grant we had been trying for a number of years to beg some money for clinics from the State health department. No soap. The State health commissioner always had more important places for his money, and after all, the mentally ill couldn't vote. But the Federal grant, specifically earmarked for mental health preventive services, gave us our first breakthrough. We used part of the money to start our first mental health clinic in Oklahoma. Since that time the Federal contribution has become a very small part of the money spent on mental health clinics. Today, the State government, the Community Chests of many cities in Oklahoma, business and fraternal organizations, women's groups-all of themcontribute to the support of the mental health clinics in that State. Yet it is the Federal grant-in-aid which gave the original impetus and which still today is the catalyst in pioneering clinical efforts. There is this further point, and it is a very important one-without the technical assistance of the community services division of the National Institute of Mental Health, most of these clinical and preventive services would not have come into being. I think few would argue against the proposition that the mental health grants in-aid program has been one of the most successful efforts of the Congress. Over the past 7 years it has made possible the establishment of 200 new clinics and the provision of additional services by another 200 clinics. Grants-in-aid under this program support many activities directed toward the psychiatrie edneation of schoolteachers, ministers, public-health personnel, vocationalrehabilitation specialists, etc. Moneys under this program also support com munity education activities-varied efforts to alert communities to the problem of mental illness and ways of handling it. Many parents are reached through prenatal and well-baby clinics. There are other activities too numerous to mention here. Now along co nes H. R. 7397, and the assurance is given that mental health activities will not be disturbed or curtailed. Nonsense. The State mental health commissioners will be thrown back to the hat-in-hand approach they were forced to adopt prior to 1946 at the mercy of State health officers who frequently find It much more congenial to build up their own departments rather than open a a new mental health clinic. The fact that page 6 of the bill barely takes cognizance of the existence of State mental health authorities is no guaranty whatsoever. The important point is still this: moneys now going directly to many State mental health commissioners for the specific purposes of fighting mental illness will, if this bill is passed, go to an amorphous State health authority, which will then ladle the money out according to its own notions. The fight against mental illness is big business. It costs the taxpayers more than a billion dollars a year in tax moneys. According to testimony presented to the House Interstate Commerce Committee (Wolverton) last October, it costs this Nation more than $3 billion in industrial productivity and $418 mill on in lost Federal income tax revenues. This, therefore, is not a problem to be lumped into a catchall general grant. Therefore, the national mental health committee suggests that the mental health grants in aid program be continued as at present. Mr. GORMAN. Dr. Barrett could not make it. He is the senior health commissioner in the field, with some 30 years of experience, and is quite opposed to this bill. I would say further, Mr. Chairman, for the record, that the State mental health commissioners as a group were not notified either by the Department of Health, Education, and Welfare or by the Congress on this particular bill; and Dr. Barrett himself is a former member of the executive committee of State health officers and finds it somewhat puzzling that he was not asked for an opinion. Senator PURIFI1. Of course, Dr. Barrett submitted a statement and we have included it in the record. Mr. GORMAN, Yes. The point was the State mental health commissioners who are also members of the State and Territorial Health Officers, were not called in for discussion on something very vital to them. Senator PURTELL. May I get this right for the record and for my own information? You mean not being called in by the Department or this committee! Mr. GORMAN. First of all not being called in for discussion by the executive committee of the State and Territorial Health Officers. Senator PURTELL. I see. Mr. GORMAN. And secondly not being apprised by the Department of this legislation and their position. The point I am emphasizing is a very clear one, and the implications should be clear. There have been great differences of opinion over the years between these two areas. I am a battle-scarred veteran of the typewriter and watched for 10 years the battles in various States to get the State mental health problem out from under in some cases a very negative State health department control, and very poor control. I do not say that in all cases, but I think I am making an honest and factual statement. It is certainly so in my own State of Oklahoma, and particularly so through the Southwest. When we made this battle to get the problem taken care of separately we had a hard fight. Now we find we must go back to the era before 1946, and again go back, hat in hand, to the State health officer and say to him, "Will you please put us in your little plan and include this problem?" That is the fundamental issue at the heart of this thing here. Senator PURTELL. Just for the record I want to make sure of this. Your complaint is being registered not against this committee or the Department right now, but against another association of those identified in the same work you are doing. Is that correct? Mr. GORMAN. Yes. For the lack of notification, and so forth. Senator LEHMAN. I think it might be interesting to ask the previous witness by what authority he was speaking here. Senator PURTELL. I think he said, and it is in the record now, whom he appeared for, but would you like to state it again, Dr. Norton? Dr. NORTON. Your question was what? Senator PURTELL. Under what authority do you appear here today? Dr. NORTON. I appear as a member of the executive committee of the Association of State and Territorial Health Officers which has been referred to here. I might also add for the last 3 years I have been assistant chairman of the mental health committee of that organization; and that the State mental health authority of North Carolina is in the State health organization. So that there was a representation in the discussions before the executive committee. We have had several others who have taken part in the discussions where the mental health authority is in the organization. Senator LEHMAN. May I ask whether the members of the Association of State and Territorial Health Officers were polled on this bill, and in speaking you represented their viewpoint, or merely an individual viewpoint, or one held by certain other individuals? Dr. NORTON. My understanding is-I got this poll from the secretary, Dr. Yoder of Wyoming, and I cannot give exactly the mechanics he used in polling it, but this is the information forwarded to me. Senator PURTELL. May I repeat what Dr. Norton said: It is my privilege to represent, and to speak for, the directors of the official State and Territorial Departments of Health, who support in principle S. 2778. As a member of the executive committee of the Association of State and Territorial Health Officers, I participated in that executive committee's study of, and action .on, the bill. So, your statement here this morning was reporting their action on the bill. Is that correct? Dr. NORTON. That is correct. And by the way, Dr. Osborne of Connecticut was the previous chairman of the mental health committee. Senator LEHMAN. Again merely for the record, may I ask whether a vote was taken by the executive committee, or a poll was had of the members of the executive committee? Dr. NORTON. Yes, sir. Senator LEHMAN. I want to establish with what weight you are testifying. Dr. NORTON. Yes, sir. And as nearly as we could this statement we have made represented the opinion of the executive committee, and we have appended the opinions of 28 States, some of whom were not represented on the executive committee. Senator LEHMAN. May I ask you whether you polled New York State? Dr. NORTON. Yes, sir. Senator LEHMAN. Is that included in your report? Dr. NORTON. I believe the State of New York is included in there. Mr. GORMAN. No. There is nothing on New York. Dr. NORTON. No, but I have in here a statement, if you would like to have one, from Dr. Hilleboe. Senator LEHMAN. I would rather have Dr. Hilleboe testify on it himself. Dr. NORTON. This is his comment on the statement we have presented. Senator LEHMAN. May I use this? Dr. NORTON. Yes, sir. Senator LEHMAN. I would like to read into the record if I may the last paragraph of Dr. Hilleboe's letter, which I think bears it out. Senator PURTELL. Would you care to have the whole letter in the record.? Senator LEHMAN. Yes, indeed. I will put the whole letter in but I want to read the last paragraph because I think it bears on the matters which were discussed by Senator Hill and myself with respect to the appropriation. Dr. Hilleboe writes as follows: It seems to me that you have stressed the importance of keeping our total Federal grants in-aid at a high enough level so that basic health services can he provided You have also pointed out that the type of formula is not as important as the amounts of money that are received in order to equalize grants among the States and to maintain essential health services. Senator PURTELL. It will be inserted in the record, without objec tion. (The letter is as follows:) Dr. Jons WM. ROY NORTON, STATE OF NEW YORK, Secretary and State Health Officer, State Board of Health, Raleigh, N. C. Dear Roy: I have just finished reading your statement for the association which you presented before the House Committee on Interstate and Foreign Commerce. This is a swell piece of work, Rey, and I want to commend you on the able way in which you have put together the available material in the short time that you had at your command. It seems to me that you have stressed the importance of keeping our total Federal grants-in-aid at a high enough level so that basic health services can be provided. You have also pointed out that the type of formula is not as important as the amounts of money that are received in order to equalize grants among the States and to maintain essential health services. Congratulations on a job well done. Sincerely yours, HERMAN E. HILLEBOE, M. D., Mr. GORMAN. In introducing this kind of thing I did not mean to get away from the major point. When the Department finishes, it always seems to be 5 minutes to 12. But I wanted to make it clear I talked to a number of State mental health commissioners who were violently opposed to this; Dr. Barrett was one, another is the mental health commissioner of Kentucky who is opposed to it, also, the mental health commissioner of Tennessee. These are conversations I had in detail. I think it is a very important point that we understand there is a disagreement of opinion on this legislation. My function in appearing here today is just to point out that the Federal grant-in-aid specifically devoted to mental health has been a tremendous catalyst. For years before that we went to many State health departments and begged and tried to get them to recognize this as a very serious problem. I tell you factually they refused to, and did not give it time and attention. In the State of Oklahoma previous to the National Mental Health Act we could not get one single public mental hygiene clinic established, despite hundreds of editorials and garlands of newspaper space, and so forth. Until the Federal aid came through and we had a specific target. Then we got clubs and Rotaries and groups to speak for it and say this is a special allocation and a special problem, and we have to do something about it. Starting with that we began a pilot mental health program and we have built it up to a strong position today. Our point is not that we say it is a separate and delicate problem. No. But we say that we are an important problem. I have been very much interested of late in States' rights, as Mrs. Hobby is, and I have just finished an article on it. (Discussion off the record.) The point I am trying to make is simply this: When it comes to States' rights who speaks for it? I think the governors of the 48 States. Since 1949 every one of the National Governors' Conferences which I have attended have pushed for separate departments of mental health. They have spent a lot of time and money in compiling two massive reports which I would like to have the committee see, but I do not want to encumber the record with them. Senator PURTELL. If you have two copies we would like to have them available for the committee if they are too voluminous to be inserted in the record. Mr. GORMAN. I will make them available, and I allude to them in my formal statement. Senator PURTELL. Thank you very much. Mr. GORMAN. They are massive studies and come out and say this: This is a problem so big and so hard to whip that we want separate departments of mental health with fully allocated authority; and we want them taken out from under the State health departments. It is a very carefully thought out thing. I had the privilege of attending this February the National Governors' Conference on Mental Health as held by the 48 governors on the subject of mental health alone and how through separate preventive and clinical work we can cut down on the cost, which is running at $1 billion a year to the taxpayers and is now $3 billion a year in lost productivity. The governors recognize it, and I go along with the council of State governments in interpreting States' rights rather than with various Federal departments who attempt to interpret it for them. I think that about concludes my statement. I think this is a problem which has two sides and I do not presume to state more than our considered opinion that we want the retention of the mental health grant-in-aid not because of the money-I make this important point here. Eight years ago when this grant-in-aid system was established, the Federal Government was contributing $2 for every dollar contributed by the States and localities, but in the last 8 years it has changed so that for every dollar of Federal money there is $6 of local money. You cannot say they are neglecting their obligation. They are doubling it. I have one final remark I might make. It is a remark made by the chairman of a House appropriations subcommittee whom I shall not name, but he said that he was not interested in just appropriating for general health. Who knows what that is? He said, "I am interested in fighting cancer and heart disease." This is a thing that is very important in getting support and in keeping the support we have been able to get over the past few years among the major State gov ernments and the clubs like the Rotary, and the Lions, and the Kiwanis. I do not know what general health is myself. Some days I think I possess it, and some days I do not. The talk about the one-package wrapped-in-cellophane grant is very fine, but I think it is good to think of the specific problems. Senator PURTELL. Thank you very much. Mr. GORMAN. Thank you, sir. Senator PURTELL. Senator Hill, have you any questions other than perhaps a dissertation on what is general health? Senator HILL. We are on mental health right now. Senator PURTELL. I would like to talk about general health. I do not feel so good today. Senator HILL. The States have increased their appropriations for mental health greatly, have they not? Mr. GORMAN, Enormously in the past few years. Senator HILL. They have set up separate mental health departments, Mr GORMAN. In the majority of the States. Senator HILL. It is the judgment of the governors conference representing all of the governors of the United States that all of the States should have a separate department of mental health? Mr. GORMAN. It was in their statement in both reports which they put out officially. |