on program moves forward, we must continue to urces currently at our command-to the nearly half n mental hospitals; to the 5 million among us who 00 who are addicted to drugs; to the 20,000 who and to the hundreds and thousands of children on the emotionally scarred, unable to learn, or too disturbed v. The challenge they pose must be confronted with e while, however, we work toward our ultimate goal: cross the land the kind of integrated and coordinated at will deal with the whole range of such mental and atever level of intensity is required.

te, then, rest on a firm base: On progress gained from construction of new centers across the country; on an g with innovation; on the provision of new services Americans; and on a continuing pledge to meet the today while striving for an even more productive

ppropriation for 1966 and the request for 1967

zed?

ion for 1967.

was authorized in 1966?

on.

ut you $15 million in 1967? correct.

uch did you have last year?

ion in 1965, $50 million in 1966 and the request

7.

projects have been approved?

ARTICIPATION IN PROGRAM

are 16 projects which have been approved. in California.

wo in Los Angeles, one in Burlingame, one in ee in Santa Clara.

Florida. Panama City, Daytona Beach, and

nnesota, one in St. Cloud and one in Minne

mbia, Mo., and two in New York. Rochester, City.

are as many in California as the rest of the her.

a greater readiness to build facilities for the California than in almost any State. They come in.

is the main reason? Here are two big States, ork. California has how many?

ia has eight.

ork has only two?

ew York has had some early difficulty in makterms of priorities, but we expect a number

lo you mean, priority?

te has to set priorities for projects.

is a question of getting the money up too?

Dr. YOLLES. Both of these States have community mental health service acts, and have construction funds authorized within those accounts.

RHODE ISLAND

Mr. FOGARTY. What about Rhode Island?

Dr. YOLLES. Rhode Island has not submitted its State plan as yet, so no applications can be received from Rhode Island.

Mr. FOGARTY. They tell me they have submitted something.

Dr. YOLLES. The documents for comment which have been submitted were preliminary documents. We have been working with them. Mr. FOGARTY. They need some help.

COST OF FUNDING ANTICIPATED APPLICATIONS

How many more applications are on hand? You say 16 have been approved?

Dr. YOLLES. We have 16 applications approved. There are eight more in the house at the moment from Kansas, Iowa, Alabama, Pennsylvania and Maine, and two more projects from New York.

As of the 25th of February, $6.8 million of available 1965 funds have been obligated, which is roughly 19 percent of the $35 million, and $613,000 of available 1966 funds have been obligated. A number of States are ready to use their 1966 funds at this time, even though these funds last for 2 years.

Mr. FOGARTY. How much would be required if you fund all you have on hand?

Dr. YOLLES. At the moment, or the ones we know will come in? Mr. FOGARTY. On hand and give me the other figure also.

Dr. YOLLES. I do not have the data with me on the ones that are in the house.

Mr. FOGARTY. Supply that for the record.

(The information requested follows:)

Mr. FOGARTY. What are the matching requirements?

Dr. YOLLES. These depend on the Federal percentage requirements in each individual State and they range from 6623 which is the highest Federal share, to 3313 Federal matching, the same percentages as those in the Hill-Burton program.

HOSPITAL IMPROVEMENT PROGRAM

Mr. FOGARTY. I have heard some good things about the hospital improvement program. The National Association for Retarded Children thinks it has made a difference in those institutions which have been successful in getting grants, which I understand will be about

60 percent by the end of 1966. I see your budget has the same number of mental hospitals and institutions for 1967 as in 1966.

Dr. YOLLES. Yes, sir.

Mr. FOGARTY. Shouldn't this program be expanding?

Dr. YOLLES. Within the overall funds

Mr. FOGARTY. Forget about the overall funds. Give us your best professional judgment.

Dr. YOLLES. Personally, professionally I am very sorry to see this program held at the same level for the coming year. This has been perhaps one of the most rewarding programs that the Congress has instituted. Some of the most startling results have come out of the State hospitals. Patients who have been on back wards, immobilized, some as long as 15 to 20 years, have been mobilized and have returned to their homes and communities because of these funds which were made available. Mentally retarded children who have additional handicaps such as blindness or hearing and speech defects, these have been picked up and the general welfare of the retarded child tremendously improved because of these grants. Mentally retarded children who have been unable to take care of themselves, who had to be dressed, who had to be washed, who were not toilet trained have become trained through the use of such funds so that they can take care of themselves even though they cannot leave the institution, allowing the personnel to be used for treatment of others. So that in the 3 years we have had this program it has had startling results throughout the United States. It is the fourth step of the program that we are not able to put on this year.

Mr. FOGARTY. What is the fourth step?

Dr. YOLLES. We had planned this program in a series of roughly six steps so that by the end of the sixth year we would have covered every institution for the mentally retarded in the United States and every hospital for the mentally ill. During the first 3 years the Congress has made $6 million available each year to cover each of those steps.

Mr. FOGARTY. What is the fourth step?

Dr. YOLLES. The fourth step would be another $6 million for this program.

Mr. FOGARTY. As a professional in that field, you think we should have that in the budget?

Dr. YOLLES. Yes, sir.

RHODE ISLAND SCHOOL FOR THE RETARDED

Mr. FOGARTY. What have you done for the Rhode Island School for Retarded?

Dr. YOLLES. I will have to check on that one for you. I can supply that for the record.

Mr. FOGARTY. Supply it for the record. I do not think you have done much.

(The information follows:)

The Dr. Joseph H. Ladd School of North Kingston, R.I., has a hospital improvement project grant and an inservice training grant from the National Institute of Mental Health. The hospital improvement project was inaugurated on June 1, 1964, and funded for $248,954 over a 3-year period. This project is focused on providing individualized programs for profoundly retarded children.

The budget provides for a project coordinator, 2 supervising attendants. 12 institution attendants, consultant services, and educational and recreational equipment and supplies. The inservice training project was started on July 1 1964, and funded for $124,740 over a 5-year period. This project is a cooperative effort with the University of Rhode Island to employ a project coordinator, consultants on inservice training and graduate student instructors who partici pate in an inservice training program for attendants.

BRINGING IN THE LAGGARD APPLICATIONS

Mr. FOGARTY. What do you realistically need to bring in the laggard applicants, and the other question goes along with it, would you agree that generally speaking the ones that most need improvement are the slowest to apply?

Dr. YOLLES. In many cases this is so.

Mr. FOGARTY. You can supply those answers for the record. (The information follows:)

In most States the highest priority task of State and local mental health personnel has been the development of State plans for community mental health center construction. Now that most of the plans have been completed, it is nee essary that those who have been involved in the statewide planning turn their attention to the needs of the individual communities. Particular effort must be given to publicizing not only the State plan but also the community mental health centers program.

Of equal importance to Federal assistance in the development of community mental health centers is the availability of funds under a State Community Mental Health Services Act. Such an act assures the community that the State will continue to share in meeting the operating costs of a local community mental health center. The funds made available by a Community Mental Health Services Act are of value to all local community programs but they are of particular significance for areas with limited resources. Such an act can be of still greater significance in these areas if provisions are made for a preferential assistance formula.

THIOTHIXENE

Mr. FOGARTY. I have just one other question. In talking to a psy chiatrist in Rhode Island he said he is working with a new drug called Thiothixene. Several hospitals throughout the country are using it on an experimental basis.

Dr. YOLLES. I do not recognize it.

Mr. FOGARTY. I do not think it is on the market. He even drew the chemical structure for me.

Dr. YOLLES. I will supply information on it for the record. Mr. FOGARTY. He told me he was using this and getting good results. Dr. YOLLES. If I can have a copy of that I will submit it for the record.

(The information follows:)

Thiothixene (P-4657B) is a thioxanthene derivative developed and manufac tured by Charles Pfizer, and has been used as an investigational drug in clinical studies for over a year. It is not on the market. Most of the investigations are on chronic schizophrenic patients, but according to recent information received from the manufacturer, the drug is also being tested in patients suffering from depression and anxiety. The major reasons for the company's interest in this drug are: (1) It may be as potent as the phenothiazine drugs (such as chiorpromazine) with fewer side effects; (2) It may have some special activating or stimulating properties. Clinical investigations of this drug are still continuing Mr. FOGARTY. Mr. Denton.

Mr. DENTON. No questions.

REORGANIZATION

Mr. FARNUM. Dr. Yolles, you talked about reorganization a number of times. But really you did not explain what the reorganization was. Do you have a chart?

Dr. YOLLES. Yes, I do.

Mr. FARNUM. Can you elaborate a little more on your organization? You can either do it now-I know it is getting late or you can. supply it for the record.

Dr. YOLLES. If you would like to see the chart, Mr. Farnum.

Mr. FARNUM. Yes. I am interested in whether or not the organization is going to improve management functions.

Dr. YOLLES. We have been addressing ourselves to the problem of reorganization because we want to tailor our administrative structure to the functions we must carry out.

We wanted to assure ourselves we had a clear line and chain of command, so that program managers knew what their responsibilities were and they knew who they were responsible to. In addition, to make very clear through our organization, how activities are focused in specific programmatic areas. In separating line and staff functions. we have created a series of offices to deal with specific services which are supplied for the entire Institute, such as development of standards, program analysis, biometrics and program planning. Then in order to reduce the span of control of the numerous programs that are subsumed under the mental health program, we have divided the Institutes' functioning into five priority areas with an associate director at the head of each one and responsible for that area.

We have also set up branches and specific centers to focus attention on specific problems. For example, a center for the studies of schizophrenia to coordinate our efforts in that field. Similarly onewhich I mentioned to Mr. Fogarty a moment ago, the Center for Study of Mental Health and Social Problems, as well as specific centers for studies of alcoholism and drug abuse. Another center which is of great significance and interest to us is the center for studies of metropolitan mental health programs. In addition there are centers for studies of suicide prevention, one on mental health of children and youth and another center for study of crime and delinquency. There are also new areas where we have to target our work such as epidemiologic studies in the field of mental health.

MANPOWER NEEDS UNDER REORGANIZATION

Mr. FARNUM. I notice you are talking about new centers. Any reorganization of an existing structure calls also for the shifting of manpower. What problems do you have, if any, here in deploying your manpower within the new structure?

Dr. YOLLES. Really it boils down to approximately three approaches. One was the problem of the capabilities and the preparation and competence of the individuals for the new positions. The second was the desires of the individual to work in a particular program area. To this end we have asked each employee of the National Institute of Mental Health to indicate where in the new organization he would prefer to work. We will match his talents and his competence with his desires to work in the area.