The Department of Mental Hygiene has over 22,000 employees, and the 1966-67 budget includes: In addition, under the Maine Community Mental Health Services Program, the Bureau provides State Grant-in-Aid funds (including classes for the trainable retardates) for up to 50 per cent of the operating expenses of local community mental health services. 15 Community Mental Health Programs 12 Mental Health Clinics 3 Towns utilizing services of out-of-state mental health clinic 18 Mental Retardation Programs (trainable) 6 Other community mental health projects The entire program serves over 8,130 persons a year, including: 3,766 Persons at State Mental Hospitals (adult and children) 1,947 New Admissions 2,819 Resident patients at beginning of year 1,068 Persons at Pineland Retardation Training Center 1,716 Persons at State-Operated Community Clinics 1,135 Persons at Outpatient Clinics in the Community Programs THE MENTAL HEALTH PROGRAM-STATE OF NEW YORK The Department of Mental Hygiene administers: 19 State hospitals for the mentally ill : 13 inpatient units for emotionally disturbed children; S narcotic addiction treatment units; 6 alcoholism treatment units; 2 day hospitals. 25 State outpatient treatment and aftercare facilities: 1 day hospital. In addition, under the Community Mental Health Services Act the Department reimburses local community mental boards for 50 per cent of the cost of community mental health services in: 226 Outpatient clinics; 40 Psychiatric units in general hospitals. The entire program serves well over 283,000 persons a year, including: 115,000 persons at State mental hospitals: 35,000 new admissions; 80.000 resident patients at beginning of the year. 27,000 persons at State schools; 21.000 at State-operated outpatient clinics; 45,000 at psychiatric units of general hospitals; 75,000 at outpatient clinics in the community program. THE MENTAL HEALTH PROGRAM-STATE OF WASHINGTON State Operated Facilities (Direct Services): 3 Hospitals for the mentally ill; 1 Treatment facility for emotionally disturbed children (provides residential and day care located at Western State Hospital); 2 Out-patient clinics for mental patients (located at Western State Hospital and Eastern State Hospital); 1 Neurological institute (located at Western State Hospital); 1 Tuberculosis unit for mentally ill (located at Western State Hospital); 1 Consultation unit (located in Seattle). Total patients in resident care at state hospitals on November 1, 1966: 3,327. The number of patients receiving some type of treatment from the Division of Mental Health during year ending June 30, 1966: 8,710. On June 30, 1966, the Division of Mental Health had 2245 full-time employees, distributed as follows: 3 State hospitals---- Mental health research institute__ 2,211 27 Total 2,238 During 1966, the total operating budget for the three state hospitals was $15,210,628. Western State Hospital.. $6, 401, 971 Northern State Hospital. Eastern State Hospital.. 4, 450, 121 4,358, 536 The State of Washington provides part of the financial support for 15 community mental health programs and total financial support for one community center (Olympic Center). The community mental health programs provide the following services: Outpatient Consultation Children's Treatment Programs- Information and Education to the Public_____ 20 20 Estimated number of persons receiving services from the community mental health programs during 1966: 3700. In 1966 $233,978 was distributed to the community mental health centers by the State of Washington. Of this amount, $47,424 was derived from the federal government. On June 30, 1966, the schools for the retarded had 1584 full-time employees. During 1966, the total expenditures for the schools for the retarded children were $11.024,263. The State of Washington provides part of the financial support for 25 community day care centers. During the year ending June 30, 1966, $64,837 was expended on the community day care centers. An estimated 500 persons received some service from the day care centers in 1966. Dr. MILLER. The preceding figures describing the dimensions of our programs are important, Mr. Chairman, because mental health is the only category of illness specifically mentioned in Public Law 89-749, which is being extended by the bill you are considering today, H.R. 6418. I think, therefore, that it is of some significance to know the proportions of the mental health programs in the States that warrant so special an identification in the law. If for no other reason, mental health needs special mention, Mr. Chairman, precisely because of its immensity. Our departments are frequently the largest in terms of payroll and work operations of any State governmental department. That is true in New York. We are also vulnerable in spite of our size with respect to participation in certain Federal public health programs, and I think an example is from the history of the formula grant program that during the past 5 years the categorical grant for the community mental health services as you made of $6.75 million which, if you were able to scale out according to each State, would be approximately $135,000 for each State. In New York State it was just under a half million dollars a year, but contrasted with combined local governmental and State governmental matched funds in New York State for community mental health servies alone of over $70 million. During that same period the categorical programs for heart disease and other important areas such as dental care increased steadily and the percentage of mental health categorical grants since 1948 has actually declined. So, in brief, to recapitulate why mental health should receive some special reference in Public Law 89-749, I would say for one because State health departments are important, are in most States now designated by the States to plan for and receive Federal public health funds, but in only four States plus the Virgin Islands, Puerto Rico, and the District of Columbia, does the health department have direct responsibility for the administration of the State mental health program, and in one of those mental retardation is in another agency; and, keeping in mind this scale and scope of programs, as I have briefly alluded to them, this does present a special problem. In six other States the mental health program is under a health and welfare agency and in all of the other 44 mental health program rests in a variety of some other State agencies than the State health department. In 18 States as of the moment there are independent departments of mental health. In such a wide range of mixed authorities it is of utmost importance that if mental health is to share in proper proportion of the public health grants it must have, we think, at this time a special identification in the law. Mr. Chairman, we wish to reaffirm our strong support of the extension of the provisions of Public Law 89-749 for comprehensive health planning. We endorse the purposes of that act which seeks to establish comprehensive planning for health services, health manpower, and health facilities at every level of Government and to broaden and make more flexible the Federal Government support of health services provided to people in their communities. We believe firmly in the values of an effective partnership of State and local health and mental health agencies, intergovernmental collaboration, and cooperation between official and voluntary programs, We favor the continuation of the new Federal system of block grants for public health services in the States established in Public Law 89-749 last year. This is an effective and efficient application of the principle of creative federalism and is a giant step forward in improving further the already excellent relationship that exists between the Federal and State Governments. The States need the flexibility to shift Federal grants support into health programs that they determine to be critical and Public Law 89-749 now gives each State that flexibility. The flexibility is dependent on at least two things: not only the law, but the regulations and the guidelines promulgated by the Federal Government and most importantly the comprehensive health planning to be done by the States. The regulations and guidelines, if so drawn as to constrict, could suffocate a good program, but we think that the regulations and guidelines as they are now being developed and as I understand will be published very soon, appear to us to be entirely consistent with the purposes of this act. The comprehensive health planning is yet to be funded. We look upon the comprehensive planning as the most important phase in the new Federal block grant program. The block grant by the Federal Government to the State will be disbursed within the State to programs with the most urgent priorities, in accordance with that comprehensive plan. The State mental health programs have just completed 2 years of comprehensive mental health and mental retardation planning, and as you know, the mental retardation planning is continuing and it is our hope that this enormous mental health planning effort and even more the capacities which this developed within the States and the investment in the States in continued never-ending planning will be properly incorporated into the total planning of the States. To some extent this will depend on the State agency designated to do the planning. In New York State we are moving toward, in fact have established an interdepartmental agency for the development of a single comprehensive State health plan as required under Public Law 89-749. The chairman of this interdepartmental agency is to be the commissioner of health, and I as commissioner of mental hygiene am to be the vice chairman. The extensive responsibilities in the total field of health which are lodged in such other departments of State government as social welfare, the State department of education, the State university, the State office of insurance, will be respected in the composition of the interdepartmental health planning agency now being established in our State, and the Governor's office is also directly represented as well by members of his cabinet, by a representative of the office of planning coordination. Mr. Chairman, we think very strongly in New York that comprehensive planning can best be achieved through a partnership among strong, clearly identified health, mental health, and other healthrelated programs. The act and the amendments which you are now considering enhances significantly the capacity of States to meet the needs of their populations by effective comprehensive planning. The requirement for planning is a major step forward. The tremendous demands for services inevitably militate against adequate financing of planning efforts in many parts of the country. The extension for 5 years of the authorization for Federal grants to the States for planning provides a means for doing what every administrator of health services wants. We have looked to our members, our member States and attempted to canvass from them what their projection would be of special needs now not met in the mental health field and mental retardation which might provide, I think, some illustration of some of the uses to which the funds authorized could be put. I am able to give you today a fairly detailed and explicit projection of the highest priority community mental health programs for which we will seek collectively Federal grant assistance in the next 7 years, assuming that this law is extended for that period of time by the Congress. I would like to add that it was possible for the States to do this because they had been engaged in a comprehensive planning effort. Thirty-four States have given me descriptions of 160 programs which they consider to be of the highest priority in combating mental illness and mental retardation, and I have with me here the full description of the 160 projected programs with cost estimates. I don't intend to burden the record with this information which is about 460 pages. However, I have prepared an analysis of the programs and estimates of costs to State and local governments and the amounts that the State mental health agencies are hoping to obtain from Public Law 89-749 through the State comprehensive health |