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Mr. HASTINGS. One other question. HEW testified there are 35 State legislatures working on, I assume, supplying more funding to community mental health centers. Have you any information where these legislatures are at the moment, how many you expect to act?

Mr. MORRIS. No, we don't have this information. We can try to gather it for the committee if it would be useful. The only thing we have is something we submitted for the record; that is a report from various community health centers that will be losing their continuation grants in the next several years or are not going to get staffing grants they once hoped they would get, because of the staffing practice on the part of the administration.

These reports indicate they are having a hard time finding alternative sources of funding. To what extent they have gone to the legislature and tried to stimulate a constructive program for that State, I don't know.

Mr. HASTINGS. I think it would be extremely helpful to this subcommittee in subsequent considerations to have that information available. I would think your national organization would be the best possible place to get that information.

Mr. MORRIS. We will try to get it.

[The following information was received for the record:]


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Mr. HASTINGS. Thank you, Mr. Chairman.

Mr. ROGERS. Dr. Roy.

Mr. Roy. I think most of the questions I would ask have been asked. Do you feel, any of you, that we will continue to have development of new community mental health centers after the discontinuation of the act? If so, will this be on the same level that we have seen over the last few years or less? How do you see the situation?

Mr. MORRIS. Perhaps I can respond initially. You say: After the act is continued

Mr. Ror. Discontinued, if indeed it is. If we follow the administration's recommendations, what is your feeling versus their feeling? Or is your feeling the same as theirs that we have established such a good thing, it will carry on of its own momentum?

Mr. MORRIS. It is clear to us, from the information we have gathered, some programs may grow into the comprehensive status without Federal support, but the number will be very limited; it will be spotty, and the resources of the Federal Government just are necessary to bring about the comprehensive programs in most cases.

I think it is clear, from the administration's testimony this morning and from earlier conversations we have had with them, that they are basing their judgment on dollars materializing; it is an act of faith they are proposing here, and there is no firm information that these dollars will develop.

Part of the problem we see also is that not so many programs will continue to develop in the comprehensive sense. We want to reach the total national coverage we were seeking, but the standardization, if I may use that word, that comes from the Federal Government's being involved in this program will no longer be there.

So what you end up with, if you do yield the stimulating authority to the States, in fact is 50 different community mental health programs that many differ dramatically from State to State.

Mr. EDIGER. In Kansas, we practically have half of the comprehensive centers we probably ought to have, and I know at least three or four areas in which it is a live issue. If we had the continued staffing act, I am certain they would be coming in, in the next year or two. Without Federal staffing act money, I can see some might add a little better arrangement with the general hospital and maybe even have a day hospital of a type, but I think there is a big difference between that and making the commitment to become a comprehensive center which is seeking to maintain people outside the hospital-in other words, the building of a new system.

I think this is where the staffing act has been such a tremendous boon and, even though there may be shortcomings to the five required services, this has been very helpful to have this kind of structure which centers have to think with to provide the alternative to the hospital situation.

Dr. DIAMOND. I don't see how we could have gotten underway and achieved what we have without the Federal input.

Mr. Roy. I want to add one thing. I think your testimony, Mr. Ediger, makes all Kansans proud of the fact you are a Kansan. I know of the job you have done in Newton, and we are extremely proud of the job done down there.

I have no further questions, Mr. Chairman.

Mr. ROGERS. Mr. Nelsen.

Mr. NELSEN. To the gentleman from Kansas, I know, in your testimony before lunch, your State was not supporting your activity. Is that true with all of the centers in Kansas?

Mr. EDIGER. Our State has permissive legislation for the counties to assess themselves up to a half-mill. Our State puts in some matching money for title 19.

Mr. NELSEN. What is title 19?

Mr. EDIGER. Medicaid. Outside of that, our State mental health dollar goes entirely to State hospitals. We want no State funding system. We have a State legislative study committee in the State legislature that is being talked about, but we don't see any additional funds for the next couple of years.

Mr. NELSEN. It seems to me the State ought to have enough interest to be putting some money into a plan or program of this kind. Most States do. I think this is a point that needs to be emphasized-that is, that the Federal Government alone can't do it if the States are not in there helping. It would seem to me the State of Kansas better get with it. I will recommend to my colleague Dr. Roy that he go back home and give them the needle.

Mr. Roy. If the gentleman will yield, if you look back over the last 20 or 30 years, Kansas has been one of the leaders as far as mental health is concerned. Although they may not be appropriating as much money as we would like, I think the record is a good one.

Mr. NELSEN. I demand equal time to rebut. Minnesota is ahead of Kansas. Thank you.

Mr. ROGERS. I might say this is one of the problems we are faced with. You see, the administration is recommending that we don't have any input and let it go strictly by whatever a State may want. The State of Kansas is obviously putting money in the State hospitals. They are supporting the State hospitals. That is not always the best way, so the local communities have to come in, encouraged by the Federal Government with a little seed money. And look at what a great result we have had.

Maybe the States don't always make the right decisions by keeping big State hospitals. Maybe it has been an encouragement for communities to have the mental health program.

Thank you.

[The following letter and attachments were received for the record:]



Chairman, Public Health and Environment Subcommittee,
U.S. House of Representatives,
Washington, D.C.

DEAR MR. CHAIRMAN: During the Oversight Hearings on the Community Mental Health Centers Act, May 9th, you expressed interest in the extent to which CMHC's have been able to obtain funding through general revenue sharing. At that time you requested information from HEW on centers which had actually received this funding.

Enclosed for your information is a list of the centers which reported to NCCMHC that they have received such funding, and the amount of that funding where this is known together with other comments made by the centers. As you

can see, unfortunately Revenue Sharing has not greatly increased the amount of money available to CMHC's.

Also enclosed is a copy of the full summary of the NCCMHC survey on Revenue Sharing.

We would like to request that these materials be included in the record of the Oversight Hearings.


Executive Director.




General revenue sharing funds disbursed in 1972 and early 1973 have been allocated by states and local governmental units for support of 21 community mental health center programs. Another 29 centers are still hopeful that they might receive some of this funding.

On a national basis, however, revenue sharing has not contributed a significant amount to community mental health centers, despite fairly vigorous efforts by centers to tap these funds.

These facts emerge from an analysis of the National Council's survey of members regarding the use of funds distributed to states and localities under PL 92-512 (General Revenue Sharing Act).

Out of a total of approximately 290 agencies surveyed, responses were received from 220 (75.8 per cent response rate). Centers responding represent 57 per cent of all operational federally funded centers. Of these respondents, 73 per cent had contacted either their state or local government (or both) in an attempt to tap this new source of funding.

Twenty-one centers received some funding through this mechanism, twenty of them from their local government's allocation, and one via the state. In general, those centers which made contacts with more than one agency at the state level, or with both their state and local government units (in other words those that made the greatest effort) were more successful in obtaining funding.

Revenue sharing dollars will be used by these centers for a variety of purposes, from operating expenses and capital outlays to initiation of new specialized programs, and replacement of Title IV-A (Social Security Act) funds or federal staffing grants which will be terminating shortly.

The success rate for centers seeking these funds is approximately 15 per cent (i.e. 15 per cent of those contacting states and localities have actually received financial assistance through revenue sharing). Several factors appear to account for this:

A general reluctance on the part of most state and local governments to fund on-going program efforts (most general revenue sharing funds are being allocated for capital outlays and other one-shot expenditures).

Widespread use of revenue sharing funds to reduce state and local taxes or to prevent the necessity of a tax increase.

Confusion among local officials as to the eligibility of center programs for aid (see earlier memos on this subject Centers are eligible for assistance, although Revenue Sharing Funds Cannot be Used to Match a Federal Grant).

Competition between high priority needs and the fact that at the local level mental health often does not have a particularly high priority.

Overlapping local jurisdictional boundaries, which often means that centers serving more than one local jurisdiction have had difficulty in raising support via revenue sharing from one locality if services funded are to be offered to residents of other localities.

As information comes in to Washington as to how states and localities are spending these funds it is clear that a 15 per cent success rate for community mental health centers is fairly significant. A recent survey by the Advisory Commission on Intergovernmental Relations shows that only 24 per cent of state budget officers and 32 per cent of county officials plan to use these funds for recurring expenses. The fact that there is uncertainty as to the future of revenue sharing was cited as having an important bearing on their decisions.

The amount of support available to centers from revenue sharing sources varies widely-from $330,000 for a construction project to less than $2,000 in some instances (a full listing of the dollars contributed is not available as this information was not asked for specifically on the survey.)

Below is a full summary of the 220 responses received on use of revenue sharing funds.


The great majority of survey respondents (73 per cent) had contacted either their local governmental unit or a state agency in an attempt to obtain revenue sharing dollars. Over a third of the centers had contacted both their local government and one or more state agencies.

Responses on contacts made with state and local agencies breakdown as follows:

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Most of those centers pursuing revenue sharing funds made contact with their local government, while a much lower percentage (37 per cent) contacted state agencies or legislators. This may reflect the fact that there is more money made available to localities under general revenue sharing (two-thirds of the amount authorized goes to local governments, and one-third to the states), and also the fact that states have been slower to appropriate these funds.


Almost without exception, centers pursuing state allocations of revenue sharing funds contacted the mental health department or state agency with responsibility for mental health and social services.

Most centers also concentrated their efforts on just one state agency, although a few had contacted several different agencies, the governor's office and/or state legislators.

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Out of a total of 220 respondents, 151 of which had attempted to tap this source of revenue only 21 centers received any assistance under general revenue sharing (10 per cent of respondents; 14.9 per cent of those requesting assistance).

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