APRIL 15, 2005
Statement of Margaret Stout of Johnston, Iowa
President, National Alliance for the Mentally Ill
To the Labor-HHS-Education Subcommittee
Committee of Appropriations
U.S. House of Representatives
Regarding FY 2006 Funding for the National Institute of Mental Health (NIMH) and the Substance Abuse and Mental Health Services Administration (SAMHSA)
Chairman Regula and members of the Subcommittee, I am Margaret Stout, President of the National Alliance for the Mentally Ill (NAMI). I am also the Executive Director of NAMI's Iowa affiliate. I am pleased today to offer NAMI's views on the Subcommittee's upcoming FY 2006 bill. NAMI is the nation’s largest grassroots advocacy organization, 220,000 members representing persons with serious brain disorders and their families. Through our 1,200 chapters and affiliates in all 50 states, we support education, outreach, advocacy and research on behalf of persons with serious brain disorders such as schizophrenia, manic depressive illness, major depression, severe anxiety disorders and major mental illnesses affecting children.
Mr. Chairman, for too long severe mental illness has been shrouded in stigma and discrimination. These illnesses have been misunderstood, feared, hidden, and often ignored by science. Only in the last decade have we seen the first real hope for people with these brain disorders through pioneering research that has uncovered both a biological basis for these brain disorders and treatments that work.
The cost of mental illness to our nation is enormous. President Bush’s White House Mental Health Commission – which completed its work in 2003 – found that the direct treatment cost exceeds $71 billion annually. This does not include the $79 billion in estimated indirect costs of benefits and social services. These direct and indirect costs do not measure the substantial and growing burden that is imposed on "default” systems that are too often responsible for serving children and adults with mental illness who lack access to treatment. These costs fall most heavily on the criminal justice and corrections systems, emergency rooms, schools, families and homeless shelters. Moreover, these costs are not only financial, but also human in terms of lost productivity, lives lost to suicide and broken families. Investment in mental illness research and services are – in NAMI’s view – the highest priority for our nation and this Subcommittee.
National Institute of Mental Health (NIMH) Research Funding
The National Institute of Mental Health (NIMH) is the only federal agency whose main objective is to fund biomedical research into serious mental illnesses. Through research, NIMH and the scientists it supports seek to gain an understanding of the fundamental mechanisms underlying illnesses that obstruct thought, emotion, and behavior and an understanding of what goes wrong in the brain in mental illness. NIMH strives, at the same time, to hasten the translation of this basic knowledge into clinical research that will lead to better treatments and ultimately be effective in our complex world with its diverse populations and evolving health care systems.
For FY 2006, the President is proposing $1.418 billion for scientific and clinical research at the National Institute of Mental Health (NIMH). This is a $6 million increase over the amount Congress appropriated for NIMH for FY 2005 ($1.412 billion), and represents a .4% increase. This is far below the overall increase proposed across the entire National Institutes of Health (NIH) of .7% (boosting the overall NIH budget to $28.687 billion). In addition, this proposed increase for NIMH for FY 2006 is below the 2.4% increase that Congress enacted for FY 2005 and far below the 8% and 9% annual increases that were achieved between FY 1998 and 2003. For FY 2006, NAMI supports the "Professional Judgment" budget of $1.497 billion recommended by the Ad Hoc Group on Medical Research and the Mental Health Liaison Group.
NAMI is concerned that the minimal increase recommended by the President for NIMH could adversely impact on the ability of NIMH (and NIH as a whole) to sustain the level of ongoing multi-year research grants and that too many valuable research projects will not be funded. Just maintaining research funding in place has the potential to wipe out opportunities to support new research that has been undertaken at NIMH in recent years – particularly new grants that have been initiated in conjunction with NIMH’s research plans on schizophrenia and bipolar disorder.
Supporting the NIMH Strategic Plan
NAMI supports NIMH's mission to reduce the burden of mental illness through research designed to transform treatment and recovery. To achieve this, especially in a time of fiscal restraint, NAMI endorses setting strategic priorities for NIMH. Identifying priorities and reorganizing internal structures will help exploit the enormous scientific gains that have already been made and bring greater focus to cross-disciplinary collaboration to accomplish these goals. The most important reason for change is that basic science now provides us with unprecedented opportunities to define the pathophysiology of mental disorders and to develop new interventions. As defined by NIMH Director Thomas Insel, NIMH's highest priorities must be:
- supporting basic science discoveries;
- translating these discoveries into new interventions that will relieve the suffering of people with mental disorders; and
- ensuring that new approaches are used for diverse populations and in diverse settings.
Redefining NIMH to Its Mission
NAMI applauds NIMH's efforts to reform the Institute on along 3 core principles: relevance, traction, and innovation.
- Relevance refers to relevance to the mission.NIMH should continue its strong support of basic science, but as the NAMHC workgroup recommends in its report (http://www.nimh.nih.gov/council/brainBehavioralScience.cfm) some research areas are more relevant than others.
- Traction refers to the capacity for rapid progress in research areas where new tools, such as 2-photon imaging, yield definitive answers to long-standing questions.
- Innovation is often endangered during periods of limited budget growth.This work is highly relevant and NIMH is gaining traction, but unless a priority is placed on such "discovery" science, this unprecedented opportunity for innovation may not receive the support it deserves.
As a result of NIMH's priority-setting -- done in extensive collaboration with consumers and families -- a list of priorities for each extramural Division has been developed to guide grantees to areas of investment. In NAMI's view, high priority should go to studies of the pathophysiology of mental illnesses and studies that will lead to new interventions aimed at reducing the burden associated with severe mental illness. While much of the basic science NIMH is supporting may not be immediately ready for translation, it will address basic questions about behavior, brain, and experience that are informed by and, in turn, inform the understanding of mental illness and recovery.
NAMI Supports Increases for Programs at the Center for Mental Health Services (CMHS) Targeted to Individuals With Severe Mental Illnesses
The Center for Mental Health Services (CMHS) – part of the Substance Abuse and Mental Health Services Administration (SAMHSA) – is the principal federal agency engaged in support for state and local public mental health systems. Through its programs CMHS provides flexible funding for the states and conducts service demonstrations to help states move toward adoption of evidence-based practice.
CMHS Programs and the Crisis Confronting the Public Mental Health System
During the recent economic downturn and resulting crisis in facing state budgets, we are witnessing widening of gaps in the public mental illness treatment system in many states. This is resulting in unprecedented cuts being enacted by states in both direct spending on mental illness treatment and supportive services, and in Medicaid funding of such services. Deep cuts to front-line clinics and providers in the public mental health system, curbs on access to newer more effective medications and closure of acute care beds in the community are just a few of the misguided strategies states are employing to close their widening budget gaps. 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: increased risk of suicide, the growing number of chronic homeless adults and the growing trend of “criminalization” of mental illness and the stress it is placing on state and local jails and prisons.
The Need to Focus on Recovery-Oriented Evidence-Based Practices
As states continue to cut funding for mental illness treatment and supportive services, CMHS programs are becoming an increasingly important source of funding for the states. First and foremost, states should be encouraged to use their CMHS Block Grant funds to prevent further cuts in services for children and adults with severe mental illnesses. NAMI also supports targeting of CMHS dollars toward investment in evidence-based, outreach-oriented service delivery models for persons with severe mental illness in the community. The need to focus limited resources on evidence-based models (such as Programs of Assertive Community Treatment, PACT) was recommended in 2003 by the President’s New Freedom Initiative Mental health Commission Report. This landmark report called for a reform of the public mental health system to eliminate system fragmentation and better reflect the priorities of recovery and community integration. More information on this report is available at: http://www.mentalhealthcommission.gov/
NAMI Supports Bush Administration Request for “Mental Health System Transformation”
The President’s FY 2006 budget includes a request for $26 million at CMHS for continuation and expansion of state incentive grant program for “Mental Health System Transformation.” This initiative is intended to continue helping states implement the recommendations in the White House “New Freedom Initiative” Mental Health Commission report from July 2003. NAMI is grateful to this Subcommittee for allocating $20 million for this initiative in FY 2005. These Mental Health Transformation grants are now being allocated to states on a competitive basis to support the development of comprehensive state mental health plans to reduce system fragmentation and increase access to evidence-based services that promote recovery from mental illnesses. States will be required to use funds to develop plans that cut across multiple systems such as housing, criminal justice, child welfare, employment and education. NAMI strongly supports this proposal as to reform our nation’s fragmented and underfunded public mental health system in order to bridge the gap between scientific advance and practice and refocus limited resources on individuals living with the most severe and disabling mental illnesses.
Mr. Chairman, NAMI would also like to take this opportunity to note for the record that these Mental Health Transformation grants are NOT an attempt to promote mandatory mental health screening programs for children that would be implemented without parental consent. As you know, well-funded anti-psychiatry groups have attempted to mischaracterize this program as part of an agenda to institute mandatory, universal screening that would occur without parental consent. As HHS Secretary Leavitt declared before this Subcommittee several weeks ago, no such program exists at HHS and no such program is being planned. NAMI shares the Administration's concerns that misplaced fears about Mental Health Transformation are a distraction. They also threaten to drive up stigma, something that President Bush has recognized as a major obstacle to more Americans seeking much needed treatment for mental illnesses. We are grateful for your efforts Mr. Chairman in fighting this attempt to mischaracterize the President's position. NAMI supports effective early identification and intervention programs that promise to address our nation's crisis in unidentified mental illnesses in youth and will help to end the tragedies that all too often ensue.
Funding for Youth Suicide Prevention Initiatives
This past fall, Congress passed -- and President Bush signed into law -- the Garrett Lee Smith Memorial Act (P.L. 108-355), authorizing new programs at SAMHSA to support states and local communities in developing comprehensive strategies for suicide prevention among adolescents and young adults. The new law also authorizes expansion of campus-based mental health services. NAMI strongly supports this new law. For FY 2005, Congress allocated $7 million for programs authorized under the Garrett Lee Smith Act, including planning grants to the states to develop comprehensive suicide prevention strategies. NAMI urges full funding in FY 2006 ($16.5 million) for suicide prevention activities authorized under the Garrett Lee Smith Act.
NAMI Supports the “Samaritan” & SELHA Initiatives to End Chronic Homelessness
The Bush Administration has put forward a proposal to end chronic homelessness within the next decade through the development of long-term planning and investment in permanent supportive housing (housing linked to services). NAMI supports this “Samaritan Initiative.” In addition, NAMI is also supporting legislation recently introduced by Senators Mike DeWine (R-OH) and Jack Reed (D-RI) and Representatives Deborah Pryce (R-OH) and Anna Eshoo (D-CA) to authorize funding for services tied to permanent supportive housing targeted to individuals that have experienced long-term chronic homelessness. This legislation, known as the Services for Ending Long-Term Homelessness Act (S 709/HR 1471). NAMI urges support for SELHA and funding for services in permanent supportive housing in FY 2006.
Chronically homeless people with severe mental illnesses and co-occurring substance abuse disorders have needs that cross the boundaries of fragmented, categorical service systems. They rarely access the comprehensive supports they need to get and keep housing. Supportive housing provides accessible, coordinated, and flexible services that lead to recovery and reintegration into community life. NAMI also urges additional funding in FY 2006 for the PATH program to address inequities in the program’s interstate funding formula that have frozen the allocation for many smaller rural states since the mid-1990s. NAMI supports S 319, legislation adjusting the "small state minimum allocation" in the PATH program.
Funding for CMHS Programs in the President’s FY 2006 Budget
NAMI also supports ongoing activities at CMHS.
- Mental Health Block Grant – CMHS’s largest program, the Mental Health Block Grant (state formula grant program), is proposed for a freeze for FY 2006 under the President’s budget proposal ($436 million).
- Childrens’ Mental Health program at CMHS – The President is requesting level funding for the Childrens Mental Health program at $105.2 million.
- Programs of Regional and National Significance – CMHS’s own discretionary budget – known as Programs of Regional and National Significance (PRNS) – would fall to $210.2 million under the President's FY 2006 budget, $64.1 million below current levels. Programs targeted for reduction include a youth violence prevention initiative ($27.4 million below its current level).
- Jail Diversion – NAMI is disappointed that the President’s budget proposes to reduce the CMHS Jail Diversion program by $3 million, down to $3.9 million. NAMI strongly supports the Jail Diversion program and urges continuation of funding in FY 2006.
Chairman Regula, thank you for the opportunity to share NAMI's views on the Subcommittee FY 2006 bill. NAMI's consumer and family membership thanks you for your leadership on these important national priorities.