June 26, 2015

By Andrew Sperling

This week the House and Senate Appropriations Committees passed spending bills for 2016 covering a range of programs including: research at the National Institute of Mental Health (NIMH), services at the Substance Abuse and Mental Health Services Administration (SAMHSA) and supportive housing at the U.S. Department of Housing and Urban Development (HUD).

The congressional bills were written under the current caps on overall spending, known as “sequestration”. This triggered veto threats from the White House whose 2016 budget asked for spending levels above these caps. The good news is despite this strict budget environment, there are no major cuts to mental health programs.

Even better are the proposed increases–above the President’s budget request–that are being proposed for research at the National Institutes of Health (NIH) in general and the NIMH in particular.

These bills (known as the Labor-HHS and Transportation-HUD Appropriations bills) will be a starting point for talks between Congress and the President about the federal budget that are expected to take place in fall 2015. NAMI submitted recommendations to Congress related to what we want to see for funding and priorities for NIMH and SAMHSA.

Below is the specific budget information related to mental health in the Congressional bills.

Mental Illness Research

Both the House and Senate budget bills fund research at the NIH above the President’s requests for 2016. This shows the growing bipartisan support for the NIH, as well as the impact of flat funding over the past five years on investments in research. There is an emerging bipartisan agreement that failing to invest in medical research has huge long-term costs for the nation in general and patients in particular.

In the House bill, NIMH is funded at $1.512 billion. This is $78.4 million above the current 2015 funding level and $23 million above the President’s request. The draft Senate bill funds $32 million for the overall NIH budget, which is $2 billion above the 2015 level–the largest single year increase for the NIH since 2003. The House bill also includes a $95 million increase for the Obama Administration’s BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies), boosting funding to $150 million. The Senate bill includes $135 million for BRAIN. This is multi-year project to invest in mapping the complex structures of the brain and advance overall brain science.

Mental Health Services

Both the House and Senate bills fund SAMHSA at $3.643 billion for 2016. This is $23 million above the current 2015 level and about $21.6 million below the President’s 2016 request.

Most programs at the Center for Mental Services (CMHS) are level funded at their 2015 level in both bills. This includes:

  • The Mental Health Block Grant program – $482.57 million
  • The Children’s Mental Health program – $117 million
  • The PATH program (outreach and engagement for homeless individuals with mental illness) – $54.6 million

Both the House and Senate bills include continuation of the 5% set aside in the Block Grant program for early intervention in psychosis. NAMI supports this set aside as critical to ensuring state investment in programs to address first episode psychosis.

The remainder of CMHS programs are funded just slightly below current 2015 levels. This includes a range of grant programs such as:

  • Primary and Behavioral Health Integration – $43 million
  • Homeless Prevention and Services – $30.9 million
  • Garrett Lee Smith Youth Suicide Prevention – $53.7 million
  • Suicide Lifeline $7.2 million
  • Tribal Behavioral Health Grants – $15 million
  • Mental Health First Aid – $15 million

Finally, outside of the overall funding for SAMHSA, the House bill gives $15 million in the budget of the Office of Assistant Secretary of Health for a new federal Assisted Outpatient Treatment (AOT) pilot program. Congress authorized this program in 2014 as an amendment to an unrelated Medicare bill. The program would fund grants given on a competitive basis for states and localities looking to apply existing state laws that allow AOT.

Housing Programs

The House bill funds HUD at $42 billion. The draft Senate bill includes a significantly lower level of funding at $37.56 billion. In the House bill, the overall HUD budget is $1 billion above the current 2015 level, but $3 billion below the President’s 2016 request. Even so, there are large cuts to a number of programs in both the House and Senate bills–as well as increases to HUD’s largest rental assistance programs.

Funding to simply renew HUD’s existing programs now consumes 83% of the HUD budget. In each case, these programs require yearly increases just to keep in place the existing housing units–with no funding for new units to reach those currently waiting for housing assistance. The one exception is funding in the draft Senate bill for 10,000 new rental vouchers for the HUD-VASH program that targets homeless veterans.

In order for these programs to expand, the current caps on spending have to be lifted. These programs include:

  • Section 8 tenant-based and project-based assistance.
  • McKinney-Vento permanent supportive housing for homeless individuals. This is HUD’s largest program serving people with mental illness. The House bill gives $2.185 billion for HUD’s homeless programs while the Senate budgets $2.2 billion. While both of these are above the 2015 level, they are significantly below the President’s request of $2.48 billion–the amount needed to restore the goal of ending chronic homelessness by the end of 2017.
  • Section 811 project-based assistance for people with disabilities. The House bill allocates $152 million, or $17 million above the 2015 level. The Senate bill allocates only $137 million, $2 million above the 2015 level.

Finally, the House bill would cancel funding in 2016 for the National Housing Trust Fund (NHTF). The NHTF is new funding which would provide grants to state housing agencies for the development of rental housing targeted to “extremely low income” households, which are those below 30% of area median income (AMI). This affects people with mental illness because people with disabilities who receive Supplemental Security Income (SSI) are below 20% of AMI. NAMI is opposed to canceling this critical grant program.

Criminal Justice

The Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) provides federal grants for collaborative programs between criminal justice and mental health systems in states and local communities.

These grants can be used for a variety of purposes, including:

  • Crisis Intervention Team (CIT) programs
  • Mental Health Courts
  • Jail diversion
  • Community reentry initiatives

In 2015, MIOTCRA was funded at $8.5 million. This year, funding for MIOTCRA was boosted to $13 million by the House Commerce, Justice, and State (CJS) Appropriations Subcommittee. This increase was largely attributable to three amendments to the bill, including one introduced by Reps. Michelle Lujan Grisham (D.-N.M.), Earl Blumenauer (D.-Ore.) and Tim Murphy (R.-Pa.). The Senate bill funds MIOTCRA at $10 million.

Contributions from Jessica Hart and Ron Honberg.

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