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Statement of Suzanne Vogel-Scibilia of Beaver County Pennsylvania, President of the National Alliance on Mental Illness to the Labor-HHS-Education Subcommittee on Appropriations - U.S. House of Representatives regarding FY 2007 Funding for the National Institute of Mental Health (NIMH) and the Substance Abuse and Mental Health Services Adminsitration (SAMHSA)
March 31, 2006
Chairman Regula and members of the Subcommittee, I am Suzanne Vogel-Scibilia, President of the National Alliance on Mental Illness (NAMI). In addition to being a practicing clinical psychiatrist, I have also been diagnosed with bipolar disorder since the age of fifteen. I am also the founder and director of an independent mental health clinic in Western Pennsylvania and serve as an assistant professor at Western Psychiatric Institute. I am pleased today to offer NAMI's views on the Subcommittee's upcoming FY 2007 bill. NAMI is the nation’s largest grassroots advocacy organization, 220,000 members representing persons with serious brain disorders and their families. Through our 1,200 chapters and affiliates in all 50 states, we support education, outreach, advocacy and research on behalf of persons with serious brain disorders such as schizophrenia, manic depressive illness, major depression, severe anxiety disorders and major mental illnesses affecting children.
The cost of mental illness to our nation is enormous. President Bush’s White House Mental Health Commission – which completed its work in 2003 – found that the direct treatment cost exceeds $71 billion annually. This does not include the $79 billion in estimated indirect costs of benefits and social services. These direct and indirect costs do not measure the substantial and growing burden that is imposed on “default” systems that are too often responsible for serving children and adults with mental illness who lack access to treatment. These costs fall most heavily on the criminal justice and corrections systems, emergency rooms, schools, families and homeless shelters. Moreover, these costs are not only financial, but also human in terms of lost productivity, lives lost to suicide and broken families. Investment in mental illness research and services are – in NAMI’s view – the highest priority for our nation and this Subcommittee.
National Institute of Mental Health (NIMH) Research Funding
The National Institute of Mental Health (NIMH) is the only federal agency whose main objective is to fund biomedical research into serious mental illnesses. Through research, NIMH and the scientists it supports seek to gain an understanding of the fundamental mechanisms underlying illnesses that obstruct thought, emotion, and behavior and an understanding of what goes wrong in the brain in mental illness. NIMH strives, at the same time, to hasten the translation of this basic knowledge into clinical research that will lead to better treatments and ultimately be effective in our complex world with its diverse populations and evolving health care systems.
For FY 2007, the President is proposing $1.395 billion for scientific and clinical research at the National Institute of Mental Health (NIMH). This is a $9 million DECREASE over the amount Congress appropriated for NIMH for FY 2006 ($1.404 billion). While this decrease is relatively small in comparison to the overall NIMH budget, it is important to note that it is the first time in decades that a President has proposed cuts to biomedical research at the National Institutes of Health (NIH) and follows the doubling of NIH funding between 1998 and 2003.
This continued, gradual decline in the NIMH and NIH budgets is expected to have a negative impact on the ability of NIMH (and NIH as a whole) to sustain the ongoing multi-year research grants that have been initiated over the past three to four years. This is further complicated by the fact that this proposed reduction would not allow NIMH and NIH funding to keep pace with the projected Biomedical Research and Development Price Index of 3.5%, i.e. the increased costs of conducting medical research.
For FY 2007, NAMI supports the recommendations of the Ad Hoc Group on Medical Research and the Mental Health Liaison Group for a $1.497 billion budget for the NIMH. This modest 5% increase above the FY 2006 appropriation reflects a restoration of funding to the FY 2005 level, consistent with 3.5% Biomedical Research and Development Price Index.
Supporting the NIMH Strategic Plan
NAMI supports NIMH's mission to reduce the burden of mental illness through research designed to transform treatment and recovery. To achieve this, especially in a time of fiscal restraint, NAMI endorses setting strategic priorities for NIMH. Identifying priorities and reorganizing internal structures will help exploit the enormous scientific gains that have already been made and bring greater focus to cross-disciplinary collaboration to accomplish these goals. The most important reason for change is that basic science now provides us with unprecedented opportunities to define the pathophysiology of mental disorders and to develop new interventions. As defined by NIMH Director Thomas Insel, NIMH's highest priorities must be:
- supporting basic science discoveries;
- translating these discoveries into new interventions that will relieve the suffering of people with mental disorders; and
- ensuring that new approaches are used for diverse populations and in diverse settings.
Redefining NIMH to Its Mission
NAMI applauds NIMH's efforts to reform the Institute on along 3 core principles: relevance, traction, and innovation.
- Relevance refers to relevance to the mission.NIMH should continue its strong support of basic science, but as the NAMHC workgroup recommends in its report some research areas are more relevant than others.
- Traction refers to the capacity for rapid progress in research areas where new tools, such as 2-photon imaging, yield definitive answers to long-standing questions.
- Innovation is often endangered during periods of limited budget growth.This work is highly relevant and NIMH is gaining traction, but unless a priority is placed on such "discovery" science, this unprecedented opportunity for innovation may not receive the support it deserves.
The NIMH Strategic Plan is critical for moving beyond the current universe of palliative treatments. Even with optimal care, children and adults with mental illness will not be able to achieve recovery (as defined as permanent remission). As NIMH Director Dr. Tom Insel has noted, consumers and families need rapid, effective treatments that target the core pathophysiology of serious mental illnesses and the tools for early detection. Mental illness research can develop new diagnostic markers and treatments, but this will require defining the pathophysiology of these illnesses. NIMH now has the research tools necessary. Now is the time to set an ambitious goal of finding cures to these extremely disabling illnesses.
Funding for Programs at SAMHSA’s Center for Mental Health Services (CMHS)
The Center for Mental Health Services (CMHS) – part of the Substance Abuse and Mental Health Services Administration (SAMHSA) – is the principal federal agency engaged in support for state and local public mental health systems. Through its programs CMHS provides flexible funding for the states and conducts service demonstrations to help states move toward adoption of evidence-based practice.
CMHS Programs and the Crisis Confronting the Public Mental Health System
Mr. Chairman, in early March NAMI released a comprehensive report on the performance of states in meeting the needs of adults with serious mental illness. Our report “Grading the States” is the first comprehensive survey and grading of state adult public mental healthcare systems conducted in more than 15 years. Public systems serve people with serious mental illnesses - such as schizophrenia, bipolar illness, and major depression - who have the lowest incomes.
The report confirms in state-by-state detail what President Bush's New Freedom Commission on Mental Health called a fragmented "system in shambles." This report makes clear that nationally, the system is in trouble (the report gives the nation a grade of D for its system of care for people with serious mental illness). The report also documents that too many state systems are failing -- only 5 states received a B (Connecticut, Maine, Ohio, South Carolina, and Wisconsin), 17 states received Cs, 19 states get Ds, and 8 got Fs (Iowa, Idaho, Illinois, Kansas, Kentucky, Montana, North Dakota, and South Dakota).
Each state grade is based in part on a "take-home test," in which survey questions were submitted to state mental health agencies during October and November 2005. All but two states responded. Colorado and New York declined. They have been graded "U" for "Unresponsive.” Based on the surveys and publicly available information, states were scored on 39 criteria. Consumer and family advocates also provided information through interviews that contributed to state narratives.
The report also included a "Consumer and Family Test Drive" a unique, innovative measurement. NAMI had consumers and family members navigate the Web sites and telephone systems of the state mental health agency in each state and rate their accessibility according to how easily one could obtain basic information. Those states that received excellent Test Drive scores were Indiana, Michigan, Ohio, South Carolina, and Tennessee. Those that received the lowest Test Drive scores were Alabama, Arkansas, Missouri, New Mexico, and South Dakota.
Each state narrative also includes a list of specific "Innovations" and "Urgent Needs" to help advocates and policymakers further define agendas for action. An overall list of innovations provides an opportunity for states to learn from one another. As the grade distribution in the report demonstrates, the United States still has a long way to go to achieve a "New Freedom" for people living with serious mental illness - a freedom based on recovery and dignity.
The Need to Focus on Recovery-Oriented Evidence-Based Practices
NAMI supports targeting of CMHS dollars toward investment in evidence-based, outreach-oriented service delivery models for persons with severe mental illness in the community. The President’s budget proposes a freeze for the Mental Health Block grant program for FY 2007 at $428.5 million. In addition, theAdministration is also requesting that at least $153 million of the $428 million requested for the Mental Health Block Grant be allocated by individual states to activities related to "Mental Health Transformation." If enacted by Congress, states would be required to ensure that a certain percentage of their block grant funds go toward reforming public mental health services based on the recommendations in the July 2003 White House "New Freedom Initiative" Mental Health Commission report.
These reforms include reducing system fragmentation, increasing access to evidence-based services that promote resiliency and recovery, ensuring systems are consumer and family driven, and eliminating racial and ethnic disparities in service access. Mental Health Transformation also includes pushing schools to partner with parents and communities to help identify students with mental health treatment needs and to link them with services. This effort to redirect Mental Health Block Grant funding is separate from the proposed continuation in FY 2007 for the 7 states that have Mental Health Transformation state incentives grants. These are state planning grants designed to further system transformation consistent with the White House Mental Health Commission report. These state incentive grants would continue for an additional year under the President's budget, with no funding for additional states (thereby reducing funding from $25.74 million, down to $19.8 million for FY 2007).
NAMI strongly supports the goals of the principles and goals underlying Mental Health Transformation and believes that Congress should demand that states allocate Mental Health Block Grant dollars to evidence-based practices that promote resiliency and recovery. At the same time, NAMI wants to make sure that this proposal does not disrupt the ongoing work of state mental health planning councils across the country. The planning councils are required to submit their Block Grant plans to CMHS by September 1 – a month before FY 2007 begins. While NAMI would hope and expect that all state mental health planning councils are developing plans that incorporate Mental Health Transformation, we are concerned that imposing a new requirement after each state has submitted its plan could be disruptive.
Funding for Youth Suicide Prevention Initiatives
NAMI strongly supports full funding ($34.7 million) for the Garrett Lee Smith Memorial Act (P.L. 108-355), and all efforts to support states and localities in developing comprehensive strategies for suicide prevention among adolescents and young adults. Suicide is the third leading cause of death for those between the ages of 10 and 24 and the second leading cause of death for American college students. The Garrett Lee Smith Act is critical to our national efforts to address this epidemic.
NAMI Supports the “Samaritan” & SELHA Initiatives to End Chronic Homelessness
The Bush Administration has put forward a proposal to end chronic homelessness within the next decade through the development of long-term planning and investment in permanent supportive housing (housing linked to services). NAMI supports this “Samaritan Initiative.” In addition, NAMI is also supporting legislation recently introduced by Senators Mike DeWine (R-OH) and Jack Reed (D-RI) and Representatives Deborah Pryce (R-OH) and Anna Eshoo (D-CA) to authorize funding for services tied to permanent supportive housing targeted to individuals that have experienced long-term chronic homelessness. This legislation, known as the Services for Ending Long-Term Homelessness Act (S 709/HR 1471). NAMI urges support for SELHA and funding for services in permanent supportive housing in FY 2007.
Chronically homeless people with severe mental illnesses and co-occurring substance abuse disorders have needs that cross the boundaries of fragmented, categorical service systems. They rarely access the comprehensive supports they need to get and keep housing. Supportive housing provides accessible, coordinated, and flexible services that lead to recovery and reintegration into community life. NAMI also urges additional funding in FY 2007 for the PATH program to address inequities in the program’s interstate funding formula that have frozen the allocation for many smaller rural states since the mid-1990s. NAMI supports S 319, legislation adjusting the "small state minimum allocation" in the PATH program.
Funding for CMHS Programs in the President’s FY 2007 Budget
NAMI also supports ongoing activities at CMHS.
- Childrens’ Mental Health program at CMHS – The President is requesting level funding for the Childrens Mental Health program at $105.2 million.
- Jail Diversion – NAMI supports continued funding for the CMHS Jail Diversion program at $6.93 million as recommended by the President.
Chairman Regula, thank you for the opportunity to share NAMI's views on the Subcommittee FY 2007 bill. NAMI's consumer and family membership thanks you for your leadership on these important national priorities.