Page images
PDF
EPUB

the time to reduce governmental obligations. The possibilities for progress would seem to call not only for maintenance but for enlargement of government support on every level-National, State, and local. Without assurance of continued public assistance, the new community-based mental health centers would be compelled to rely on fees after the initial grants provided for in the bill expire. This has serious implications for future utilization. It will inevitably lead to a return of the present discriminatory situation where mental health centers are compelled to give priority to those who can afford to pay.

The bill's present requirement that agencies proposing to operate the centers give assurance of a "reasonable volume of services to persons unable to pay" is not sufficient to insure against this development as experience in the case of physical illness plainly demonstrates. Most general hospitals now provide some volume of service on both an outpatient and inpatient basis to those considered indigent, but this has hardly gone far in solving the medical care problems of large sections of our population. Medical indigency, as many recent studies show, is not identical with poverty. It is well-known that the bulk of the industrial working population would not qualify for psychiatric treatment programs that require "indigency" as a condition of eligibility while, on the other hand, even if they should entirely drain their family resources, they would still be unable to secure the kind and quality of treatment needed.

In order to meet the problem of providing comprehensive mental health services so strongly urged in the President's message to Congress, it is necessary to implement the present bill, H.R. 3688, with a broad mental health insurance program under social security.

Improvement of voluntary health insurance protection for mental illness would, of course, be a step forward, particularly for the hundreds of thousands of union members who are covered by collective-bargaining plans.

As has been documented elsewhere

(3) the position of the insurance companies that it is not economically feasible to provide meaningful coverage of mental illness is no longer, if it ever was, tenable in the light of new treatment methods that are now available. In the past, the impact of public policy and government initiative has been most helpful in stimulating the insurance companies to take corrective measures and we would look forward to sustained activity on the part of both the executive and legislative branches of government to provide this necessary stimulus in respect to mental illness.

At the same time, voluntary health insurance coverage does not by itself give adequate protection. Its coverage is far from inclusive and its benefits uneven and rarely adequate to meet the needs of the low-cost policyholder.

In the case of old-age insurance, enactment of the Federal pension program served to promote the provision of pension benefits under voluntary insurance plans. Together they have helped immeasurably to raise the economic level of older people. We can see a similar pattern of insurance protection being developed for the mentally ill based on broad national coverage under social security and supplemented by private plans.

We would like to point out finally that solving the problem of making psychiatric services financially possible for the majority of the mentally ill is a particularly crucial one. Compelling a worker to become a ward of the State or to demonstrate indigency as a condition of securing needed services is merely to add to the stigma which still attaches itself to mental illness in many sections of our society. On the other hand, a broad mental health care program which provides facilities and staff as the present bill does and an all-inclusive mental health insurance program under social security will place the mentally ill on a new level of human dignity and bring us closer to our goal of achieving a state of complete physical, mental, and social well-being for all.

REFERENCES

1. Srole, Langner, Michael, Opler, Rennie; "Mental Health in the Metropolis : The Midtown Manhattan Study, 1962."

2. Hollingshead, August B. and Redlich, Fredrick C.; "Social Class and Mental Illness," 1958.

3. Avnet, Helen H.; "Psychiatric Insurance." Group Health Insurance, Inc., 1962.

98493-63-29

STATEMENT OF WALTER A. MUNNS, PRESIDENT, SMITH KLINE & FRENCH LABORATORIES, PHILADELPHIA, PA.

Mr. Chairman and members of the committee: Smith Kline & French Laporatories has long been interested in the problems of mental illness and retardation and their alleviation. We are a manufacturer of drugs for the treatment of mental and emotional disorders, and have for many years worked closely with professional groups and individuals in the mental health field. As a result of this experience, we are convinced that community-oriented programs of mental health will provide increased preventive and treatment facilities for the mentally ill and retarded. The experience upon which we base this viewpoint is varied. As the producers of a number of drugs for the treatment of mental disorders, we have frequently discussed mental health problems with leaders in programs of institutional care and public health. My company has also participated during the past decade in a number of national conferences and organizations which helped to stimulate and support the studies of the Joint Commisison on Mental Illness and Health. Moreover, guided by the judgment of professionals in mental health, we have ourselves advocated the philosophy of treatment set forth in the Joint Commission report, and have produced at company expense a large number of educational materials supporting this philosophy.

The Smith Kline & French Foundation has also contributed substantially to research and programs in mental health. Although the foundation is legally separate from Smith Kline & French Laboratories, having been established in 1952 as a charitable trust, its philosophy with respect to community mental health programs is similar to that of the company. I have therefore attached to this statement a record of the foundation's contributions to mental health causes, along with a brief description of the foundation.

In the light of this experience, we feel that we can make constructive comment on the subject matter of House bills 3688 and 3689. In our opinion these bills represent a significant forward step in the recognition and solution of our national mental illness problem. We particularly favor the emphasis these bills place upon community, rather than centralized, services. In our judgment, communities should participate actively in planning and staffing services for the treatment of their mentally sick people. The availability of such services at the community level will, be believe, make them more acceptable and available to people in need.

Taken together, these two bills embrace a comprehensive and forward-looking program of prevention and treatment that should do much to relieve overburdened State mental institutions and to bring therapy, rather than merely custodial care, to the mentally ill and retarded throughout the Nation.

In my statement to the Senate Subcommittee on Health, with reference to Senate bills 755 and 756, I expressed the concern of Smith Kline & French Laboratories with certain aspects of these bills. I would like to repeat these points:

1. The nature of the State agency administering the program and the duration of support.—We believe it important that the State agency receiving these funds should be medically oriented, and that medical guidance should be available in the planning and administration of these services. In our opinion it is also important that Federal participation in local programs, which the bill limits to 4 years and 3 months from initiation, should be used to strengthen local community facilities, so that they become fully autonomous and will not continue to require Federal assistance.

2. The role of voluntary insurance in the financing of treatment for the mentally ill. We are concerned that steps be taken to stimulate the use of voluntary insurance as a method of payment for mental health services. The President, in his message on this subject, said: "The services provided by the new comprehensive mental health centers should be financed in the same way as other hospital and medical costs; that is, by individual fees for services, individual and group insurance, other third-party payments, voluntary and private contributions."

We support this principle.

I should like to emphasize, however, that our position in support of this proposed legislation is not altered by the qualifications stated above.

Smith Kline & French Laboratories appreciates the opportunity to place this statement in the record of the House Committee on Interstate and Foreign Commerce, Subcommittee on Health and Safety. We hope that our remarks

have been of assistance to the committee and that the Congress will take favorable action on the two bills.

ATTACHMENT TO STATEMENT OF WALTER A. MUNNS, PRESIDENT, SMITH KLINE & FRENCH LABORATORIES, PHILADELPHIA, PA., ON HOUSE BILLS 3688 AND 3689

The Smith Kline & French Foundation is a charitable trust established under the laws of the Commonwealth of Pennsylvania by Smith Kline & French Laboratories, pharmaceutical manufacturer.

Three trustees appointed by the company have full discretion in making awards, but are instructed by the trust instrument itself to "endeavor to give preferential consideration to charitable, educational, and scientific uses and purposes which may be related, directly or indirectly, to the welfare of Smith Kline & French's employees and to its interest as a corporation." But grants are avoided that might provide the company with benefits measurably greater than those received by the community.

The attached summary and list includes contributions in the field of mental illness and retardation only.

Summary-Mental health grants, Smith Kline & French Foundation

[blocks in formation]
[blocks in formation]
[blocks in formation]

The American Dental Association recognizes the seriousness of the mental illness problem in this country and commends the President of the United States and this committee for their deep interest in this acutely important health matter.

The association believes that in general the bills H.R. 3688 and H.R. 3689 are well conceived and should provide the stimulus for rapid advancement in the control and prevention of mental diseases. In particular, the association approves the emphasis that this legislation places upon preventive research and upon community participation. The association believes firmly that through expanded research and personnel training programs, coupled with a marked increase in diligent community effort, the major health problems in this country can be solved.

Enactment and implementation of H.R. 3688 and H.R. 3689 should provide a powerful stimulus for the development of comprehensive mental health programs at the community level.

1,800

1,500

81, 185

3,000 11,750

500 8,000

« PreviousContinue »