National Alliance on Mental Illness
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Does Your Governor Support Federal Flexibility To Serve Persons With Co-Occurring Disorders?
In a meeting today with staff of the United States Senate Committee on Health, Education, Labor and Pensions (HELP), mental health advocates were asked: Which Governors support flexibility in SAMHSA (Substance Abuse and Mental Health Services Administration) Block Grants to finance integrated treatment programs for persons with co-occurring mental and addictive disorders?
An issue in the legislative reauthorization of SAMHSA is the responsibility (or abdication of responsibility) of the Mental Health and Substance Abuse Block Grants (and service systems) to provide integrated treatment for persons with co-occurring mental and addictive disorders. Senate HELP staff are struggling to find an effective response.
The mental health advocacy community has proposed a legislative amendment which would allow, at the discretion of the Governor, states to use a portion of their Mental Health and Substance Abuse Block Grant funds to finance integrated treatment. States would have to report on how they used the funds. The exact legislative language being proposed by the mental health advocate community is:
Amend Section 1955 to read as follows:
A State receiving amounts under Section 1911 or 1921 may use a portion of such amounts to fund integrated treatment services for children, youth, and adults who have co-occurring serious mental illness and addictive disorders. The Secretary shall obtain appropriate program data on integrated treatment programs. In administering this section, the Secretary shall ensure that federal reporting requirements do not unduly hinder or pose a barrier to States’ ability to combine or commingle funds from Section 1911 or 1921 in order to provide an integrated program of services to individuals with co-occurring disorders.
Please contact your Governor and ask them to support SAMHSA legislative flexibility for SAMHSA Mental Health and Substance Abuse Block Grants to fund integrated treatment for co-occurring mental illness and addictive disorders. Telephone numbers for the fifty Governors are listed at the end of this alert. Ask your Governor to send a letter of support to:
The Honorable William H. Frist
Ask that copies be sent to:
If you can obtain a copy of the letter, please send it to Clarke Ross, at NAMI, Colonial Place Three, 2107 Wilson Blvd., Suite 300, Arlington, VA 22201-3042.
Below is NAMI’s original April, 2, 1999 NAMI E-News on this legislative issue.
FEDERAL ACTION ALERT
GRASSROOTS ACTION NEEDED TO ALLOW BLOCK GRANTS TO EFFECTIVELY SERVE PERSONS WITH CO-OCCURING DISORDERS
CONGRESS AND GOVERNORS NEED TO HEAR FROM NAMI MEMBERS
National studies commissioned by the federal government estimate that 10 million Americans have co-occurring mental and addictive disorders. Disagreements between the mental-illness and addictive-disorders communities over shared responsibility for persons with these co-occurring illnesses has become an obstacle to the legislative reauthorization of the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal-government agency charged with administering services programs for these two populations.
Staff members of the Senate Committee on Health, Education, Labor, and Pensions (HELP) are drafting legislation to reauthorize the Substance Abuse and Mental Health Services Administration (SAMHSA). NAMI, the National Mental Health Association, the Bazelon Center for Mental Health Law, and others have been advocating that both the Mental Health Block Grant and the Substance Abuse Block Grant effectively and equitably finance integrated treatment programs for persons with co-occurring mental and addictive disorders. Because of opposition by the substance abuse community, in many ways supported by SAMHSA’s staff, Senate HELP staff have not allowed such effective and equitable financing.
1. Contact your governor and request that he or she ask members of the United States Congress to expressly allow both block grants to financially support integrated-treatment programs in SAMHSA reauthorization. A list of governors and their telephone numbers is provided at the end of this alert.
2. Contact your members of the United States Congress and encourage them to expressly allow both block grants to support integrated-treatment programs in SAMHSA reauthorization. All members of Congress can be reached by calling the Capitol Switchboard at 202-224-3121. Fax, email and mail addresses can be accessed through the policy page on the NAMI website at http://www.nami.org/policy.htm and click on Write to Congress.
3. As the immediate debate is before the Senate HELP Committee, their roster is listed below. These contacts are urgently needed.
James Jeffords, Chairman (R-VT), Edward Kennedy, Ranking Member (D-MA), Judd Gregg (R-NH), Christopher Dodd (D-CT), William Frist (R-TN), Tom Harkin (D-IA), Mike Dewine (R-OH), Barbara Mikulski (D-MD), Mike Enzi (R-WY), Jeff Bingaman (D-NM), Tim Hutchinson (R-AK), Paul Wellstone (D-MN), Susan Collins (R-ME), Patty Murray (D-WA), Sam Brownback (R-KS), Jack Reed (D-RI), Charles Hagel (R-NE), Jeff Sessions (R-AL).
At issue is a proposal by the mental illness community that SAMHSA’s two block grants (mental health and substance abuse) effectively and equitably co-finance integrated-treatment programs for persons with co-occurring disorders. This is known as "blended funding." Integrated treatment means mental illness and addictive disorders services and interventions are delivered simultaneously at the same treatment site, ideally with cross-trained staff. What is not considered integrated treatment is sequential treatment (treat one disorder first, then the other) or parallel treatment (in which two different treatment providers at separate locations use separate treatment plans to treat each condition separately but at the same time).
The addictive-disorders community argues against state discretion to combine mental-health and substance-abuse block grant funds expressly for integrated treatment because of waiting lists for other priority populations such as people with AIDS who are substance abusers and pregnant women who are substance abusers. This community further argues that integrated treatment programs can be jointly financed now so long as each and every requirement contained in both block grants, including reporting and auditing requirements, is fully met. Integrated-treatment providers argue that the requirement that every penny of the substance abuse block grant be exclusively spent on addiction services and that every penny of the mental health block grant be exclusively spent on mental health services are obstacles because such exact and strict reporting adherence does not allow financing of cross-trained staff and integrated non-clinical support services.
As an alternative to giving states discretion to combine block-grant funds expressly for integrated treatment, the addictive-disorders community advocates a new federal government discretionary and competitive grant program to demonstrate how integrated-treatment programs can work and a two-year study of the issue. The mental-illness community believes it is unrealistic in 1999 to expect the federal government to establish a brand-new grant program (whose funds will likely go only to exemplary programs) and that such a program would delay resolution of the core issue: should not both block grants financially support integrated treatment for persons with co-occurring disorders?
MENTAL HEALTH AMENDMENT SOUGHT BY NAMI
NAMI and other mental illness advocates are merely asking that states be allowed to blend block grant funds for integrated treatment, that states should report how they have spent block grant funds for integrated treatment, and that SAMHSA’s reporting requirements will not prevent such blending of funds. The exact language we are seeking would amend Section 1955 of the Act and reads as follows:
"A State receiving amounts under section 1911 or 1921 may use a portion of such amounts to fund integrated treatment services for individuals who have co-occurring serious mental illness and addictive disorders. The Secretary shall obtain appropriate program data on integrated treatment programs. In administering this section, the Secretary shall ensure that federal reporting requirements do not unduly hinder States in their ability to combine or commingle funds from section 1911 and 1921 in order to provide an integrated program of services to individuals with co-occurring disorders."
The 50 Governors
Alabama Don Siegelman (D) 205-242-7100