SELECTED FEDERAL FUNDS TO STATES FOR MENTAL RETARDATION PROGRAM ACTIVITIES FY 1968-73

MENTAL HEALTH BUDGET

STATEMENT OF CONGRESSMAN SEYMOUR HALPERN OF NEW YORK

Mr. Chairman, once again we are faced with the threat of mental health programs being severely handicapped. The President's budget calls for a $15 million cutback in training programs of the National Institute of Mental Health's programs $7 million in psychiatric residency training and $8 million in undergraduate training. According to studies by the American Psychiatric Association, this cut would result in a 36 percent reduction of psychiatric residency positions, from 4,275 to 2,227. In addition, a tremendous multiplier effect on the loss of psychiatrists would be created by the loss in supportive professions due to the cut in undergraduate training.

It is difficult to understand the reasoning behind such a cut. At no other time in the history of the United Staes has here been such an understanding of the vastness of the problems of mental and emotional illness. In a mid-February report Secretary Richardson called alcoholism "the most abused drug in the United States" and sited the "inadequacies of present prevention and treatment programs." In his 1972 Health Care Message, President Nixon called drug abuse a "national emergency" and described new programs aimed at the elimination of drug use. The 1970 Community Mental Health Amendments provide for muchneeded expansion of mental health programs, especially for children and persons in poverty areas. How can we on one hand support the expansion of all these mental health programs and on the other, cut off funds which supply the manpower necessary to make these programs function effectively and efficiently? Without the skilled professional men and women trained in the area of mental health, these programs are useless.

Let us, for a moment, consider the savings we have incurred by supporting training of psychiatric residents. In 1946, there were only 3,000 psychiarists. About the only source of help for the mentally ill was in large, overcrowded mental institutions. Over a half million persons were jammed into the institutions and one out of every two hospital beds was occupied by the mentally ill. The number of patients in State mental hospitals was rising at the rate of 13,000 a year. Fortunately this trend did not continue. With the establishment of the National Institute of Mental Health in 1946, came a threefold program of training, research, and patient care. From a handful of psychiatrists in 1946, we have progressed to 25,000 psychiatrists today. This increased number of psychiatrists has had an incalculable effect on the problem of mental illness. In 1955, there were 558,000 persons confined to mental hospitals. By 1970 this figure had declined to 338,592-a 39-percent decrease. This was due, in part, to the advent of tranquilizing drugs and antidepressants, but a major impact was the increase in care available from trained psychiatrists. In terms of dollar savings, if we had not responded to this need for more psychiatrists, 128,000 more beds would have been required in the last 14 years at a cost of over $3.6 billion. Compare this to the $15 million needed to continue the program.

We can hardly consider only the monetary aspect. Without the advances made possible by psychiatric training, approximately 740,000 persons would now be in State and county hospitals 373,000 more than at present isolated from families, friends, and community with little or no hope of recovery.

Let us examine the problems of the mentally and emotionally ill more closely. Alcoholism

There are an estimated 9 million alcoholics in the United States today, with about 200,000 new cases developing each year. Alcohol was a factor in more than 50 percent of all fatal automobile accidents in 1970. The rate of alcoholism among those admitted to mental institutions is 20 percent. The National Institute of Alcohol Abuse and Alcoholism is carrying on extensive programs in the areaalcohol treatment centers are being planned and services for alcoholics are part of comprehensive mental health centers. The Department of Transportation is funding projects in 35 States. Project grants and State formula grants are budgeted to provide care and treatment for the alcoholic. The Veterans' Administration and the Department of Defense have extensive programs designed specifically for the problem drinker. These programs are wonderful, but without ualified psychiatrists and mental health professionals they are useless.

Drug addiction

The drug problem in the United States is increasing at an alarming rate. According to official estimates, in 1960 there were only 55,000 heroin addicts in the United States. In 1970, the figure was 400,000. Now it is estimated to be at least half a million. A recent study by the NIMH Center for Studies of Prevention of Suicide show that young heroin and cocaine users have a suicide rate at least 15 times greater than others in the same age group.

The Drug Abuse Office and Treatment Act of 1972 provides for greatly increased funding of community mental health centers which treat addicts. Under this act States will receive funds for antidrug programs and expended drug treatment is to be provided by the Public Health Service and in veterans hospitals and military hospitals.

All the money in the world can't produce an effective program when there is no qualified person to treat the addict.

Children

Ten percent of all school age children need psychiatric care for emotional problems. According to a New York survey by the American Psychiatric Association, only one out of every 1,400 children between the ages of 2 and 5, needing care are treated by private psychiatrists in clinics. The number of boys in mental hospitals has increased six-fold since 1950 compared to a two-fold increase in this population.

The Joint Commission on Mental Health of Children examined the problems of mental illness and emotional disturbances in children and recommended comprehensive prevention and treatment programs at all levels, from a Presidential Advisory Commission to neighborhood treatment centers. The 1970 Community mental health centers amendments provide for comprehensive child mental health programs. Response to this problem will mean utilization of even more mental health personnel, in particular, psychiatrists. Veterans

The Vietnam veteran is bringing home problems of drug addiction and alcoholism. He has participated in an unpopular, confusing war and frequently needs help in readjusting to civilian life. In 1971, there were 37 alcohol treatment units operating and 44 drug addiction centers are proposed for fiscal 1973. There are 48,391 Vietnam era veterans who are receiving compensation for serviceconnected psychiatric and neurological disorders. The VA has responded to mental disorders of all veterans; in all they operate 33 neurological hospitals which require complete psychiatric staffing. Suicides

Suicide now ranks 11th in cause of death in the United States. An estimated 21,290 people committed suicide in 1968. The rate for those between the ages of 15 and 24 has increased 67 percent in the last decade. These are people who desperately need the best counseling and treatment available.

Time has permitted me to mention only a few of the specific problems in mental and emotional illness. There are other problems, no less important, in particular, mental health of the aged. If we allow the psychiatric residency and undergraduate training programs to be cut, the delivery of mental care will be so severely damaged it might never recover. This cut isn't just an attempt to pare down the budget of the National Institute of Mental Health, it is an attempt to phase out the mental health training programs entirely.

We cannot afford to rely on funding of psychiatric training under other programs; it will never materialize. Psychiatric residency programs are relatively new arrivals in medical school hierarchies; they cannot successfully compete with other specialities. Also, whereas other medical specialities recover most of their residency training costs from charges for inpatient care in teaching hospitals, a small number of beds are involved in teaching psychiatry.

There is more at stake than the question of continuing expansion of mental health programs. It's a question of whether or not we can afford to take such a giant step backwards in the delivery of mental health care. It is very obvious to anyone who has the slightest insight of the prbolems of mental health that the answer is "No."

UNIVERSITY-AFFILIATED MENTAL RETARDATION CENTERS

STATEMENT OF SENATOR ROBERT DOLE OF KANSAS

U.S. SENATE, Washington, D.C., May 3, 1972.

Hon. DANIEL J. FLOOD,
Chairman, Labor, Health, Education, and Welfare Appropriations Committee,
Capitol Building.

DEAR CHAIRMAN FLOOD: Attached is a statement concerning the Kansas University Affiliated Mental Retardation Center and its 1973 funding needs. I would ask that this statement be included in the record of your committee hearings. Thank you for your cooperation, and I would greatly appreciate any consideration your committee might give the funding needs of the Kansas center.

Sincerely,

BOB DOLE, U.S. Senate. STATEMENT SUBMITTED BY SENATOR DOLE REGARDING THE KANSAS UNIVERSITY AFFILIATED MENTAL RETARDATION

Mr. Chairman, I appreciate the opportunity to appear before your committee and to call the committee's attention to the program of the Kansas University Affiliated Mental Retardation Center and its funding needs.

The program of the Kansas Mental Retardation Center as outlined by Dr. Richard Schiefelbusch, its director, in his testimony before the committee last year, will provide many benefits and services to the developmentally disabled in Kansas and their families. The center's program, once operational, will train health manpower to work with the developmentally disabled in Kansas and also provide diagnostic and advisory services along with an organized system for improved delivery of these services. Thus, the center will be instrumental in attaining for Kansas the national goal of improving the lives of the developmentally disabled.

The university affiliated mental retardation center has faced many problems in its struggle for existence. Numerous attempts have been made to obtain program funds for the center from the maternal and child health services in the Department of Health, Education, and Welfare, but no funds have been made available because maternal and child health appropriations were not sufficient to sustain even the existing university affiliated centers at their past levels of operation. In 1971, a commitment was made by MCH to fund the Kansas program if additional appropriations were made available by Congress in 1972; however, even though a higher MCH appropriation request for 1972 did receive congressional approval, inflated operational costs in existing UAF's exhausted the extra appropriations and made it impossible to fund the Kansas UAF. For similar reasons, funds for the Kansas UAF were not included in the 1973 MCH budget. This delay in funding has created serious hazards to the potential development of the Kansas program. The uncertainty of the program's future has caused professionals who were tentatively committed to participate in the program to seek employment with a more certain future. In anticipation of 1972 funding the UAF program at the medical center facility was organized to such a degree that announcement of funding would have confirmed tentative commitments and the program could have rapidly expanded to its full potential. A delay in funding now will cause the program to fall behind schedule, creating situations which, if allowed to further deteriorate, could stifle the eventual effectiveness of the program.

Construction is nearly completed on the physical facility which is to house the UAF mental retardation center in Kansas City. Construction of this building represents commitments by the State, the university and the medical center to improving the lives of the handicapped in Kansas. In recognition of this commitment to the program and the potential growth which was being jeopardized by the delay in funding. I appeared before the Senate Appropriations Subcommittee for Labor, Health, Education, and Welfare asking that the second 1972 supplemental appropriation bill include $112,000 for the Kansas center to enable it to begin operating immediately and take advantage of the excellent groundwork which has been laid. This request was included in the supplemental appropriation bill approved by the committee and passed by the Senate on May 1.

I would like to bring fiscal year 1973 funding needs of the Kansas UAF to your attention at this time and outline the proposed program which these funds would support. A detailed budget outlining the proposed exepnditure of the requested ds is attached.