Letter from Richard C. Birkel, Ph.D., to The Honorable Thommy Thompson, Secretary HHS

Feb 26 2002

February 26, 2002

The Honorable Tommy Thompson
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201

Dear Mr. Secretary:

On behalf of the 220,000 members and 1,200 state and local affiliates of the National Alliance for the Mentally Ill (NAMI), I am writing to thank you for important increases in the President's FY 2003 budget that affect research and services for consumers and families living with severe mental illnesses.

As the nation's largest organization representing people with severe mental illnesses and their families, NAMI would like to offer our views on spending requests for FY 2003 at key agencies within the Department of Health and Human Services (HHS), specifically the National Institute of Mental Health (NIMH) and the Center for Mental Health Services (CMHS). NAMI is especially grateful for increases proposed even in the face of the constraints imposed by the current economic downturn and the increased need for spending on homeland security and national defense. On the other hand, we have specific concerns on which we will seek to work with both you and Congress to address in the months ahead.

National Institute of Mental Health (NIMH)

NAMI is grateful for President Bush's commitment to meet the goal of doubling the federal investment in biomedical research at the National Institutes of Health (NIH) by 2003. NAMI was an early supporter of the bipartisan effort in Congress to double the NIH budget, begun in 1998 by key leaders in Congress including Senators Arlen Specter of Pennsylvania and Tom Harkin of Iowa and Representatives John Edward Porter of Illinois and David Obey of Wisconsin. Completing the effort will be an achievement of which the President truly can be proud.

While strongly applauding the overall achievement, NAMI notes that the proposed increase for NIMH lags far behind the nearly 14% increase proposed for the other NIH institutes. NAMI is disappointed that the percentage increase recommended for NIMH for FY 2003 is far below increases recommended for other medical research.

Thanks to important research funded by NIMH, important advances have been achieved in treatment for people living with serious brain disorders, such as schizophrenia and bipolar disorder, over the last decade. But we still have a long way to go. Medical science has yet to produce cures for severe mental illnesses. Furthermore, the most promising evidence-based treatments and services remain inaccessible for people who need and deserve them. From biomedical research to services research, NAMI believes that research on severe mental illnesses are under-funded. The FY2003 investment lacks equitable proportion to the scientific opportunities that exist and terrible burdens of cost and pain that such disorders impose on NAMI families and the general public.

According to a recent study conducted by the World Health Organization, no less than four of the top ten causes of disability worldwide are severe mental illnesses. Major depression, bipolar disorder, schizophrenia, and obsessive-compulsive disorder account for an estimated 20 percent of total disability resulting from all diseases and injuries. Based on NIH's own estimates, for every research dollar spent, 15 cents is allocated to AIDS, 10 cents on cancer, two cents on heart disease, and less than one cent on schizophrenia and other severe mental illnesses. In contrast, the total cost of schizophrenia to society, per research dollar spent, is $161.26, compared to only $65.65 for heart disease, $9.96 for cancer, and $6.86 for AIDS. More equitable, increased investment is clearly needed for NIMH's research needs.

Center for Mental Health Services (CMHS)

NAMI is especially pleased to learn that the President proposes a $7 million increase for Projects to Assist Transition from Homelessness (PATH) to help homeless individuals with severe mental illnesses and co-occurring substance abuse disorders. The Administration's proposed increase for PATH would result in an additional 31,000 homeless individuals with severe mental illnesses receiving services. Given the disproportionate representation of adults with severe mental illness among the chronically homeless population, NAMI strongly applauds the Administration's efforts to place the highest priority in meeting their needs for permanent supportive housing and community-based services.

At the same time, NAMI is disappointed that all other CMHS programs are slated for a freeze or modest reductions for FY 2003. This is especially troubling given the current budget pressures facing public mental health agencies in most states. Surveys of NAMI's state affiliates in recent months indicate that most states are proposing substantial reductions to core public services for children and adults with severe mental illnesses. Freezing the $433 million Mental Health Block Grant program will hurt many states even more, as legislatures confront cuts in services for consumers living with severe mental illnesses.

NAMI is also disheartened to learn of the Administration's proposal as of this date to cut funding for the CMHS Projects of Regional and National Significance (PRNS) program by $7 million in FY 2003. We are particularly concerned about this in view of the current emphasis within SAMHSA and CMHS on knowledge dissemination and evidence-based programs. In particular, NAMI is concerned that the administration is proposing to terminate technical assistance centers, which promote peer support, consumer empowerment programs, and evidence-based practices such as the Program for Assertive Community Treatment (PACT).

Likewise, NAMI is distressed that community action grants, which also support knowledge dissemination and replication of evidence-based practices, including integrated treatment, jail diversion, police training and cultural competence, are at risk of being discontinued in FY 2003. Communities have used these grants constructively to stimulate the development of good programs and services for people with severe mental illnesses.

President's New Freedom Initiative (NFI)

Finally, NAMI would like to thank both you and the President for many items in the FY 2003 budget request that relate to the President's New Freedom Initiative (NFI). NAMI strongly supports the Administration's efforts to promote independence and community integration for people with disabilities. We look forward to working with the President's upcoming commission on mental illness services to ensure that NFI goals and objectives reach every individual American living with severe mental illness.

Thank you for your attention to the concerns of NAMI's consumer and family members. Please know that NAMI shares your vision of an HHS that focuses priorities on research and services targeted to those who live with illness and disability.


Richard C. Birkel, Ph.D.
Executive Director