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sifall not being called in for discussion by the

the state and Territorial Health Officers. Ite 1.d fondly not being apprised by the Department z1 their position. The point I am emphasizing

the implications should be clear. There have - auf opinion over the years between these two "paraprel veteran of the typewriter and watched ".. Various States to get the State mental health : oder in some cases a very negative State health advery poor control. : 1 all cases, but I think I am making an honest -'t. It is certainly so in my own State of Okla

through the Southwest. - Fattle to get the problem taken care of separatetot. Now we find we must go back to the era beSo back, hat in hand, to the State health officer

1. you please put us in your little plan and in

grant we had been trying for a number of years to beg some money for clinics from the State health department. No soup. 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 ('ommunity Chests of many cities in Oklahoma, business and fraternal organizations, women's groups-all of them contribute to the support of the mental health clinics in that State. Yet it is tha Fuleral 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 krants 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 prograin subwort many activities directed toward the psychiatric education of schoolteachers, ininisters, public health personnel, Vocationalrehabilitation sucialisin, etc. Joneys under this program also support com. munity education activities--varied efforts to alert communities to the problem of mental illness and ways of hanilling it. Many parents are reached through prenatal and well-baly clinics. There are other activities too numerous to mention here

Snow alonk 4411*** 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 ninch 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 eng nizance of the evistence of State mental health authorities is no guaranty what Never The important point is still this: moness now going directly to many State mental health commissioners for the specific purposes of lighting mental line** will, if this bill in passed, go to an amorphous State bealth authority, which will then ladle the money ont according to its own notions,

The fight against mental illness is big business. It costs the taxpayers more than a bollion dollars a year in tax moneys. According to testimony presented to the lone Interstate commerce Committee (Wolverton) last October, it can this Vittion more than $3 billion in industrial productivity and sils million in lost Föderal income tax revennes This, therefore, is not

a problem to be lumpad into a catchall general grant.

Therefore, the national mental health committee suggests that the mental benith grants in aid program be continued as at present.

Mr. GORMAS. Dr. Barrett coull not make it. lle in the senior health commisjoner in the fielet, with some 30 years of experience, and ispute opposed to this bill. I would be further, Mr Chairma). for the record, that the State mental health commissioners as a group were not notified either by the Department of Health, Exlucation, and Welfare or by the Congress on this particular bill: and Dr. Barrett himself in a former member of the erecutive committee of State health officers and find it somewhat puzzling that he was not asked for an opinion,

Senator Pukinn. Of course, Dr. Barrett submitted a statement and rehave included it in the record.

Mr. GORMY, You The point was the State mental health com missjoners who are also members of the State and Territorial llealth Officers, were not called in for alicuion on something very vital to them.

Senator Pueri LL. 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?

Dental issue at the heart of this thing here.
Just for the record I want to make sure of this.
elig registered not against this committee or the
LIT, but against another association of those iden-

nk you are doing. Is that correct?
in For the lack of notification, and so forth.
15. Ithink it might be interesting to ask the previous
"ority he was speaking here.
I think he said, and it is in the record now, whom

I would you like to state it again, Dr. Norton? i pojestion was what? 3. Coler what authority do you appear here today! far as a member of the executive committee of the

an Territorial Health Officers which has been Inight also add for the last 3 years I have been

i the mental health committee of that organizaeste mental health authority of North Carolina

tb organization. So that there was a representamiehefine the executive committee. We have had

to taken part in the discussions where the mental

the organization. 1 Mar I ask whether the members of the Associa

con torial Health Officers were polled on this bill, · represented their viewpoint, or merely an inup one held by certain other individuals?

uderstanding is-I got this poll from the secresa but this is the information forwarded to me. ***2Mas I repeat what Dr. Norton said:

• Troming, and I cannot give exactly the mechanics

pant, and to speak for, the directors of the official State -ma's of Health, who support in principle S. 2778. As

it commenittee of the Association of State and Territorial peted in that executive committee's study of, and action

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Mr. Gorman. First of all not being called in for discussion by the errutive 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. Tlie 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 separate-
ly we had a hard fight. Now we find we must go back to the era be-
fore 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 in-
clude 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 iden-
tified 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 organiza

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 individualš?

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
.00, the bill.

LIBRARIES

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yra bare stressed the importance of keeping our total

gh enough level so that basic health services can be my pointed out that the type of formula is not as important zapat are received in order to equalize grants among rewntial health services. jd well done.

HERMAN E. HILLEBOE, M, D.,

Commissioner of Health. tydlucing this kind of thing I did not mean to major point. When the Department finishes, it minutes to 12. But I wanted to make it clear

if State mental health commissioners who were weis: Dr. Barrett was one, another is the mental

f Kentucky who is opposed to it, also, the mental 2 Tennessee. These are conversations I had

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. Norrox. Yes, sir.

Senator LEHMAN. I want to establish with what weight you are testifying

Dr. Norrox. 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 representeil 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. XORTUN. I believe the State of New York is included in there.
Mr. GORMAN. Xo. 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 LEHLAX. I would rather have Dr. Hilleboe testify on it himself.

Dr. NORTON. This is his comment on the statement we have presented.

Senator LEIMAN. May I use this!
Dr. XORTUN. Yes, sir.

Senator LEIMAN. I would like to read into the record if I may the last paragraph of Dr. Hilleboe's letter, which I think bear it out.

Senator PirrELL. Would you care to have the whole letter in the record.?

Senator LEIAN. Yes, indeed. I will put the whole letter in but I want to read the la-t 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 Frueral grants-in-nid at a high enough level so that baste health services can Het pitonsidled You have also pointed out that the type of formuia is not as Important ne the amounts of money that are received in order to equalize grants smong the states and to maintain essential health services.

Senator PURTELL. It will be inserted in the record, without objection. (The letter in it follows:)

STATE OF Nrw YORK.
DEPARTMENT OF HEALT.

41 bany, March 16, 1955
Dr Jou Wm. Roy NORTON,
Nt9tary and State Health Officer, State Board of Health,

Raleigh, N. o. DEAR Roy: I have just finished reading your statement for the association which you preeented before the House Committee on Interstate and Foreikn Commerce. This is a well piece of work, Rry, and I want to commend you on the able way in which you have put together the avaliable material in the bort time that you had at your command.

important point that we understand there is a

a on this legislation. Faring here today is just to point out that the ecifically devoted to mental health has been For rears before that we went to many

State td beared and tried to get them to recognize problem. I tell you factually they refused to, s# and attention. at ma previous to the National Mental Health

e single public mental hygiene clinic estabwis of editorials and garlands of newspaper id came through and we had a specific target. i -* i Rotaries and groups to speak for it and say o'tion and a special problem, and we have to do

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Tyr hegan a pilot mental health program and we

strong position today. Our point is not that Prand delicate problem. No. But we say that we

wh interested of late in States' rights, as Mrs. I finished an article on it.

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ming to make is simply this: When it comes to tridis for it! I think the governors of the 48 mify one of the National Governors' Conferences

kave pushed for separate departments of menz te spent a lot of time and money in compiling Rich I would like to have the committee see, but

her the record with them. 72. If you have two copies we would like to have

manittee if they are too voluminous to be

જ. make them available, and I allude to them in

- Thank you very much. mare massive studies and come out and

witing and so hard to whip that we want separate

say

this:

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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.,

Commissioner of Health. Jr. 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 soruething 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

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xfore you feel the Federal Government should cuns directly to your State mental health departw programs, rather than going through the

departments, or in some other way? xwer to that, I feel the Federal Government ** tishes of the 48 State

governors. -I' the State governors!

Pall

. Mr. Chairman. Thank you very much, Mr. Gorman. stand in recess until 10 a. m. tomorrow, Tueswe will discuss vocational rehabilitation, and Is Oveta Hobby, Secretary of Health, Educa

terlater received for the record :)
AMERICAN SOCIAL HYGIENE ASSOCIATION,

Near York, N. Y., March 25, 1956.

imate committee on Labor and Public Health,

phington, D.C. spa that you received our wire of March 24, which read af your wire of March 22. Deeply regret that it will ' testify on March 29, but we will forward statement for

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 Gorernors' ('onference 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 sud 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 gove 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 PIRELL. Thank you very much.
Mr. GORMAN. Thank you, sir.

Senator PIETEI L. Senator Hill, have you any questions other than perhaps a dissertation on what is general health?

Senator lliu. We are on mental health right now.

Senator PrutiluI would like to talk about general health. I do not feel so good today.

Senator Huu The States have increased their appropriations for mental health greatly, have they not?

Mr. GORMIN. Enormously in the past few years.

Senator Hu. They have set up separate mental health departments

Mr GORMAN. In the majority of the States.

Senator HALL. 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. Gormin. It was in their statement in both reports which they put out officially.

Chat we regret that it was impossible for us to testify on
Irter that the enclosed statement which we have prepared

Ba'th Grant-in-Aid Amendments of 1954 may be placed - the record of hearings.

CONRAD VAN HYNING, Erecutive Director. that the enclosed joint statement on the current status og indtrol program may be of some interest to you and your

mit herewith.

L. Pas Hexing, EXECUTIVE DIRECTOR, AMERICAN SOCIAL
IIME ASSOCIATION, NEW YORK CITY
ald, of which I am executive director, has been actively

wide vedereal disease control program for 40 years,
*** sf which progress has been made toward the ultimate
* leadership of the Congress, which has always recog-
mat these diseases to our national health and strength. It
21:42has continue to give such leadership and to suggest
**thin the framework of S. 2778 that this statement is

Bal of renereal disease control has not been steady * Pierid War I, when we first realized the need for nation

* Progress in the 1920's was followed by a rise in rates

** 09 the 1930's. In World War II and the years that .* t rates again rose. Beginning, however, in fiscal 1947

program based on active case finding, contact tracing, therapy, brilliant successes were achieved. In fiscal

disrase rates rose again in 17 States and the District thea: the situation calls for continued vigilance and, in

Federal responsibility and congressional leadership.

peas clear that we believe that the grant-in-aid to the device for equalizing the financial burden of control S the case of a health problem of national significance.

ou dear that we have the greatest confidence in the et distinguisbed State health officers to deal with the se remarks is that the veneraal diseases are national

within their own jurisdictions. The point that

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