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Congress Moves Forward On FY 2000 Spending Bills Covering Mental Illness Research And Services
Federal Action Alert

For Immediate Release, 5 Oct 99
Contact: Chris Marshall
703-524-7600



After months of delay, the House and Senate are finally moving forward on legislation to fund mental illness research and services programs for the new fiscal year. Even though the federal fiscal year began on October 1, ongoing funding for these programs, as well as most federal agencies, has been extended at current levels through a "continuing resolution." In the meantime, both the House and Senate are working on their separate versions of the FY 2000 Labor, Health and Human Services (HHS) and Education Appropriations bill (S 1650, House bill still unnumbered) that fund most major health and human service programs through October 1, 2000. Of key importance to NAMI members in the Labor-HHS Appropriations bill are specific funding levels and critical policy prioritization set forth by Congress for the National Institute of Mental Health (NIMH) and the Center for Mental Health Services (CMHS).

NIMH

Both the House and Senate Labor-HHS bills include bigger increases for NIMH than recommended by the President. Specifically, the House sets NIMH funding for FY 2000 $930.4 million (a $75.2 million increase over FY 1999, or +8.1%), while the Senate boosted NIMH up to $969.5 million (a $114.2 million increase over FY 1999, or +13%). These increases are slightly above the average for the rest of the $17 billion National Institutes of Health (NIH) budget. By contrast, the President's FY 2000 budget request for NIMH was only $875.9 million. Current year funding for NIMH is $855.2 million.

It is important to note that these major increases for biomedical research were very difficult for the House and Senate Appropriations Committees to achieve given the strict limits on federal discretionary spending that remain in place, despite recent reports of large federal budget surpluses in the coming years. NAMI advocates therefore owe a debt of gratitude to Senator Arlen Specter (R-PA) and Representative John Edward Porter (R-IL) for their leadership in increasing the NIMH under such difficult circumstances. Their commitment to supporting scientific research on serious brain disorders and strengthening services for the most severely ill consumers is deeply appreciated.

The major political struggle between Congress and the President over whether, and how, to stay within the current discretionary spending limits (including charges that each side is using budgetary gimmicks and attempting to dip into Social Security surplus funds) is likely to continue throughout the fall. Regardless of the outcome, NAMI is hopeful that funding for the NIH in general, and NIMH in particular, will be closer to the desire of Congress than to the President's request.

In addition to supporting increased funds for NIMH, NAMI is also enthusiastically supporting a targeted initiative within NIMH's portfolio for clinical research on child and adolescent disorders focusing on teen violence and suicide. These priorities were set forth in S 1555, legislation introduced in August by Senators Pete Domenici (R-NM) and Edward M. Kennedy (D-MA). The Senate Appropriations Committee report accompanying S 1650 contains specific references to these priorities and urges greater attention to them in NIMH's priority activities. The following is an excerpt from the Senate Appropriations Committee report.

Children's mental health- The Committee is aware of NIMH's focus on funding additional research on children's mental disorders, with a special emphasis on gaining a clearer knowledge of the extent of mental disorders in children. The Committee encourages this emphasis to continue, including NIMH's efforts to encourage more scientists to build careers in this field. Woefully little is known about mental illness in children, and there are far too few investigators in this area. In addition, little is known about the long-term effects of the medications that--although approved for adults--are also the front line of treatment for children. Psychiatric disorders are not easily recognized in children, yett in many cases the mental disorders of childhood are the precursors of adult, or lifetime, mental illnesses. It is now known that many children and adolescents suffer from depression, which in its most severe forms may underlie acts of violence, including the self-inflicted violence of suicide. It is critical, therefore, that better understanding of the causes and the best interventions in these illnesses be a priority in order to prevent many cases of adult mental illness.

CMHS

On federal funding for services, both the House and Senate FY 2000 Labor-HHS Appropriations bills attempt to accommodate the Administration's request for a $70 million increase for the Mental Health Block Grant program (up from its current $288.8 million level to $358.8 million). Specifically, the House bill increases Block Grant funding by $11.2 million (up to $300 million), while the Senate bill adds $21.2 million (up to $310 million). NAMI supports these increases and continues to urge members of Congress to target increased funds to high priority populations such as adults and children with severe mental illnesses who lack access to treatment services and to direct states to invest Mental Health Block grant dollars into replication of PACT programs.

Both the House and Senate bills also include modest increases for other CMHS programs including: PATH services for homeless mentally ill adults (up $2 million in the House bill and $5 million in the Senate bill, from its current $26 million level), Childrens Mental Health (up $5 million in the House bill, frozen at $78 million in the Senate) and PAIMI protection and advocacy (up $2 million in the Senate bill, to $25 million. This increase for P& A programs is specifically linked to investigating deaths and injuries related to inappropriate use of restraints and seclusion in psychiatric hospitals. CMHS's own discretionary budget (known as Knowledge Development and Application) was actually cut by $10 million in the House bill (down to $85.6 million), and increased by $40 million in the Senate bill. Over half of the resources in CMHS's KDA budget is directed to federal interagency initiatives to reduce school violence.

Finally, both the House and Senate Appropriations Committees reports accompanying the FY 2000 Labor-HHS Appropriations bills contain specific language regarding the efficacy of integrated treatment for co-occurring mental illness and substance abuse. Both note that parallel and sequential treatment tend to fail, and both urge SAMHSA to provide assistance to the states on how to use substance abuse and mental health block grant funds to promote integrated treatment. The following is an excerpt from the Senate Appropriations Committee report.

The Committee is impressed with evidence that integrated mental health and substance abuse treatment is effective for meeting the needs of individuals who suffer from mental illness and also have an addictive disorder. Sequential and parallel treatment of these disorders generally fails to result in recovery for this population, which is in great need of improved services. There is significant evidence that without effective treatment, these individuals have a higher risk of homelessness and tendency for violent behavior. States may use funds from both the mental health and the substance abuse block grants to treat individuals with co-occurring disorders. The Committee believes that the Department can provide technical assistance to States that plan to provide this type of integrated treatment.

ACTION REQUESTED

The full Senate is now in the midst of debate on the Labor-HHS Appropriations bill, while the full House is likely to take up the bill next week. However, this schedule may be complicated by opposition to several "offsets" in the House bill, including a change in the method for paying out the Earned Income Tax Credit (EITC) that has attracted attention in the national press (and is being opposed by the White House and Texas Governor George W. Bush). Without this offsetting savings for FY 2000, House leaders may have to delay bringing the bill to the House floor. Of particular concern to NAMI is a proposal to make up for these lost savings by imposing a small across-the-board cut on every program and agency in the Labor-HHS bill. Despite this potential delay, NAMI advocates are urged to contact members of their state's congressional delegation and urge them to support both the House and Senate Labor-HHS Appropriations bills.

  • Urge them to support the substantial increases for biomedical research, including the NIMH and make clear the importance of scientific advance to the understanding of serious brain disorders and the need for development of new treatments,

  • Urge them to support efforts to direct NIMH's resources to the most serious and disabling forms of mental illness in adults and children where the public health threat is most costly for society,

  • Urge both your senators to support an amendment likely to be offered by Senator Paul Wellstone (D-MN) to increase the Mental Health Block Grant by an additional $49 million bringing the overall increase over FY 1999 to $75 million, and direct all additional increases to priority NAMI populations and services such as PACT, and

  • Urge all House members to oppose efforts to enact any across-the-board cuts as part of any effort to bring the bill under the existing discretionary spending limits (NAMI supports efforts to adjust the spending upward in order to make long overdue increases in mental illness research and services now that there are federal budget surpluses).

All members of Congress can be reached by calling the Capitol Switchboard at 202-224-3121 or by going to the NAMI website at www.nami.org/policy.htm and click on "Write to Congress."


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