Mr. CARDWELL. We might take a quick look at the Food and Drug
Administration to give you some feeling for where the changes are
occurring. As we point out, it is not an item that will be dealt with by
the subcommittee so you may want to pass on quickly.

Let's move to the Health Services and Mental Health Administra-
tion.

MENTAL HEALTH RESEARCH

Mr. CARDWELL. Research in mental health will go up about $6 million. It doesn't represent any significant growth in program level. Mr. FLOOD. This is not under NIH?

Mr. CARDWELL. No. This one activity is a separate research institute dealing with mental health only and the National Institute of Mental Health administers the mental health programs.

DECREASE IN PSYCHIATRIC TRAINING

Manpower development in the field of mental health goes down $15 million. There are two items that decrease. One is a decrease of $7 million for support of the psychiatric residency training program. When this program was initiated there was a serious shortage of psychiatrists and a goal was set for the training of psychiatrists. Mr. FLOOD. That is graduate work in psychiatry?

Mr. CARDWELL. That is right.

Mr. FLOOD. Not so-called paramedics?

Mr. CARDWELL. No, sir.

Mr. FLOOD. The entire program?

Mr. CARDWELL. Leading a physician into the practice of psychiatry. Mr. FLOOD. It is not a paramedic program?

Mr. CARDWELL. No, sir. In this particular case the adjustment does not deal with paramedics. Manpower development, in general, in this sense would include graduate, undergraduate and paramedical training. The reduction deals only with two items-psychiatric residency training the phasing out of that program on the grounds it has served its purpose and a reduction of $8 million in other undergraduate activities, primarily related to shifting financial assistance to the Office of Education and the Bureau of Health Manpower Education.

Mr. FLOOD. Was the psychiatric program intended when born to be eliminated after a certain period?

Mr. CARDWELL. It was meant to develop a certain level of physicians coming out of the pipeline.

Mr. FLOOD. You mean in mere numbers?

Mr. CARDWELL. Mere numbers. We feel we have developed those numbers.

Mr. MEYER. There were 3,000 psychiatrists, Mr. Chairman, when the program was started.

Mr. FLOOD. When was that?

Mr. MEYER. It was initiated in 1947.

Mr. FLOOD. And as of now?

Mr. CARDWELL. About 25,000 now.

Mr. MEYER. The original goal of the program, Mr. Chairman, was to train about 12,000.

Mr. FLOOD. And you have 25,000?

Mr. MEYER. Yes.

Mr. FLOOD. Therefore, you feel it has served its purpose?

Mr. CARDWELL. The mental health community I don't believe is go

ing to agree with us.

Mr. FLOOD. You can be sure they will not.

Mr. CARDWELL. They are going to want to continue a Federal subsidy for this kind of training.

Mr. MICHEL. We went through the same thing last year.

Mr. CARDWELL. My recollection was this committee supported the action and the Senate restored the item. The other reduction of $8 million would in part eliminate all other undergraduate assistance for mental health personnel. Future support for health manpower development will be administered on a non-categorical basis through the Bureau of Health Manpower and the Office of Education for undergraduate student aid.

COMMUNITY MENTAL HEALTH CENTERS

The community mental health centers program goes down $15 million. This is only because no new funds are requested to support construction. There would be by 1973 some 562 centers supported by the Government compared to 529 in 1972. Of that number about 422 would be operational.

TRANSFERS FROM OEO

There is as you can see an increase of $15 million in narcotic addiction and drug abuse. There is an increase of $10 million in alcoholism special projects. I would like to point out that this increase represents a transfer of specific projects from OEO to HEW.

Mr. FLOOD. So the record will be clear, what is OEO?
Mr. CARDWELL. The Office of Economic Opportunity.

Those programs were developed there as experiments and are now deemed to be operational and are shifting to HEW. It does not represent an aggregate increase in such projects but a shift of resources from one Federal agency to another.

ST. ELIZABETHS HOSPITAL

There is an increase of about $2 million in St. Elizabeths Hospital for mandatory costs and repairs and maintenance.

Mr. FLOOD. The jurisdiction insofar as subcommittees of the Appropriations Committee is concerned, for St. Elizabeths Hospital, is really split between two of them.

Mr. CARDWELL. The Federal subsidy for St. Elizabeths Hospital is under the jurisdiction of this committee. The District of Columbia's share of the cost of operating the hospital comes under the District of Columbia Subcommittee.

Mr. FLOOD. And the District of Columbia Subcommittee is chaired by the distinguished gentleman, Mr. Natcher, who is also a member of this subcommittee.

Mr. CARDWELL. Yes. While on the subject we might mention we are. at this moment engaged in fairly active discussions with Mayor Washington and his staff which we hope will lead, during the current fiscal year, to the transfer of St. Elizabeths from Federal jurisdiction to the jurisdiction of the District of Columbia. It is a significant move and a lot of details will have to be worked out. Financing is going to prove to be one of the big problems as one would expect. Both Mr. Natcher as chairman of that subcommittee and you, Mr. Chairman, will be hearing more about this in the days ahead, I am sure.

FEDERAL FUNDS FOR STAFFING OF MENTAL HEALTH CENTERS

Mr. MICHEL. Before you leave the mental health area, I recall, in connection with staffing some of these mental health centers, we ran into the problem of you folks providing for staffing if you also had a part of the construction action and there were communities like mine where we went ahead and constructed everything on our own without Federal help and we got left out in the cold on the staffing.

Mr. CARDWELL. That policy has been changed and the policy now is to review the projects on their merit without regard to whether there had been a Federal involvement in construction. Secretary Richardson, I think, deserves the credit for that. As you probably well know there was quite a debate within the executive branch as to which was the better policy and we think we now have it straightened out. Mr. MILLER. In fact in 1972 we will be able to fund all approved projects. There will be no backlog in 1972.

Mr. MICHEL. That is good.

MENTAL HEALTH PROGRAM FOR CHILDREN

Mr. CARDWELL. There is one item I guess is fairly new to this part of the budget, the mental health program for children. This was the special authority in the Community Mental Health Centers Act which you funded through the aegis of this committee first in 1972. The budget will hold that program level at $10 million.

HEALTH SERVICES PLANNING AND DEVELOPMENT

Going to what we now call the health services planning and development, I might point out to you that this group of activities has heretofore been arranged in the budget with each of the subactivities of research and development having its own separate appropriation, and the budget we are presenting this year proposes a single appropriation for health services planning and development with each of these items as activities under that appropriation, and the chart has been so arranged.

COMPREHENSIVE HEALTH PLANNING

I guess the most significant items there involve the comprehensive health planning increase of $16 million. This would involve 100 new area wide planning agencies to be created across the country.

REGIONAL MEDICAL PROGRAMS

The regional medical programs accounts for an increase of $31 million. Within that amount of $130 million, $93.6 million relates to regular RMP projects and is at about the same level as 1972. There is a special increase of $7 million for emergency medical service research and development projects.

MEDICAL FACILITIES CONSTRUCTION

The item that has drawn the most questions so far in the presentation of the budget to the public deals with medical facilities construc