National Alliance on Mental Illness
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STATEMENT OF GLORIA WALKER
OF CINCINNATI, OHIO
ON BEHALF OF THE NATIONAL ALLIANCE FOR THE MENTALLY ILL
REAUTHORIZATION OF THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA)
BEFORE THE SUBCOMMITTEE ON SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES
COMMITTEE ON HEALTH, EDUCATION, LABOR AND PENSIONS
UNITED STATES SENATE
JULY 15, 2003
Chairman DeWine, Senator Kennedy and members of the Subcommittee, I am Gloria Walker of Cincinnati, Ohio. Since 2000, I have served on the Board of Directors of the National Alliance for the Mentally Ill (NAMI). I am also a Past President of NAMI Ohio, having served in that capacity from 1998 until 2000. I am also the mother of a son who has struggled with mental illness for nearly 20 years. It is from these perspectives – a leader in the NAMI movement and as a family member – that I offer the following views on the future of SAMHSA and the need to improve the federal government’s response to the growing crisis in our public mental health system.
Who is NAMI?
NAMI is a nonprofit, grassroots, self-help, support and advocacy organization of consumers, families, and friends of people with severe mental illnesses, such as schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, autism and pervasive developmental disorders, attention deficit/hyperactivity disorder, and other severe and persistent mental illnesses that affect the brain.
Founded in 1979, NAMI today works to achieve equitable services and treatment for more than 15 million Americans living with severe mental illnesses and their families. Hundreds of thousands of volunteers participate in more than one thousand local affiliates and fifty state organizations to provide education and support, combat stigma, support increased funding for research, and advocate for adequate health insurance, housing, rehabilitation, and jobs for people with mental illnesses and their families. Local affiliates and state organizations identify and work on issues most important to their community and state. Individual membership and the extraordinary work of hundreds of thousands of volunteer leaders is the lifeblood of NAMI's local affiliates and state organizations.
I am pleased today to submit the following testimony on behalf of the National Alliance for the Mentally Ill (NAMI) on legislation to reauthorize the Substance Abuse and Mental Health Services Administration (SAMHSA).
Public Mental Health System In Crisis
Mr. Chairman, as you know in a matter of days President Bush’s Commission on Mental Health (chaired by our own Mike Hogan of Ohio) will be releasing its final report. We expect this report will document what too many NAMI members know from personal experience – that the public mental health treatment and support system in most states is in serious disrepair. In fact, as the Commission noted in its Interim Report last fall, this "system" is in fact not a coherent system, but rather a fragmented and underfunded series of programs crossing multiple layers of government with little accountability and coordination. I can tell you from personal experience that this confusing system overwhelms consumers and families with conflicting eligibility rules and reliance on service models that are inconsistent with the enormous scientific advances that have been made in recent years with respect to recovery-oriented interventions for severe mental illness.
The result of this system in collapse is that children and adults living with severe mental illness are increasingly over-represented in the chronic homeless population and in local jails and prisons. The failure of this system is also reflected in our nation’s alarmingly high suicide rate. This year NAMI completed its most comprehensive survey of our consumer and family membership – 3,400 respondents. The findings are alarming.
Nearly half of the consumer respondents reflected in the survey had been hospitalized within the past 12 months and 40 percent needed emergency services. Fewer than one-third received evidence-based, recovery-oriented services such as assertive community treatment programs, supported employment services, and substance abuse treatment. More troubling is that the lack of appropriate treatment translated into extensive involvement with the criminal justice system—43% of the consumers in the NAMI survey have been arrested or detained by police.
SAMHSA’s Response to the Growing Crisis in the Public Mental Health System
Given SAMHSA’s limited resources ($3.2 billion in a system estimated to consume more than $44 billion), it is unrealistic (and probably unwise) to expect the agency to assume responsibility for complete reform of the complicated and fragmented system that consumers and families must navigate. At the same time, SAMHSA can (and should) play a leadership role in assisting states and localities in modernizing and reforming the way mental illness treatment and supports are delivered. Reauthorization legislation therefore affords an important opportunity for Congress to sharpen the agency’s mission to assist state and local mental health authorities in this effort.
NAMI is pleased that the Bush Administration has appointed three leaders with experience in running state mental health authorities to manage SAMHSA and the Center for Mental Health Services (CMHS): Administrator Charles Curie of Pennsylvania, Deputy Administrator James Stone of New York and CMHS Director Kathryn Power of Rhode Island. Each brings vast experience in managing and reforming services and working with NAMI organizations at the state and local level.
NAMI Recommendations for SAMHSA Reauthorization
Chairman DeWine, NAMI is extremely grateful for the leadership that you have provided in Congress in bringing attention to this enormous and growing problem. NAMI strongly supported your efforts in passing legislation authorizing the Mental Health Courts program at the Justice Department (P.L. 106-515). NAMI is proud to support your legislation (S 1194) to expand the ability of state and local law enforcement and corrections systems to cope with their growing burden of responding to offenders with a history of untreated severe mental illness – most of them low-level non-violent offenses.
As you know, effective jail diversion programs, Mental Health Courts, and programs to help adult and juvenile offenders with mental illnesses transition back into the community require close collaboration and cooperation between corrections, courts and mental health systems. Too often, mental health systems have been reluctant to do their part to help these individuals, many of whom would not have ended up in correctional systems had they received timely and appropriate mental health services and supports. At the Federal level, SAMHSA has worked collaboratively with the Department of Justice to provide technical assistance and support for jail diversion and community reentry programs for offenders with mental illnesses.
NAMI strongly urges that the SAMHSA reauthorization legislation be utilized as an opportunity to expand the agency’s current jail diversion program and to expand the jurisdiction of this program to include community reentry and transition for juveniles and adults with mental illnesses exiting criminal justice systems. We also urge that SAMHSA be encouraged to work even more closely with the Department of Justice and other relevant Federal Agencies (e.g. the Social Security Administration, the Center for Medicaid and Medicare Services, and the Department of Housing and Urban Development) in carrying out these important activities.
6) SAMHSA should continue its efforts to address the absence of a coherent service system for children and adolescents with serious mental illness
The impending release of President Bush’s New Freedom Commission report on Mental Health will emphasize the wholesale fragmentation and lack of coordination between various systems responsible for providing treatment and services to individuals with mental illnesses across the country. These problems are particularly profound for children and adolescents who suffer from mental illnesses. It is well documented that families of children with mental illnesses frequently have no place to turn to access the services that their children need. As a consequence, children with mental illnesses are even more disproportionately represented in juvenile justice systems than adults with mental illnesses are in adult correctional systems. Moreover, many families are literally forced to give up custody of their children to access care for their loved ones. This is a national tragedy.
As a first step, NAMI recommends that Congress establish, through legislation, an interagency body on children’s mental health to improve collaboration, systems coordination, and blended funding of services for children with mental illnesses across all relevant federal programs. SAMHSA, as the nation’s lead agency for mental health services, should be vested with lead responsibility for this important function.
Additionally, CMHS – through the Children’s Mental Health Services Program also funds the Comprehensive Community Mental Health Services for Children and Their Families Program – provides grants to public entities providing comprehensive community-based mental health services for children and adolescents with mental illnesses. NAMI strongly supports the federal investment in creating home and community based services for children with mental illnesses and their families. We look forward to working with the Subcommittee to ensure that the program is further improved so that children and adolescents with serious mental illnesses receive services that are evidence-based, effective and associated with that outcomes that are tracked to ensure accountability.
NAMI is deeply grateful for the opportunity to offer our views on SAMHSA reauthorization legislation. We look forward to working with you and your colleagues on this legislation and other matters that will come before this Subcommittee.