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practicable than an arbitrary division into direct services to patients on the one hand, and all other supporting services and staff on the other.

Third, each community mental health center should be required to develop a plan that will guarantee an appropriate range of services for elderly persons, for children, for alcoholics, and for other drug abusers. The argument that one catchment area does not generate a caseload heavy enough to warrant such comprehensive programs is too often used as a way to evade all responsibility for such neglected groups.

Fourth, each center should be required to develop and maintain an effective working relationship with the State hospital to which it relates, so that appropriate screening of patients before admission to a State hospital and aftercare following discharge from a State hospital can be provided within the catchment area.

Fifth, continuous evaluation of community needs and of the extent to which services meet those needs must be required of each center. Ongoing and independent analysis of program effectiveness by the Department of Health, Education, and Welfare or NIH, NIMH, whichever is organizationally appropriate, should also be mandated. Sixth, priority in awarding funds should be given to catchment areas which are not yet serviced by community mental health centers. To encourage timely development of needed services in areas that lack ready access to planning staffs- that is, areas relatively unsophisticated about "grantsmanship"-the granting agency should be directed to assume an advocacy consultative role in developing grant requests insofar as such assistance is acceptable to the catchment area concerned.

Finally, support to all funded centers should be extended until such time as national health insurance, other federally funded health service delivery programs, such as HMO's, or other third party payment mechanisms can begin to assume the costs of the centers' services. Thank you very much.

Dr. MILLER. Thank you, Dr. Campbell, for very useful testimony. I would like to call now on Mrs. Betty Still, president of the Jamaica-Flushing Mental Health Council.

STATEMENT OF BETTY STILL, CHAIRMAN, JAMAICA-SOUTH FLUSHING MENTAL HEALTH COUNCIL, QUEENS, N.Y.

Mrs. STILL. Thank you, Dr. Miller. Good morning, Dr. Christmas and other friends. This is my first time to appear before you and since you said there was some opportunity for folks to speak, I thought I would get my name in.

I am a consumer, a layman, the chairman of the Jamaica-South Flushing Mental Health Council, of which I believe you have heard. We have been in the process of working on a grant for the last 4 years. Two of those years, I have been the chairman. Our grant was received, adopted, what have you, but it was never funded.

As a layman, I really cannot understand that if you follow all of the guidelines, If you run to Albany or to Washington, if you send letters into the different offices and then you come back and you say

we receive a letter that the grant was approved with no money, how can you really set up a center and how can you really service people?

Again, as a layman, I say how do you go out into the community and say please come over and support our grant. We have it approved, but we have been waiting for the last year to receive funds. Now, how do we go back to explain? How do I go to the council now to explain to them and tell them why we cannot set up a center.

We do not have such a center in Queens, and it took quite a bit of time and energy to go into the community to explain to them that we do need this, and we want your support. The guidelines said we should have community input. You can not keep community people interested unless you show them something besides paper.

I think too much paper has been used and perhaps some building could have gone up and some staff had been paid if we stopped so much of the paperwork.

I feel there should be perhaps two or three sets of guidelines and then the community could use that particular guideline that they desire and then they could proceed on when it is submitted if by chance they have left out something then they would go back and take care of that, but, for Heaven's sake, after they have followed all the guidelines, I can not see why the moneys have not come down.

If you will, I would like for you to explain to me, not now, but maybe I could get something in writing so I could take it to the Council.

Why is it when we know there is a need and, of course, you know there is a need, the city knows there is a need, when you follow all of the steps, then you send back a blank piece of paper-there is no money. You really can't keep people interested.

Do you feel that people may have to tear down walls? Do you feel they should write on walls? Should they destroy buildings and then suddenly money is found to put up these structures to help people? Do you feel a person must really crack up and go berzerk in order to get something?

As a layman, I am asking this because I think I have worked rather hard as well as the rest of the people coming to meetings, uniting them, running downtown, running to Albany, going to Washington, and this is no paid thing. This is a voluntary thing and when I stand up and try to persuade others to do this because I feel that something will come through yet and after a year's time you don't see anything what do you tell people?

Do you say let's take this bus and turn it over in front of the commissioner's office and then they find money? Is this proper? I would like to know what do you plan on setting up for a community when you ask for community participation because we say 50 percent consumers professionals may be a little more dignified in doing thingsbut when you are out here with the hard core community and you are trying to persuade them to do something, you have to show them something besides paper and pencil.

I would like to know if you can help me with this.

Dr. MILLER. I am glad that the record will include such a direct description and report of what it feels like to be involved in the development of a center which, as you described it, finally was approved, but not funded.

I wouldn't attempt to try to answer as if I were a Congressman, and I am not sure it is appropriate for me to turn this meeting into a discussion of other matters at the moment. But your experience is not unique, and that makes it all the more important that we have a record of that kind of experience which could be matched, I suspect, in a number of places.

The past extension of the mental health centers legislation might address itself to that particular center, but more would be required if the same situation is not to take place again in the fture. So I thank you for your testimony.

I would like to call now on Dr. Paster, director of the Washington Heights Mental Health Center.

STATEMENT OF DR. VERA PASTER, EXECUTIVE DIRECTOR, WASHINGTON HEIGHTS-WEST HARLEM-INWOOD MENTAL HEALTH CENTER

Dr. PASTER. Thank you. I think the timing is very appropriate. I am referring to the presentation of the previous speaker, because I have experienced the frustrations described. I would like to add a happier postscript in the context of this hearing.

The Community Mental Health Centers Act provided the thrust for a changed concept in mental health care that 10 years later is still in the process of being realized.

It takes time to change habits, behavior and thought patterns developed over many generations. In 1963 there were already years of asylums for the insane; years of hospital-based voluntary clinics for the emotionally disturbed, but each pursuing its own treatment goals for the selected few, rarely even recognizing the existence of the others; years of the entrenched interests setting the standards and determining the criteria that indicated who should and who should not be served; who should serve and who should not.

The remarks of the previous speaker are particularly relevant in this respect and the experiences that I would like to share with this committee follow up in the same vein. It seems to me that 10 years is not too much time to reconceptualize the theory of mental health or to bring about the skills to attain these new goals or to generate the courage, and the determination to do so. Required are a steadfast will and the processes to actually implement an expanded concept of health care that I believe was intended by the Community Mental Health Centers Act.

If it was the intention oft he act to reconceptualize the care of the mentally ill, if it was the intention to extend mental health care services and to involve the community, then we are still in the process of becoming.

With prior permission, and in the spirit of the content, I would like part of the time for my testimony to be shared by the chairman of our board, a community member. This examplifies the partnership that I believe is one of the intentions of the act.

The provisions of the community mental health center with its supervisory structure at NIMH has made it possible, and has given hope to community groups to activate themselves on their own behalf

I would like to refer to those I know best, the people in the Washington Heights-West Harlem-Inwood section of Manhattan in New York City.

This is a group of ordinary citizens, black and white, poor and middle class, people on welfare, people with jobs, professional people and lay people who have been banding together to look for alternatives for meeting their mental health needs.

In so doing, they are developing the concept. They are putting meaning into the concept of a program of mental health that is directly responsible to and responsive to the community. Legislation provides the thrust. The actual implementation takes dedication, work and struggle, accidents, mistakes and learning and doing.

I think that is what is happening in our area.

In 1968 several residents of Washington Heights learned that the entrenched training and research-oriented university medical institution in their area had been asked to develop a community mental health center. Because the Community Mental Health Center Act prescribes community input, that was the initial access. Thus, these persons, Mrs. Emma Bowman, Mr. William Hatcher, Dr. Reuben Mora, and others, felt encouraged to involve themselves.

They involved themselves to the point of asking to participate in the planning of the community mental health center. When this interaction escalated in conflict, the act itself was the force that legitimated the thrust of the community to have its priorities addressed.

All of this resulted in the community's being given the charge by the city and the State mental health departments to develop the community mental health center program for the area. That would never have happened had there not been that act.

The momentum provided by the potential availability of Federal funds to help financially provide for five essential services directed to their needs, generated an energy among this group of citizens that is increasing still 5 years later. This community is taking seriously the intent of the act and in so doing, is not putting a new label on an old bottle by calling an old medical care package a community mental health center.

The intent sought by the community and which is, in the attempt of being realized, is community involvement, preventive care, effectiveness and availability of service to those who need it most, coordination of programs and a comprehensiveness of the service for people who have need.

It has truly involved a large number of community persons. These people meet together regularly to learn about and to formulate their own concepts of mental health and mental health delivery services. They determine their own needs and interact with various segments of local government. They work with planning boards and neighborhood action programs, get out the vote, write to Congressmen, and become involved as active members who have something to say about what happens to them.

Many have been stimulated to return to school. People who may have dropped out of high school are going back to college and getting advanced degrees. They have addressed their energies to the means of

improving their community starting with mental health issues and extending to seeing that the streets are cleaner, and on to bringing in large programs of general health care, also to be addressed to the community's needs. They care, they show that they care. This, in turn, generates a force, a force of neighbors committed to each other and committed to improving life and demonstrating that there is some hope to do so. This makes for a mentally healthier community. I feel that this process in and of itself, is a great answer to mental health for the community.

Professionals employed by this community have no ivory tower. They are in constant interaction with the community and thus are enabled to program for the real priorities of the people.

They must seek out ways of initiating contacts and effectiveness and visibility in reaching those who suffer and preventing breakdowns and becoming a vital part.

The interaction between the paid staff and volunteers takes place at the monthly meetings, at the monthly board of directors meetings, and in committees in which community people work together with staff on specific programs, both in the center and out in the community.

This kind of joint force prepares the base for forward thrusts and makes for a mutual education that is the foundation of a real partnership.

So, we have the involvement of the people in their own mental health care.

What programs has this collaboration produced? I will give you just a couple of examples to convey the spirit of what an act of Federal legislation may look like on a very, practical local level.

One example is the generation of action coalitions directed toward a neighborhood menace, that was a single-room occupancy that attracted the poor, the disadvantaged, the miserable of the community and was a locust for all kinds of drugs, alcoholism, prostitution and crime. The people in the community were afraid of it and ashamed of it. But also those people who were activated themselves to care, cared also for the residents.

Ten agencies, including a broad range, for example, board of health, visiting nurses, drug programs, civic groups, the department of social services and so forth were brought together by the Washington Heights-West Harlem-Inwood Mental Health Council to plan forceful action to do something about this situation and to help the people

in it.

The city machinery for dealing with these problems, was engaged and brought up to our area. The landlord was met with, contended with. The result of this was that he was forced to remove the building violations and he was persuaded to provide space for agency personnel to work right out of that building.

In addition to that, the composition of the residents of the SRO was changed. At this point, the aged, the physically disabled, the alcoholics, the drug abusers, are clients who are being worked with a variety of ways right on their own grounds.

Another program is operation doorbell. Here staff and community contacts a householder of an apartment houses, and with this person

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