At the 3-day conference, held in Chicago in December 1965 and cochaired by Gov. Otto Kerner, of Illinois, and Senator A. M. Spradling, of Missouri, scores of State legislators and county commissioners hammered home the point that the Federal contribution to community mental health services, even with the inclusion of the 1963 and 1965 legislation, fell far below that made by most States and many local communities. Arguing for a renewal and broad expansion of the Community Mental Health Centers Act of 1963, the major resolution of the conference-unanimously adopted by the hundreds of delegates-stated:

Of the total annual public mental health expenditure of $2 billion in this country, only $115 million, less than 4 percent, is available for ongoing local community mental health services. The share of the Federal Government in this funding is less than 10 percent ***. It is therefore imperative that the Federal Government, which receives the largest share of the tax dollar from our people, provide critically needed additional seed money for these programs.

It is the concensus of the conference that the national goal of 2,000 new community mental health centers to be established by 1975, as envisioned by the landmark 1963 and 1965 Federal legislation will not be realized without expanded Federal, State, and local support.

We cannot realize President Kennedy's dream of a broad network of community mental health centers in the next decade by cutting back on congressionally approved authorizations. The cut of $15 million proposed by the administration means that 50 communities in all parts of this land will be unable to construct mental health centers reaching an estimated 10 million people.

We therefore propose the full $65 million for community mental health centers originally authorized by the Congress in 1963. That, in essence, concludes my statement.

(Chart attached to Mr. Gorman's statement follows:)

Mr. FOGARTY. I just have a couple of general questions. Your request for $287,300,000 is only $300,000 above what the Institute of Mental Health asked the Department for?

Mr. GORMAN. I didn't know that.

Mr. FOGARTY. They asked for $287,057,000 and you are asking for $287,358,000. You are close to what they thought they ought to have, but the Department made a $6 million cut. Then the Bureau of the Budget cut it down to $253,115,000. That is quite a significant cut, isn't it?

Mr. GORMAN. Yes, sir.

Mr. FOGARTY. In your opinion, do you think we can afford this problem in Vietnam and also put up $287 million to apply to mental health? Mr. GORMAN. Let me put it very simply, Mr. Chairman.

The programs we are asking for make people productive. They make them taxpayers. I think the reduction of 83,000 patients in our State hospitals and the return of many to successful employment is

one answer.

If you have a person who is an alcoholic who loses his job, what happens to his family? His family goes on relief. I don't think there is any other solution but to treat that person.

Mr. FOGARTY. I think a budget like this could make money.

Mr. GORMAN. I think it could. We have proven it in the reduction in mental hospital populations-we have cut the costs to the States-in 10 years by $6 billion.

Mr. FOGARTY. Why do you think the Bureau of the Budget is in this cutting mood? I can't understand it myself. What do you think? You have been around a long time now.

Mr. GORMAN. I will be very frank in saying that it is considered necessary this year to put in a tight budget and demonstrate prudence, but I don't think this budget is prudent over the long run.

Mr. FOGARTY. I don't think so either. I think it is just the opposite. Tell us how it is the opposite.

Mr. GORMAN. For instance, under the training recommendations in this budget

Mr. FOGARTY. Don't you think the President has been led to make a mistake in this budget?

Mr. GORMAN. Yes, very definitely.

The President said in 1963 that we would need an increase of $15 million a year in training alone. To turn out the psychiatrists, social workers and so forth to do the job. What is the point in opening a community mental health center if you haven't got the staff for it?

We are being asked to do all these things with an increase in the training budget of $3 million as against a projection of $15 million a year as the needed annual increase to do the job.

Now the first year of President Kennedy's budget, he proposed $17 million more, but that ended the big increases.

Mr. FOGARTY. You have talked about President Kennedy's budget from 1963. How does this budget compare with his projections in 1963? If you haven't a breakdown, can you supply it for the record? Mr. GORMAN. In the three areas he projected it in, I have one.

Mr. FOGARTY. You are talking about mental health and mental retardation

Mr. GORMAN. I am talking about the three areas; training, hospital improvements and in-service training grants which were the three parts of his message in 1963. He made projections in all those three areas and we are way behind them today.

For example, in training the President's recommendation is $89 million. The Kennedy projection for fiscal 1967 was $114 million. We are way behind.

Mr. FOGARTY. How about the other two?

Mr. GORMAN. Hospital improvement grants, we should be at 36 million, and we are at 18 million.

Mr. FOGARTY. Just half.

Mr. GORMAN. Just half, and the same as we had this year. Mr. FOGARTY. That is about par for this whole budget for the Institutes of Health.

What is the other one?

Mr. GORMAN. The in-service training programs, the training of ward personnel in State hospital and the schools for mentally retarded should be at $11 million, but it is at $6,850,000.

Mr. FOGARTY. How about his message on mental health and mental retardation and the community mental health centers?

Mr. GORMAN. We have authorized legislation on the books and the 3d year proposal by the administration is $15 million less than the authorized level.

Mr. FOGARTY. Give us both figures. The President's budget

now

Mr. GORMAN. The President's budget proposes $50 million and the authorized level is $65 million.

Mr. FOGARTY. That is what President Kennedy recommended.

Mr. GORMAN. That is right, and that is what the Congress adopted. Mr. FOGARTY. How about the mentally retarded?

Mr. GORMAN. I don't have that figure on research facilities for the retarded or university-affiliated centers.

Mr. FOGARTY. You say you would like to have more personnel to help the States and localities to develop these plans and applications? What about the localities that just don't care about these programs? Mayors and Governors who just don't think this is much of a program, and they don't want to spend the necessary State money. Don't you think they ought to spend some State money?

Mr. GORMAN. I sure do.

Mr. FOGARTY. Or city money?

Mr. GORMAN. Yes. We are not going to get these community mental health centers off the ground without local and State money.

Mr. FOGARTY. I am thinking about my own State. We have one of the slowest in the country and we still don't have a plan.

Mr. DENTON. Like Indiana used to be.

Mr. FOGARTY. Like Indiana used to be. I hope we never get that bad. They have changed in Indiana, but our State seems to be going the other way. They had no plan for any community mental health

centers.

Mr. GORMAN. I could say this on that subject, that if the States don't get in-after all, if the Federal matching money is only onethird of the total for those States that don't get in with matching money, these centers will not be built. We will still put people off in these human warehouses.

Mr. FOGARTY. Before Dr. Felix left Government employ, he thought this plan was the greatest thing that ever happened in the field of mental health, and that in the years to come this would produce great results. Do you think the same today?

Mr. GORMAN. Yes.

Many States have not gotten off the ground yet. Some haven't even gotten their plans in yet. The number of centers under construction is small, frankly.

Mr. FOGARTY. Don't you think the Governors should do a better job?

ADDRESS BY HON. BILLIE S. FARNUM

Mr. GORMAN. We have taken a whack at them. We held a Governors conference on mental health in 1965. Congressman Farnum gave a very fine address.

Mr. FOGARTY. We will put that address in the record if it is that good.

Mr. GORMAN. It was a very good address.

(The address referred to follows:)

THE CONGRESSIONAL VIEW BY BILLIE S. FARNUM, MEMBER OF CONGRESS, MICHIGAN,

19TH DISTRICT

(National Conference on Community Mental Health Programs, Chicago, December 15, 1965)

Anyone who has been in public life as long as I have has attended literally hundreds of conferences. But I want to say that this in one of the more unusual ones I have had the privilege to participate in. The Council of State Governments and the National Institute of Mental Health are to be congratulated for putting this program together and attracting participants with such a broad variety of backgrounds.

Someone once characterized the psychiatric profession as consisting of a handful of doctors who have been talking to themselves for 50 years. I certainly think this meeting shows that such a characterization is misleading-at least with respect to the psychiatrists represented here.

Of course, politicians never conceive of themselves as being persons who commune only among themselves but election results often prove differently.

It really is a pleasure for me to take part in this meeting. It allows me a chance to discuss a problem which has occupied a great deal of my attention for many years-the problem of how to get the most from our tax dollars in the field of mental health.

My interest extends back to the time when I was auditor-general of Michigan. In my opinion there is no other field of State government in which is is more imperative that a wise expenditure of tax dollars be made than in the field of mental health. This is true not only for the taxpayer, because such a large portion of the State tax dollar goes to mental health, but it is even more true from the standpoint of the mentally ill. Tax dollars spent unwisely on mental patients are not only a waste to the taxpayer-they are of little benefit to the mentally ill My interest in wise expenditure of money in the field of mental health has naturally carried over into the Congress, where I am a member of the House Appropriations Subcommittee which passes on Federal appropriations for mental This Nation is wealthy enough to pay for effective programs for the mentally ill, but no nation can afford poor programs.

health.

THE NATIONAL COMMITMENT TO HEALTH CARE SERVICES

Perhaps there are some people somewhere who still ask themselves, "am I my brother's keeper?" with respect to mental health services, but I think we need not trouble ourselves with this question. We can no longer afford laissex-faire in mental illness. Anyone's mental illness is everyone's problem.

And so in the past few years, Congress, under the leadership of Presidents Kennedy and Johnson, has passed landmark legislation which is meant to provide the framework for a systematic and sustained attack against mental illness in this Nation and against factors which breed mental illness.

These several acts are indicative of a social consciousness which I'm sure the people of this country applaud. I think it is logical to expect that the Nation will never retreat from its present policy respecting mental illness, but will move continually forward as changing conditions dictate.

SERVICES FOR ALL WHO NEED THEM

The new Federal legislation makes an attempt to provide services for all those in need. Medicare is a good example of this. Under improved public assistance and medical assistance provisions of that legislation, there will no longer be a twilight zone of persons who, though they cannot afford medical services, are still not medically indigent under the terms of State law. Medicare also recognizes that even though a person may not be indigent under the meaning of the law, he may yet be unable to pay all his medical expenses. The law attempts to bridge the gap between what the person can pay and the total expense of his care.

TYPE OF PATIENTS

A great number of patients in our State mental institutions come from the lower end of the socioeconomic scale. This, I think, is not altogether coincidental. How many such persons would now be productive members of our society if they had been accorded adequate treatment for their problems before their illness reached almost insurmountable proportions? And how many would not have encountered overwhelming difficulties had not the abrasiveness of a hostile environment resulted in constant stresss?

Some of the recent Federal legislation looks to the prevention of mental illness through improving the environment of millions of our citizens.

Examples are the conomic Opportunities Act and the Appalachia Regional Commission legislation.

Other legislation that broadens the range of services to the disadvantaged are the Vocational Rehabilitation Act and the Elementary and Secondary Education Act.

ECONOMIC OPPORTUNITY ACT

The Economic Opportunity Act represents a concerted attempt to eliminate the causes of poverty. The act has important implications for the mental health professions because poverty is a prime breeding ground for mental disorders and retardation.

The community action program affords Federal support of up to 90 percent for community-directed, self-help programs. The Congress appropriated $880 million to be used in fiscal 1966 for such programs.

One of the unqualified successes of CAP was Operation Headstart, a program for preschool, severely deprived youngsters conducted last summer. More than one-half million youngsters participated. Operation Headstart was an attempt to lift children from the absolute bottom of the socioeconomic scale to the cultural experience level of the children they will be attending school with. Clearly, community mental health programs have an important place within the definition of community action programs.

THE EDUCATION ACT

The Elementary and Secondary Education Act of 1965 also authorizes establishment of special programs for disadvantaged children, and the special training of teachers.

The need for such special programs is brought into sharp focus when we consider that if present trends continue the number of children in State mental hospitals will be twice in 1970 the number hospitalized in 1960.

Facts developed by the President's task force on manpower conservation furnish further proof of the need for special education efforts. The task force reported that one-third of our youth fail to qualify for military service and that onehalf of the number fail due to mental deficiencies. Forty percent of those who fail the mental test never attended high school and four out of five are high school dropouts. Nearly half of those rejected for military service due to educational deficiencies had fathers who did not complete the eighth grade.