The subcommittee has received many statements, telegrams, and letters and if possible, I would like to have them printed at this point in the record. STATEMENT OF THE AMERICAN PARENTS COMMITTEE, INC., BY MARGARET K. TAYLOR, EXECUTIVE DIRECTOR I am Margaret K. Taylor, executive director of the American Parents Committee, Inc., a nonprofit, nonpartisan, public service organization. Since its formation in 1947 the American Parents Committee has worked exclusively for legislation in behalf of America's children. Through the office of the Chairman, Mr. George J. Hecht, who is also the published of Parents' magazine, and the Washington office, it keeps abreast of a wide range of legislative proposals affecting children. The Board of Directors and National Council, composed of one hundred fifteen outstanding leaders of national, State and local child welfare organizations across the country, determine by majority vote the position of the Committee on legislative proposals. The American Parents Committee shares with you a concern about all situations in which the prospects for normal development of any of our children are imperiled, and a particular concern for those children for whom preventive measures are now already too late. For this reason we have placed high on our list of legislative goals for 1963 "an expanded program on Mental Retardation as recommended by the President's Panel on Mental Retardation." We commend to you the excellent report just issued under the title "A Proposed Program for National Action to Combat Mental Retardation." It is clear that we must have coordinated action on a number of fronts, within and outside the Federal Government, to achieve the various objectives set forth by the Panel. While bricks and mortar do not make a program, without them programs everywhere are seriously hampered. The bill sponsored by Representative Oren Harris (H.R. 3689) providing as it does for the construction of facilities for research and services for the mentally retarded, constitutes an important basic step in upgrading existing programs and making possible new ones for this disadvantaged group. Those familiar with the fields of knowledge basic to the study of mental retardation know that many sciences must interdigitate, in order to shed light on the causes of this condition and on the combinations of environmental conditions, stimuli, experieces, and treatments which will enable each mentally retarded child to make the maximum possible progress. Today, even with all our modern instruments of communication, the face-to-face contact between scientists still affords the best opportunity for the communication or verification of nascent ideas from which new discoveries emerge. Some important work relevant to mental retardation is done in laboratories by men who never see or talk to a mentally retarded child, but much needed research requires that mentally retarded persons be available as subjects. To foster such research, therefore, it is necessary to provide the physical facilities in which scientists with various disciplinary backgrounds find it convenient to work and communicate with one another and also to establish contact with retarded subjects; at the same time we must make sure that these same mentally retarded children and adults are themselves provided with the most favorable environment for their own growth and development, even as they are being observed and studied. Such research and clinical facilities especially designed to foster this kind of work are almost non-existent in this country today. While we can applaud the persevereance and devotion of those investigators who may manage to produce results under unfavorable conditions, we must recognize that it is the mentally retarded who are paying the price of the inefficiencies and delays which inevitably ensue. Likewise, the services needed by the mentally retarded are varied. Around the country parents have been organizing programs for their children, housing them where they could, in church basements, in abandoned school buildings, on sufferance in settlement houses out of hours, and in war surplus sheds. These children deserve more at our hands. Surely an attractive and appropriate building is the most tangible and obvious evidence that a community and a nation does care. Yet the grants-in-aid available under the hospital and medical facilities construction program, of which your Committee has such just reason to be proud, cannot properly be diverted to day care centers, group homes, imaginatively conceived programs of residential care, sheltered work or activity centers and the like. Moreover, in view of the continuing need and demand for hospital, nursing home, and clinic facilities for the general population, it is clear that special facilities for the mentally retarded will not receive the needed support and participation from the Federal Government unless Congress makes clear its intent that funds be specifically allocated to be used for precisely such purposes. We believe that H.R. 3689 is well drafted to stimulate construction of physical facilities for research, service, and training of personnel, in this neglected field. We recommend its early passage, not only as a sign of Congressional belief in the dignity and rights of the mentally retarded, but also a point of departure from which planning at the State and community level can proceed without further delay. Thank you, Mr. Chairman, for giving me this opportunity to present our views to you and your Committee. SULLIVAN, MCMILLAN, HANFT & HASTINGS, Duluth, 2, Minn., March 21, 1963. Hon. ANCHER NELSEN, DEAR MR. NELSEN: I am writing you as president of the Duluth Mental Hygiene Clinic, a nonprofit corporation, which provides community mental health services to residents of this area. Recently I was informed that you are a member of the Health Subcommittee of the Interstate and Foreign Commerce Committee which will hold hearings on March 26 through March 28 on the Federal Community Mental Health Centers Act of 1963 (S. 755), in which we of the Duluth Mental Hygiene Clinic are very much interested. For your information, the Duluth Mental Hygiene Clinic has been serving residents of this area since 1938. After the adoption of the Minnesota Community Mental Health Program in 1957, the services of the clinic could be and were materially expanded. At that time, Dr. John Haavik, formerly in the private practice of psychiatry in the City of Duluth, was employed as medical director of the clinic. Since 1957, demand for services of the clinic has increased steadily. The clinic now serves the southerly half of St. Louis County, Carlton County, and Cook County, as well as the City of Duluth. Recent increases in demand for services furnished by the clinic has made it necessary for us to employ an additional full-time psychiatrist plus supplementary staff personnel. As a result, the present quarters of the clinic are entirely inadequate. In an attempt to resolve the space problem, we have explored a multitude of possibilities and have reached the conclusion that the best solution to the problem lies in the construction of a new clinic building. We have, among other things, investigated the possibility of obtaining Hill-Burton funds for this construction program but have been advised that by virtue of a peculiar provision in the Hill-Burton Act, we are not eligible to receive, as a diagnostic and treatment center, Hill-Burton funds for this project. Our problem apparently is not unique. We are informed that the ineligibility for funds applies to all mental health clinics in the nation which are organized and operated as private non-profit corporations. The ineligibility apparently stems from the fact that although mental health clinics fall within the definition of diagnostic and treatment centers under the Hill-Burton Act, Subsec. (d) of Sec. 291v. U.S.C., relating to applications for Federal funds in connection with the construction of diagnostic or treatment centers provides: "(d) Notwithstanding subsection (a) of this section no application for a diagnostic or treatment center shall be approved under such subsection unless the applicant is (1) a state, political subdivision, or public agency, or (2) a corporation or association which owns and operates a non-profit hospital (as defined in Section 291 (i) (g)).” In order to make Hill-Burton funds available to mental health clinics throughout the nation organized on the same basis as the Duluth Mental Hygiene Clinic, we suggested some time ago that this subsection be amended by adding thereto a third category to read somewhat as follows: "or (3) a non-profit corporation or association which administers a community mental health service program and which is eligible under the law of the State in which such services are provided to receive assistance or grants from such State in support of such program." This suggestion was apparently presented by the Minnesota delegation to the Surgeon General's Conference on state hospital construction held in Washington on January 7. It is an interesting fact that at this conference, the Ohio delegation presented a similar proposal. In this connection, I am enclosing for your information a copy of a letter which I received from Dr. Helen L. Knudsen, Director, Division Hospital Services, Minnesota Department of Health. You will note that in the last paragraph of her letter, Dr. Knudsen asked that members of our board meet with members of the St. Luke's Hospital Board and others concerning the feasibility of planning for sufficient space in a contemplated addition to St. Luke's to house the Duluth Mental Hygiene Clinic and the Duluth Rehabilitation Center. At that meeting, which I attended, the entire situation was discussed. I believe it was apparent from this discussion that such a plan was not feasible in view of the space requirements of the hospital and the limited space available. At this meeting, I asked the representative of the United States Public Health Service whether the Duluth Mental Hygiene Clinic would not be eligible for funds for the construction of a new clinic building under the rehabilitation center provisions of the Hill-Burton Act. Although he indicated that we might be eligible under this section, he pointed out certain problems in connection therewith but indicated, however, that no funds were presently available under this section. The problem of the Duluth Mental Hygiene Clinic is becoming more acute as each month passes. We have run into one difficulty after another. We are, therefore, vitally interested in the Community Health Centers Act of 1963, although we recognize that funds under this act will not be available until the fiscal year ending June 30, 1965, which may be too late in our case. We are also vitally interested in an amendment to the Hill-Burton Act which would make us eligible for funds as a diagnostic or treatment center under that act. We would sincerely appreciate any assistance you can give us in resolving this problem. As I have indicated, a satisfactory solution must be found within the very near future if the services which we render to the people of northeastern Minnesota are not to be jeopardized. As you may or may not know, the Duluth Mental Hygiene Clinic receives grants in aid from the State of Minnesota under the Minnesota Community Mental Health Program. In connection therewith, we are required to submit annually to the Commissioner of Public Welfare a program of our activities. I am enclosing for your information a copy of the current program. I might add that, in addition to the functions we now perform, we have been requested by a responsible welfare agency in Duluth to undertake the establishment of a new phase of the mental health program, i.e., a social and recreational program for discharged mental patients. We have been told that this program would probably necessitate our employing two additional staff members. This, of course, would necessitate additional space. Sincerely yours, P. M. HANFT. STATE OF MINNESOTA, DEPARTMENT OF HEALTH, Minneapolis, February 20, 1963. Re: Proposed Duluth Mental Hygiene Clinic, Duluth, Minn. DEAR MR. HANFT: Your correspondence of January 3, 1963, was brought to the attention of Dr. Ralph E. Dwork, the Health Officer of Ohio, who also served as Chairman of the Legislative Committee of the Conference of the Surgeon General with the State Hospital Construction (Hill-Burton) Authorities held in Washington on January 7-9, 1963. It is interesting that Ohio and Minnesota had submitted similar items relative to mental health center eligibility. The final recommendation from the Conference reads as follows: "That the Surgeon General recommend to the Secretary of the Department of Health, Education, and Welfare that the administration support an amendment to the Hospital and Medical Facilities Survey and Construction Act to allow as an eligible applicant for assistance under the diagnostic and treatment category "A non-profit corporation or association which receives direct financial assistance other than fee for service from any governmental unit for the operation of a mental health center or clinic." You called us last week regarding the possibility of including the proposed Duluth Mental Hygiene Clinic under the Rehabilitation Facilities category and we have contacted the Kansas City Office of the U.S. Public Health Service and learned that although there has been no such Hill-Burton project in Iowa, the Minnehaha Guidance Center in Sioux Falls, S. Dak., received Hill-Burton funds under the Rehabilitation category of the Hill-Burton program. A copy of the program for this Center which has just been received from Kansas City as well as a copy of the cover letter is attached herewith. In our opinion, this is a vocationally oriented rehabilitation center which includes mental health services. On Tuesday morning, February 26, Mr. E. C. Slagle of our staff and Mr. William Shuler, Architect of the Kansas City Office, U.S. Public Health Service, will be in Duluth to visit St. Luke's Hospital in connection with its proposal for replacing the oldest part of the existing hospital under the Accelerated Public Works Program. We would like to arrange for a meeting at St. Luke's Hospital at 10:00 A.M. with representatives of St. Luke's Board as well as the Boards of the Mental Hygiene Clinic, the Rehabilitation Center and Dr. Fischer to discuss the feasibility of planning for sufficient space in St. Luke's Hospital to provide for the housing of both centers. Obviously the availability of A.P.W. funds depends upon additional appropriations. However, it appears that St. Luke's priority for funds would be strengthened substantially by incorporating these services into a single structure which would avoid duplication of facilities and personnel and substantially strengthen the services. Sincerely yours, HELEN L. KNUDSEN, M.D., Director, Division of Hospital Services. STATEMENT OF CHARLES H. FRAZIER, MEMBER OF THE BOARD OF DIRECTORS OF THE NATIONAL ASSOCIATION FOR MENTAL HEALTH My name is Charles H. Frazier. I am director of development for the Philadelphia Gas Works, a division of the United Gas Improvement Co., and a resident of Philadelphia. I am here today to testify as a member of the Board of Directors of the National Association for Mental Health in behalf of its 800 chapters and divisions and its enrolled membership and volunteer corps of more than a million. I am also chairman of the board and past president of Pennsylvania Mental Health, Inc., the State division of the National Association for Mental Health. My organization-the National Association for Mental Health-has been in existence since 1909-first as the National Committee for Mental Hygiene, and then, since 1950, under its present title. The representatives of the National Association for Mental Health have been here in the Capitol many times before to testify on various mental health measures. In 1946, we came to Congressional hearings to urge enactment of the National Mental Health Act. And almost every year since then, we have come back again to testify on appropriations measures for the National Institute of Mental Health. For many of the people who are here to testify today, and perhaps even for some of the Members of Congress, mental health may be a matter of relatively recent interest. But our organization has been in this work for many decades. I make note of this, not to establish any prior claim or prerogative or position of authority, but rather to impart to you, some of the great satisfaction that we we feel in the knowledge that such a measure as H.R. 3688 is now before the House for consideration and, we hope, for enactment. Fifty-four years ago when the National Committee for Mental Hygiene was organized by Clifford Beers, there were few who knew about mental illness and the mentally ill. Then there were known only the lunatic asylums-the horrible places where you sent away the brother or mother or father who went out of his mind-and you sent that relative away because no one knew that anything could be done with him except to shut him away so that he would not be any trouble to society, nor any harm to himself. This was how you handled insanity or lunacy then. A few psychologists and psychiatrists identified the different forms of abnormal behavior-but they were practically the only ones who knew or even cared, except for the few hardy doctors and social workers and interested citizens who had visited the lunatic asylums, and there had seen the human wreckage, the miserable, starved, frozen, brutalized, terrorized things that were once human. And it was only these few people who saw, even in those broken things, the hand and the spirit of God, and the persistent image of a human being, twisted and misshapen and distorted though that image was. It was these few people and some others who were drawn to the cause, who saw in the misshapen beings-not sub-humans possessed by demons, not witches, not the work of the devil-but human beings who had something wrong with them-something wrong that made them behave so differently, so peculiarly. There was great wisdom in these men and women-wisdom which led them to see the bizarre behavior as symptoms, and which led them to understand that these were symptoms of disordered functioning, just as the symptoms of physical illness were the evidences of disordered functioning. And with this insight and wisdom, they were able to see then, some 50 years ago, that science would continue to probe insanity, and to attempt to identify the different forms, and seek to learn the causes, and how to prevent them, how to treat the victims and how to cure them. It was this wisdom and this vision that motivated first this handful and then hundreds of others and then thousands of others to work for improvement and change. Many years have passed since the first organized efforts began, and many changes have taken place-none easily, none quickly, none spontaneously. Government agencies and government officials worked on this. And with them the psychiatrists and social workers and psychologists and clergymen and other professional people. And along with them the service groups and fraternal organizations and their hundreds of thousands of members. And with them the business organizations and the trade unions. And in the center and in the lead, the mental health associations. And as a result of all this work, some truly great advances have been made. Today, there is hardly a newspaper, hardly a radio program, hardly a magazine issue, hardly a television program that does not concern itself in a truly serious way and knowledgeable way with the mentally ill, and the branch of medicine which treats them, that is, psychiatry. Today, mental illness is no longer a dark and mysterious and secret subject. And today, we recognize the mentally ill as sick people, suffering from biological and psychological disorders -disorders which can be treated and corrected. Certainly, medical science does not have all the answers to mental illness, but it does have some of the answers. And more important than that, it knows that there are answers-that they can be found-and when found, they can be applied to the relief of the millions of sufferers from mental illness-a name which covers dozens of different individual disorders of the mind, each with its own causes-each requiring different and special treatment. I have spoken of the many different forces which, working together, have achieved this change. And everyone deserves great credit. But if I were asked to identify the one single force which did most to implement this change and stimulate and catalyze many of the other forces which were thrown into action, I would say it was the National Mental Health Act of 1946 and the agency which it brought into being-the National Institute of Mental Healthand the services and programs of that agency. In an unobtrusive way, that Act and that agency, provided grants, technical assistance, guidance to the states and communities and foundations and schools of training and centers of research, making it possible for them to develop sorely needed programs of training, programs of research, and community mental health services. I say, unobtrusively, because my organization, with contacts in literally every community of any size in the United States, has not encountered a single instance where this federal aid brought with it federal domination, federal interference, or federal control. Now, it may be that there have been such instances, but if there were, they certainly did not come to our attention. The brunt of the work, and the great overriding burden of the expense, and the genius of inventiveness and creativity has without a doubt been borne by the states and the localities and the foundations, private organziations, schools and other local agencies and institutions. And there it will continue as it must, because that is where the major and primary responsibility and authority is and must remain. But we must also welcome the kind of aid which the federal government has given to facilitate and stimulate the development of great human |