Since they have a separate mental health authority they have not been able to determine the total effect on their State of fiscal 1956 over fiscal 1955. KANSAS Approves in principle in spite of the projected loss of $18,000 a year in Federal funds. Disapproves of the extension and improvement or type 2 grant until it is more clearly spelled out. Feels that the basic services which are not adequately nourished at the present time would need this additional support. KENTUCKY Is not familiar enough to make detailed comments but believes it has some disadvantages for their State. LOUISIANA Approves of the latitude given by block grants and the additional latitude to State health authorities in determining fiscal policy. MASSACHUSETTS Trying to ascertain whether funds received under the terms of the proposed law will be subject to reappropriation by their State legislature before their department can actually use its share. If so, feel that they will fare at least as well as under the old categorical allotment policy. Dislikes the application of the new formula. MISSOURI Approves opportunity of developing a health program suited to the individual State. Sees no disadvantages if the State is allowed to use 95 percent of the total according to the determinations of the State health authority in accordance with recommendations of the A. S. T. H. O. executive committee and the A. M. A. Would lose $22,000. NEVADA Approves the advantages of flexibility. Disapproves in (2) the squaring of the per capita income factor and changes in matching formulas. Most Public Health Service grants are now 50 cents State to $1 Federal and this bill changes it to $2 State and $1 Federal. Believes $1 State to $1 Federal would be fair to all with 85 percent, 10 percent, 5 percent distribution. NEW MEXICO Approves block grants provided for in S. 2778 as funds will be more wisely spent at State level. Would prefer 85 percent, 10 percent, 5 percent distribution. NORTH CAROLINA Approves S. 2778 in principle and likes the increased flexibility and adaptability for State and local health department areas. Would prefer only small amount, say 10 and 5 percent, respectively, under (2) and (3) with main portion going to support (1). Special projects should be approved by State health department or mental health authority. Federal support continuation in the Federal-State-local partnership is of greatest importance. OHIO Approves flexibility of S. 2778 as compared to categorical grants. Advantages and disadvantages depend entirely on amounts appropriated and distributed among the three types of grants. OKLAHOMA Approves single grant-in-aid fund instead of categorical grants. Disapproves of allowing the Department of Health, Education, and Welfare to earmark large funds to type 2 extension and improvement and type 3 special project grants at the expense of established health programs. Another dis advantage would be the reductions of Federal funds available to the State. Feels that the bill should provide specific ratios of amounts to be appropriated in the three types of funds. OREGON Approves of the flexibility in the use of funds. Does not approve the lack of assurance in each type of fund for a certain percent of the grant and does not feel that one can commit States 6 years in advance in the type 2 grants. Loss of 20 percent to the State, comparing fiscal 1956 to fiscal 1955 is disapproved. TENNESSEE Is going to leave the decision concerning testimony for this and other legisla tion to the judgment of the executive committee of the association. Approves the block grant in principle but realizes that this depends upon adequate publicbealth appropriations. TEXAS Opposes grants being made to other than official State health agencies. WEST VIRGINIA Approves flexibility in administration of basic public-health services, Disapproves that less money is available for basic general-health services and would approve an 85 percent, 10 percent, 5 percent distribution. WYOMING Approve of the ind vidua! flexibility allowed in the States by a block type of grant. Feel that the specific percentages of funds going into each of the three types of grants should be spelled out in the legislation and at least 90 percent should be inade available for general support. Disapprove of the fact that we are losing $10,000 in fiscal 1956 as compared to fiscal 1975 but feel that adequate appropriations for public-health services could remove this objection. Senator PURTELL. Thank you, Dr. Norton. Senator Cooper. Senator COOPER. I addressed the question to Mr. Rockefeller of the perhaps insistence of local health officers on more funds for support. Do you think there would be too much emphasis placed on just the operating facilities in this new program, or would you be interested in the other parts of the program, like the extension and improvement program? Dr. NORIIN. I can say that most of us feel, as is true apparently for the Federal appropriations, that it is possible there will be a leveling off of State and local appropriations which have up to now been going up. Since 1950 as was brought out the Federal appropriations have been coming down, particularly this fiscal year which we are in now, But I can say as an administrator of the Public Health Service in the State, and having talked with a good many of the others, that we do not feel that we can put too much emphasis on support at this time. We feel that is the most important part of it; although we are very much interested in the other two categories, Senator Hua. Doctor, I have listened to your statement with interest. I note emphasis on two matters. One is the matter of adequate financial support, which you just referred to in regard to the drop in the Federal appropriation from $13 million in 1950 to $22 million this year, and $19 million next year. Is that right? Dr. NORTON. That is right. Senator HILL. As I said before, unless you have the gas in your car you are not very dynamic. Dr. NORTON. That is very true. And unfortunately this most drastic cut came after 34 of the State legislatures had adjourned for 2 years, which left us in a particularly difficult situation. Senator HILL. The other point is that instead of a 65-25-10 percentage ratio, your association believes it ought to be 85 for the support program, 10 percent for extension and improvement, and 5 percent for special projects. Dr. NORTON. That is right. Senator HILL. That is from your experience operating in the State health departments, and the experience of other State officers? Dr. NORTON. I would say this: If Federal and local appropriations were on the increase, as they were for many years, then we would favor a larger percentage of extension and improvement, and special projects, because we would have enough for support; but with appropriations leveling off we felt the most important thing is continuing support where we have well-trained and experienced personnel, and where we know how to do the job, rather than extending too much into new fields and employing new specialists in those fields. That is why we feel support is the most important thing. Senator HILL. You would write these percentages into the law? Dr. NORTON. The executive committee would like for it to be written into the law, but we are so unfamiliar with just how these things come out eventually, that we wanted to express our opinion here and leave it to you gentleman to work it out the best way you could after you know how we feel about it. Thank you very much. Senator HILL. Thank you, Doctor. Senator PURTELL. Senator Lehman. Senator PURTELL. Thank you very much, Doctor Norton, for appearing and helping us. Is Dr. Joseph E. Barrett, commissioner of the Department of Mental Hygiene and Hospitals of the Commonwealth of Virginia here? (No response.) Senator PURTELL. He is not here. Without objection his statement will be included in the record at this point. (The prepared statement of Dr. Barrett is as follows:) STATEMENT OF JOSEPH E. BARRETT, M. D., COMMISSIONER, DEPARTMENT OF MENTAL HYGIENE AND HOSPITALS, COMMONWEALTH OF VIRGINIA, RICHMOND, Va. I am most appreciative of your indicated willingness to hear my personal comments regarding S. 2778. I have been working in the field of mental health for more than 30 years and know something of the problems. I refer here to the overall problems, including the care and treatment of the mentally ill in public-supported hospitals, as well as the so-called preventive efforts as exemplified by mental hygiene clinics, public-education programs, research and personnel-training programs. I am sure each of you is familiar with the problems of securing adequate financial support for an active-treatment program in the mental hospitals. An unprecedented impetus was given to the so-called preventive program, etc. when the Congress passed the National Mental Health Act and made specific appropriations for its operation. Association of State and Territorial Health Officers. On page 2 there is a paragraph with a plea for more money to go into support, and it is stated: Should, for instance, as much as 25 percent of the total be allocated for extension and improvement, worthy as that is, with its biennial reduction of one-fourth of the Federal fund participation, many of the States would be embarrassed and possibly resentful, as well as hard put to take over so large a part of the load, under our present system of taxation. They agree in there that more funds for support rather than for what you might call categorical programs should be allotted. That is all I have. Mr. ROCKEFELLER. Might I comment on that, Mr. Chairman? Mr. ROCKEFELLER. I think what is back of the comment in that letter is this: They are worried about this total decline as shown on this chart since 1950 down to here. That I think is the basic concern they have. They do not mind the idea of improvement, but they are worried about the total reduction of their support funds and the effect on the States. That is a pretty substantial decline that has taken place. I think that is the basis for their fear. Senator PURTELL. I want to make clear that the sheet showing the participation in the States is in the record. Senator LEHMAN. I want to ask one question. Under the expenditures, what are the figures on mental health? Mr. ROCKEFELLER. It is a total Federal expenditure of $11 million. I am having a little trouble reconciling that figure with your $100 million, to tell you the truth. Dr. Scheele seems to know what the answer is. Dr. SCHEFIE. We do not, by regulation, permit the States to expend the fund- they receive from our grant for the giving of custodial care in mental institutions. The big bulk of the expenditure in most States is for the operation of the mental institutions. Our funds are used more in the front end of the problem, such as in treatment and diagnostic clinics, They are mental-health clinics. Our funds may not be used in the actual care of patients. Senator LEHMAN. I thought that chart purported to be a comparison of Federal grants for mental health with those of the States. Mr. ROCKFYFITER. It does, Senator LEHMAN. Due to the fact that New York has $100 million that $11 million does not seem very realistic. Senator PURTF11. They are matched funds. Secretary HORRY. It does not in the framework of the Federal law. Dr. Scheele made the important point that all of the States spend in custodial care great sums for the care of the mentally ill. These are not shown as matching funds. Senator LEHMAN. May I ask you one other question which I failed to 4-k before? The statement was made by somebody here that all States would fare better under this program than they have. On the last sheet in the second column of Public Health you show $17,514,000. I realize perfectly well that that figure cannot possibly be binding and that it is dependent on a great many different ifs, ifs, and ifs. I realize that. But when I read the appropriations for the various years from 1936 to 1954 of the Federal grants-in-aid published by the services, that amount seems completely inadequate, as do the amounts that have been appropriated in recent years, which were larger than that, which also appear to be inadequate. In 1950 we appropriated for Federal grants-in-aid for the Public Health Services $43,135,000. From that time each year the appropriation was very substantially reduced, so that in the year 1954 we appropriated only $22 million for all of these grants-in-aid, as compared to $43 million in 1950. Under this plan it is estimated, although I realize without any real Enality, that the amount that would be available to grants-in-aid in public health would be only $17 million. What I am trying to do to emphasize the complete inadequacy of the amount that is made available by the Federal Government in grants-in-aid to the States. I think if you really want to help the States and get them to welcome Federal aid, I think you have to make the program more attractive than it appears to me to be at the moment. Mr. ROCKEFELLER. There is one point that should be called to your attention. That is, there is a 10 percent reduction from that figure because of the special project grants, which are not allocated on a State basis. Not that that answers your question, because you are talking in far bigger figures than that, I understand. Senator LEHMAN. Thank you. Senator COOPER. Mr. Chairman. Senator PURTELL. Senator Cooper. Senator COOPER. I notice you have a chart there which shows the appropriation in 1950 which Senator Lehman referred to, and which Continues on from 1950 to 1954. Could you put in the record the appropriations in each of those categories beginning, let us say, in 1950 down to this year? Senator PURTELL. You may have those included in the record. Senator COOPER. Yes. Because we have a statement on 1950, and I think it would be proper to show what the various appropriations Lave been in all the years since then. Senator PURTELL. I think that sheet accompanied the chart, Senator. Did you get one? Senator COOPER. No. Senator PURTELL. Federal grants-in-aid for Public Health Services. Senator COOPER. All right. Senator LEHMAN. I think instead of 1950 to 1954 it should be from 1936 to 1954. Senator COOPER. I think you are right. Senator LEHMAN. That is the sheet I have. (The table referred to was previously submitted.) Senator PURTELL. Are there any other questions? Senator HILL. There is one thing. In reference to some of the figures, it seems the program is getting smaller each year because of the reduction in funds. Is that not true, Mrs. Secretary? In other Words, Senator Lehman called attention to the fact that in 1950 there were $43 million appropriated and in the Korean war we had $38 |