Congress Moves Forward On Research And Services Funding For FY 2001, Labor-HHS-Education Spending Set For House-Senate Conference Committee
Senate Adds National Regulation Of Restraint
Because of policy differences and cuts to major parts of the Clinton Administration's education program, the President has pledged to veto both bills. Given the close margin by which each bill passed last month, it is certain that a veto could not be overridden. Thus, major differences over policy and spending will have to be resolved before the Labor-HHS-Education bill is signed into law, on or about the beginning of FY 2001 on October 1. As in recent years, it is expected that re-estimates for higher anticipated budget surpluses for the coming fiscal year will play an important role in adding more funding to the bill in order reach a compromise that is acceptable to the White House.
Over the coming weeks, members of a House-Senate Conference Committee will begin working out differences between the two bills and negotiating with the White House over a final compromise. As this process moves forward, NAMI will be pressing members of the Conference Committee and the White House on a number of key funding priorities for research and services programs. Specifically, NAMI will be asking that the final Labor-HHS-Education bill includes:
2. the Clinton Administration's $416 million request for the Mental Health Block Grant (a $60 million increase) - with specific direction from Congress that states target increased Block Grant funds to specific populations (adults and children with severe mental illness) and evidence-based approaches (e.g. PACT), a $6 million increases for the PATH program (up to $37 million), and the Senate-passed $3 million suicide prevention initiative, and
3. retention of the Senate-passed amendment to curb the inappropriate use of restraint and seclusion in psychiatric hospitals (details below).
More details on each of these issues are included below. NAMI affiliates and members in the states and districts of members on the House-Senate Conference Committee are especially urged to contact conferees regarding these key concerns for individuals with severe mental illnesses and their families. The Senate has already appointed the following conferees: Robert Byrd (D-WV), Thad Cochran (R-MS), Larry Craig (R-ID), Pete Domenici (R-NM), Dianne Feinstein (D-CA), Slade Gorton (R-WA), Judd Gregg (R-NH), Tom Harkin (D-IA), Ernest Hollings (D-SC), Kay Bailey Hutchison (R-TX), Daniel Inouye (D-HI), Herb Kohl (D-WI), John Kyl (R-AZ), Patty Murray (D-WA), Harry Reid (D-NV), Arlen Specter (R-PA) and Ted Stevens (R-AK).
The House is expected to name the following conferees next week: Henry Bonilla (R-Laredo/San Antonio, TX), Randy "Duke" Cunningham (R-Escondido, CA), Rosa DeLauro (D-New Haven, CT), Jay Dickey (R-Pine Bluff/Hot Springs, AR), Steny Hoyer (D-Greenbelt/Waldorf, MD), Ernest Istook (R-Oklahoma City, OK), Jesse Jackson, Jr. (D-Chicago/Homewood, IL), Nita Lowey, (D-White Plains, NY), Dan Miller (R-Sarasota/Bradenton, FL), Anne Meagher Northup (R-Louisville, KY), David Obey (D-Superior/Wausau, WI), Nancy Pelosi (D-San Francisco, CA), John Edward Porter (R-Deerfield/Waukegan, IL), Roger Wicker (R-Tupelo, MS) and C.W. "Bill" Young (R-St. Petersburg, FL).
All members of the House-Senate Conference Committee can be reached by calling the Capitol Switchboard at 202-224-3121 or by going to the policy page of the NAMI Web site at www.nami.org/policy.htm and click on "Write to Congress."
For mental illness research and services there are important contrasts between the House and Senate bills. These contrasts are due in part to the differences between the overall spending allocations between the two bills - the Senate bill has an allocation that is $4.3 billion more than the House bill. This is most apparent when comparing funding for scientific research at the National Institutes of Health (NIH), where the Senate bill increased spending by $2.7 billion, $1.7 billion more than the House bill, and $1 billion more than the President's original FY 2001 request. As a result, the increase for NIMH in the Senate bill is substantially more than the House. The Senate bill recommends an increase of $143 million for NIMH, a nearly 14% increase, up to $1.118 billion. The NIMH FY 2000 budget was $978.4 million.
While the increase for NIMH recommended by the House is much smaller than the Senate, House Labor-HHS-Education Subcommittee Chairman John Edward Porter (R-IL) has made clear that he intends to push for the higher Senate allocations for both NIH and NIMH. NAMI strongly supports this bipartisan effort to ensure that the overall NIH budget is increased by 15% for FY 2001. Such an increase will keep Congress on pace toward doubling the overall NIH budget over the next five years.
At the same time, NAMI is concerned that the level recommended for NIMH in the Senate bill is the smallest among all of the 13 institutes within the NIH. While this percentage spread - 15.16% for NIH compared to 14.70% for NIMH - is relatively small, it appears at odds with the growing recognition that severe mental illnesses are among the most costly in terms of disease burden to society and have historically been under-researched. These findings were documented last year as part of the White House Conference on Mental Health, the Surgeon General's Report on Mental Health and the Surgeon General's Action Plan on Suicide. Thus, NAMI urges advocates to express appreciation for the overall funding of NIH research and encourage a revision of the relative increases to better reflect the true costs of serious mental illnesses to society and the excitement of brain research, with any adjustment dedicated to research on serious mental illness.
Overall, the budget for CMHS receives a modest increase in both the House and Senate bills, but in different areas. For example, the House bill fully funds the President's recommended increase for the Mental Health Block Grant of $60 million above the FY 2000 level of $356 million (bringing funding up to $416 million). By contrast, the Senate bill increases the Mental Health Block Grant by only $10 million (up to $366 million). Instead, the Senate bill directs an additional $50 million to the CMHS Knowledge, Development & Application (KDA) program for school violence prevention. This would bring total spending for the CMHS school violence initiative up to $90 million. The House bill would actually trim the CMHS KDA program by more than $4 million.
Other CMHS programs receive either a freeze, or a modest increase under both bills. The PATH program is increased by $5 million in the Senate bill (up to $36.9 million) and is frozen in the House bill. The Children's Mental Health Program is increased by $4 million in both bills (up to $86.8 million). Finally, the Protection and Advocacy (PAIMI) program is increased by $1 million in the Senate bill (up to $25.9 million) and is frozen in the House bill.
Both the House and Senate bills declined to separately fund the Clinton Administration's $30 million request for "Targeted Capacity Expansion". This initiative would have directed funds to services in "non mental health settings" for persons without a severe mental illness diagnosis to foster "healthy families and communities." Instead, the House bill contains "report language" urging CMHS to collaborate with the Department of Justice in efforts to help local communities divert criminal offenders with severe mental illnesses out of jails and into treatment programs. NAMI continues to support efforts on the part of Congress to push CMHS to emphasize approaches such as jail diversion and mental health courts over "mental health prevention and promotion" in the KDA program.
SENATE RESTRAINT AND SECLUSION AMENDMENT
On June 30, the Senate adopted an amendment authored by Senator Christopher Dodd (D-CT) and offered on the floor by Senator Tom Harkin (D-IA) designed to protect residents of hospitals (including public and private psychiatric hospitals), nursing homes and residential treatment centers from the inappropriate use of physical restraints and seclusion. Specifically, the amendment requires such facilities that receive federal discretionary funds to protect and promote the rights of all residents - including the right to be free from mental and physical abuse, corporal punishment and any restraint or involuntary seclusion imposed for discipline or staff convenience. The amendment would require that restraint be imposed only on the written order of a physician.
In addition, the Dodd Amendment includes new reporting requirements for facilities to report, within 7 days, all deaths that occur while a resident is restrained or in seclusion (or 24 hours after a restraint has ended). This reporting requirement would apply to all facilities covered by the federal PAIMI (protection and advocacy) law. Finally, the amendment calls on HHS to develop regulations regarding adequacy of staffing, training of personnel involved in applying restraints and notification of deaths. Senators Joseph Lieberman (D-CT) and Arlen Specter (R-PA), chair of the Senate Appropriations Subcommittee on HHS, spoke on the floor in favor of the amendment.
NAMI supports Congressional passage of the amendment as passed by the Senate. The possibility of getting a stronger amendment is slim given the opposition to the entire package by the hospitals, residential treatment centers, and psychiatrists. Ideally, we would have wanted at least four changes to the Senate passed provisions. These are:
b) definition of seclusion amended to exclude placement in "time out" from the definition,
c) debriefing requirements for staff after a restraint has been ordered, and
d) a face-to-face evaluation within an hour of the application of restraints and seclusion.
It is expected that there will be objections to the amendment as improper "authorization" legislation added to an appropriations bill. It is therefore critically important that NAMI advocates press all members of Congress - especially members of the House-Senate Conference Committee - to retain the Dodd Amendment in the final bill.
SENATE SUICIDE AMENDMENT
When the Labor-HHS-Education bill was on the Senate floor the week of June 26, Senator Paul Wellstone (D-MN) successfully advocated for an amendment adding $3 million to the CMHS budget to improve the effectiveness and responsiveness of suicide hotlines and crisis centers. NAMI strongly urges that the House-Senate Conference Committee retain this important step forward in suicide prevention.
SSBG AND CHIP FUNDS RESTORED
On June 27, during debate on the Labor-HHS-Education appropriations bill, Senate leaders reached agreement restoring funds to both the Social Services Block Grant (SSBG) and state Childrens Health Insurance Program (CHIP) accounts. Both of these programs were proposed for significant cuts in the original version of the Labor-HHS-Education bill that was reported by the Senate Appropriations Committee on May 11. The Senate Appropriations Committee had proposed to transfer to the Labor-HHS-Education bill $1.9 billion in unspent CHIP funds going back to FY 1998, with a promise to restore these funds to CHIP in FY 2003. Childrens advocates, including NAMI, objected because states were supposed to be given up to 3 years to draw down CHIP funds after the program began in 1998. Funds unspent after this 3-year period were supposed to be redistributed back to the states, not back into the federal Treasury. The amendment adopted by the full Senate on June 27 restores this original agreement keeping funds in the CHIP program.
On SSBG funding, the original Senate Labor-HHS-Education bill had proposed to cut funding for the program by nearly $1.2 billion, down from its FY 2000 level of $1.775 billion to $600 million. Under pressure from human service advocates, Senate leaders agreed to restore SSBG funding up to the level in the House bill ($1.77 billion). In the coming weeks, advocates will also be pushing conferees to restore SSBG back to its FY 1996 level of $2.38 billion.
The SSBG, also known as Title XX, is a formula grant program that distributes funds to the states for a wide-array of social services to a broad population of individuals and families in need including families transitioning off of welfare, the elderly, children in foster care and protective services, homeless families and individuals and people with disabilities. Unlike most other federal human service block grants, SSBG provides states with maximum flexibility to target SSBG funds to the services most in need in their state. According to survey conducted by the National Governors Association earlier this year, a number of states use SSBG funds to serve adults and children with mental illnesses in settings that include adult corrections, homeless shelters, foster care and juvenile justice. Among these states are Arizona, Iowa, Illinois, Indiana, Mississippi, Ohio, Oregon, Pennsylvania, Texas and Wisconsin.