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Other requirements for project approval

Applicants would have to meet several other requirements set forth in the bill, such as providing assurances that adequate financial support will be available for construction of the project and for maintenance and operation of the facility when completed, and that in the construction of the facilities all laborers and mechanics will be paid not less than the prevailing wages in the locality, and overtime pay in accordance with and subject to the Contract Work Hours Standards Act.

Mr. ROBERTS. Thank you, Mr. Secretary. I think you make a very strong case for these bills. I would like, however, at the outset for us to get for the record the total for the construction of the mental health facilities and then the construction of the mental retardation research centers.

Secretary CELEBREZZE. The cost factor for construction of mental retardation research centers is $30 million. The projected cost of the mental retardation facilities is approximately $150 million. Direct program expenses for mental retardation would be the $1,730,000; so that the total program cost as represented by H.R. 3689 for mental retardation over a 5-year period would amount to $181,730,000.

In the mental health program, the community mental health centers, the program calls for a total construction appropriation of $330 million. Initial staffing of mental health centers calls for $204 million; direct program expenses calls for $2,965,000; for a total program of $536,965,000-over a 5-year period.

Mr. HARRIS. Will you include that table in the record?
Secretary CELEBREZZE. I would be happy to.

Mr. HARRIS. It would be easier to refer to.

Secretary CELEBREZZE. Yes; I will furnish it to the record.

Mr. ROBERTS. That will be placed in the record, without objection. (The document referred to follows:)

Estimated cost of mental retardation and mental health programs for fiscal years

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Mr. ROBERTS. I think, Mr. Secretary, before we go into this new program that we ought to have some outline of what the Federal Government is doing in the field of mental health and retardation under its existing authority. Now let me set those out for you where I would like for you to have an outline. For example, in research, the training of personnel, in construction of facilities and in community services.

(The material referred to follows:)

DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Obligations for mental retardation by category and agency for fiscal years 1955, 1963, and 1964

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SUMMARY OF PUBLIC HEALTH SERVICE MENTAL HEALTH PROGRAMS, CURRENT AND PROPOSED LEGISLATIVE AUTHORITIES

The Community Mental Health Centers Act of 1963, as proposed in H.R. 3688, would provide Federal assistance for the construction and initial operation of community mental health centers. As a backdrop against which the need for this specific legislation can be more appropriately considered, a highlight review of the historical development of the Public Health Service mental health program, and its current programs is outlined below. Historical detail in terms of legislative and appropriation history is attached (ap. A and ap. B, respectively).

I. KEY LEGISLATIVE DEVELOPMENTS

In terms of national significance, there have been three keystone acts in the field of mental health and illness: The National Mental Health Act of 1946, the Health Amendments Act of 1956, and the Mental Health Study Act of 1955. The act of 1946 established the National Institute of Mental Health and authorized the broad programs of research, training, and technical assistance which have characterized the mental health effort of the Public Health Service up to present time.

With one exception-the authorization of mental health project grants under title V of the Health Amendments Act of 1956-the Public Health Service is operating its programs under authorities contained in the initial basic act of 1946. That one exception, however, has been highly significant; it provided the basis for continuing emphasis, through demonstration and project grants, on the prompt and effective translation of research findings to their practical applica

tion to the care, treatment and rehabilitation of the mentally ill, and to the development and establishment of improved methods of institutional operation and administration.

Finally, the Mental Health Study Act of 1955 provided the basis for the historic study conducted by the Joint Commission on Mental Illness and Health. The final report of the Joint Commission was transmitted to the Congress in the spring of 1961 and provided the background to the development of the President's proposed national mental health program which was submitted to the Congress in his special message early this year.

II. HIGHLIGHT REVIEW-PROGRAM DEVELOPMENT

A. Background

The National Institute of Mental Health is the Federal Government's principal instrumentality for the support and conduct of research, training and technical assistance programs in the field of mental illness and health. The Director of the Institute is responsible to the Surgeon General as the focal point of leadership and coordination of the total mental health program of the Public Health Service.

Since the establishment of the NIMH in 1948, there has been a basic transition in the character of the national effort in the field of mental health. Institute programs have evolved from a simple dimension of program effort oriented toward a beginning program of psychiatric research and mental health training to a complex, diversified system of Federal support of mental health activities on a broad national base.

In recognition of mental illness as one of the Nation's most serious health problems, program developments over the years have drawn a complex family of diverse disciplines into the mental health field-the biological, the clinical, the social and behavioral sciences. There has been a marked intensification of mental health activities. There has been an emergence of improved technology, large scale collaborative efforts, both in research and in the application of research knowledge, and a marked acceleration of program effort along specific disease or problem oriented lines in response to public pressure as reflected in congressional mandates, for example, alcoholism, drug addiction, psychopharmacology, delinquency and mental retardation.

Against this backdrop of program growth and development, the NIMH has evolved a program structure that embraces substantially all aspects of mental health activity-from basic research to disease control and community programs. These programs have been administered as a unified whole in order to assure maximum effectiveness in terms of an integrated, coordinated total mental health effort.

B. Analysis of current programs

(a) Research, training, and community services-NIMH Programs Over the years, the major program effort of the Institute has been accomplished through grants and related contracts. In 1962, for example, 85 percent of the total appropriation was for the support, through grants, of research, training, and community and technical assistance activities in non-Federal settings-universities, research and training institutions, State and local mental health institutions and agencies. Since 1962 represents the most recently completed fiscal year, it provides an appropriate baseline for the presentation of an overview of the Institute's programs. With this in mind, and directing the presentation to the extramural program area which represents 85 percent of the total program effort, a series of three tables has been developed setting forth, for each of the three major functional areas (research, training and community services), the following:

Table 1.

-An overview by major types of support programs; Table 2.-An overview by State; and

Table 3.-An overview by problem area.

The tables follow:

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TABLE 1.-NIMH extramural program allocations: Fiscal year 1962 1

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1 Data for this and all subsequent tables exclude intramural programs and costs for review and approval and other administrative activities.

2 Includes $2,000,000 for basic projects in areas of psychopharmacological research.

3 Denotes less than 1 percent.

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TABLE 2.-NIMH extramural program expenditures: By States, fiscal year 1962

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