cell cultures.

Planning for these research

gies revealed complementary and shared elements that led to

plans into a single. cost-efficient initiative

Therapeutic Medications Development, Diagnostic Centers Psychiatric Linkage, Integration of Basic and Clinical Approaches Regional Iraging Centers for the Study of Mental Disorders and Molecular Neurobiology.

ADAMHA BLOCK GRANT

In recent years, researchers have discovered that rany with serious mental illnesses also suffer from

individuals

ུ:༢

ticularly during acute Phases

sental illnesses. This is something. Mr. Chairman, which many our family members who have experienced the mental illness of loved ore can Vouch for. Unfortunately, most rental health providers in the community are not equipped to treat substance abuse disorders. Similarly, most substance abuse providers are not knowledgeable about or willing to treat mental illnesses. As it is Currently structured, the Alcoholism, Drug Abuse, and Mental Health Administration (ADAMHA) Block Grant 15 an ideal mechanism for focusing federal resources into the comprehensive treatment needs individuals with mental illnesses and substance abuse disorders.

airman. we 100k to your Subcommittee for leadership 17 zing the importance of dual planning and coordinated efforts y Work Grant recipients in treating individuals with these Jual

es.

PROJECTS TO AID THE TRANSITION FROM HOMELESSNESS

Chairman, it is conservatively estimated that 35% of all individuals are seriously mentally ill. Many of these -dividuals also suffer from substance abuse disorders. Last year, Congress passed important legislation designed to address the needs of this population called "Projects to Aid the Transition from Homelessness" or PATH.

The intent of PATH is to link housing and services for persons ho are homeless and mentally ill, including those who suffer from

or

substance abuse disorders. 80% of the monies dispersed to community providers by states must be used for purposes such as community mental health services, case management services, substance alcohol abuse treatment, and referrals for primary health services. 20% of the monies may be used for housing purposes such as minor renovations, security deposits, one-time rental payments, and coordinating between housing and service providers. States are required to contribute $1.00 for every $3.00 of Federal funds received under PATH.

The Budget submitted by the President targets $42 million for PATH. This is far below the $75 million authorized for the program by Congress last year. This despite the fact that PATH builds upon an approach which has already proven successful under the Stewart B. McKinney Act, the Mental Health Services Block Grant program. NAMI members familiar with the implementation of that program agree that its only shortcoming was that not enough monies were available on an annual basis to begin to meet the needs of this vulnerable and highly deserving population. PATH represents a significant step forward towards addressing this problem. We therefore respectfully urge the Subcommittee to appropriate the full $75 million for this important program.

COMPREHENSIVE STATE MENTAL HEALTH PLANNING GRANTS

Mr. Chairman, in 1986, Congress passed the Comprehensive Mental Health Planning Act (P.L. 99-660) As a result of this Act, all States were required to develop a comprehensive plan for addressing the treatment and services needs of persons with mental illnesses in the community. The Act further mandated that mental health planning Councils be developed in all States, with at least 50% of all members comprised of individuals with mental illnesses and their families. Today, all 50 states, the District of Columbia, and seven territories have developed such plans, in many of them the first long-range blueprints for addressing the needs of this population in a coordinated, cohesive fashion ever developed. The

mental health planning Councils were an integral part of this process in all cases.

The process is now entering into its second, most crucial stage, implementation of these plans. The work of the Councils in overseeing implementation will be crucial to this process. Recognizing this, Congress last year authorized $5 million for these Councils as part of the Mental Health Amendments of 1990 (P.L. 101-639). Although a relatively small amount, these monies are used productively to enable Planning Council members to monitor, evaluate, and revise existing planning and implementation activities. We therefore urge the Subcommittee to appropriate the full $5 million for these grants.

In

overarching goal of

conclusion, Mr. Chairman, if the conquering mental illness by the year 2000 is to be met, it is essential that the elements which could be supported by the NAMI/MHLG budget proposed here be put into place now. As I have tried to emphasize in this short space and time, the entire spectrum of fields related to mental illness are ripe with genuine research opportunity, from basic

neuroscience and behavioral

Now is the time for this

science to health care systems. Subcommittee and the Congress to come out in strong support of these critical endeavors, and ensure that the future of this nation will receive the full benefit of today's potential so that this does not become the "Decade of Mediocrity."

Senator HARKIN. Thank you very much, Dr. Judd. This subcommittee, and this Senator in particular, has been very supportive. The National Institute of Mental Health, last year, we increased by $101 million, $398 million to $491 million, almost a 30percent increase.

Dr. JUDD. Yes; for which we were very grateful, Mr. Chairman. Senator HARKIN. You wound up pretty good. We wound up with $458 million. We had to come down from that, we had to compromise with the House on that, so we have a record of strong support. We want to continue that strong support as much as the budget will allow us to take advantage of the increased focus the decade will bring, and to make sure that we fulfill those objectives that were set out during this decade. So by the year 2000, we will have made some giant strides toward unlocking some of the secrets that we know are there.

Dr. JUDD. Exactly.

Senator HARKIN. We need the research done. We are getting closer all the time to unlocking some of those doors, and now is not the time to back off.

Dr. JUDD. Wonderful.

Senator HARKIN. Thank you, Dr. Judd.

Dr. JUDD. Delighted to hear that. Thank you very much, Mr. Chairman.

STATEMENT OF DANIEL T. BROSS, EXECUTIVE DIRECTOR, AIDS ACTION COUNCIL

Senator HARKIN. Our next witness is Daniel T. Bross, executive director of the AIDS Action Council.

Mr. Bross, welcome to the subcommittee. And your statement will be made a part of the record in its entirety. Please summarize it.

Mr. BROSS. Thank you, Mr. Chairman, Senator Gorton, members of the subcommittee staff.

I am Dan Bross, executive director of the AIDS Action Council. The council represents more than 500 community-based AIDS service organizations at the front lines of the AIDS epidemic. I want to thank you for the opportunity to testify this morning, and to convey the AIDS community's appreciation for your leadership, and particularly your efforts last year in providing funding for the Ryan White CARE Act.

Unfortunately, once again this year, AIDS Action must come before you again with an urgent appeal for increased AIDS funding. Ten years after the reports of a strange new illness, AIDS has killed more than 100,000 Americans. There will be 60,000 newly diagnosed cases of AIDS this year alone. Every single day, 125 people die of AIDS, and 110 more become infected with HIV.

As someone who has worked for the last 5 years at the community-base level, I can tell you that the suffering out there is real, it is terrible, and it is getting worse. AIDS Action Council convenes the Coalition of National Organizations responding to AIDS, representing more than 150 national groups, actively fighting the

virus.

In the coalition's expert judgment, it would take $3 billion in 1992, or $1 billion above the President's request to adequately ad

dress the epidemic. I am happy to submit a copy of our appropriations recommendations for 1992 for the record. We make this request recognizing the constraints imposed by the Budget Enforcement Act, but as a Nation we must recognize the threat that AIDS poses to our national security, and respond just as resourcefully as we have to perceived threats abroad.

Today I want to focus on the most neglected aspect of our Nation's response to the epidemic: care for men, women, and children with HIV. This year, AIDS Action Council's top priority is full funding of the Ryan White CARE Act. The statistics I cited earlier are a brutal reality for AIDS service organizations, all of which handle overwhelming caseloads to make up for the lack of services in their communities. Yet even for community-based groups, service cuts may be the harbinger of the future. Caseloads in the 16 cities under title I of the CARE Act have increased 20 percent in the last year. With 5-percent inflation, and with two additional cities now eligible, title I funding will need to be increased by 30 percent, just to meet the same fraction of need addressed last year. The funding provided in title I is making a difference in those cities, but without significant increase in services, we will have to lag-we will not be keeping up in the increase in caseloads. The same can be said for State services funded by title II of the act. Between the level of funding proposed by the President and the expiration of overlapping funding cycles, there will be an actual decline in the level of care States can provide.

As you know, title III's early intervention programs were not funded last year. We do not know how many people have developed AIDS as a result. However, we do know that some 600,000 HIV infected Americans now need early intervention care. Sadly, only a tiny number are receiving it.

Together the CARE Act's three titles comprise a comprehensive response to the care needs of people with HIV. Full funding of these programs at more than $500 million above the President's request would represent a dramatic and unprecedented increase in funding. But please, remember that the care for people with HIV has been neglected by the Federal Government for 10 years. Consequently, the epidemic continues to devastate our Nation's health care delivery system.

PREPARED STATEMENT

Mr. Chairman, literally hundreds of thousands of Americans with HIV and their families are looking with hope to this committee. Please do not disappoint them.

Thank you.

[The statement follows:]

STATEMENT OF DANIEL T. BROSS

Good morning Mr. Chairman, my name is Dan Bross. I am executive director of the AIDS Action Council. The Council represents the 500-plus community based AIDS organizations who are at the frontlines of the nation's fight against AIDS.

I want to thank you for the opportunity to testify this morning and to underscore the AIDS community's appreciation for your leadership in the fight against AIDS. Once again, however, AIDS Action Council comes before you with an urgent appeal for increased funding for our nation's AIDS programs.