Mr. ROBERTS. Has the gentleman concluded?
Mr. PEPPER. Yes, sir.

Mr. ROBERTS. Thank you for your statement. We appreciate your appearance very much.

I have no questions.

Mr. Rogers from Florida.

Mr. ROGERS of Florida. Mr. Chairman, I am pleased to see my colleague from Florida here. We are very pleased to have your feelings on this bill which will be very helpful to the committee.

Mr. PEPPER. Thank you. It is one of the needs of our State, Mr. Chairman, and all those who are interested in this subject are doing a great service to the country to meet this challenge.

I am glad to see my distinguished colleague here on this committee. Thank you very much for your kindness.

Mr. ROBERTS. The distinguished gentleman from Arkansas, the chairman of the full committee.

Mr. PEPPER. I am certainly glad to see the lead taken in this field by your distinguished chairman. I want to support him in any way I can.

Mr. HARRIS. Thank you, Mr. Chairman.

I want to express my thanks to our colleague from Florida for his interest and for taking time from his busy schedule to come to this committee. We have known of course that his interest as exemplified in his statement here today has of course existed over a long period of years. We recognize the importance of this legislation.

I introduced the legislation the gentleman referred to at the request of the President, after HEW submitted it here. It of course comes down as the administration measure. As chairman of the committee, it is my hope that with the valuable assistance and information from the gentleman from Florida and other colleagues in the House who are interested in the program, we will be able to work out a satisfactory program to meet the needs in this field.

Mr. PEPPER. Thank you very much, Mr. Chairman.

Mr. ROBERTS. The gentleman from Colorado.

Mr. BROTZMAN. Thank you, Mr. Chairman.

Mr. Pepper, I have a question or two. Do I understand your testimony is on behalf of a bill that is exactly like H.R. 3688? Is that correct?

Mr. PEPPER. That is correct. I introduced the same bills that the distinguished chairman has introduced to show my interest in and

my long connection with this subject and my desire to help in any way I could to progress this legislation.

Mr. BROTZMAN. Now I understand you to say that Florida was spending less than 2 percent of her State budget, is that correct? Mr. PEPPER. That is right.

Mr. BROTZMAN. Do you happen to know what this would be in dollars and cents that the State of Florida has spent in the last year for the mental health needs of the people in the State?

Mr. PEPPER. I think Florida spent in 1961-63 the figure of $38,630,483 for the biennium.

Mr. BROTZMAN. That was in the last biennium, is that right? Mr. PEPPER. That took care of 10,166 patients. That was for the State.

Mr. BROTZMAN. Now generally speaking, what type of a mental health law have you in the State of Florida?

Mr. PEPPER. Well, we have legislation which simply provides the State institutions to which mental patients may be sent when they are adjudicated to be mentally incapable or of such mental disorder as should require that kind of attention. Then there is a type where under our law you may go sort of voluntarily without being adjudicated, providing a doctor, of course, certifies that it is desirable for you to do so. So there are two ways you may enter, one is the voluntary process an the other is an adjudication by the county judge.

We have several of these institutions around over the State. As I have said, up until a few years ago we only had one over in west Florida, a place named Chattahoochee. I think it is in Mr. Fuqua's district. It was in Mr. Sikes' district. Now we have several others around over the State. There are a good many more in south Florida but as I say the facilities we have are not nearly adequate to meet the problems. All of them are vastly overcrowded.

I have known personally of many instances of patients who could not be admitted to any of our institutions because they did not have the beds or the room for them. These institutions do not have the money to provide the staffing that they should have. While our average is lower than the national average, I think our State is making a relatively comparable effort, but I think that this problem is so vast and so immense that it is just not being adequately met and we need Federal help.

Mr. BROTZMAN. I think you testified that the county judge is the determiner of whether or not a person has to be committed to an institution.

Mr. PEPPER. That is right.

Mr. BROTZMAN. Or they can go voluntarily if they choose.

Mr. PEPPER. That is right.

Mr. BROTZMAN. Now this 2-percent figure in the State of Florida, does this include expenditures for capital improvements as well as for professional care to care and maintain these people?

Mr. PEPPER. No, I think that figure relates only to operating expenses. I do not believe that includes the capital outlay, the buildings. Mr. BROTZMAN. How long has it been in Florida since you have built more of these types of institutions; that is, the regular brick and mortar construction to provide more facilities?

Mr. PEPPER. We built several. Perhaps Mr. Rogers might remember when the one was built in West Hollywood. We built several in the past few years. The one in West Hollywood, I suppose within the last 5 years maybe, probably within the last 5 years, it is in Broward County, in Mr. Rogers' district.

We have been adding to our facilities in the last several years but we still do not have anything like enough. Our Governor has proposed to recommend some additional facilities to the legislature which is going to meet in a few days but my opinion is that we are not nearly adequately meeting the challenge of this problem in our State. We do not intend to be neglectful of these people who are certainly deserving of our concern, but this is just another instance of where I think the Federal Government can supplement what is being done in the States and should approach the problem on an overall basis for the country. They should help the States and encourage the States to do more.

Mr. BROTZMAN. Do you think there is going to be a program in the Florida Legislature under the leadership of the Governor in this area?

Mr. PEPPER. I do not know what the Governor's recommendations will be but I am sure that he will have to make some recommendations that will provide more facilities because the patient load is increasing all the time. Our population is increasing. We now have almost 52 million population. Of course it is just like other facilities, you have to provide more as you have more demands. But whatever the Governor recommends, I am sure that it is not adequately going to meet the challenge of this problem.

Mr. BROTZMAN. You do not know exactly what he is going to recommend, do you?

Mr. PEPPER. I know he is not going to recommend enough. I just know that as a matter of commonsense because the problem is so large, that it takes so much money, and there are so many demands for money I am just morally certain that the Governor is not going to recommend that the legislature appropriate enough money to meet the problem adequately because it would cost more than the legislature feels that it could appropriate, I imagine; more than the Governor feels he can recommend, also.

Mr. BROTZMAN. This is just your feeling though, you have not talked to the Governor?

Mr. PEPPER. No, I have not, but I would venture to say that in his recommendation the Governor would say that this has not anything like met the problem but at least we should make this much progress. That is what he will say, I believe.

Mr. BROTZMAN. Do you think there is any danger that the enactment of such a bill as this would curb the incentive on the part of the people of Florida to solve this problem?

Mr. PEPPER. One the contrary, it would encourage them and tend to push them a little bit to do more than is being done. Like a lot of the other Federal aid programs, it is a stimulus to the States to meet problems that they are not adequately meeting, many of the Federal programs are. We have a Veterans' Committee in the House and I can assure you that this problem is nothing like adequately being met by the Veterans' Administration.

Mr. BROTZMAN. The simple fact is though the money is going to come from the same place?

Mr. PEPPER. I beg your pardon?

Mr. BROTZMAN. The money for this program here or the one in Florida is basically going to come from the same place, and that is part of it is going to come from the people of Florida.

Mr. PEPPER. Well, that is true, there is no doubt about that. You know, it has been my observation over the years that I have been associated with Washington that the Federal Government as a general rule has held up higher standards than are to be found in many, if not in most, of the States. The Federal Government has taken the lead in so many fields, not because it was looking for new territory to invade but because there were problems that were not being adequately met. After all, these are people that are citizens of the United States; citizens of the States in which they live, and also citizens of the United States. They are our people as well as State people that we are talking about.

The Federal Government in so many fields has willingly taken the lead and set high standards and furnished credible examples to the States and at the same time provided funds that the States were not able to provide. Furthermore, in my State, and I am not going to say whether it should or should not be that way, we found it desirable to have it that way, but practically all of the revenue for our State government comes from excise taxes. We do not have a State inheritance tax and we do not have a State income tax, so we do not have anything like as broad a base of taxation as the Federal Government has.

Our ability to raise funds according to our present constitutional structure is nothing like as great as the ability of the Federal Government with a larger tax base that it can rest its appropriations upon. It may well be that we are one of those States that is not particularly geared, as it were, to meet all of the problems that we have, with the burden falling rather unduly on the masses of the people.

Mr. BROTZMAN. The method of taxation in the State of Florida has been determined in Florida, is that not right?

Mr. PEPPER. That is correct.

Mr. BROTZMAN. That is a system that has been picked by the leaders there.

Mr. PEPPER. It may be a matter that many people would not agree with, but it is not going to do these poor mental patients any good to argue about the constitutional deficiencies relating to the tax structure of the State of Florida. They are there, they are suffering. They appeal to our conscience and are the subject of our concern. We are talking about practical ways to help them. The Federal Government can help, and I feel it proper that it should render a greater service to these people than it is now rendering.

Mr. BROTZMAN. I wondered how practical the approach was in the State of Florida to the problem. You mentioned something was being done and I wondered really what you were trying to do to solve the problem there.

Mr. PEPPER. As I said, we are not far away from the national average and the amount that we are contributing is constantly increasing. I do not claim in any sense of the word that we have done all that we should have done; we have not. I think we will do more in the future, and this legislation will encourage us to do still more.

98493-63

Mr. BROTZMAN. Thank you.

Mr. ROBERTS. Our next witness is the Secretary of Health, Education, and Welfare.

We are very happy to have you today. I believe this is the first time that you have honored our subcommittee with your appearance. You have been before the full committee. We are very happy to have you and have you introduce the gentlemen who are accompanying you, Mr. Secretary, for the record.

STATEMENT OF HON. ANTHONY J. CELEBREZZE, SECRETARY, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE; ACCOMPANIED BY WILBUR J. COHEN, ASSISTANT SECRETARY; BOISFEUILLET JONES, SPECIAL ASSISTANT FOR HEALTH AND MEDICAL AFFAIRS; DR. LUTHER L. TERRY, SURGEON GENERAL, THE PUBLIC HEALTH SERVICE; AND DR. JACK C. HALDEMAN, CHIEF, DIVISION OF HOSPITAL SERVICES, PUBLIC HEALTH SERVICE

Secretary CELEBREZZE. Mr. Chairman and distinguished members of the committee, I have with me Mr. Wilbur J. Cohen, Assistant Secretary, Mr. Boisfeuillet Jones, Special Assistant for Health and Medical Affairs, Dr. Luther L. Terry, Surgeon General of the Public Health Service.

Mr. Chairman, the legislative proposals under consideration by your committee today-H.R. 3688, H.R. 3989, and other similar bills-are directed toward two related and long-neglected health problems; mental illness and mental retardation. The urgency of these problems, and the essential actions required to meet them, were set forth in the President's special message on February 5 of this year.

Nearly a million and a half people receive treatment every year in institutions for the mentally ill and mentally retarded. On any given day the total number of patients in these institutions is about 800,000-including nearly 600,000 mental patients and over 200,000 who are mentally retarded. But these institutional figures do not represent the total number of persons afflicted. Among the mentally retarded, for example, those confined to institutions represent only 4 percent of the 5 to 6 million retarded persons in this country. The others, the remaining 96 percent, are cared for at home.

The cost of caring for these afflicted persons is huge. The expenditure from tax funds alone, apart from private and voluntary expenditures, is approximately $2.4 billion a year for direct outlays. Of this total nearly $2 billion is for mental illness, and over a half a billion dollars is for mental retardation. In addition to their direct outlays for care, the States and localities spend approximately $250 million annually for special education, welfare, rehabilitation, and other services for retarded persons outside of public institutions.

For the most part, however, these huge annual outlays provide only minimal care in grossly inadequate facilities. Three-fourths of the State mental institutions were opened prior to World War I. Many are fire and health hazards. Almost all are understaffed. The average expenditure per patient in State institutions is only $4 a day, and in some States the average is less than $2 a day.