June 30, 1970
Page 22233
STATEMENT BY SENATOR EDMUND S. MUSKIE IN SUPPORT OF APPROPRIATIONS FOR STAFFING OF COMMUNITY MENTAL HEALTH CENTERS
As a member of the U.S. Senate Committee on Aging and Chairman of the Subcommittee on Health of the Elderly, I am most concerned about the low level of funding requested for the staffing of Community Mental Health Centers.
The Administration is requesting $60,100,000 for staffing grants to Community Mental Health Centers in 1971, an increase of $12,550,000 over the 1970 estimate. However, because of the low level of funding appropriated to Community Mental Health Centers in 1970, the National Institutes of Mental Health has informed the Committee on Aging that they now have $20,000,000 more approved applications for staffing grants than they can fund.
The proposed $60,100,000 will provide only continuation grants to those centers with staffing grants already in operation. No funds have been proposed for new projects.
This has serious implications for the elderly in this Nation who are suffering from varying degrees of mental disorders.
Of the 165 centers now in operation throughout the country, only 30 have special geriatric programs. It is safe to assume that the elderly are already on the low end of the priority ladder in Community Mental Health programs.
This may be true because it is very difficult to recruit trained professionals to work with older mentally ill individuals. The cure is less dramatic, the treatment of an older person makes heavy demands on the time and patience of workers, therapeutic gains are usually smaller and the mental illness is often complicated by chronic physical ailments.
It takes time to discover what is troubling an older person – perhaps he is hard of hearing and the psychiatrist has to repeat his questions many times, his so-called "hallucinations" may in fact be due to an advanced state of undetected diabetes; his "wanderings" and loss of memory may be the result of brain damage caused by a stroke.
Obviously, specialized treatment programs are necessary for these older patients. Some already in practice in the 30 centers with geriatric programs include: Sheltered workshops which help provide the older patient with a sense of usefulness and worth, coordinated medical and psychiatric treatment in order to determine the degree of actual mental disorder and the extent of physical illness, and intensive outreach services to find mentally impaired older citizens in the community, and make them aware of this service.
Outreach is a most important component of any service program for recent studies indicate that the elderly may be less likely to make use of Community Mental Health Centers than younger persons. The National Institute of Mental Health reports that anywhere from 15 to 25 percent of elderly persons living in their own residences have some degree of mental disorder and that a minimum of 8 percent of these individuals are known to be severely disturbed. Yet, the number of aged persons using outpatient psychiatric clinic services is only 2 percent of, the overall population.
There are some good reasons for this underutilization. First, older people are frightened and embarrassed at the thought of being treated for mental problems. Second, many, especially the poor and the isolated are unaware that the services exist. And third, the same problems keep older people from taking advantage of these services which keep them from participating in other social programs: lack of income and poor transportation facilities.
Lack of adequate staffing for community mental health centers can create the greatest difficulties of all.
In far too many instances, the elderly person, directed to a local community health center by family or friends, arrives at that center only to wait for hours for an appointment. After a cursory examination by a psychiatrist or psychiatric social worker, who probably has no knowledge of geriatric psychiatry and who is overworked because the center is understaffed, the professional decides that there is nothing that he can do except perhaps prescribe tranquilizers for "depression" as the elderly person is, in his opinion, hopelessly "senile."
The professional, unfamiliar with geriatric psychiatry, does not ask about eating habits, social contacts, living conditions, or physical health – nor does anyone else at the center. This is not due to unfeeling negligence on the part of the staff. It happens all over the country in every outpatient psychiatric clinic or mental health center where there is not a specialized geriatric program simply because no one on the staff is trained to work with older people.
The elderly individual leaves the center discouraged and humiliated, without having his problems acknowledged or alleviated. He is not likely to return to that clinic should his condition worsen; he is much more likely to end up in a state mental hospital or nursing home at great expense to State and Federal government.
We must also consider the relationship between the lack of adequate community mental health centers and the increasing efforts of State mental hospitals to rehabilitate elderly patients. In the past ten years, most have stopped the practice of "dumping" older patients into back wards to languish with no care for years. They are making great efforts to get these patients back into the community.
This is a most welcome development; however we must consider what "community" means to the older person who has spent years in a mental hospital.
Because there is often no place in the outside community where an older mental patient can continue his rehabilitative treatment, to him the "community" means a nursing home where he more than likely receives custodial care – that is, no care. Thus, all of the rehabilitative efforts by the State hospital are wasted and the patient finds himself, in effect, in another back ward.
The National Institute of Mental Health estimates that 55% of the residents in nursing homes and related facilities serving the chronically ill are mentally impaired. In researching a forthcoming report on Mental Health and the Elderly, the Committee on Aging staff found that this may well be a conservative estimate. When asked by the Committee staff for the number of mentally impaired persons residing in their facilities, several nursing home administrators replied that at least 75%" of the patient population was mentally impaired to some degree and that 25 - 40 % were severely disturbed.
Many of these people could be treated in the community – if there were facilities in the community to treat them.
The Community Mental Health Centers were meant to be just such facilities. If the Centers were adequately staffed with trained personnel, thousands of Federal and State dollars could be saved in institutional care alone. Hundreds of thousands of individuals – young and old – could be saved from the agony of mental illness.
When I talk about saving the State and Federal Government thousands of dollars, it is not wishful thinking. The most recent estimated cost of mental illness in the United States – 1963 – was $7 billion of the total cost of all illness. More than $2 billion was spent directly for hospital and physician services and the remaining $5 billion represents estimated economic losses in productivity of persons who died or became disabled as a result of mental illness.
As of mid-1963 in the United States, about 292,000 persons aged 65 and over with mental disorders were resident in long-stay institutions – state mental hospitals, homes for the aged, nursing homes and convalescent hospitals. The only place that number has decreased has been the State mental hospital. All other long-stay facilities have increased their mentally ill aged population.
State and Federal Governments are providing expensive institutional care for a great many elderly persons who could be cared for while living in their own residences if there were adequately staffed Community Mental Health Centers to assist them.
Although as Chairman of the Subcommittee on Health of the Elderly, I am particularly concerned with problems of the aged, we must not forget that limited funding for Community Mental Health Centers will affect all age groups.
The Administration proposal calls for no new projects for 1971. The meaning is clear – no new services for the elderly, children, teenagers, young mothers or workingmen.
When we consider the mounting stresses of day-to-day living in our society today, we cannot afford to deny the care we have promised.
I urge that the level of funding for staffing of Community Mental Health Centers be raised to fund at least $20,000,000 worth of approved applications for staffing grants and the development of new projects for older Americans suffering from mental disorders. Only then will the Community Mental Health Centers Act be properly implemented.