or custodial care or for people to train them, perhaps, in useful work, and things of that nature.

Mr. COHEN. Yes. And there would have to be some physicians and some psychologists and some nurses and some paramedical personnel, just as Mr. Jones said in connection with the comprehensive mental health facility.

Mr. ROGERS of Florida. Would you set any minimum standard for them?

Mr. COHEN. This would be in connection with the construction grant. We provide that there must be minimum standards for the maintenance and operation of the facilities. The component of thatlet me put it this way: We would not want to make a construction grant for the Federal Government to spend a lot of money unless the community gave some assurance that in its maintenance and operation it was going to carry out what the construction was for.

But as Mr. Roberts says, the important distinction here is that there is no staffing grant funds on the 4-year basis for the mental retardation facilities such as there are in connection with the comprehensive community mental health services.

Mr. ROBERTS. Would you yield?

Mr. ROGERS of Florida. Yes.

Mr. ROBERTS. For instance, I happen to have in my home community a nonprofit, volunteer group which has obtained some property, and they operate about, I think, 2 days a week strictly on UGF funds, or I think they do get some money from the city and county. And they maintain this community facility for, say, 2 days a week, the best that they can do with the volunteers they have. Some of these ladies are teachers, some psychologists, some have had various types of workshop training, and some know something about rehabilitation. Now, would that type of facilities be able to participate in this program?

Mr. COHEN. Well, when you use the word "facility" there, do they already have a building that comprises all of this?

Mr. ROBERTS. Yes.

Mr. COHEN. Well, the main factor in title II of this bill is the grant for the construction of the adequate facilities.

Mr. ROBERTS. That would be up to the State, probably the State health department or some similar agency, to determine whether or not this type of operation would be eligible under the act?

Mr. COHEN. Yes.

Let me explain first how the Federal act would operate.

First, the Federal Hospital Counsel as expanded by this bill would, after consultation with the Surgeon General and the Secretary and the other persons concerned with this, lay down general regulations as outlined in section 203 of the bill for determining the kind of services that are needed for the mental retarded, the general manner in which the State agency shall determine priority on the general lines of the Hill-Burton concept of priority, general standards of construction and equipment, and provision for adequate facilities for these individuals.

Then, in the light of those general regulations that one sent out to all of the States, each State and each locality would have to propose a series of projects with priority in the State for getting this money.

And probably if this community that you are saying already has an adequate facility, then another community that didn't have one at all would probably end up with a much higher degree of priority in terms of the limited amount of Federal funds, because the thought behind that program is to extend these facilities to areas that don't have them.

Mr. ROBERTS. Of course, as the facility is now, it is not adequate, in that they can only operate about 2 days a week, and as a matter of fact, they have many, many applications from people they would like to help, but they simply cannot take care of them under the limited resources that they have.

Now, I wouldn't want us to write a piece of legislation that would discourage this type of local effort, I would want it to certainly encourage it, and where there is need for this particular type, I wouldn't want to penalize the pioneers and the people that are going ahead, you might say, without any State help. And these people are doing it within a metropolitan area of about 40,000 people. So I would want the Secretary to consider that very carefully before we put anything in there that might eliminate them.

Mr. COHEN. Yes. The big point here, Mr. Roberts, is that in this area we do not give this facility the staffing aid that we give the comprehensive community mental health facilities. And I don't know the situation that you are speaking of, but if the problem was that they didn't have enough funds or personnel or both to man the facility as extensively as they wanted, the problem would still remain as a local financing problem under this bill, because they couldn't get any operational cost help as they could in the other area.

Now, in the area that Mr. Jones mentions there may well be a community mental health service that was not comprehensive that had two or three items, as Mr. Jones suggested. But with the addition of some more personnel and some more facilities, it might be able to become a comprehensive community mental health center within a short period of time. In that case, they would then be able-that, however, is not the case here with the mental retardation facilities, we just haven't had as much background or experience in dealing with this, and it was for that reason that we did not add the staffing grant funds.

However, I would have to be frank and say that in the light of the questions you asked, that would still be a problem for many communities.

Mr. ROBERTS. Of course, I understand too that the supply of trained personnel, teachers of the deaf and handicapped, would come under another committee.

Mr. COHEN. Yes.

Mr. ROBERTS. I understand why you are not requesting that.

Mr. ROGERS of Florida. Is there any reason who you didn't provide for some staffing of the mental retardation factilities?

Mr. COHEN. Well, I think it is because we are in a more, as I tried to say, an earlier stage of development here. And in the work that we have done of this we were not as able to be-to see ahead just what was involved. I would say, if you asked me in principle, I would say that probably they ought to get some staffing help just like the community mental health centers. But since we didn't know enough

about it, we were rather cautious, and we felt that if we got some of these centers and facilities started and there did appear that there would be a problem after a period of time, our only recourse would be to come back and recommend to you how that would be handled.

Mr. ROBERTS. Of course, I know you know the bill, and I am not trying to make any discussions here except to say that I am wondering if, as this develops in some of the 10 regional research centers that are going to be set up, if that could be a kind of a place for training some of these people who would be farmed out, or maybe loaned, to some of these small communities who so desperately need this help. Could that be worked out?

Mr. COHEN. Yes, Mr. Roberts. That is very definitely a fundamental conception underlying this entire program. The point I mentioned about the centers being connected with universities-and in fact these centers could be used so that internships and residencies and predoctoral and postdoctoral traineeships would be developed here so that it would help to expand the volume of trained personnelI was going to mention the point, I was going to mention earlier when I said there was one more distinctive feature of that bill, and that is, in title II, section 201 in connection with the construction of the mental retarded facilities, we have earmarked exactly half the moneys that are authorized or that we thought we would request to be appropriated only for grants for the construction of these facilities for the mentally retarded which are associated with a college or university hospital, or other appropriate part of a college or university the ground that with a limited amount of money, some of it should definitely be associated with an educational, teaching, medical complex, so that you would be training personnel to meet the manpower shortage.

If we were just to construct all of it in places where it was solely treatment, as important as that might be, it wouldn't generate the new personnel that is necessary to do a better job. And we think, if you are going to spend Federal money, it should definitely have a teaching and a manpower increase element in it.

Mr. ROGERS of Florida. So you envision 10 centers for half of it? Mr. COHEN. No, I am talking about the facilities on the half. The 10 centers, I don't know where they would exactly be, but I think a large number of them would end up in some kind of a medical education complex, because the need for such highly professional personnel let's say personnel in the field of genetics, you are going to have to have Ph. D.'s in the field of genetics, you are going to have Ph. D.'s in the field of psychology, you are going to have to have pharmacologists-you are not just going to have those people in appropriate numbers outside of some educational-medical complex.

Mr. ROGERS of Florida. What do you estimate the cost of maintaining a staff for one of these facilities would be?

Mr. COHEN. The maintenance of the staff for a mental retardation facility-I don't happen to have that with me, but I will be glad to put that in the record.

I think you are going to find on that one that the probability is that the operational costs on that are going to vary a good deal. It was that very factor that made us think twice before recommending to you that the Federal Government undertake financing it. There perhaps is some experience in the United States on that, but I think

we would really have to wait for actual local experience before we would have a good estimate. But we will put in the record the best we have.

(The material referred to follows:)

Examples of staffing patterns of three types of services offered in facilities for the mentally retarded and estimated costs

Mr. ROBERTS. I think this has been very beneficial to the committee, and I would like to thank you, the Secretary, Mr. Jones, Dr. Terry, and all of you who have attended. I appreciate it very much. I am sorry we have had to hold you all day, but I think that this will be very helpful to us, and we are grateful to all of you gentlemen. Mr. COHEN. Thank you, Mr. Chairman.

Mr. JONES. Thank you, Mr. Chairman.

Mr. ROBERTS. The Chair would like to announce that the hearings will continue tomorrow morning in the same hearing room at 10 o'clock.

(Whereupon, at 3:55 p.m., the hearing was adjourned to reconvene at 10 a.m., Wednesday, March 27, 1963.)

MENTAL HEALTH

WEDNESDAY, MARCH 27, 1963

HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON PUBLIC HEALTH AND SAFETY

OF THE COMMITTEE ON INTERSTATE AND FOREIGN COMMERCE,

Washington, D.C. The subcommittee met at 10:22 a.m., pursuant to recess, in room 1334, Longworth Building, Hon. Kenneth A. Roberts (chairman of the subcommittee) presiding.

Mr. ROBERTS. The subcommittee will please be in order.

The hearings today on mental health and mental retardation will continue and our first witness today is the distinguished Governor of the State of Tennessee, the Honorable Frank G. Clement. We are very happy to have the Governor with us today. I think most of you know that he is one of the outstanding young Governors in our great Union, a keynoter of our Democratic Convention in 1956, and the Governor appears here today in his official capacity, and we are particularly happy to have you, Governor.

I might mention this is a double pleasure to me in that your press secretary was formerly a staff member and worked with us here for some time in the field of highway safety. I know of the fine leadership that you have taken in this field, the fine work that is being done, and was done in your first administration. I am sure it will continue under your next administration as Governor of the great Volunteer State.

It is a real pleasure to have you with us and we will be happy to have your testimony at this time.

STATEMENT OF HON. FRANK G. CLEMENT, GOVERNOR OF THE STATE OF TENNESSEE, ACCOMPANIED BY EDWARD F. JONES, PRESS SECRETARY TO THE GOVERNOR

Governor CLEMENT. Thank you very much, Chairman Roberts. To you and your two distinguished associates who are here I can only say this, that you took the words out of my mouth. I was going to remark about the fact that you were kind enough to loan Eddy Jones to me and we are glad to have him, I will put it that way, as press secretary. I am not going to take up a great deal of your time, Chairman Roberts, and you gentlemen of the committee. I appreciate the chance to appear on behalf of the bills that I understand you are considering because they bear on a subject that I have been closely identified with for the past 10 years.

While this identification with mental health has not qualified me to speak as a professional in the field, I might add this, although I do