In administering the above provision we do not contemplate making a detailed examination of the books and records of every recipient of a grant. However, selective checks may be made to provide reasonable assurance that grant funds are being properly applied or expended.

Chairman, Committee on Interstate and Foreign Commerce,
House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: This letter is in response to your request of February 15, 1963, for a report on H.R. 2567, a bill to amend the Public Health Service Act in order to provide a broadened program in the field of mental health and illness of grants for prevention, research, training, salaries, facilities survey, and construction of facilities for treatment of the mentally ill and mentally retarded. The bill would amend the Public Health Service Act by adding a new titletitle VIII-and repealing sections 303 and 304 of that act. The new title would include two parts: Part A-Grants for Research, Training, and Salaries; and Part B-Survey and Construction of Facilities for the Treatment of the Mentally Ill and Mentally Deficient.

Under part A, the Surgeon General would be authorized to make grants to States, with appropriations authorized for each year beginning July 1, 1963, as follows:

(1) One hundred million dollars for investigations, experiments, demonstrations, studies, and research projects for the development of improved methods of preventing mental illness and mental retardation, and relating to the care, treatment, and rehabilitation of the mentally ill and the mentally retarded.

(2) One hundred million dollars to assist in the training of personnel at schools, colleges, and other institutions of learning; at institutions for the mentally ill or mentally retarded; or in community mental health programs. (3) Two hundred million dollars for paying or supplementing the salaries of teachers, trainees, professional personnel, and others working with the mentally ill, mentally retarded, or in community mental health programs. Under part B, the Surgeon Genetral would be authorized to make grants in aid to the States for surveys and construction of facilities for the treatment of the mentally ill and mentally deficient, with appropriations as follows:

(1) Two million dollars for construction surveys, to remain available until expended.

(2) One hundred million dollars annually, beginning July 1, 1963, for construction of facilities for the treatment of the mentally ill and mentally deficient, including rehabilitation facilities.

Mental illness and mental retardation are among the Nation's most critical health problems. In his special message on mental illness and mental retardation, February 5,1963, President Kennedy proposed two national programs, one for mental health, the other to combat mental retardation. The President emphasized three major objectives for these programs: Seeking out the causes of mental illness and of mental retardation and eradicating them; strengthening the underlying resources of knowledge and especially of skilled manpower which are necessary to mount and sustain an attack on mental disability; and strengthening and improving the programs and facilities serving the mentally ill and mentally retarded. To implement these programs the President recommended intensified activity under various on-going programs and the enactment of legislative authority for new programs. Administration bills designed to implement these recommendations have been introduced as H.R. 3688 providing for construction and staffing of comprehensive community mental health centers; H.R. 3689 for combating mental retardation through the construction of research centers and of facilities for the care, treatment, and rehabilitation of the mentally retarded; and H.R. 3386 which would amend the Social Security Act to provide for planning for comprehensive action to combat mental retardation, and for an expansion and improvement of the maternal and child health and crippled children's programs aimed at the prevention of mental retardation.

Although we are in full accord with the objectives of H.R. 2567 which closely parallel the objectives emphasized by the President in his message, we feel that the programs proposed by the administration represent the most desirable approach to the achievement of these objectives, and we therefore urge enactment of the administration bills in lieu of H.R. 2567.

We are advised by the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program.

Sincerely,

ANTHONY J. CELEBREZZE, Secretary.

Mr. ROBERTS. I will also place in the record before the close of the hearing today certain communications from Governors of States and other public officials in connection with this important subject.

Mr. Pepper.

STATEMENT OF HON. CLAUDE PEPPER, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA

Mr. PEPPER. Thank you very much.

Mr. Chairman and members of the committee, I am very grateful for the privilege of appearing before your honorable committee in support of the bills which I have introduced which in turn are the bills introduced by the distinguished chairman of this committee. All of our bills have the full endorsement of the present administration.

H.R. 4663 would authorize grants-in-aid to public and nonprofit institutions for the construction of centers for research in mental retardation and related aspects of human development, to assist in means of finding causes thereof and the means of prevention or means of ameliorating its effects. The bill would authorize $8 million for each of the fiscal years 1964-66 and $4 million for 1967 and for 1968 for this purpose. The Surgeon General of the U.S. Public Health Service would administer the program and approve or disapprove applications for grants which could not exceed 75 percent of the necessary cost of construction.

H.R. 4663 would also authorize grants to public and nonprofit institutions for the construction of facilities for the care and treatment of the mentally retarded, including facilities connected with college and university hospitals or other appropriate parts of colleges or universities under State plans approved by the Surgeon General upon the basis of population, the extent of the need for the facilities and the financial needs of the respective States. Under the bill, $5 million would be appropriated for this purpose for the fiscal year ending June 30, 1965, and $10 million for each of the next 4 years.

Title I of H.R. 4664 would authorize the Secretary of Health, Education, and Welfare to make allotments to States on the basis of approved plans for the construction of public and other nonprofit community mental health centers on the basis of appropriations determined by Congress beginning with the year ending June 30, 1965. The primary factors which the Secretary would take into account are population, the extent of the need for such centers in each State, and the financial needs of the respective States.

Title II of the bill would authorize the Secretary to make grants to public or nonprofit institutions to which a grant was made under title I to meet the cost of the initial staffing of community mental

health centers on the basis of appropriations determined by Congress. Any such grant may not exceed 75 percent of the staffing cost during the first 15 months, 60 percent for the next year, and 45 and 30 percent, respectively, for the next 2 years.

Mr. Chairman and members of the committee, Congress recognized this problem during World War II. During the war I was chairman of the Subcommittee on Wartime Health and Education of the Senate Committee on Education and Labor, which made a study of the problems and needs with respect to mental illness and mental ill health in the United States. That subcommittee held a number of hearings on the health needs of our veterans and our civilian population.

In January 1945 the subcommittee issued its interim report No. 3 in which the staggering extent of mental illness was first disclosed. For example, the report pointed out that of 4,212,000 young men 18 to 37 years of age who were rejected for military duty by the Selective Service as of June 1, 1944, 1,282,000 or over 25 percent of the total rejected were for mental diseases and deficiencies. The report stated:

It has long been known that approximately two-thirds of the illness encountered in general medical practice is essentially neuropsychiatric in origin and that half of the patients in hospitals at any one time are there because of serious mental disorders. Indeed, one may safely predict that in any group of 15-yearolds 1 out of 22 will someday be committed to a mental institution.

Our subcommittee recommended the establishment of community psychiatric clinics, hospitals in planned medical centers, and for the training and education of professional personnel. The subcommittee said:

From a longer range point of view, the establishment of child-guidance clinics in all communities is urgently needed to prevent early social maladjustments. You may recall, Mr. Chairman, that in 1946 the chairman of your full committee then, the late Honorable Percy Priest, Representative from Tennessee, sponsored H.R. 4512, and I sponsored in the Senate S. 1160. These two bills were merged into Public Law 487 of the 79th Congress which authorized the establishment of the National Institute of Mental Health at Bethesda, a broad national program of research into the causes and prevention of mental ill health, training of personnel in the treatment of psychiatric disorders with some experimental research in community mental health centers.

This act gave the impetus to Congress for a rapid growth in the appropriations for a national mental health program. This growth is reflected in the following figures of Federal funds provided in 1946, 1950, and 1963. Funds for this activity were $66,000 in 1946; $10,019,000 in 1950, and $143,599,000 in 1963.

In 1949 Florida had only one State mental health hospital at Chattahoochee. It was 540 miles from Miami. It had at that time only 3,000 beds and 6,000 patients. Many patients from south Florida had to spend their time in Tampa jails during their travel to the hospital at Chattahoochee.

May I interpolate, Mr. Chairman, I was chairman of the Veterans' Committee in the Senate for a number of years. I recall on one occasion I sent telegrams to the sheriffs of Florida and my recollection is that I got replies that 25 veterans in Florida were in the jails of our State because there were not any adequate mental institution for

them to go to. I think we still have very deficient facilities in our veteran setup in Florida. We did not have any provision to take care of psychiatric cases with our veterans. The nearest to our State was in Augusta, Ga. So this pertains not only to the civilian population but there are very many great needs also in the veterans field.

In the Miami area there was only one nonpublic institution. It had no psychiatrist and no neurologist.

At the present time there are in addition to the State mental hospital at Chattahoochee, the South Florida Mental Hospital in West Hollywood just outside of Dade County, the Northeast State Hospital and the George Pierce Wood Memorial Hospital.

Dade County now has facilities at the Jackson Memorial Hospital, the above-mentioned South Florida State Mental Hospital, a new day-care center at the veterans facility at Coral Gables, a mental health department within the Dade County Health Department, and the Dade County Child Guidance Clinic.

But the record clearly shows that these facilities in Florida are wholly inadequate to meet the pressing needs in the field of mental health. The Florida Association for Mental Health pointed out in December 1962:

At Chattahoochee many patients are housed in substandard, unsafe, old buildings. It would be preferable to eliminate the need for these buildings rather than to replace them.

The association recommended that facilities be provided for mentally retarded patients and special facilities for older nonpsychotic offenders.

The South Florida Mental Hospital at West Hollywood in December 1962 had about 430 geriatric patients, one-third of the total. Of the 430, about one-half are not really mentally ill, although they do suffer from mental lapses which are concomitant with old age. In addition, 70 percent of those on the hospital's waiting list are in this category.

You may recall, Mr. Chairman, that in the mental health appropriation for the fiscal year ending June 30, 1963, made by Congress, $4,200,000 was included to assist the States in developing broad State mental health care programs. The State of Florida has taken advantage of this appropriation by making use of a Federal grant thereunder for the development of a comprehensive program of mental health care in Florida.

Moreover, the American Psychiatric Association with the assistance of the State and local mental health groups made a survey and held hearings in Miami on July 25-27, 1962, in Miami and other hearings in Pensacola, Tallahassee, Jacksonville, Orlando, and Tampa. This survey, summarized in the October 1962 monthly bulletin of the Mental Health Society of Greater Miami, expressed the need as follows:

Facilities and services for the mentally ill and seriously disturbed childrenmore and better services for the patient coming out of the mental hospitals, lowcost clinics, psychiatric services in general hospitals, day and night hospitals, more and better facilities for the senior citizen, psychiatric services in the courts, jails and stockades and probation services, better legal definitions of sane and insane, more appropriations for training and research.

It also recommended that the seven different State units which now deal with mental illness should be combined into one State department

of mental health, regional treatment centers for children, and community mental health centers. Similar recommendations have been made by the Florida Association for Mental Health.

Mr. Chairman, Florida, and particularly south Florida, lacks the proper facilities for the proper care of the mentally ill and the mentally retarded. Federal facilities for all practical purposes do not exist in Florida. Almost all of the seriously mental sick veterans must be sent to the veterans' hospitals at Augusta and Atlanta, Ga., and at Gulfport, Miss. These hospitals have long waiting lists.

Incidentally, if I may interpolate again, a little while ago in Miami we had a case of a psychiatric patient who threatened to kill the police. He called up my secretary and demanded that she get him into the veterans' hospital and threatened to do her bodily injury if she didn't do it. Finally the police had to lock him up and keep him for several days until they could make arrangements to send him up to Augusta, Ga., because there was not any room, even for that dangerous patient, in the veterans' hospital at Coral Gables. That is significant of the shortage there is even in the field of the veterans.

In the 2-year period 1959-61 the following data shows that Florida expended less than 2 percent of the total State expenditures for the care and treatment of mentally ill persons. In the United States the comparable figure was about 3 percent. The table at the end of my testimony with respect to all Florida State mental health hospitals and the South Florida Hospital clearly shows the inadequacy of mental health facilities in Florida.

The State of Florida and all the communities therein now spend per capita respectively $2.60 and 21 cents in 1960 in comparison with $5.19 and 36 cents for the United States.

Mr. Chairman, I need not relate the details or the data published by the Joint Information Services of the American Psychiatric Association and the National Association of Mental Health in its 1962 edition of 15 indices of mental health. These data show clearly the great need for expanded community health centers, for the staffing of these centers with highly trained professional personnel, and for the construction and servicing of facilities for the mentally retarded. Florida in these respects is highly deficient.

It is my belief that the quicker Congress passes the legislation now before your subcommittee, the faster the comprehensive mental health programs will be able to get underway. Dade County, which is my own county, needs it; Florida requires it; the national health and safety and defense demand it. We must move forward to conquer the great emergency created by existing mental ill health and the lack of facilities for treatment and prevention.

I urge you strongly to report these bills out favorably at the earliest possible convenience and pleasure of your honorable committee.

I would like to leave as a part of my statement, Mr. Chairman, a little table where I have some data about the number of patients and the amount with relation to my State in this field.

Mr. ROBERTS. Without objection, that will be included as part of your statement.

(The table referred to follows:)