National Alliance on Mental Illness
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Senate Committee Reports SAMSHA Reauthorization Bill
NAMI's Co-Occurring Disorders, Targeted Block Grant Proposals Rejected
On Wednesday, July 28, 1999, the Senate Committee on Health, Education, Labor, and Pensions (HELP) favorably reported, by a vote of 17-1, S. 976, the "Youth Drug and Mental Health Services Act of 1999." The legislation reauthorizes the Substance Abuse and Mental Health Services Administration (SAMHSA).
The legislation contains many positive initiatives, including Senator Christopher Dodd’s (D-CT) restraints regulations and reporting requirements. [Refer to NAMI E-News Volume 00-18 of August 2, 1999 for details.] Missing from the legislation are NAMI’s two highest priorities with SAMHSA: granting governors discretion to blend both mental health and substance abuse block grant dollars to fund integrated treatment for persons with co-occurring mental and addictive disorders and targeting additional mental health block grant dollars to evidence-based programs for persons with the most serious mental illness, such as the evidence-based PACT (Programs for Assertive Community Treatment) program. The National Governors’ Association (NGA) staff reported that not a single governor asked NGA to support giving them discretion to blend block grant dollars for integrated treatment programs for persons with co-occurring disorders.
SAMHSA GRANT PROGRAM OVERVIEW
S. 976 would establish new federal grant programs to develop community systems to prevent and treat violence and its consequences in younger populations, would establish a new federal grant program to "wrap around" mental health and substance abuse services for youth offenders, and reauthorizes the existing SAMHSA discretionary and block grant programs. Discretionary grant programs are to give a priority in future funding to the interface between mental health, substance abuse, and primary care.
PERFORMANCE PARTNERSHIP BLOCK GRANTS
Both the mental health and substance abuse block grant programs would be required to use a common set of performance measures that would be used for accountability, including those with a co-occurring substance use and mental disorder. The state plan must specify the strategy and obstacles to achieving performance goals. Data infrastructure development grants are also authorized to supplement the performance measurement requirement.
The existing mental health block grant annual state mental health plan for an organized community-based system of care for individuals with mental illness is amended to include a description of "available services and resources in a comprehensive system of care, including services for dually diagnosed individuals." The plan must contain quantitative targets to be achieved in implementing the system.
The existing role of the state mental health planning and advisory councils is continued. Efforts by mental health advocates to increase the role and financial support for the councils failed. The state substance abuse directors were again able to convince the Senate HELP committee that creation of a state substance abuse planning and advisory council was an unneeded unfunded mandate.
NAMI’s effort to target additional mental health block grant dollars to only evidence-based treatment programs for persons with the most serious illness, such as PACT, did not succeed.
INCREASED FOCUS ON PERSONS WITH CO-OCCURRING DISORDERS
NAMI and the other mental health advocacy national associations had strongly advocated that governors be given discretion to blend mental health and substance abuse block grant dollars to fund integrated treatment for persons with co-occurring mental and addictive disorders. But with the two national associations of state mental health and substance abuse directors agreeing to not mention integration treatment and to restrict funding to the sole purposes of each distinct block grant as "authorized by law," and with no governor asking for this discretion, these advocacy efforts failed. [Refer to NAMI E-News Volume 99-148 of June 3, 1999 for details.]
Three provisions in the legislation address the population with co-occurring disorders:
1. The mental health block grant must include in its description of a community-based system of care a description of services available to persons with co-occurring disorders.
2. SAMHSA is to develop a report to the Congress which is to contain a summary of existing programs, summary of improvements necessary, and a summary of evidence-based practices for serving persons with co-occurring disorders.
3. The Senate legislation contains the recommendations of the National Association of State Mental Health Program Directors and National Association of State Alcohol and Drug Abuse Directors that block grant programs may be spent for persons with co-occurring disorders "as long as funds available under such sections are used for the purposes for which they were authorized by law." The effect of this requirement is that mental health funds may only be spent for mental health and substance abuse may only be spent for substance abuse. The language allows failed programs of parallel and sequential treatment to be continued while there is no mention of the need for integrated treatment.
P&A AUTHORITY TO BE EXPANDED
When the funding for the Protection and Advocacy (P&A) program for persons with mental illness (PAMI) exceeds $30 million, these state programs may serve persons in community-based programs. Current law restricts P&A authority to persons in "institutional" facilities meaning 24 hour bed programs, or those who were discharged from a bed facility within the past 30 days.
CHARITABLE CHOICE ALLOWED
S. 976 would allow religious organizations to apply for federal funds for substance abuse services without having to alter the religious character of the organization or the religious freedom of individuals served by such programs. This legislation would allow such programs to require employees to adhere to the religious tenets of the organization.
S. 976 was voted out of the Senate HELP committee by a vote of 17-1. Senator Paul Wellstone (D-MN) voted against the bill because of this charitable choice provision. The Senator also vowed to hold up Senate floor consideration of the legislation unless this provision was deleted. The Senate is likely to consider the legislation under an "unanimous consent" rule, meaning that any one Senator can prevent the legislation from passing.