December 20, 2001
Congress Completes Action on FY 2002 Funding for
Mental Illness Research and Services Programs
After months of delay, Congress has completed action on spending legislation for mental illness research and services for fiscal year 2002. The massive $123.8 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 FY 2002 actually began back on October 1, funding levels for the remaining nine months of the fiscal year have now been set. President Bush is expected to sign HR 3061 by the end of the week.
It is important to note that the Labor-HHS-Education Appropriations bill was the legislative vehicle for the Domenici-Wellstone mental illness parity amendment that House conferees rejected on December 18 (see NAMI E-News, Vol. 02-39 for further details). Differences between the House and Senate over mental illness parity, as well as President Bush's education bill, held up final action on HR 3061 for weeks. While the Domenici-Wellstone amendment was not included in the final version of HR 3061 (a major disappointment for NAMI), House and Senate conferees did extend the 1996 limited federal parity law (parity only for annual and lifetime dollar limits).
In addition, the final bill adds the following advisory language: "The conferees recognize the devastating impact of mental illnesses on Americans from every walk of life and the widespread bipartisan support of mental health parity legislation in both houses of Congress. The conferees strongly urge the committees of jurisdiction in the House and the Senate to convene early hearings and undertake swift consideration of legislation to extend and improve mental health parity protections during the second session of the 107th Congress" (i.e. in 2002). While this language is not legally binding on Congress, it is an important step forward in forcing action on the part of key House leaders who blocked the Domenici-Wellstone amendment in recent weeks.
Mental Illness Research at NIMH
The final House-Senate agreement on the Labor-HHS-Education Appropriations bill for FY 2002 contains an overall increase for NIH of $3 billion, up to $23.28 billion. This level is well above the $2.5 billion increase recommended by the House and the Bush Administration increase of $2.5 billion (up to $23.2 billion). This represents nearly a 15% increase - maintaining the bipartisan goal of doubling the federal commitment to biomedical research by 2004 - a goal that NAMI enthusiastically supports. For NIMH, the final Labor-HHS-Education bill for FY 2002 includes $1.249 billion, more than a $131 million increase over the FY 2001 level of $1.118 billion. This 13% increase represents a major victory for NIMH, although the agency's increase is slightly below the average for the 13 research institutes at NIH. This allocation for NIMH represents a splitting of the difference between the House recommended level ($1.228.8 billion) and the higher Senate recommended level ($1.279.4 billion).
NIMH is the principal federal agency responsible for scientific research on mental illness. NAMI strongly supports NIMH's scientific mission to advance research on severe mental illness. 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 is grateful to the leadership of key members of the House and Senate Appropriations Committees and the Bush Administration for the overall funding increases at both NIMH and NIH. NAMI also encourages Congress and the Bush Administration in 2003 and beyond to revisit the relative increases for institutes within NIH to better reflect the true costs of severe mental illnesses to society and the promise of brain research to have greater emphasis on basic scientific and clinical research on diseases such as schizophrenia, bipolar disorder and major depression.
Services Programs at CMHS
While increases for mental illness service programs at the Center for Mental Health Services (CMHS) - part of the Substance Abuse and Mental Health Services Administration (SAMHSA) - were far below those for NIH and NIMH, Congress was able to increase spending for many of the agency's programs. Overall, SAMHSA's FY 2002 budget will be $3.138 billion - more than half of which is allocated to the states through formula grant programs. 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 final version of HR 3061 includes a $13 million increase for the Mental Health Block Grant - also known as the "Mental Health Performance Partnership" program. This brings the program up to $433 million for FY 2002. This is $7 million below the level recommended by the House, but well above the President's proposal to freeze the program at its FY 2001 level of $420 million. The Mental Health Block Grant is a state formula grant program financing services for adults with severe mental illnesses and children with severe emotional disturbances. As a block grant, decisions regarding targeting of funds are deferred to the state mental health commissioners and state mental health planning councils. NAMI supports the Mental Health Block Grant program and is working to require states to better target these limited resources to evidence-based programs that serve children and adults with the most severe mental illnesses.
- PATH - For FY 2002, Congress has allocated $39.85 million for the PATH program (community-based services for homeless individuals with mental illness). This is a $3 million increase over the program's FY 2001 level of $36.85 million. Like the Mental Health Block Grant, PATH is a formula grant program to the states.
- Programs of Regional and National Significance (PRNS) - The final Labor-HHS-Education bill includes a $26.68 million increase for the CMHS PRNS budget (bringing the level up to $230.07 million). This level is above the amount allocated by both the House and the Senate in their original labor-HHS-Education bills for FY 2002. However, nearly all of these increases above the House and Senate proposed levels are for specific earmarks and projects directed by members of Congress, many of which are directed to several meritorious programs in specific states and communities. Among these congressional earmarks are $500,000 for the Texas Medication Algorithm program and $800,0000 for the Mentally Ill Offender Crime Reduction demonstration program in Ventura County, CA. The PRNS program represents 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 originally proposed to cut the CMHS PRNS budget by $16 million, largely by not renewing expiring service demonstration programs, a proposal largely rejected by Congress.
- Jail Diversion - As noted above, nearly all of the increased funds for the CMHS PRNS program in the final FY 2002 Labor-HHS-Education Appropriations bill are directed for specific programs. Among these directives is $4 million for a new national 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 $4 million 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 specific amounts set aside in the CMHS PRNS account for specific national initiatives are $20 million for children with PTSD who experience or witness trauma, $3 million for model suicide prevention programs, $2.5 million for counseling for public safety workers and $5 million for outreach services for senior citizens.
- Childrens' Mental Health - For FY 2002, the CMHS Childrens mental health program will be funded at $96.7 million - a $10 million increase over FY 2001.
- PAIMI - For FY 2002, Congress increases funding for the PAIMI protection and advocacy program by $2.5 million and maintained an existing directive for P& A agencies to place a high priority on investigating deaths and injuries resulting from the inappropriate use restraint and seclusion in psychiatric hospitals and other institutions.
- Youth Violence Prevention - For FY 2002, Congress added an additional $95 million as part of PRNS budget specifically for CMHS's ongoing school violence prevention program ($5 million more than was allocated in FY 2001).
- Social Services Block Grant - The final version of the FY 2002 Labor-HHS-Education Appropriations bill includes $1.7 billion for the SSBG program, $25 million below its current level. This is the same amount requested 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.