Imágenes de páginas

canvasses each family in that building. Each family is asked to consider its needs and build on this increased awareness to get together with other families to discuss mutual concerns.

We have experiences of some neighbors having been neighbors for 20 years speaking to each other for the first time at these meetings which are held in lobbies of the buildings. There are frequently housing problems and other practical problems. We provide the staff support, we get the people in who can redress the grievances, and we help the tenants direct their thoughts beyond the immediate pressing


We are encouraging these housing associations to form block associations. We have experienced the success of people living in unhealthy, unsafe conditions for many years suddenly seeing that it is possible to physically change their surroundings.

We have seen block associations develop recreation programs for the youth whom they had considered to be menaces up to that time. One more example: Under the leadership of the council, heads and some staff of every mental health and every human service agency in the community now know each other, talk to each other and meet regularly to plan and coordinate programs. This articulation of services is implemented by joint sponsorship of programs, by sharing staff ing within agencies, by task forces that we described before, and by other means.

For example, the State hospital has assigned staff to community agencies to facilitate aftercare services.

The council and the original training research-oriented university hospital are now cosponsoring a home for seriously emotionally disturbed adolescents as an alternative to hospitalization.

This community mental health concept has also shaped the kind of mental health care and the availability of care developed in the community.

The doors of the center are open from 9 a.m. to 9 p.m., 5 days a week. Informal contact is encouraged. All kinds of activities take place at the center. One can have one's needs met without having to undergo a complicated process.

It forces professionals to look for means of giving care other than those traditionally used, for example, group therapy around making clothing and furniture.

It pushes us to the streets to work with youths and youth gangs. It pushes us to the isolated rooms of the withdrawn. It makes us actively reach out to do what we are supposed to do, and to address the people to whom we are responsible if we fail to do so.

The fact of a Community Mental Health Service Act then has provided the resources to render the services that the community knows that it needs. This act demands not only to be continued, but to be expanded. It provides the impetus, it provides the energy, it provides the very practical financial support. It provides the force for people to begin to work together. We are only beginning to explore the vast potential of the actual technical means of fulfilling its goals.

I would like to now put a comma to this presentation, and have it continued by the other half of this partnership represented by Mr. Hatcher.


Mr. HATCHER. Thank you, ladies and gentlemen, for giving me this opportunity to add to what our director has given us up to now. I would like to make one correction. She said 1968. That is taking about 18 months of energy and effort from us and I would like to put that back. It was much earlier than that.

I might say our organization is probably an accident, because at the beginning, we had no intention of taking the route we finally took. We merely wanted to have an input in the developing of the mental health center at that time, supposedly sponsored by the university in our community.

A conflict developed, of course, and we took another route.

To backtrack a little, I, myself, am a layman also. I have no background in health or mental health. I am in fact a merchant. I have been asked many times how does a merchant happen to be in mental health? I could add that I am in more than mental health. I am also in health. We are hoping to bring the health services in our area under the same terms that we were able to bring mental health.

They both fit in the same category in that we have no local health services and we had no local mental health services.

To get back to why I am here, Mrs. Bowen mentioned by the director, happened to be appointed to a job called the executive secretary of the then Community Mental Health Board. She and I are very friendly. We both recognized that she had been appointed merely out of the fact that she had been a politically active person in the election of the mayor.

We determined that it would be more than just a political appointment, because the guidelines said she was to, as I remember, "alleviate the stigma associated with mental illness." She had no idea or anything about how to go about this. Mental illness or mental health to us meant people incarcerated in hospitals. She requested my assistance and I gave it.

In the process, we started to bring people together, something we both were experienced in and we started to discuss mental health under one of the services called education and information or consultation and information, which had an animated film and at the end of it, the statistic read, there are more people occupying mental health beds than all other diseases combined.

This was shocking to most of us. We never dreamed such a thing existed. Then we started thinking of all the people in the streets who should have been in beds and it was even larger.

We began a series of seminars in which we discussed mental illness under the leadership of two psychiatrists and a psychologist, Dr. Maimie Clark. From that, we had about 65 people participating in a 12-series seminar, we began to learn about mental illness and health and the effect it was having on people in general. It was about this time that we learned about the projected mental health center for our


It all fitted in. This is why we tried to have an input, based on what we had been learning through our consultation and education programs. We had spread it throughout the community among teenagers as well. We set up a series of seminars with teenage clubs, which were very productive, with some adult input.

We held a workshop with discussion leaders, composed of people who went through our program. They were all discussion leaders on mental health, and what have you.

We were not successful in getting our ideas put across to the projected sponsors. We were told, "This is not mental health. These are social problems." We insisted they were mental health problems. We insisted if a person had on a tight shoe, his mental stability is affected also, especially if his feet was hurting.

A conflict developed, and in the end the community, under the Mental Health Act, rebelled and demanded the right to develop its own mental health service program and center. Because of certain people being in positions at that time, especially the commissioner of the New York State Department of Mental Hygiene and the leader of the NIHM region. Ând because they understood our position, they gave us terrific encouragement. They were first to recognize what we were trying to do and the first to give us recognition as an agency to develop the mental health center. In the meantime, this community had been working out of members' houses late into the night putting together a program of the proposal of the services it would like to see developed in the area. It was truly a community thing.

The task force developed a program, would come to a meeting and read the outline of what they had, there would be criticism from the meeting and back again to put the ideas across until finally we put together a proposal of the services we would like to see in the community, then we proceeded to demand that that proposal be accepted and late we began to develop the mental health project.

We proceeded toward our goal and again because of certain people in certain key positions and not meaning to embarrass anyone, I would like to name Dr. Miller, who was of terrific assistance, although he was not present there.

I would like to add the now commissioner of the Department of Mental Health, Dr. Christmas, was not in the position she is now, but she was participating in what we were doing. This was an encouragement that led us to think we had someone who would be useful and responsive to what we were trying to do despite the fact that the professional community in general was not in approval of us. Many times, people though we did not know what we were doing, and there are some current situations like that.

In many instances, we did not know what we were doing, but we knew what we wanted and we would know when we had it. That is what it was all about.

Well, the end result is that we now have the only, so far as we know at least, the only mental health center, and we can call it that now even though it is not officially named, that has a program developed by the community and a staff that has been hired by the community and is responable to the community, I think, in the country, possibly in the world.

You can believe what our director has told you. It is working. It is not directed to mental illness alone. Dr. Paster did not say last year the council sponsored two block parties. It was instrumental in assisting other block parties.

One of its projects now is getting people interested in co-op buildings through other sources we have and moneys available to them. We feel that the community has now begun to realize there is something it can do. It does not have to take what is left at all times. Again, we were lucky when we came up with a person with the sensitivity of our director, Dr. Paster. By the way, she is not the first director. We were not as successful with the first one. This is also along the lines of one of our frustrations, and one of the things that could have blown what we were trying to do. It gave us a black eye, saying we were nonprofessionals saying he, a professional, does not know what to do.

Let me say for the record, we did not say that our former director didn't know what he was doing. He may have known very well what he was doing. We said he was not doing what we wanted done. That is what happened. So, this is a community that knows what it wants and it is proceeding in that direction.

I can only say here that possibly we have been lucky. Again, in that we and certain people in key positions who recognized what they were doing, were sensitive to us and gave us the encouragement that was needed to get to where we are now.

Thank you.

Dr. MILLER. Thank you very much. I think the record will show the closer we get to the center in human terms the more meaning it has. This may turn out to be one of the richest testimonies this congressional committee will have the opportunity to consider.

I also note that both of them were saying as others have said in describing something of their own experience that the process of participation in itself was health-giving, and we are talking about a living organism and not something that is fixed but is changing, growing, struggling, flourishing.

The hour grows late. There are two more people I would like to call upon. It is now 11:52. I am told that we must adjourn this part of this session at 10 after 12 and just before that I want to make an announcement about this afternoon's session and further discussion.

I will have to ask the next two speakers if they would try to limit themselves to 7 or 8 minutes each if they can. I would like to call now on Dr. William Hart, who is the director of the Rochester, N. Y. Mental Health Center and I believe someone will be speaking for the National Association of Community Mental Health Centers. Dr. Hart. STATEMENT OF DR. WILLIAM HART, DIRECTOR, ROCHESTER MENTAL HEALTH CENTER, ROCHESTER, N.Y., IN BEHALF OF THE NATIONAL COUNCIL OF COMMUNITY MENTAL HEALTH CENTERS Dr. HART. I wish to thank Congressman Symington and Congressman Hastings for their able replacements. I think the previous speakers have really given the guts of the issue and I would like to add what I think are some of the technical issues we have to get to. As mentioned, I am director of the Rochester Mental Health Center and am representing the National Council of Community Mental Health Centers.

The Rochester Center is old as centers go. We are now in our 7th year of operation. In response to one of Congressman Hastings' questions earlier, this year, I believe we will run about 50 percent of our budget income, from medicaid. I don't know what the percent is throughout New York State but I guess it is getting up to that level. It may be that the center has to be in operation sometime before it does get to that level. I don't know why there is such a low amount across the country other than the length of operation and the way some States handle it. Along that line, our grant is down to about 10 to 12 percent so when you look as to where we are getting more Federal money, medicaid, probably accounts for 25 percent of our Federal funds while only 10 percent is via the categorical grant which I think may lead some to look to the future in terms of national health insurance and other methods of funding. As far as the mental health center is concerned, next year is our last year of funding and after that we could get along without the direct categorical grants.

In terms of the mental health movement, I think it is very important that the Mental Health Act be continued. I think it is absolutely necessary that grants be available for the development of new centers. I think without the Federal money the new centers will not develop. The Federal money is a third force in the community and creates an impact to develop idiosyncratic services to meet the needs of a particular community. Also, if new centers do not develop, if you look at New York State we are about 15 percent covered with new centers, but if new centers do not develop present centers will have a tendency to wither and die, and become quite a different thing from what they are. I do not think the present centers, because we are small in numbers, when you look at the whole country, can maintain the impetus for the mental health of the community and what it means.

Also the length of the grant should be extended to 11 years from 8 years to bridge to the national health insurance. Even though the centers in existence are small in number and cover a small percentage of the United States I think it is important they be preserved as the new centers come into being. The National Council of Community Mental Health Centers has a complete plan and outline of what they feel should be in the bill and to which I ascribe and copies are available of this. I think that the Federal money again might be characterized as preserving the independence of the centers. The Federal money has really allowed the development of voluntary nonprofit, nongovernmental centers. This is not attacking the Department of Mental Hygiene, or the city of New York in their operation, but I think their operations are strengthened by an independent agency that vies with them in some sense of the word, and in the long run strengthens them also.

Very briefly concerning unified services, I am sure the centers will, in the long run, have a very beneficial broadening, decentralizing effect on the implementation of the Unified Services Act. I think the kind of consultation and information from the community that the centers can bring will be very important in the implementation of this.

Another brief point-HMO health centers in the future may be the major source of funding for mental health services. The funds may very well come through health centers. Health centers in general

« AnteriorContinuar »