and communities across the Nation, taking those necessary technical steps that lead, ultimately, to the construction of individual centers. State plans are being reviewed as they are developed and submitted-a prerequisite for the formal submission of proposals for specific centers within the State. In this way, inventories of existing community resources and surveys of current needs are made to mesh with projected goals. Over 40 State plans-covering over 90 percent of the country's population-have been received, and 28 of them approved. The other 12 are being reviewed. The pace of activity is also quickening in the submission by communities of specific construction proposals conforming with already approved State plans. Sixteen such proposals have now been approved-setting in motion center programs that range across the country in States as widely separated as New York and California, Florida, and Missouri; and in settings as divergent as a rural plain and an urban metropolis. The program, then, is well underway, and we can expect it to be propelled forward with the availability of funds for staff—the living core of the centers program. There are those who, sharing our own zeal, would have wanted us to speed ahead at a faster pace who would like to see new community mental health centers offering services in every American community now. Today, in the face of our country's need, they share our own impatience. This ideal cannot be faulted, and we will not be satisfied until the entire American community is served. But our enthusiasm must be tempered with realism. Attempts at speed without the careful development and utilization of sound professional and administrative procedures are unrealistic; and, quantity without quality is self-defeating. Ours is an innovative program-involving new concepts in architecture, in manpower, in professional services-and such programs require time to build: time between the appropriation of funds and the psychological readiness of communities and States to act; between the readiness to act and the development and submission of tangible plans and proposals; and between the approval of a program and its actual operation. History teaches us that all new programs-if they are to be successful-must follow a similar course of careful planning and development. Even more important is our insistence on quality-our conviction that there is no substitute for excellence where the health and welfare of our citizens are concerned. One out of every two center construction proposals submitted for re view has been returned for further strengthening. Implied here is no lack of concern for human needs, but rather the sure knowledge that we serve these needs best if, as scientists, we adhere to high standards. We meant to build a program in which numbers and novelty will not replace soundness of purpose and design. A community mental health center can only rise from firm foundations: from systematic priorities in the allocation of resources; from convincing evidence that services will in fact reach the people for whom they are intended; from a certainty that care will be comprehensive that the continuum of human needs will be met by a continuum of responsive services. IMPACT We are proud of our standards, and of the immediately tangible evidences of progress. But I want to share with you our conviction that our progress cannot be gaged solely by bricks and mortar. Those of us close to the centers construction task are aware that this new program is far more than one of construction alone that its impact cannot be measured solely in physical terms. The fact is that we have inspired here a revolution in mental health activities across the country. Old and unrewarding attitudes toward mental health needs are changing, and they are being restructured in communities and States across the Nation. No longer is mental health seen as the privilege of the few who can afford private care, with the sickest and neediest of our fellow men shunted away in distant hospitals, removed from the conscience and concern of the community. All Americans, the indigent along with the wealthy, the laborer and blue collar worker along with the professional, are beginning to be seen as the community of effort that forms the centers program. A community mental health center can succeed only if it is accepted by the citizens of the community in which it is located. Through our public information program, the Institute is working to achieve acceptance, in all segments of the American community, of the revolutionary idea that the mentally ill can and will be treated within the community itself. As a result of planning activities, long entrenched patterns of passivity are changing. Communities have become involved in planning for the mental health of their own residents, with new services appearing at the local level, and the States-26 of which have now passed Comunity Mental Health Services Actshave begun to advance the organization and distribution of their own mental health resources. Patterns in the financing of mental health services have been revolutionized. In some States Federal money is being matched with State money exclusively; in others, with State and local money in still others, with private funds. As recommended last summer by the National Governors' Conference, the Institute-working with the Council of State Governments-is encouraging the development of the broadest possible base for the financing of community mental health programs. In response to the manpower needs of the centers program, changes have begun to take place in the substance and emphasis of our own training programs, so that, for example, residency training will now include a growing emphasis on problems of community mental health, with residents working in the community itself to learn the role of psychiatry at its roots. Many researchers, too, are becoming aware of their roles in the new program, with community surveys and epidemiological studies that are beginning to reveal a clearer picture of the distribution of needs among our people. PROGRAM COORDINATION Clearly, we are advancing toward the new goals posed by the community mental health centers program-but always, however, with an eye toward our continuing responsibilities in our more traditional programs. Like a war fought on the battlefield, our war against mental illness demands the gaining of new ground, but not without the consolidation of territory already won and held. We must integrate the new ground with the old, new services with tested ones, new training and research programs with established ones. It would hardly profit our citizens if we were to design, plan, and build new facilities for services were we not also to have available the basic knowledge, the techniques, and the technicians that are the foundation of any helping process. As our new construction program moves forward, we must continue to attend-with all the resources currently at our command-to the nearly half million Americans still in mental hospitals; to the 5 million among us who are alcoholics; to the 60,000 who are addicted to drugs; to the 20,000 who annually commit suicide; and to the hundreds and thousands of children on the other side of happiness emotionally scarred, unable to learn, or too disturbed to live at peace in society. The challenge they pose must be confronted with our present skills. All the while, however, we work toward our ultimate goal: To bring to communities across the land the kind of integrated and coordinated mental health programs that will deal with the whole range of such mental and emotional illnesses-at whatever level of intensity is required. Our achievements to date, then, rest on a firm base: On progress gained from careful planning; on the construction of new centers across the country; on an insistence on quality along with innovation; on the provision of new services to increasing numbers of Americans; and on a continuing pledge to meet the needs of the mentally ill today while striving for an even more productive tomorrow. Mr. FOGARTY. The appropriation for 1966 and the request for 1967 are both $50 million. How much is authorized? Dr. YOLLES. $65 million for 1967. Mr. FOGARTY. What was authorized in 1966 ? Dr. YOLLES. $50 million. Mr. FOGARTY. They cut you $15 million in 1967? Mr. FOGARTY. How much did you have last year? Dr. YOLLES. $35 million in 1965, $50 million in 1966 and the request. is for $50 million in 1967. Mr. FOGARTY. What projects have been approved? PARTICIPATION IN PROGRAM Dr. YOLLES. There are 16 projects which have been approved. There are eight projects in California. One in San Rafael, two in Los Angeles, one in Burlingame, one in Santa Barbara, and three in Santa Clara. There are three in Florida. Panama City, Daytona Beach, and Winterhaven. There are two in Minnesota, one in St. Cloud and one in Minneapolis. There is one in Columbia, Mo., and two in New York. Rochester, N.Y., and New York City. Mr. FOGARTY. There are as many in California as the rest of the United States put together. Dr. YOLLES. There is a greater readiness to build facilities for the mentally disturbed in California than in almost any State. They were one of the first to come in. Mr. FOGARTY. What is the main reason? Here are two big States, California and New York. California has how many? Dr. YOLLES. California has eight. Mr. FOGARTY. New York has only two? Dr. YOLLES. Yes. New York has had some early difficulty in making their allocations in terms of priorities, but we expect a number more to come in. Mr. FOGARTY. What do you mean, priority? Dr. YOLLES. Each State has to set priorities for projects. Mr. FOGARTY. There is a question of getting the money up too? Dr. YOLLES. Both of these States have community mental health service acts, and have construction funds authorized within those accounts. RHODE ISLAND Mr. FOGARTY. What about Rhode Island? Dr. YOLLES. Rhode Island has not submitted its State plan as yet, so no applications can be received from Rhode Island. Mr. FOGARTY. They tell me they have submitted something. Dr. YOLLES. The documents for comment which have been submitted were preliminary documents. We have been working with them. Mr. FOGARTY. They need some help. COST OF FUNDING ANTICIPATED APPLICATIONS How many more applications are on hand? You say 16 have been approved? Dr. YOLLES. We have 16 applications approved. There are eight more in the house at the moment from Kansas, Iowa, Alabama, Pennsylvania and Maine, and two more projects from New York. As of the 25th of February, $6.8 million of available 1965 funds have been obligated, which is roughly 19 percent of the $35 million, and $613,000 of available 1966 funds have been obligated. A number of States are ready to use their 1966 funds at this time, even though these funds last for 2 years. Mr. FOGARTY. How much would be required if you fund all you have on hand? Dr. YOLLES. At the moment, or the ones we know will come in? Mr. FOGARTY. On hand and give me the other figure also. Dr. YOLLES. I do not have the data with me on the ones that are in the house. Mr. FOGARTY. Supply that for the record. (The information requested follows:) Mr. FOGARTY. What are the matching requirements? Dr. YOLLES. These depend on the Federal percentage requirements in each individual State and they range from 66% which is the highest Federal share, to 3313 Federal matching, the same percentages as those in the Hill-Burton program. HOSPITAL IMPROVEMENT PROGRAM Mr. FOGARTY. I have heard some good things about the hospital improvement program. The National Association for Retarded Children thinks it has made a difference in those institutions which have been successful in getting grants, which I understand will be about |