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1949: In April 1949, the National Institute of Mental Health was established as one of the Institutes of the NIH and the Division of Mental Hygiene was abolished. The Lexington and Fort Worth neuropsychiatric hospitals (originally established as narcotics farms in the act of 1929) were transferred to the Division of Hospitals, Bureau of Medical Services, PHS, with provisions for cooperative arrangement for use of such hospital facilities for mental health research and training purposes.

1949: The Surgeon General, by General Circular No. 43, provided that the Director of the National Institute of Mental Health shall be responsible in a staff capacity to the Surgeon General as the focal point of leadership and coordination for the total mental health program of the Public Health Service. 1955: Public Law 182, 84th Congress-the Mental Health Study Act of 1955. Provided for an objective, thorough, and nationwide analysis and reevaluation of the human and economic problems of mental illness. Authorized the Surgeon General to make grants for such a study of the entire field of mental illness and such grants were made to the Joint Commission on Mental Illness and Health begining in 1956.

1956: Public Law 911, 84th Congress-Title V of the Health Amendments Act of 1956.

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Provided authority for mental health project grants to State mental hospitals and other organizations for "* * investigations, experiments, demonstrations, studies, and research projects with respect to the development of improved methods of diagnosing mental illness, and of care, treatment, and rehabilitation of the mentally ill, including grants to State agencies responsible for administration of State institutions for care, or care and treatment, of mentally ill persons for developing and establishing improved methods of operation and administration of such institutions."

1961: The final report (the culmination of 5 years of study) of the Joint Commission on Mental Illness and Health was submitted to the Congress, the Surgeon General, and the Governors of the several States-as required by law under the Mental Health Study Act of 1955.

1961: The President requested the Secretary of the Department of Health, Education, and Welfare, together with the Secretary of Labor and the Administrator of Veterans' Affairs to undertake an analysis of the final report of the Joint Commission and suggest possible courses of action. The findings and recommendations of this study group were reported to the President in December of 1962.

1963: The President transmitted his special message on mental health and mental retardation to the Congress recommending a national mental health program to be implemented, in part, through existing legislation and, in part, through proposed legislation (specifically with respect to mental health; H.R. 3688).

APPENDIX B
APPROPRIATION HISTORY

The highlights of the appropriation history for mental health activities in the Public Health Service for the major functional areas of the PHS mental health effort-research, training, and community services-are set forth in the following table. It will be noted that appropriation "allocations" are included for the Service's two neuropsychiatric hospitals located at Lexington, Ky., and Fort Worth, Tex. (originally identified in the legislative history as the two "narcotic farms"); these hospitals are administered by the Bureau of Medical Services, PHS and the amounts represent extrapolations from the "Hospitals and medical care" appropriation. It will also be noted that the tabulation excludes Hill-Burton funds since the appropriations for that program represent general hospital construction grant financing and therefore are not earmarked for the categorical area of mental health and illness; on the other hand, a separate highlight review of the Hill-Burton program has been prepared to show the extent to which these funds have been used over the years for the construction of mental hospital and other related facilities.

Appropriation history of Public Health Service mental health programs by major functional area for selected fiscal years

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1 Legal basis: Fublic Law 487 (currently reflected in secs. 217, 301, 302, 303, 304, 431,
433 of the Public Health Service Act).

2 Legal basis: Public Law 487 (currently reflected in secs. 301, 431, 433 of the Public
Health Service Act).

3 Legal basis: Public Law 487 and Public Law 911 (currently reflected in secs. 217,
301, 302, 303, 311, 312, 314, 431, 433 of the Public Health Service Act).

4 Grants during the period 1956-61 were made to the Joint Commission on Mental Illness and Health under authority of Public Law 182 (currently reflected in sec. 304 of Public Health Service Act).

'Legal basis: Public Law 487 (currently reflected in secs. 301, 311, 312, 431, 433 of the Public Health Service Act).

Legal basis: Public Law 672 (currently reflected in secs. 301, 302, 341-347 of the Public Health Service Act).

Secretary CELEBREZZE. The administration's total program in mental retardation, as proposed in the 1964 budget, calls for approximately $204 million. This compares with about $128 million that we are spending in the present fiscal year-so that the 1964 budget calls for an increase of some $76 million in the mental retardation field.

Our current program of $128 million includes money which is spent by the Children's Bureau, for example. It also includes money which is spent by the National Institutes of Health. Funds are included for the Bureau of Family Services for its mental retardation programs.

So today we have a program involving a Federal expenditure of $128 million for a variety of mental retardation programs-research, services, education, care, and so forth with respect to care, alone, the Federal Government today spends relatively little as compared to State and local capital and operating expenditures for institutional care of some $300 million. The States and local communities, in addition to that $300 million, spend $250 million in services; that is, special education, welfare, and rehabilitation. In summary, then, the States and local communities are spending approximately $550 million as against the Federal expenditure this year of $128 million in the field of mental retardation.

In the mental health program the figures

Mr. HARRIS. Let's stop right there then. What you have just said, is for mental retardation under existing law.

Secretary CELEBREZZE. Yes; I was comparing the expenditure of Federal Government as against the expenditure at State and local levels.

Mr. HARRIS. Yes, I recognize that, but what new authorization do you need, to do what you cannot do under existing authorization? Secretary CELEBREZZE. Unless we get the new

Mr. HARRIS. Unless you get the new authorization.

Secretary CELEBREZZE. Yes. The new emphasis must of necessity be on research. As I stated earlier, until about 1954 we didn't pay too much attention to this problem. The cause of mental retardation is an unknown source in 75 to 85 percent of the cases. That means that we have to establish comprehensive research centers.

Mr. HARRIS. I appreciate that. I think I recognize the full need for research, but do you have any authorization for mental retardation research now?

Secretary CELEBREZZE. No; I am trying to give the background. Mr. HARRIS. I was just trying to shortcut it. I did not want to repeat or ask you to repeat what you have already said.

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Secretary CELEBREZZE. The importance of the present bill is that it would authorize $30 million for construction grants which would mit us, with State matching funds, to construct 10 research centers so that we can find the answers to some of the mental retardation problems. In addition of course under title II it would cooperate in expanding community mental retardation facilities which are badly needed and for which there is no current authorization.

Mr. HARRIS. Let's stay with research first and then we will go over to that. Let's take one at a time before we pass over it so fast. Secretary CELEBREZZE. The construction cost of mental retardation research centers in this bill is $30 million.

Mr. HARRIS. Do you have authorization for research under the present law?

Secretary CELEBREZZE. We have authorization for research but we do not have specific authorization for construction of research facilities in this particular category of mental retardation.

Mr. HARRIS. That is what I wanted to find out. Now all of your present research is going on where?

Secretary CELEBREZZE. All of our present research is going on under the NIH program in the National Institute of Neurological Diseases and Blindness and the National Institute of Mental Health; newly established the National Institute of Child Health and Human Development will also support research in this field. However, with respect to the specific construction authority which we are now requesting, there is no specific provision now for the construction of this particular category.

Mr. ROBERTS. That is all research?

Secretary CELEBREZZE. This is all research that we are doing now which totals some $23 million out of our total outlay in 1963 of roughly $128 million for all aspects of our mental retardation effort.

Mr. HARRIS. I did not intend to get into this, Mr. Chairman, because I imagine you or somebody else will do it, but what I am trying to do, Mr. Secretary, is to get this record straight as to what you propose to do here. In other words, what authority do you need that you don't have now, what are you doing now in this area, and would the additional authority be overlapping and an extension of what you are presently doing? You are going to have to answer these questions and we might as well find out now.

Now is all of this research costing $128 million going on now ? Secretary CELEBREZZE. The $128 million is the total program which we spend now on a Federal level in the mental retardation area including the $23 million for research.

Mr. HARRIS. All right. Does the Federal Government spend that itself in research or does it allocate part of it to non-Federal institutions?

Secretary CELEBREZZE. A great deal of this is allocated. As a matter of fact, I would say 95 percent of it is allocated through grants to institutions for research. I may have misled you, Congressman. The total cost of research is not the $128 million, that is the Department's total 1963 program for mental retardation. Now I can furnish for the record a complete breakdown for you on this. (The material referred to appears on p. 78.)

Mr. HARRIS. I think it would be helpful if you would do that.
Secretary CELEBREZZE. All right.

Mr. ROBERTS. May I ask also, Mr. Chairman, of the full committee, that the Secretary break it down in the categories that I mentioned of research, training of personnel, construction of facilities, and in community services, which would be helpful to the committee. Under the research category I think we would like to have an account of the allocations that were made to other institutions.

Secretary CELEBREZZE. I didn't hear your last part of that.

Mr. ROBERTS. The allocations that you mentioned when you say 95 percent will be made up of that.

Mr. HARRIS. I am sure the other members will adopt this approach. I don't want to take the time to do it but I did want to get a definite

breakdown as to what you are proposing here that you can't do now. That is the purpose. If you will give us that information it would be helpful.

Secretary CELEBREZZE. Basically the things we cannot do now are the new items we are calling for in this bill, which is construction authority for research centers and for the basic mental retardation facilities.

Mr. HARRIS. I am sure you and your staff must know that but you come here and tell us you are spending $128 million in this program and then you ask for $30 million more in the field of research and $150 million more for community centers, I believe it is, isn't is?

Secretary CELEBREZZE. Community retardation facilities.

Mr. HARRIS. What I am trying to find out is what you are doing now with the $128 million that does not cover what you propose to do here?

Secretary CELEBREZZE. I will refer that to my specialist, Mr. Cohen. Mr. COHEN. Mr. Chairman, the $128 million is the figure for fiscal year 1963 that encompasses all of the activities of the Department of Health, Education, and Welfare in the field of mental retardation. Mr. HARRIS. All right. Tell us what these encompass.

Mr. COHEN. The first aspect, which deals with prevention and treatment, including research, training and services of the Public Health Service, totals $23 million, made up of two components. Mr. HARRIS. Prevention of what?

Mr. COHEN. Prevention of mental retardation, research and training in the prevention of mental retardation.

Mr. HARRIS. That encompasses how much money?

Mr. COHEN. That encompasses roughly $23 million and consists of expenditures of two Institutes in 1963, the National Institute of Mental Health, $7,288,000, and the National Institute of Neurological Diseases and Blindness, $15,839,000.

Mr. HARRIS. Is that all the authorization you have for that program?

Mr. COHEN. No, that is the expenditure figure for 1963. In 1964 it is increased, and there is no specific authorization limit on those two items.

Now the next component of our expenditures on prevention and treatment involved the Office of Education, which is not involved in this particular bill but which in 1963 involved a total expenditure of $1,578,000 made up of expenditures for the training of personnel for the teaching of mentally retarded children, $1 million; the cooperative research program, which involves learning research for the teaching of the mentally retarded of $517,000; and the salaries and expenses of the exceptional children's program in the Office of Education of $61,000; making a total of $1,578,000.

The Welfare Administration, including the Children's Bureau, and the Bureau of Family Services, has a total of $1,791,000. That component is not involved in this legislation either, the Maternal and Children's Services and other activities. There is, as you know, a separate bill authorizing expansion of those appropriations which goes to the Ways and Means Committee and is pending before that committee.

Then in the field of vocational rehabilitation there is $4,775,000 being expended in 1963. This total is made up of $3,550,000 for grants

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