Planning for Community Mental Health Centers, Thesis of Nursing

Download Planning for Community Mental Health Centers and more Thesis Nursing in PDF only on Docsity! In presenting the dissertation as a partial fulfillment of the requirements for an advanced degree from the Georgia Institute of Technology, I agree that the Library of the Institute shall make it available for inspection and circulation in accordance with its regulations governing materials of this type. I agree that permission to copy from, or to publish from, this dissertation may "be g r a n t e d by the professor under whose direction it was written, or, in his absence, by the Dean of the Graduate Division when such copying or publication is solely for scholarly purposes and does not involve potential financial gain. It is under­ stood that any copying from, or publication of, this dis­ sertation which involves potential financial gain will not be allowed without written permission. 3/11/65 b PLANNING FOR COMMUNITY MENTAL HEALTH CENTERS A THESIS Presented to The Faculty of the Graduate Division by Phillip E 8 Ogle In Partial Fulfillment of the Requirements for the Degree Master of City Planning Georgia Institute of Technology Augustj 1966 i i i TABLE OF CONTENTS P a g e ACKNOWLEDGMENTS . . „ . . . . , . . . - . . . . . . * . . . . o i i LIST OF TABLES „ . v SUMMARY . . . . . . , . . c o c . . o . . , . o . . o . , o . o v i CHAPTER I . INTRODUCTION , . • . . . . . . . . . . . . . . . . . • . 1 T h e Communi ty M e n t a l H e a l t h C e n t e r s A c t S t a t e F i n a n c i a l A s s i s t a n c e P u r p o s e and S c o p e o f S t u d y I I . COMMUNITY MENTAL HEALTH CENTERS , . 4 S e r v i c e s O f f e r e d I n p a t i e n t C a r e O u t p a t i e n t C a r e E m e r g e n c y T r e a t m e n t P a r t i a l H o s p i t a l i z a t i o n C o n s u l t a t i o n and E d u c a t i o n P e r s o n s t o Whom S e r v i c e s A r e Made A v a i l a b l e M e t h o d s o f T r e a t m e n t P e r s o n n e l A d u l t Teams A l c o h o l i s m Teams C h i l d r e n ' s Team B u i l d i n g and F a c i l i t i e s I I I . STATE PLANNING FOR COMMUNITY MENTAL HEALTH CENTERS , , . 11 D e s i g n a t i n g S e r v i c e A r e a s o f C e n t e r s L o c a t i n g C e n t e r s W i t h i n t h e S e r v i c e A r e a s A c c e s s i b i l i t y t o t h e P o p u l a t i o n E x t e n t and D i s t r i b u t i o n o f M e n t a l I l l n e s s A v a i l a b i l i t y o f F a c i l i t i e s and P e r s o n n e l C o m m u n i t y I n t e r e s t and P a r t i c i p a t i o n E s t a b l i s h i n g P r i o r i t i e s f o r C o n s t r u c t i o n o f C e n t e r s I V . LOCAL PLANNING FOR COMMUNITY MENTAL HEALTH CENTERS . . . 16 S e l e c t i n g t h e L o c a l M e n t a l H e a l t h A g e n c y C i t y o r C o u n t y G e n e r a l H o s p i t a l s iv TABLE OF CONTENTS (Continued) CHAPTER Page Local Health Departments State System of Mental Hospitals Nonprofit Organizations Housing the Center's Services Housing Services in General Hospitals Housing Services Separate from Financing the Center's Operation Appropriations from Local Governments Gifts Patients General Hospitals APPENDIX 30 LITERATURE CITED 32 OTHER REFERENCES 33 V LIST OF TABLES Table Page 1. Desirable Floor Space Requirements of a Community Mental Health Center 9 2. Location Characteristics of Eleven Proposed Community Mental Health Centers „ = . . . « , „ 24 J CHAPTER I INTRODUCTION Historically, the treatment of the mentally ill has been inadequate and ineffective. Most mentally ill persons were sent to large state mental hospitals where treatment was primarily custodial. The Federal Government has recognized the need for improved mental health facilities and more effective treatment of the mental 1 y iii. by making funds available to com­ munities for establishing community mental health centers. The Community Mental Health Centers Act In 1963, Congress enacted the Community Mental Health Centers Act (Title II of Public Law 88-164), which authorized grants totaling $150 million for construction of public and other nonprofit mental health cen­ ters. Authorizations include: j>35 million for the fiscal year ending June 30, 1965; $50 million for the fiscal year ending June 30, 1966; and $65 million for the fiscal year ending June 30, 1967.^ These funds may be used to finance the construction of new buildings and to expand, remodel, or alter existing buildings. Funds are awarded through states to communities as grants-in-aid for up to two-thirds of the construction costs of the centers,, The Secretary of Health, Education, and Welfare makes allotments to states based on: (l) population; (2) the need for facilities; and (3) the financial needs of the states. Allotments have ranged from $100,000 in five states to about $2.7 million in New York in 1965. In 1965, Congress adopted Public Law 89-105, which amended the Community Mental Health Centers Act of 1963. The 1965 amendment authorized funds to meet the costs of technical and professional personnel serving in new, nonprofit mental health centers and to meet staffing costs of new services added to existing mental health facilities. The Act authorized grants totaling: $19.5 million for the fiscal year 1966; $24 million for the fiscal year 1967, and $30 million for the fiscal year 3 1968- The funds may be used to meet staffing costs for the first 51 months in which a community mental health center is in operation. The Secretary of Health, Education and Welfare is authorized to make grants not exceeding 75 per cent of staff costs in the first 15 months of opera­ tion, 60 per cent in the next 12 months, 45 per cent in the next 12 months, and 30 per cent in the last 12 months. State Financial Assistance Since Federal funds may be used only to finance construction and staffing costs, the states are partly responsible for assisting communities in meeting the operational costs of the centers. At the present time, 25 states have Community Mental Health Services Acts which provide matching grants to communities for specified types of 4 local mental health services. A list of states having these Acts may be found in Appendix A. Purpose and Scope of Study Assuming adequate financial support and the necessary supply of trained mental health manpower, it is estimated that 500 to 700 centers may be built by 1970. The purpose of this study is to provide a guide for the planning of centers in states and communities. 3 Chapter II describes the operation of a community mental health center,, Chapter I I I describes a program for the preparation of a state mental health centers plan. Chapter IV presents a guide for the plan­ ning of centers at the community level. 6 and clergymen, and to local agencies such as schools, public health departments, police, courts, and welfare departments concerning the emotional problems of individuals with whom they deal. Public educa­ tion is carried out by the use of: (l) newspapers, radio, and television; (2) speeches before local groups and organizations; and (3) seminars, lectures, and training institutes. Persons to Whom Services are Made Available Any person in the community needing mental health treatment and care may take advantage of the center's services. The center will pro­ vide treatment to persons whether they have acute emotional illnesses, mild neuroses, or minor emotional reactions to such things as marriage difficulties, new jobs, and new additions to the family. Many of the persons served by the center are adults, including special services for alcoholics and drug addicts. Also, special services are provided to elderly persons, A unit of the center provides services to children, including juvenile delinquents. In addition, the center provides diag­ nostic and counseling services to the mentally retarded and their families. Methods of Treatment The methods of treatment provided in a community mental health center involve whatever is necessary to cure patients of emotional dis­ orders. Treatment programs include individual psychotherapy, group psychotherapy, psychiatric drugs, electro-shock, resocialization and a variety of ancillary therapies such as recreational and occupational therapy. A patient may receive one or several methods of treatment, depending on the seriousness of his mental disorder. 7 Personnel To provide services, the center will require a wide range of profes­ sional, technical, clerical, and other types of personnel. Needed pro­ fessional personnel included psychiatrists, general practitioners and other physicians, clinical psychologists, psychiatric nurses and psychiatric social workers. Technical personnel include psychiatric aides and tech­ nicians, physical therapists, occupational therapists, recreational ther­ apists, vocational counselors, and group workers. If the center is engaged in extensive research, special personnel such as biochemists and statisti­ cians are also needed. Clerks, typists, and other clerical staff are needed for reception work, typing, filing, and record keeping. In addition, various other staff members such as dieticians and janitors are needed for the operation of the center. An effective method of organizing personnel to effectively and efficiently provide services is to divide available personnel into teams. Normally, the personnel of a center can be divided into three team cate­ gories: (l) adult teams; (2) alcoholism teams; and (3) children's teams. Adult Teams Several adult teams will be needed since each team is responsible for patients in a specific geographic area of the community. Although the number of teams depends on the size of the center's service area, three or four adult teams are usually sufficient. Each adult team should be headed by a psychiatrist. The team should include a social work supervisor and two or three social caseworkers. Sev­ eral nurses, including practical nurses and psychiatric aides are also needed along with recreational aides, a psychologist, and a vocational counselor. Clerical personnel consists of a chief clerk and typist who assume reception and clerical duties, typing, and record keeping. 8 A l c o h o l i s m Team T h e a l c o h o l i s m t eam i s r e s p o n s i b l e f o r t r e a t i n g a l l a l c o h o l i c s i n t h e s e r v i c e a r e a and s h o u l d b e h e a d e d b y a p s y c h i a t r i s t o r p h y s i c i a n . A d d i ­ t i o n a l p e r s o n n e l c o n s i s t s o f a p s y c h o l o g i s t , p s y c h i a t r i c s o c i a l w o r k e r s , , n u r s e s , and v o c a t i o n a l c o u n s e l o r s . A l s o , s t u d e n t t r a i n e e s s u c h a s p s y c h i a ­ t r i c r e s i d e n t s and d i v i n i t y s c h o o l p o s t - g r a d u a t e s c o u l d b e u s e d 0 C l e r i c a l s t a f f s h o u l d i n c l u d e t h e same p e r s o n n e l a s t h a t o f t h e a d u l t t e a m . C h i l d r e n ' s Team T h i s t eam i s r e s p o n s i b l e f o r a l l e m o t i o n a l l y d i s t u r b e d c h i l d r e n i n t h e c e n t e r ' s s e r v i c e a r e a and s h o u l d b e h e a d e d b y a c h i l d p s y c h i a t r i s t c O t h e r c h i l d p s y c h i a t r i s t s s h o u l d a l s o b e o n t h e t e a m . O t h e r t eam member i n c l u d e p s y c h o l o g i s t s , s o c i a l c a s e w o r k e r s , t e a c h e r - t h e r a p i s t s , and p e d i a - t r i c i a n s o V o l u n t e e r w o r k e r s may a s sume r e c e p t i o n r o o m and b a b y s i t t i n g d u t i e s , c e r t a i n c l e r i c a l f u n c t i o n s , and v a r i o u s p l a y and s c h o o l a c t i v i t i e s , , C l e r i c a l w o r k e r s s i m i l a r t o t h o s e i n t h e a d u l t and a l c o h o l i s m t e a m s s h o u l d b e i n c l u d e d o B u i l d i n g and F a c i l i t i e s M o d e r n c o m m u n i t y m e n t a l h e a l t h c e n t e r b u i l d i n g s a r e a d e p a r t u r e f r o m t h e d r a b j c u s t o d i a l a p p e a r a n c e o f m o s t e x i s t i n g m e n t a l h e a l t h f a c i l ­ i t i e s . Many o f t h e c e n t e r ' s b u i l d i n g s a r e m o d e r n i n d e s i g n and a r e s i t u a ­ t e d on l a r g e s i t e s c The c e n t e r s c o n t a i n m o d e r n f a c i l i t i e s and e q u i p m e n t f o r t r e a t m e n t and c a r e o f t h e m e n t a l l y i l l . T a b l e 1 s h o w s t h e m a j o r a c t i v i t y a r e a s and d e s i r a b l e f l o o r s p a c e r e q u i r e m e n t s o f a p r o p o s e d c o m m u n i t y m e n t a l h e a l t h c e n t e r 0 I n t h i s e x a m ­ p l e , a l l s e r v i c e s w i l l b e h o u s e d i n a s i n g l e , new b u i l d i n g . The c e n t e r i s s i t u a t e d o n a s i t e o f 2 , 1 a c r e s i n a l a r g e c i t y . A p p r o x i m a t e l y 3 0 , 0 0 0 s q u a r e f e e t o f p a r k i n g s p a c e i s p r o v i d e d on t h e s i t e t o a c c o m m o d a t e 6 8 a u t o m o b i l e s . The c e n t e r c o n t a i n s n i n e m a j o r a c t i v i t y a r e a s . T h e f i r s t o f t h e s e a r e a s i s t h e r e c e p t i o n - a d m i n i s t r a t i o n a r e a , w h i c h c o n t a i n s a CHAPTER III STATE PLANNING FOR COMMUNITY MENTAL HEALTH CENTERS All states are preparing plans for community mental health cen­ ters in accordance with Public Law 88-164, The agency preparing the plan in most states is the state mental health agency or the agency respon­ sible for the Hill-Burton medical facilities program. State community mental health center plans must be approved by the Secretary of Health, Education, and Welfare, The Secretary has estab­ lished broad policies and procedures to regulate the states in the plan^ ning and construction of the centers. Individual construction applica­ tions must be approved by the Surgeon General, A comprehensive state mental health centers plan should recommend a network of centers accessible to the entire population of the state and furnishing adequate treatment and care for those in need. To accomplish this objective requires that the state community mental health center planning agency: (l) designate service areas of the centers; (2) recom­ mend the location of centers within each service areaj and (3) establish priorities for construction of the centers. Designating Service Areas of Centers Each state should be divided into community mental health center service areas covering the entire state. If the state is receiving federal construction funds under Public Law 184, each center's service area must serve a population of not less than 7 b , 0 0 0 and not more than 1 2 0 0 , 0 0 0 persons* Some of the service areas may be only a portion of one city or all of a city. Other service areas may contain several counties, one county, or a portion of a county., Locating Centers Within the Service Areas After the state has been divided into service areas, the state center planning agency should recommend appropriate locations for com­ munity mental health centers within each service areao Factors to be considered in locating the centers are; (l) accessibility to the popu­ lation; ( 2 ) extent and distribution of mental illness; ( 3 ) availability of facilities and personnel; and (4) community interest and participa­ tion,, AccessibilitY to the Population Centers should be highly accessible to the population., In many cases this may mean the location of centers in areas having large popula­ tions and high population densities,, Moreover, the centers should be located to take advantage of: (l) available transportation facilities; and (2) travel patterns and travel times between retail trading areas, educa­ tional, religious and recreational facilities, medical and mental health facilities, and major centers of employment. Extent and Distribution of Mental Illness Centers should be located in areas having large numbers of mental illness cases 0 Therefore, the extent and distribution of mental illness should be estimated within each service area 0 The first step in estimating the extent and distribution of mental illness is a tabulation of the diagnosed cases of mental illness within the state 0 The number, types, and locations of diagnosed cases are ] 3 obtained from the records of psychiatrists and other professionals in private practice, general psychiatric hospitals, outpatient clinics, and other facilities in which the mentally ill are treatedo Estimating the extent and distribution of mental illness also requires a tabulation of people having emotional disorders which have not been diagnosed and treated,, These persons have disruptive problems such as poor adjustment to school, antisocial behavior, alcoholism, damaging emotional reactions to physical illness, marital difficulties and unemployment. Information about these people may be obtained from school counselors, nursing and foster homes, rehabilitation agencies, departments of probation and correction, the courts, police departments, family and social agencies, and health and welfare departments,, The number and types of diagnosed and undiagnosed cases of mental illness should be tabulated for each service area in the state and put on a map to show the distribution of mental illness within service areas. These data will indicate the portion of the service areas containing the greatest number of mental illness cases» Availability of Facilities and Personnel The location of centers will be influenced by the availability of mental health facilities and personnel. Communities within the service area not having adequate facilities and personnel are logical choices for center locations, since these communities have the greatest need for mental health facilities and services. It is desirable that a com­ munity which is selected as a center's site have some type of mental health facilities and personnel to serve as a basis for establishing a center, A survey should be made of all public and private facilities in I 6 CHAPTER IV LOCAL PLANNING FOR COMMUNITY MENTAL HEALTH CENTERS Local planning for community mental health centers involves three essential steps; (l) selecting an agency to operate the center; ( 2 ) housing the center's services; and (3) financing the center's operation. Selecting the Local Mental Health Agency Each community should select the appropriate agency or agencies to provide the services of the center. The elements of service offered by a community mental health center need not be under one r o o f or a single g sponsorship. Agencies assuming responsibility for the local center's program can be a combination of public and private agencies which most effectively meets the needs of the community. Services of a community mental health center may be provided by city or county general hospitals, by local health departments, by the state mental hospital system, by non~ L profit organizations or by some combination of these. City or County General Hospitals A mental health center may be an administrative unit of a general hospital. The director of the center is usually appointed by the hospital's governing board. Staff members are selected by the agency of the general hospital responsible for staff appointments. Selections are usually approved by the hospital medical board and by the hospital governing board, A mental health center attached to a city o r county facility must 1 accept indigent patients and may accept involuntary patients by agreement. An example of a general hospital serving as a community mental health center is the psychiatric center of Mr. Sinai Hospital in New York City. The center is an administrative and functional part of the general hospital and uses all hospital facilities in providing inpatient and out­ patient services, day and night treatment, and aftercare 0 A center which is part of a general hospital is usually provided with established, comprehensive facilitieso In many instances, these facilities allow the center to offer a broad program of treatment, train­ ing, and research Inpatient and outpatient services are especially suited to placement in a general hospital. Patients can be moved from inpatient care to outpatient care with relative ease while receiving continuity of therapeutic treatment. The major disadvantage of a center being located in a general hospital is lock of autonomy. The center is subject to administrative control by hospital authorities, which may interfere with the efficient operation of the center. For example, the selection of professional staff may often be slow and cumbersome. In one hospital the director of the center selects professional staff and recommends his selection to the hospital's committee on staff appointments. The committee's recommenda­ tion must then be approved by the hospital's medical board and the board of managers. Local Health Departments A center may be organized as an administrative unit of a local health department. The director of the center, who is usually appointed by a city or county manager or the director of the local health department, L8 is responsible for the operation of the center and may appoint key pro­ fessional personnel. One or more local advisory boards are often estab­ lished. The center operated by the San Mateo County (California) Depart­ ment of Public Health and Welfare is an excellent example of a center organized as an administrative unit of a local health department. This agency, which offers a variety of services, has one of the most compre- 9 hensive mental health programs in the United States, The director of the center is appointed by the county manager with the approval of the county board of supervisors. The director appoints the mental health program chief who selects professional staff. The county civil service commission appoints a professional board which is responsible for review­ ing appointments of psychiatrists and psychologists. Before final selec­ tion is made, staff members responsible for independent or semi-independent programs are interviewed by community leaders.. Under California's Short- Doyle Act, the county board of supervisors must appoint a seven-member community mental health advisory board 0 Membership includes one repre­ sentative each from the county board of supervisors, the judiciary, private medical practitioner's, private psychiatrists, and three lay members,^ 0 Most local health departments have adult clinics, child guidance clinics, a public health nursing service, and other programs and facili­ ties sufficient to establish diagnostic services, outpatient treatment, aftercare, and consultation and education. It may be necessary for a health department to establish a mental health hospital or add a unit to a general hospital for inpatient and emergency care. However, its primary value may be to provide treatment which can prevent hospitalization. Most of the hospital's patients are those paying the required patient fees. Centers operated by nonprofit organizations may develop a highly flexible program since there is no outside control over policies and day- to-day operations. Financing the center is more difficult because of less government financial participation. Increased availability of mental health insurance, however, will make private hospitals within the economic reach of many persons with low incomes."^ Housing the Center's Services Every community establishing a center must determine how the serv­ ices of the center can most appropriately be housed. In most instances, communities will find it advantageous to house at least some of the cen­ ter's services in general hospitals. Housing Services in General Hospitals General hospitals provide an excellent basis for establishing cen­ ters, since most hospitals already have facilities which can be used and expanded to provide mental health services. Also, many general hospitals admit psychiatric patients. Certain elements of the center's services, such as inpatient care, emergency care, and partial hospitalization, are espe­ cially suited to being housed in a general hospital. These services require extensive use of personnel and facilities which most general hospitals can at least partially provide. By housing the center's services in a general hospital, more effec­ tive utilization of space and a lower cost of operation may be obtained. It is more convenient for staff members to treat the center's patients 2 2 if all patients are in one place. Moreover, coordination of mental health services is much easier and a higher quality of patient care may be achieved. In addition, the center and the hospital can share per­ sonnel and facilities. For example, physicians can treat both mental and medical patients, and the hospital]s kitchen can provide meals to patients of the center and the general hospital. If a general hospital is used as a basis for establishing a cen­ ter, it is usually desirable to locate the center on the same site as the general hospital. The center can be constructed as an addition to the hospital or as a building separate from the general hospital, Of 11 applications for federal construction funds reviewed by the U, S, Public Health Service in Atlanta, Georgia, 8 proposed that the centers be located on the same site as a general hospital. Four communities proposed new buildings separate from general hospitals and four are to be additions to general hospitals. Housing Services Separate from General Hospitals The general hospital is only of secondary importance in locating outpatient care, consultation and education, and the screening of patients prior to hospital admission. Since the provision of these services does not require extensive use of facilities and equipment, it is more important that they be accessible. Where possible, these services could be housed in mental health clinics. Factors to be considered in locating the clinics are; (l) transportation facilities; ( 2 ) community facilities^ ( 3 ) cases of mental illness^ and (4) population characteristics. Transportation Facilities, Many patients receiving certain types of treatment, such as outpatient care, will visit the clinic and return 23 home in the same day. The clinic will also be visited by patients' families, professional and technical personnel, volunteer workers, and welfare, clergy, and medical representatives concerned with the care and treatment of patients 0 The more easily the clinic can be reached, the greater will be the flow of activity through it and the greater the like- 12 lihood of its acceptance by the community. Therefore, a primary feature of the clinic should be its accessibility from all sections of the com­ munity. The clinic should be located on or close to major thoroughfares. Also, especially in communities that rely heavily on mass transportation facilities, the clinic should be located near transit stations and bus stops. Community Facilities, Patients of community mental health centers are encouraged to retain their relationships with the community, Patients should follow their normal life's routine as closely as possible 0 Clinics should be located so they will be convenient to such community facilities as shopping districts, theaters and other entertainment facilities, churches, and recreation facilities. Cases of Mental IllnesSo The primary goals of the center are intensive treatment of the mentally ill, an early return of patients to society and prevention of relapse. To achieve these goals requires as little disturbance to the patient's family and community relationships as possible. It is, therefore, desirable to locate services other than inpatient care in or near districts in the community with large numbers of existing and potential cases of mental illness 0 Information needed to estimate the extent and location of existing and potential cases of mental illness in the community are: (l) the number and place of residence 26 Ways of Housing Services. Clinics can be housed in several ways. If existing local public health clinics are already adequately located, outpatient care, partial hospitalization and emergency treatment could be provided in these clinics. Another possibility is to provide outpatient care, emergency treatment, and the screening of patients prior to hospital admission in mobile units similar to the bookmobile or mobile x-ray units. Also, it may be desirable to rent space to obtain an adequate location where services can be effectively provided. For example the San Mateo County (California) Department of Public Health and Welfare rented space in a large shopping center to establish a clinic which housed outpatient care and consultation and education. In some cases, it may be desirable to construct new clinics sep­ arate from the general hospital to obtain an adequate location for certain services. The site on which the building is to be constructed should be 10 to 15 per cent larger than initial space requirements. The cost of the site should be within the range of the center's budget, although an inade­ quate site should not be acquired just because it is inexpensive or donated. Land Use Considerations. To be accessible to the persons which the center is intended to serve may require certain services of the center to be located in or near residential areas. Also, to encourage use of the center, certain services may be located in intensive commercial areas where large numbers of persons can use the center while carrying on their daily activities. Table 2 shows the type of land use in the areas surrounding eleven proposed mental health centers. Six of these centers are proposed to be 27 located in predominately residential areas 0 Four centers are proposed to be located in commercial areas, and one is to be located in a vacant por­ tion of the community. Although mental health clinics, do not have significant physical characteristics which may make them undesirable land uses, they do gener­ ate traffic and may be psychologically offensive. Therefore, it would not be desirable to locate clinics in single-family residential areas. Financing the Center's Operation Communities are responsible for meeting most of the operating costs of mental health centers. Operating costs may be financed by: (l) appro­ priations from local governments; ( 2 ) gifts; and ( 3 ) patient fees. In addition, it should be re-emphasized that many states provide funds to communities for meeting some costs of providing mental health services. Communities, therefore, should investigate to see if such funds are avail­ able. Appropriations by Local Governments Appropriations by city and county governments are the primary sources of operating funds. If a center serves only one city or county, the local government may provide funds for the operation of the facility. If a cen­ ter serves a regional area, a contractual arrangement between the center and local governments is desirable. Each local government's share may be based on population and family income levels. The amount of funds which a center receives from local governments depends on: (l) the available sources of financing; and ( 2 ) the type of agency operating the center. The Penn Foundation is a privately owned and operated facility receiving only five per cent of its income from Bucks 28 County and Montgomery County Pennsylvania- The Foundation's operational costs are primarily financed by fees for services. The Greater Kansas City (Missouri) Mental Health Foundation is a nonprofit corporation which contracts with Kansas City to provide mental health services. Approxi­ mately one-half of the Foundation's operating costs are met by funds pro­ vided by Kansas City and Jackson County, Missouri. The Jacob L. Reiss Mental Health Pavillion is a clinical division of St. Vincents Hospital, a private facility located in New York City. About 4 0 per cent of the center's annual operating budget is derived from the City of New York. Gifts Contributions from philanthropic organizations, voluntary agencies, and private foundations are important sources of funds. Also, individual citizens, as well as local industries and businesses, are often willing to underwrite certain costs. Gifts are primarily used to supplement other methods of financing. Although some gifts are large, they are seldom a dependable source of annual income. Generally, gifts constitute less than ten per cent of most centers' annual operating funds. Patient Fees Most mental health centers charge fees for services, although the amount charged varies significantly. Fees, however, are generally based on the ability of the patient to pay. For example, in one center the fee is determined by considering such factors as family size, living expenses, medical and legal expenses, savings and investments, and income. Fees account for a large percentage of the annual income of most privately operated centers. In some cases, fees are paid by local governments for the care of indigent patients. Expenditures of Prairie View Hospital in Newton, APPENDIX A STATES HAVING COMMUNITY MENTAL HEALTH SERVICE ACTS Name of State Year Act Was Adopted California 1957 Colorado 1963 Connecticut 1955 Idaho 1965 Illinois 1961 Indiana 1955 Kentucky 1964 Louisiana 1964 Maine 1959 Michigan 1963 Minnesota 1957 Nevada 1965 New Hampshire 1965 New Jersey 1957 New York 1954 North Carolina 1963 North Dakota 1963 Oregon 1961 Rhode Island 1962 South Carolina 1961 Texas 1965 Utah 1961 Vermont 1957 Wisconsin 1959 Wyoming 1961 Sources U a S. Public Health Service, Atlanta, Georgia 32 LITERATURE CITED 1. U. S. Congress, Senate. Community Mental Health Centers Act of 1963. Title II of Public Law 88-164, S. 1576, 88th Cong,, October 31, 1963, p. 9. 2. U. S. Department of Health, Education, and Welfare, Public Health Service. Fact Sheet: The Comprehensive Community Mental Health Centers Program. Washington: Government Printing Office, n,d., p p „ 2-3. 3. U. S. Congress, House of Representatives, Mental Retardation Facili­ ties and Community Mental Health Centers Construction Act, Amendments of 1965. Public Law 89-105, H. R. 2985, 89th Cong,, August 4, 1965, p, 2. 4. Atwell, Robert H. The Financing of Mental Health Centers: A National View. Baltimore: National Commission of Community Health Services, 1964, p 0 9. 5. Yolles, Stanley F. "Mental Health Program Evolves as Shared Endeavor," Public Management, Vol. XLVII, April, 1965, p, 88, 6. Dorsett, Clyde. "New Directions in Mental Health Facilities," Journal of the American Institute of Architects, November, 1964, p, 1, (Reprint.) 7. U. S. Department of Health, Education, and Welfare, Public Health Service, op, cit., p. 6. 8. Georgia Department of Public Health, Division of Mental Health, A Comprehensive Mental Health Plan for Georgia, Atlanta: The Depart­ ment, 1965, p. 11, 9. Glasscote, Raymond, and others. The Community Mental Health Center: An Analysis of Existing Models. Washington: The Joint Information Service of the American Psychiatric Association and the National Association for Mental Health, September, 1964, p, 45, 10. Ibid., p. 50 11. Georgia Department of Public Health, Division of Mental Health, op, cit., p. 46. 12. Dorsett, op. cit., p, 2, 13. U. S. Department of Health, Education, and Welfare, Public Health Service, Worksheet to Accompany Application for Staffing Grant: Community Mental Health Center Act. Washington: Government Printing Office, n.d., p. 2. 33 OTHER REFERENCES 1. Georgia Department of Public Health, Medical Facilities Planning Section. Preparation of a Program and Project Narrative for a Com­ munity Mental Health Center. Atlanta: The Department, March, 1966. 2. Joint Commission on Mental Illness and Health, Action for Mental Health. New York: John Wiley and Sons, Inc., 1963, 3. Knight, James A. and Winborn, E. Davis. Manual for the Comprehensive Community Mental Health Clinic. Springfield^ Illinois: Charles C. Thomas, 1964. 4. U. S, Department of Health, Education, and Welfare, Public Health Service, Community Mental Health Centers Act of 1963; Regulationso Washington! Government Printing Office, (Reprint from the Federal Register, May 6, 1964). 5. . Concept and Challenge: The Comprehensive Community Mental Health Center. Washington: Government Printing Office, 1964, 6. . Guide for the Preparation of an Application for Community Mental Health Center Construction Assistance, Washington: Government Printing Office, n.d. 7. . Planning of Facilities for Mental Health Services, Washington: Government Printing Office, January, 1961. 8. . The Community Mental Health Centers Act (1963): A Commen­ tary. Washington: Government Printing Office, I960.