October 12, 2001
Congress Moves Forward on Funding for Mental Illness Research and Services Programs
After months of delay, Congress has begun action on spending legislation for mental illness research and services for the fiscal year that began on October 1. The massive $123.1 billion FY 2002 Labor-HHS-Education Appropriations bill (HR 3061) includes important increases for mental illness research and services programs, including the National Institute of Mental Health (NIMH) and the Center for Mental Health Services (CMHS). Despite the fact that the new fiscal year began nearly two weeks ago, it is expected that Congress will act quickly on HR 3601 and get it to the President's desk within the next two weeks.
Congress and the White House have agreed to overall discretionary spending levels - including programs under the Labor-HHS-Education Appropriations bill. Thus while important differences exist between the Senate, the House and the President over individual agency and program funding levels, they are relatively minor and are not expected to result in significant delays or prolonged partisan disputes that have characterized action on the Labor-HHS-Education spending bill in recent years. Congressional leaders in the White House are eager to expedite action on FY2002 spending bills in order to direct their attention toward anti-terrorism measures and efforts to stimulate the faltering economy.
For programs of concern to NAMI - at both NIMH and CMHS - there are important differences between the House and Senate versions of HR 3061. For biomedical research, the House bill limits increases for the National Institutes of Health (NIH) - including NIMH - to President Bush's 11.4% increase (a boost of $2.5 billion), while adding additional funds for a number of other HHS agencies including CMHS. By contrast, the Senate bill provides the NIH with a larger 16.8% increase (a $3.4 billion boost), but freezes spending for most other HHS programs (including most programs at CMHS). Differences between the House and Senate bills are expected to be resolved within the next two weeks.
As this process moves forward, NAMI will be pressing members of the House-Senate Conference Committee on the FY 2002 Labor-HHS-Education Appropriations bill and the White House on a number of key funding priorities for research and services programs. Specifically, NAMI will be asking that the final version of HR 3061 include:
- The Senate recommended level for mental illness research at the NIMH (up to $1.279 billion) - a 16% increase (as opposed to the 11.4% increase recommended in the House bill) with specific direction from Congress for all increases above the current level to go toward basic scientific and clinical research on severe mental illnesses; and
- The House recommended level for the Mental Health Block Grant (a $20 million increase) - with specific direction from Congress that states target increased Block Grant funds to specific populations (adults and children with severe mental illness) and evidence-based service models (e.g. PACT), the recommended $3 million increase for the PATH program included in both bills (up to $40 million), and the House recommended $5 million allocation for the new CMHS jail diversion program.
More details on each of these issues are included below. NAMI affiliates and advocates in the states and districts of members on the House-Senate Conference Committee are especially urged to contact conferees regarding these key concerns for individuals with severe mental illnesses and their families. While conferees have not been named by either the House or the Senate, it is expected the following members of Congress will be appointed to the Conference Committee.
Senate: Robert Byrd (D-WV), Thad Cochran (R-MS), Larry Craig (R-ID), Mike DeWine (R-OH), Judd Gregg (R-NH), Tom Harkin (D-IA), Ernest Hollings (D-SC), Kay Bailey Hutchison (R-TX), Daniel Inouye (D-HI), Herb Kohl (D-WI), Mary Landrieu (D-LA), Patty Murray (D-WA), Harry Reid (D-NV), Arlen Specter (R-PA) and Ted Stevens (R-AK).
House: Randy "Duke" Cunningham (R-Escondido, CA), Rosa DeLauro (D-New Haven, CT), Kay Granger (R-Ft. Worth, TX), Steny Hoyer (D-Greenbelt/Waldorf, MD), Ernest Istook (R-Oklahoma City, OK), Jesse Jackson, Jr. (D-Chicago/Homewood, IL), Patrick Kennedy (D-Woonsocket/Newport, RI), Nita Lowey, (D-White Plains, NY), Dan Miller (R-Sarasota/Bradenton, FL), Anne M. Northup (R-Louisville, KY), David Obey (D-Superior/Wausau, WI), Nancy Pelosi (D-San Francisco, CA), John Peterson (R-State College, PA), Ralph Regula (R-Canton, OH), Don Sherwood (R-Scranton, PA), Roger Wicker (R-Tupelo, MS) and C.W. "Bill" Young (R-St. Petersburg, FL).
All members of the House-Senate Conference Committee can be reached by calling the Capitol Switchboard at 202-224-3121 or by clicking on "Write to Congress."
As was noted above, the Senate bill contains an overall increase for NIH of $3.4 billion, up to $24.1 billion, while the House holds to the President's recommended increase of $2.5 billion (up to $23.2 billion). As a result, the increase for NIMH in the Senate bill is more than the House bill. The Senate bill recommends an increase of $162 million for NIMH, a 16% increase, up to $1.279 billion, while the House bill recommends $1.238 billion (a $131 million increase, or 10.6%). The NIMH FY 2001 budget was $1.118 billion. Both bills maintain the ongoing 5-year bipartisan plan to ensure that the overall NIH budget is doubled by 2004 a plan that NAMI has enthusiastically supported.
At the same time, NAMI wants to ensure that whatever the final funding levels are agreed upon by Congress and the White House, that the percentage increase for NIMH is at least equal to the percentage increase among all of the 13 institutes within the NIH. Given that severe mental illnesses are among the most costly in terms of disease burden to society and have historically been under-researched, NAMI believes a strong case can be made for Congress to keep NIMH's increase on par with all other institutes. NAMI urges advocates to express appreciation for the overall funding of NIH research and encourage a revision of the relative increases to better reflect the true costs of serious mental illnesses to society and the excitement of brain research, with any adjustment dedicated to research on serious mental illness.
As noted above, the House was able to include important increases for CMHS in its version of the FY 2002 Labor-HHS-Education Appropriations bill. By contrast, the Senate bill freezes most CMHS programs at their current levels. Below is a summary of funding levels for selected programs of concern to children and adults with severe mental illnesses and their families:
- Mental Health Block Grant - The House bill includes a $20 million increase for the Mental Health Block Grant (a state formula grant program financing services for adults with severe mental illnesses and children with severe emotional disturbances). This would bring the program up to $440 million. By contrast, the Senate bill proposes to freeze the program at its $420 million level,
- PATH - Both the House and Senate bill propose to increase PATH (community-based services for homeless individuals with mental illness) by $3 million, up to $40 million,
- Programs of Regional and National Significance (PRNS) - The House bill proposes a $20 million increase for CMHS PRNS budget (bringing the level up to $223.5 million). The Senate bill proposes a freeze. PRNS is the discretionary budget for CMHS, i.e. funds under federal control of CMHS, as opposed to the Mental Health Block Grant and PATH that are formula grant programs to the states. The President had proposed to cut the CMHS PRNS budget by $16 million, largely by not renewing expiring service demonstration programs.
- Jail Diversion - The entire $20 million increase for PRNS in the House bill is earmarked for specific programs. Among these directives are $5 million for a jail diversion program that would fund treatment and community supports to non-violent criminal offenders with severe mental illnesses. NAMI strongly supports this program as an essential companion to the new federal Mental Health Courts program at the Justice Department and in important potential resource in addressing the growing and very disturbing trend of "criminalization" of mental illness. Other earmarks in the House bill for the CMHS PRNS program are $10 million for the children with PTSD who experience or witness trauma and $5 million in targeted services for senior citizens,
- Childrens' Mental Health - The House bill proposes a $6 million increase, up to $97.7 million, while the Senate bill proposes a freeze at the current $91.7 million level,
- PAIMI - Both the House and Senate bills include a $3 million increase for the protection and advocacy program, with a directive for P& A agencies to maintain a priority on investigating deaths and injuries resulting from the inappropriate use restraint and seclusion in psychiatric hospitals and other institutions,
- Youth Violence Prevention - The House bill proposes a $10 million increase, up to $100 million, while the Senate bill recommends maintaining the program at $90 million,
- Social Services Block Grant - The House bill proposes $1.7 billion for SSBG program, $25 million below its current level (the same amount request by the Bush Administration). While the SSBG program operates outside of CMHS's jurisdiction, it is a state formula grant program that many states use to fund community-based services for children and adults with severe mental illnesses.
The Case for Increased Federal Investment in Mental Illness Research at NIMH
NIMH is the principal federal agency in charge of funding biomedical research into brain disorders. NIMH supports and conducts an integrated program of basic and clinical research and research training in biology, neuroscience, and epidemiology. Research initiatives include programs in major brain disorders such as schizophrenia, major depression, bipolar disorder, panic disorder, and obsessive-compulsive disorder.
Over the past five years, NIMH has received important increases in funding through the bipartisan leadership in Congress. This increase amounts to a major down payment toward the bipartisan goal of doubling the federal biomedical research budget (including that of NIMH) by the year 2004. NAMI strongly supports this effort, which has also been endorsed by President Bush.
Research is the ultimate source of hope for NAMI consumers and family members. Already, research has yielded tremendous advances, underscored the fact that severe mental illnesses are brain disorders, and provided amazing treatment advances. The results to date have fueled NAMI's advocacy to end stigma and discrimination against people with severe mental illnesses. And, perhaps more importantly, the results have made recovery a real possibility for individuals who suffer from these chronic, disabling, and not infrequently life-threatening diseases.
Nonetheless, further research is imperative if we are to prevent the next generation from suffering. Much has to be learned. Still the causes and mechanisms of these diseases are mostly unknown. Treatment is imperfect; it does not work well for all individuals who have these brain diseases. There are no cures for severe mental illnesses, and existing treatments and services shown to be effective are all too often not available to the people who need and deserve them. While steady research-funding gains have been achieved, NAMI believes that severe mental illness research, from the most basic to services research, remains underfunded, given the tremendous scientific opportunities that exist and the severe burden that these diseases present to the public as well as to our families.
A 1996 independent study by the World Bank and World Health Organization (DALY: Disability Adjusted Life Years) found that four of the top ten causes of disability worldwide are severe mental illnesses: major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder. These brain disorders account for an estimated 20 percent of total disability resulting from all diseases and injuries. But using the most recent estimates from NIH, one finds that $1.00 is invested in research for every $6.86 in costs of AIDS, $9.96 in costs of cancer, $65.65 in costs of heart diseases, and $161.26 in costs of schizophrenia. In other words, 15 cents is spent on AIDS research per dollar of costs, compared with 10 cents for cancer, two cents for heart disease, and less than one cent for schizophrenia.
NAMI believes that more focus is needed at NIMH on severe mental illness research at all levels to at least 85% of the total budget. NIMH's origins spring from a congressional and public desire to enhance the treatment of severe mental illnesses. The severe and ongoing burden of these diseases absolutely requires that NIMH enhance its attention to these areas and support only the best research at the basic, clinical, and services level that shows promise for individuals with these conditions. Further, research at all levels should be closely linked, so that advances rapidly translate into better treatment and service for individuals with these illnesses.
NAMI Supports Targeted Increases for Severe Mental Illness Treatment Service Programs at CMHS
Despite recent modest increases in federal funding, there has been a continued widening of gaps in the public mental illness treatment system in many states. The consequences of these emerging cracks in the service system are readily apparent, not just to NAMI's consumer and family membership, but also to the public: the growing number of homeless adults on our nation's streets who receive no treatment services, well publicized tragic incidents involving individuals with severe mental illness who are not accessing adequate treatment services and the growing trend of "criminalization" of mental illness and the stress it is placing on state and local jails and prisons.
NAMI supports targeting all additional funds for the MHBG to state and local evidence-based, outreach oriented service delivery models for persons with severe mental illness in the community. In particular, NAMI is urging to Congress to direct any increase in MHBG funding to assertive community treatment (including the Program of Assertive Community Treatment, PACT). PACT has proven especially effective in serving persons who are the most treatment resistant, persons with a co-occurring mental illness and substance abuse disorder and persons who are high users of inpatient hospitalization services.
In 2000, Congress passed legislation reauthorizing all SAMHSA and CMHS programs and authorizing several new programs targeted to adults with severe mental illnesses. NAMI strongly supports funding for these new programs including jail diversion, and dual diagnosis for co-occurring disorders.
NAMI supports increases for the PATH program. PATH is a formula grant program to the states to support local programs serving homeless persons with severe mental illness. This increase in PATH will help communities all across the country increase access to treatment and supports for the growing number of homeless with severe mental illnesses. Finally, NAMI supports reform of the CMHS Projects of Regional and National Significance (PRNS) program in order to establish a new role for the agency as a leader in assisting state public mental health systems in replicating evidence-based programs serving individuals with the most severe and disabling mental illnesses (e.g., PACT). NAMI urges that particular focus be placed on assisting states in reaching the most vulnerable and disenfranchised populations with severe mental illnesses such as the homeless and non-violent offenders in the criminal justice system.