FY 2002 Research and Services Appropriations
Increased funding for research and services programs is a critical issue for NAMI. Later this spring, Congress will draft a spending bill for the fiscal year that begins October 1, 2001 that will include funding for dozens of federal agencies, including the National Institute of Mental Health (NIMH) and the Center for Mental Health Services (CMHS). The following materials are NAMI’s FY 2002 priorities for funding of CMHS and NIMH that will be included in the FY 2002 Labor, HHS, and Education appropriations bill.
All NAMI members are encouraged to contact their Senators and member of the House of Representatives and encourage them to support increased funding for mental illness research and services following the talking points below. If a NAMI member’s Representative serves on the House Committee on Appropriations or its Subcommittee on Labor, HHS, Education and Related Agencies, it is very important that these members of Congress be contacted and urged to follow the talking points. All members of Congress can be reached by calling the Congressional Switchboard at 202-224-3121 or by clicking on “Write to Congress” on the Public Policy home page of the NAMI website, http://www.nami.org/policy.htm
Over the past two years, funding for the Mental Health Block Grant (MHBG) has been increased by more than 31% (up from its FY 1999 appropriation of $288.8 million to $420 million in FY 2001). This important formula grant program to the states supports community-based services to adults and children with severe mental illnesses and persons with a dual diagnosis of mental illness and addictive disorder.
States use their MHBG allocation to support local treatment service programs that include rehabilitation, case management, housing-related supports and other services designed to enhance the recovery and independence of people with mental illness. States allocate funds on the basis of annual plans, developed through input from state Mental Health Planning Councils, that are submitted to the federal Center for Mental Health Services (CMHS). While the MHBG represents only a small portion of overall state and local public mental health spending nationally, it is an important source of funds for programs that focus on the most severely mentally ill in many states.
• Despite the recent increases in federal funding, we have witnessed 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.
• The cause of these growing gaps in the services are varied and complicated: state and local budgets cuts, the trend toward privatizing state Medicaid programs through contracting with private managed care firms, cuts in Medicaid Disproportionate Share Hospital (DSH) funding and expansion of mission of public mental health programs beyond serving the most severely disabled consumers.
• 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 programs utilize a 24-hour, 7 day a week, team approach that delivers comprehensive treatment, rehabilitation and support services in community settings. High quality PACT programs are typically implemented at a cost significantly less than placing an individual in a jail, residential treatment program or hospital. PACT is 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 as close to their authorized levels as possible: jail diversion ($10 million), dual diagnosis for co-occurring disorders ($40 million) and emergency mental health centers ($25 million).
• NAMI is also concerned that the Substance Abuse Block Grant is not currently supporting programs serving persons dually diagnosed with mental illness and addictive disorders. Evidence-based treatment, as confirmed by the NIH, verifies that integrated treatment, as opposed to parallel collaborative approaches, is the most effective model for serving persons with a dual diagnosis. NAMI therefore supports efforts to direct SAMHSA to use funding from both programs to promote integrated treatment services for persons with co-occuring mental illness and addictive disorder.
• NAMI supports increases for the PATH program – currently funded at $31 million for FY 2001. 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.
• NAMI supports reform of the CMHS Knowledge, Development and Application (KDA) 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 children and adults with the most severe and disabling mental illnesses (e.g., the Program of Assertive Community Treatment, 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.
NAMI, in the interest of maintaining an open dialogue with all advocates, regardless of our agreement or disagreement with their views, will pursue discourse and exchange over confrontation whenever possible. We invite all mental health and mental illness advocates to join us in crafting innovative and practical solutions to the many serious problems we face as consumers and family members; problems that include a broken and under funded mental health system, a society that continues to demonize and marginalize all who live with mental illness, and a mental health/mental illness movement rife with division.
Sincerely, Rick Birkel, Executive Director, NAMI
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. The agency’s FY 2001 budget was increased by more than 12 percent, up to its current level of $1.107 billion. 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 2005. NAMI strongly supports this effort, which has also been endorsed by President Bush.
NAMI’s Advocacy Goals and Strategies
NAMI strongly supports efforts to substantially increase federal funding to ensure that there are adequate resources for promising biomedical research into brain disorders and genetics and support for initiatives focused on neural receptors, receptor subtypes, and modulators. NAMI applauds efforts in Congress and from the Bush Administration to increase funding for NIH, and urges that increases enacted in FY 2002 for the NIMH be directed to the most serious and disabling brain disorders. NAMI also supports changes in the NIMH mission that will place greater emphasis on the most serious brain disorders—including schizophrenia, major depression and bipolar disorder—in its research portfolio.
Talking Points on Research Funding
• 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. Clearly, an inequity exists when one compares the burden of severe mental illnesses versus the investment we make in this area of research.
• Greater efforts are needed to expand research funding focused on severe mental illness and to increase consumer and family involvement in the research enterprise through more input into the decision-making and planning processes at NIMH, specifically, and at NIH overall. NAMI strives for membership on committees inviting such input and taking advantage of other mechanisms that allow for real and timely comment to increase accountability in order to ensure that taxpayer dollars are being put to appropriate use.
• 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.
April 6, 2001
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