STATEMENT OF THE NATIONAL FARMERS UNION MR. CHAIRMAN AND MEMBERS OF THE SUBCOMMITTEE: National Farmers Union wishes to express strong support for H.R. 3688 and H.R. 3689, embodying the President's proposals for programs to combat mental illness and mental retardation. Rural America suffers from extreme scarcity of both doctors and medical facilities of all kinds. But especially in short supply are specialists who are competent to deal with mental illness and mental retardation. Most State institutions for mental illness are in or near the great metropolitan centers far removed from isolated rural and isolated semirural counties which constitute two-thirds of all counties in the Nation. There are about 40 million farm and small town residents who live in these rural counties far removed in time and space from old style mental health facilities. It is for these reasons that Farmers Union enthusiastically endorses the new concept of community mental health centers provided in this new program. One of the most difficult problems in the treatment of mental illness has been the return of the patient to the neighborhood where friends and relatives live. It has been especially difficult in small towns of rural America. Therefore, the community mental health center with it's better geographic distribution has special significance and value to rural residents in the years to come. Farmers Union has in the past been a strong supporter of the Hill-Burton Act, and rural residents have benefited from it at least equally with anyone else. It has been a most successful program because it was wisely provided with a well-balanced Federal Hospital Council. We note that H.R. 3688, section 302, enlarges and changes this balanced composition of the Council. We believe there is no harm in enlarging the Council but we believe it very important that the original proportionate composition should be retained with half the members representative of consumers of hospital services and familiar with the need for hospital services in urban or rural areas. We oppose having more than half the Council composed of representatives of providers of the services. We believe, in dealing with mental health, it is even more important to have the general public fully represented with at least half the members of the Council. As mentioned before communication with the community is a major problem in rehabilitating mental patients. So public participation on the Federal Hospital Council becomes more important than ever before to assure the utmost confidence, understanding and cooperation. Mr. Chairman, with this one change in H.R. 3688, we can give these bills our wholehearted support. STATEMENT OF THE AMERICAN OSTEOPATHIC ASSOCIATION I am Carl E. Morrison, D.O., chairman of the Council on Federal Health Programs of the American Osteopathic Association. The association is a federation of divisional societies of osteopathic physicians and surgeons in legalized practice in all the States. Its objective is "to promote the public health, to encourage scientific research, and to maintain and improve high standards of medical educacation in osteopathic colleges." We appreciate the privilege of submitting this statement in support of the pending bills H.R. 3688 and H.R. 3689 relating to mental illness and mental retardation. In 1946, the American Osteopathic Association supported legislation establishing a National Institute of Mental Health in the Public Health Service. Much of the remarkable progress that has been made in dealing with mental health since that time is due to the research and training programs accomplished under the auspices of the National Institute of Mental Health. In 1955, the American Osteopathic Association supported legislation authorizing a special study and evaluation of the Nation's resources for coping with the mental health problems of the Nation. The report of this study contained in "Action for Mental Health," published in 1961, has helped tremendously to focus public attention on mental health. As stated by the President in his epochal message to Congress on February 5, the twin problems of mental health and mental retardation are among our most critical health problems. They occur more frequently, affect more people, require more prolonger treatment, cause more suffering by the families of the afflicted, waste more of our human resources, and constitute more of a financial drain upon the Public Treasury and the personal finances of the individual families than any other single condition. There is an acknowledge shortage of trained professional personnel for service in these areas. The Health Professions Educational Assistance Act (H.R. 12, which this Committee favorably reported to the House earlier this month) would increase the opportunities for training of physicians through Federal matching grants for construction of new or expanded teaching facilities and for financial aid where necessary to enable students to complete their professional education in schools of medicine or osteopathy. The teaching grants program of the National Institute of Mental Health, in which medical and osteopathic schools participate, significantly augments both the quality and amount of mental health instruction in these institutions, including teaching hospitals. The facilities of some State psychiatric hospitals are available for training. Fourth-year students at the Kirksville College of Osteopathy and Surgery serve a portion of their clerkship at Missouri State Hospital No. 1 at Fulton, Mo. Fourth-year students at the Philadelphia College of Osteopathy will spend a portion of their clerkship at the Embreeville State Hospital in Pennsylvania. Physicians, D.O., are also in residency training at this hospital. The National Institute of Mental Health also sponsors programs for bringing to the nonpsychiatrist physician information on the advances in mental health practice. This program will need to be greatly expanded in view of the projected return of mental health care from the isolated custodial institutions to the mainstream of local medical practice through comprehensive community mental health centers advocated by the President and proposed in H.R. 3688. Speaking of the role of physicians in relation to the proposed comprehensive community mental health centers, the President's message on February 5 states: "Private physicians, including general practitioners, psychiatrists, and other medical specialists, would all be able to participate directly and cooperatively in the work of the center. For the first time, a large proportion of our private practitioners will have the opportunity to treat their patients in a mental health facility served by an auxiliary professional staff that is directly and quickly available for outpatient and inpatient care." We hope the program will be administered at all levels in consonance with that pronouncement and understanding. Title I of H.R. 3688 authorizes a 5-year program of grants for the construction of comprehensive community mental health centers, with the Federal Government providing 45 to 75 percent of the project cost, and short-term project grants for the initial staffing costs of these centers, with the Federal Government providing up to 75 percent of the cost in the early months, on a gradually declining basis, terminating such support for a project within slightly over 4 years. The HillBurton pattern would be followed. The Federal funds would be allocated to the States and projects would be assigned priorities under approved State plans. Section 104(a)(3) requires that an approved State plan must provide for designation of a State advisory council to consult with the State agency in carrying out the plan. We think the requirement should spell out the necessity for inclusion of representatives of the health professions. The desirability of such a requirement is emphasized by the provision authorizing the States to provide minimum standards for maintenance and operation of centers which receive aid under this title. It is further indicated by the necessity that all groups pull together in meeting and resolving the mental health problem. According to the President's message, a comprehensive community mental health center in receipt of Federal aid may be sponsored through a variety of local organizational arrangements. Ideally, the center could be located at an appropriate community general hospital, many of which already have psychiatric units. In such instances, additional services and facilities could be added-either all at once or in several stages-to fill out the comprehensive program. In some instances, an existing outpatient psychiatric clinic might form the nucleus of such a center, its work expanded and integrated with other services in the community. Centers could also function effectively under a variety of other auspices: As affiliates of State mental hospitals, under State or local governments, or under voluntary nonprofit sponsorship. There are in excess of 300 hospitals staffed entirely by doctors of osteopathy, most of which are general hospitals and about half of which are nonprofit. Some of these have psychiatric units and a number maintain outpatient psychiatric clinics. Title I of H.R. 3689 authorizes a 5-year program of grants for construction of centers for research on mental retardation and related aspects of human development, with the Federal Government providing up to 75 percent of the necessary cost of construction. Applications for grants would be approved by the Surgeon General only if the applicant is a public or nonprofit institution which the Surgeon General determines is competent to engage in the type of research for which the facility is to be constructed. Title II of H.R. 3689 authorizes a 5-year program of grants for construction of public and other nonprofit facilities for the mentally retarded, with a provision that $5 million appropriated for the first year and $10 million of the sums appropriated for each of the next 4 years "shall be available only for grants for construction of facilities for the mentally retarded which are associated with a college or university hospital (including affiliated hospitals) or other appropriate part of a college or university." The Federal share would be from 45 to 75 percent of the cost of construction of any project. The program would operate under State plans providing for designation of a State advisory council and authorizing minimum standards (to be fixed at the discretion of the State) for the maintenance and operation of the facilities receiving the Federal aid. For the same reasons applicable to section 104 (a) (3) of H.R. 3688, we think section 204(a)(3) of H.R. 3689 should spell out the necessity for inclusion of representatives of the health professions on the State advisory council. The American Osteopathic Association joined with other voluntary organizations in the National Leadership Conference on Action for Mental Health and followup regional conferences sponsored by the National Association for Mental Health held during 1962. These conferences emphasized the necessity for representation of voluntary organizations on State planning bodies, if effective local action is to take place and have meaning to local communities. OLYMPIA, WASH., April 9, 1963. Congressman KENNETH ROBERTS, Member of Congress, Public Health and Safety Committee, Appreciate your support of House bills 3688 and 3689 re Federal aid to further State mental health programs and those developing research and training in field of retarded. Heretofore, Federal aid not available for State mental hospitals and State institutions for retarded. Critical need now exists to increase funds in these areas to insure improvement in research, training, and treatment through increased development. Legislature State of Washington past few years has given considerable attention to these areas but unable to increase funds to any great extent at this time due to other State programs in need of financial assistance. Federal aid would be a step forward and I urge your personal support and consideration. GARRETT HEYNS, Director of Institutions, State of Washington. LAS VEGAS, N. MEX., March 25, 1963. Hon. KENNETH ROBERTS, Member of Congress, Chairman, House Subcommittee on Public Health and Safety, We heartily approved President Kennedy's proposed mental health program. New Mexico State Hospital endorses H.R. 3688 and H.R. 3689 as progressive and far-reaching plan for treatment of mentally ill and mentally retarded. THOMAS H. HOGSHEAD, Superintendent, New Mexico State Hospital. Hon. KENNETH ROBERTS, Member of Congress, HARTFORD, CONN., March 25, 1963. Chairman, House Subcommittee on Public Health and Safety, Two measures before your committee H.R. 3688 and H.R. 3689-will, if adopted, greatly hasten the implementation of effective new concepts in the diagnosis care and treatment of mental illness and mental retardation which Connecticut, among other States, is eager to adopt. The soundness of the approach embodied in these bills is widely supported in Connecticut. May I respectfully urge your committee to give these measures favorable consideration. WILFRED BLOOMBERG, M.D. Commissioner of Mental Health, State of Connecticut. ATLANTA, GA., March 25, 1963. Hon. KENNETH ROBERTS, Chairman, House Subcommittee on Public Health and Safety, As the mental health authority of the State of Georgia, I urge favorable consideration of H.R. 3688 and 3689 relating to Federal assistance in construction and operation of mental health centers and construction of research centers and facilities for the mentally retarded. We strongly support in principle this legislation. S. C. RUTLAND, M.D., Deputy Director, Georgia Department of Public Health. Hon. KENNETH ROBERTS, Member of Congress, CONCORD, N.H., March 25, 1963. Chairman, House Subcommittee on Public Health and Safety, New Hampshire firmly supports President's mental health and retardation program (H.R. 3688 and 3689). JOHN L. SMALLDON, M.D., Director, Division of Mental Health. BATON ROUGE, LA., March 26, 1963. Hon. KENNETH ROBERTS, Member of Congress, Chairman, Subcommittee on Public Health and Safety, New House Office Building, Washington, D.C.: Louisiana State Health Authority endorses H.R. 3688 and H.R. 3689. Matching State funds are available to carry out these plans and will greatly assist Louisiana's mental health and retardation program. WINBORN E. DAVIS, Director, State Department of Hospitals. RALEIGH, N.C., March 26, 1963. Hon. KENNETH ROBERTS, Member of Congress, Chairman, House Subcommittee on Public Health and Safety, In support of S. 755 and S. 756 I submit that science and commonsense have presented practicable methods for the treatment of rehabilitation of mental handicap and a rising hope for their prevention. The needed impetus is toward putting ideas into action and furthering needed research by encouraging the construction and initial operation of community-orientated mental health facilities (S. 755) and the construction of facilities for research in human development (S. 756). As a citizen, psychiatrist, and North Carolina's commission of mental health, I urge your committee's serious consideration of these bills. Dr. EUGENE A. HARGROVE. Commissioner of Mental Health, Hospital Board of Control. Hon. KENNETH ROBERTS, AUGUSTA, MAINE, March 26, 1963. Chairman, House Subcommittee for Public Health and Safety, House bills 3688 and 3689 would provide assistance to advances in programs for the mentally ill and mentally retarded in Maine. The Department of the Mental Health and Corrections of the State of Maine would appreciate your support at hearings scheduled for Wednesday March 27. WILLIAM E. SCHUMACHER, M.D. Director, Bureau of Mental Health. Hon. OREN HARRIS, U.S. Representative, House Office Building, Washington, D.C.: SANTA ANA, CALIF., March 25, 1963. Orange County Association for Mental Health at its regular meeting March 18 has approved support and endorsement of following bills H.R. 3688, 3689 as the one voluntary association dedicated to total fight against our national No. 1 health problem, mental illness. We recognize the need for community facilities, are working towards this end. Hon. KENNETH ROBERTS, ORANGE COUNTY ASSOCIATION FOR MENTAL HEALTH. TOPEKA, KANS, March 26, 1963. Chairman, House Subcomittee on Public Health and Safety, The Kansas Mental Health Authority, the State board of social welfare, the State director of institutions, and the State mental health program director, urge favorable consideration of H.R. 3688 and H.R. 3689 to permit establishment and/or expansion of comprehensive community mental health centers, and to permit construction of research centers and facilities for the mentally retarded. We believe mental health services should be available closer to the people needing them and that expansion of services must be planned and then carried out accordingly. We will look forward to improving community mental health services in Kansas in the future. Hon. KENNETH ROBERTS, R. A. HAINES, M.D., State Director of Institutions. JEFFERSON CITY, Mo., March 25, 1963. Chairman, House Subcommittee on Public Health and Safety: Your House bills 3688 and 3689 certainly have the complete endorsement of those of us responsible for the direction of the program of Missouri's Division of Mental Diseases. We have just established a section on mental retardation within our division and are developing a master State plan in that area. A bill is now pending before the Missouri State Legislature to establish three mental health centers at general medical centers across our State to offer early rapid intensive treatment for Missouri's mentally ill. GEORGE A. ULETT, M.D. Director, Missouri Division of Mental Diseases. |