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FEDERAL AND CITIZEN ACTION FOR MENTAL HEALTH

BY

The Honorable John E. Fogarty
Representative, Second Congressional District, Rhode Island

For Delivery
November 18, 1965
to the
National Association for Mental Health, Inc.

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New York, New York
It is a personal pleasure for me to be here with you
this afternoon. Having had as one of my concerns the health
needs of our people, I am very much aware of the vital role
of volunteer health organizations such as fhe National
Association for Mental Health.

We who are in Congress as representatives of the people
must hear from the people, and I assure you that we do. We
hear from the people on a private basis and we Boar from the
people through organizations they have formed--such as yours--
to raise a strong, unified voice to problems they feel are
deserving of national attention.

I have been in Washington for more than 25 years now,
and I have seen that clear, united citizen action surrounding
any problem does impress the councils of the capital city.

In our democratic way of life--despite the doubtings of the
more cynical--there is no force greater than the echeereea

and collective voice of our citizens.

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As Chairman of the House Subcommittee dealing with
health matters, it has been my experience that the appearance
of witnesses at Congressional hearings is an important step
toward the adoption of progressive health measures.

A good deal of any legislator's time is and must be
devoted to getting at the facts of a situation. He must know
and understand very thoroughly any problem he is called to
act upon, and problems of health are no exception.

Representing as it does citizens and professionals
very closely attuned to mental health needs in our States and
communities, the National Association for Mental Health
has become a highly valuable and most sensitive listening
post. It is a listening post for those in legislative
positions at all levels of government who must deal with the
public health problem of mental illness.

But there is an important step beyond informing
appropriate committees of national health needs. That is,
the hard work of follow-up. Citizens who can follow through
by getting the facts to their own Congressman, and to their
State legislators, perform a vital service, both to the
cause they espouse, and to the governing bodies who require

elucidation.

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One illustration of highly effective action by this
Association was the work done to bring before the Congress
the need for Federal funds to aid in staffing the centers
in their early years. Following a timely Leadership
Conference held in Washington by the National Association for
Mental Health, many members of the Association apparently were
in direct touch with their Congressmen. The result was
that visibility was given to the need, and information helpful
to their considerations was available.

Fortunately, every State in the Nation now has or is in
the process of obtaining a record of facts about its mental
health needs and capacities for care and treatment. With
Federal aid, as part of the national mental health progran,
thousands upon thousands of volunteers and professional
people have participated in frank review and mental health
planning as a step upward ae away from neglect and blighted
conditions. These State plans will be a rich resource on
which to draw for vital guidelines to citizen action for
many years to come,

There is, indeed, so much to grasp and to act upon in

this great work ahead of us, I hope that I may be pardoned
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for mixing a little business with the pleasure of being here.
While I am more often in the position of absorbing facts
about Hie health of our Nation, I should like to reverse that
role for a moment, to convey to you some facts of interest
in the current stage of our Nation's mental health drive.
The first fact is one I have already suggested--the
high importance of citizen action as regards prevailing needs.
I cannot stress too Se the basic responsiveness of
governing See matter where they are--to popular causes.
The second fact is that no Federal health measure--
and this includes the vital provision of several key mental
health bills--can ever be the final fruit of our considerations.
The Federal Government can only seed developments. It cannot
of itself produce the harvest. This is true in every aspect
- of our national life, and it pertains sharply to the advancement
of health in America.
With Federal impetus, we can and have increased our
health research activities and knowledge. With Federal impetus,
we can and have greatly increased the Nation's supply of

health professionals. With Federal impetus, we can and have
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augmented facilities for treatment and penctice of preventive
measures. Our pcal after all, is not only to improve
treatment of mentally ill patients, but also to prevent the stains
of disorder that can spread over man's mind and his emotions.

The key word here is "impetus." It does not mean power,
it does not mean magic, or control, or supervision. It does
not even mean "money,'' although some people may disagree with

a

me on that. In Webster's dictionary, “impetus” means
driving force," an "incentive." That is what it means in
Congress, too.

When we vote for health measures and poprorrictione.
we have a picture in our minds, a visualization. We visualize
that the States and communities across the country will, with
this incentive, go on to accomplish the goal of our efforts:
that they will move ahead and actually implement the services,
the programs, the work that is so vitally needed. ‘

A case in point is the Community Mental Health Centers
Act of 1963. This Act provides Federal aid for constructing

community mental health centers during the next few years.

It provides allotments to the States for centers given priority
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by the States and approved for construction or expansion of
existing facilities.

But this aid can only seed a community mental health
movement that has been long overdue in this country. The
entire appropriation over the years for this purpose is limited
to $150 million, and while this is 4 valuable Gaccotive. 12
can be only that. The Federal funds must be matched and more
than matched by support at the State level and in localities.
State Community Mental Health Services Acts must be
strengthened, if and where necessary. Local taxation must be
reviewed and strengthened as a source of revenue for the
mental health services, if and where necessary. Private
sources for funds--such as voluntary health insurance plans and
community chest activities--must be brought right up to the
front lines in the battle against mental illness and stagnant
systems of treatment.

One of the great concerns of President Johnson as our
national leader has been the health of our people. While
the community mental health centers movement will and must

revise old ways of caring for the mentally sick, its greatest
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promise is as an instrument for the positive protection and
promotion of the mental health of citizens. The centers are
Ss become part of the community’s bastion against disease
and disability and, as such, are integral to the new community
aad social action programs of a Great Society.

The present Congress has recognized fully and acted
upon many meneures in light of our changing, expanding, and
urbanizing society. One of these is the recent Amendment to
the Community Mental Health Centers Act. This new Amendment
provides Federal aid for staffing the centers in their initial
years. But here again, this seeentied aid is and must be
limited. It is to be made available on a percentage basis,
and only in the early years of the centers, to help them get
underway.

The third fact I should like to submit is, I fear, not
quite as rousing as the one concerning the importance of
citizen action. Nor is it quite as heartening as is the
Federal impetus toward correctives in the mental health field.
It is a truth grimmer, i: itely grimmer, than any recital of .

our mutual responsibilities
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The truth is that we in our affluence have simply not
taken adequate care of our mentally and emotionally troubled
citizens. We have not taken care of our disturbed children.

We have not taken care of our troubled adolescents. We have

not taken care of our elderly whose mental health may be failing.
We have not taken care of the problems of alcoholism, of

suicide, of drug addiction.

Now, we may assert, and properly so, that some problems
of society and of the human being are and always have been
universal. The shame is not that these problems are present,
but that we have not exercised the use of our modern Knowledge,
the use of our modern prosperity, the use of our modern
benefits either to reduce the incidence ee problems,
or to take enlightened, humane care of them once they have
had their dark influence.

It is sometimes useful to cite national statistics.
Figures from the National Institute of Mental Health, for
example, reveal an alarming national record on care of
emotionally disturbed children and young people. Mental

hospital statistics show a marked increase in the number of
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young patients. From 1950 to 1960 the first admission rates
in State and county mental hospitals for children under 15
rose from 10.4 per 100,000 Soulation to 21.5. The rates
for youths between 15 and 24 rose from 58.8 per 100,000 to
19.3.

But stronger still than these figures is the sight of
one child, one single family, one single person who needs
care and treatment and who needs it badly and cannot get it
because it is not to be had in his community.

Stronger still than the number 60,000, which represents
the toll of drug addiction in our cities--and, incidentally,
represents also an insidious crime potential--is the sight of
one drug-ridden human being whose internal problems, often
both mental and physical, are so complex as almost to defy
real assistance. Yet, as with other areas of human breakdown,
mental health authorities have advised us again and again
that while services and treatments and help cannot be the
ultimate and the perfect or a cure of magic, services can
and do help to reduce disability and to reverse the tragic

outcome of utter negligence.
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For some mental health problems, figures are available
in abundance, such as the rise in admissions to mental
hospitals. Other problems do not lend themselves to national
computerizing. In any case, it is the individual, the family
who is affected by tragedies of mental and emotional disarray
who supply the strongest evidence of our need for action.

Finally, I should like to submit for your consideration
a brief review of the present opportunities to respond vigorously
and courageously and effectively to our country's mental health
needs.

The community mental health legislation to which I have
referred is an opportunity and a challenge. It can be a
driving force toward revolutionizing the care, treatment and
prevention of the mental illnesses in this country.

The new Social Security Amendments known as "Medicare"
are an opportunity and a challenge. Under this law, persons
over 65 can have within their reach the dignity of proper care
in general or mental hospitals, and proper care in rehabilitative
services. Benefits for the mental illnesses are provided

through two plans--a basic plan and a voluntary insurance plan
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which may be chosen under Medicare in addition to the basic
coverage. I would urge all those who are working in the mental
health field to acquaint themselves with these provisions
fully.

And there ce Federal programs--such as those
in the fields of education, of vocational rehabilitation, and
of mental retardation which when seen as a whole can be
linked together in service to our people. They can be linked
where it counts most--at the community level. They can be
activated in harmony with one another. They can be implemented
through the work and cooperation of all groups in the community--
whether volunteer or professional, whether medical or
religious or educational, whether ares public or private.
If there is one over-riding fact I would leave with
you today, it is that we have now, all of us, moved into a
second stage, if oa, of our mental health developments.
We have moved beyond cangie. unilateral considerations. To
consider mental health today is to consider all of the
community's opportunities and potentials. It is to work not
only within one organization--vital as the work is--but to

work hand-in-hand with whatever group and organization,
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whatever planners, legislators, and citizens can help bring
about the kind of mental health care and services we all
envision for our country.

I have presumed, with a quarter-century of service in
the Congress, to feel somewhat like a veteran as regards
our Nation's mental health problems. But, in a sense, none
of us are veterans--not even the National Association for
Mental Health with its long, proud history of service to the
‘American people. Even we are neophytes, newcomers in the
growing movement to bring adequate mental health care to this
Nation. We are novices in the ranks because our greatest
challenges--as well as our greatest opportunities--still lie

ahead: yet to be acted upon and yet to be achieved.

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