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Evidence-Based Treatment Gains Congressional Support


For Immediate Release, October 27, 2000
Contact: Chris Marshall

On October 26, a bipartisan coalition of House members introduced legislation to support evidence-based treatment such as PACT under the Medicaid Program. Representatives Marcy Kaptur (D-OH) and Barbara Cubin (R-WY) introduced the Medicaid Intensive Community Health Treatment Act (HR 5572) that provides States with the option of coverage for intensive community treatment for people with serious brain disorders under Medicaid.

All NAMI members and advocates are encouraged to contact their members of the House of Representatives and urge them to cosponsor HR 5572 and provide states with this important option to offer evidence-based community treatment programs like PACT that have shown to be more effective in treating people with severe mental illnesses. All members of Congress can be reached by calling the Capitol Switchboard at 202-224-3121 or by going to the policy page of the NAMI website at and click on "Write to Congress."

For more information on PACT (Program for Assertive Community Treatment) please go to the NAMI website at

Below is a NAMI press release praising the introduction of HR 5572.

For Immediate Release
October 27, 2000

Arlington, VA-The National Alliance for the Mentally Ill (NAMI) today praised U.S. Representatives Barbara Cubin (R-WY) and Marcy Kaptur (D-OH) for introducing a bill to allow states to use Medicaid funds to invest in community-based programs serving adults with serious brain disorders.

"We are extremely grateful for the bipartisan leadership of these Members of Congress to expand access to evidence-based approaches such as the Program for Assertive Community Treatment (PACT)," said NAMI Executive Director Laurie Flynn. "These programs give the highest priority to serving individuals with the most severe mental illnesses-the same ones who too often fall through the cracks of public mental health systems."

Known as the "Medicaid Intensive Community Health Treatment Act," the Kaptur-Cubin bill would provide states with the option of covering intensive community mental health treatment under the Medicaid program. States could offer a new set of consolidated, optional services under federal Medicaid law.

The new intensive community treatment option would include key elements of the PACT model, including a recovery-oriented, 24-hour-a-day, seven-day-a-week, mobile, interdisciplinary team approach to treatment. Comprehensive services would include treatment for individuals with co-occurring mental illness and substance abuse disorders, medication education and management, and family education.

"This option represents the most innovative, successful approach for helping people with the most chronic mental illnesses," Flynn noted. "PACT offers rehabilitation and recovery where traditional treatments often are unsuccessful."

"It also is cost-effective," Flynn said. "Numerous peer reviewed studies demonstrate that PACT substantially reduces inpatient mental health care. Likewise, studies also show that family and community outreach and education creates more positive attitudes toward people with mental illnesses."

Currently, federal financing of community-based mental health care is spread across more than six optional Medicaid service categories. Patchwork state and county programs are marked by lack of coordination, inflexible funding streams, and missing service components. In contrast, the Kaptur-Cubin proposal would permit states-through a single policy decision-to finance all necessary community-based services.


What is PACT?

The Program of Assertive Community Treatment (PACT) is one of the most successful mental health service delivery models today. PACT is evidence-based and outreach-oriented. It utilizes a 24-hours-a day, 7-day-a-week, interdisciplinary, mobile team approach to treatment. It delivers comprehensive treatment, rehabilitation and support services in community settings.

High quality PACT services typically are implemented at costs significantly less than those of putting individuals with severe mental illnesses in a hospital, residential treatment facility, or jail. PACT also is especially effective in serving individuals for whom previous, traditional treatment has been unsuccessful, including those with co-occurring substance abuse disorders and high use of inpatient care. Among the services typically integrated into PACT are 24-hour comprehensive care, psychiatric rehabilitation, integrated mental illness and substance abuse treatment, housing or housing supports, crisis intervention and peer counseling.

Policy Objectives

Federal funding of community-based mental health services is greatly diffused, spread across numerous mandatory and discretionary programs. Within Medicaid, community-based mental health services run through more than six separate optional service categories. Moreover, the complicated federal scheme relies on numerous state and local funding streams. The inevitable result is a complex, confusing patchwork of programs, with fragmented services at the community level. Wide disparities also exist among the states in Medicaid spending on mental health services: New York, Massachusetts, and Wisconsin are at the high end; Illinois, West Virginia and Texas are at the low end.

In 1995 and 1997, efforts were made to amend Medicaid to allow assertive community treatment as a state option. In 1997, the effort failed as a result of preliminary estimates by the Congressional Budget Office (CBO) to "score" the option as a mandatory program, involving significant costs. The estimate was based in part on assumptions that states would use the option to draw additional federal Medicaid dollars.

In fact, many PACT services already are available to states as optional Medicaid services. The new option need not incur federal obligations. The Medicaid Intensive Community Health Treatment Act will permit states to finance consolidated, community-based services. It also represents a cost-effective state-level response to problems associated with deinstitutionalization, homelessness, and the costly trend toward criminalization of mental illness.