The Bazelon Mental Health Policy Reporter

Volume II : Issue 4 : November 20, 2003

Support the Bazelon Center. Your tax-deductible donation helps the Bazelon Center keep you informed on important developments in mental health law and policy. Not a Subscriber? Sign up now to receive action alerts and updates from the Bazelon Center.

In This Issue:

For Once, Advocates Welcome Inaction

Newsbytes:

• Children’s Mental Health Bill Gathers Steam
• Filibuster Blocks Controversial Nominee
• House Speaker Downplays Importance of Parity

New Publications from the Bazelon Center

For Once, Advocates Welcome Inaction

The Administration’s Medicaid reform plan and reauthorization of the Individuals with Disabilities Education Act (IDEA) and the Temporary Assistance for Needy Families (TANF) program appear to have stalled this year. For once, mental health advocates have good reason to applaud lawmakers’ inaction.

In each, proposed changes could weaken existing law and threaten access to services and supports that help adults and children with mental disabilities to live fuller lives in the community.

Earlier this year, the Bush Administration floated a proposal to radically remold the Medicaid program, replacing the program’s entitlements with a capped block grant. Medicaid currently funds half of all community mental health services in the nation, and mental health advocates feared that the proposal would allow states to reduce benefits for many of the program’s beneficiaries and eliminate coverage of services for others. Thankfully, the White House’s proposal has gone nowhere since it was denied a critical endorsement by the bipartisan task force appointed by the National Governors Association to review the plan.

Ironically, children with mental disabilities may have reason to be thankful that IDEA reauthorization appears to have stalled for the year. Lawmakers have been working for almost two years on IDEA reauthorization legislation, but a final bill has yet to emerge.

At issue is how easily children with disabilities can be excluded from the free, appropriate public education to which they are entitled under the IDEA. While the Senate’s bipartisan bill is an improvement over House-passed IDEA legislation, negotiated compromises between the two chambers would likely ultimately weaken existing protections that prevent unfair exclusion of children with disabilities from educational opportunities.

Current law protects children with disabilities who violate school conduct codes from classroom exclusion when the violation results from their disability. The law also supports behavioral assessments critical to designing and implementing effective behavioral interventions and supports that can reduce or eliminate behaviors that may otherwise interfere with learning. House legislation would eliminate these provisions.

The Senate’s inaction keeps in place—at least for the moment—the IDEA’s support for considerations to help maintain education opportunities for students with disabilities.

Lawmakers have also failed to push forward the draconian changes in the TANF program adopted earlier this year by the House. TANF recipients are three times more likely to have at least one physical or mental health impairment than adults not receiving benefits under the program, according to a GAO study. Studies also show that, since the 1996 law authorizing the program was passed, recipients with disabilities are more likely to be dropped from the program than people who do not have disabilities — often before obtaining a job. The House bill would make it even more difficult for people with disabilities to maintain TANF benefits by eliminating flexibility in the program’s work requirements that has allowed some states to begin to address the serious barriers people with disabilities and their family members face in securing and maintaining employment.

Inaction on other mental health bills was less welcome. Neither the Senate nor the House passed the “Senator Paul Wellstone Mental Health Equitable Treatment Act,” which seeks to end private insurance discrimination against people with mental illnesses (see related article, below), or the “Family Opportunity Act,” which seeks to expand access to Medicaid-funded children’s mental health services in the community.

Hopefully, next year will bring a renewed commitment to addressing the country’s important mental health priorities. For now, advocates can ask only that lawmakers observe a maxim commonly applied to other public servants: first, do no harm.

NewsBytes

Children’s Mental Health Bill Gathers Steam
The “Keeping Families Together Act” (S. 1704 and H.R. 3243) is gaining momentum in Congress. The bill, introduced last month by Senators Susan Collins (R-ME), Mark Pryor (D-AR), Norm Coleman (R-MN) and Jeff Bingaman (D-NM) and Representatives Jim Ramstad (R-MN), Patrick Kennedy (D-RI) Pete Stark (D-CA), Charlie Norwood (R-GA), Spencer Bachus (R-AL), Charles Pickering (R-MS), Mike Castle (R-DE), and Nancy Johnson (R-CT), seeks to improve access to children’s mental health services and to end the tragic practice of custody relinquishment by promoting comprehensive interagency systems of care for children with mental or emotional disorders. The bill currently has 20 co-sponsors in the House of Representatives and five in the Senate. Children’s mental health advocates are working together to urge more lawmakers to co-sponsor this important legislation.

• Learn more about the legislation
• Urge your Senators and Representative to co-sponsor the “Keeping Families Together Act” by sending them a message at http://www.congress.org. Remember to identify yourself as a constituent.
• Share your story. If you are a parent who has relinquished custody of your child to obtain needed mental health services, lawmakers need to hear from you. By humanizing the issue, your story can help lawmakers understand the desperate need for change.

Filibuster Blocks Controversial Nominee
The nomination of Janice Rogers Brown to the U.S. Court of Appeals for the District of Columbia was blocked last Friday, following a more than 40-hour marathon Senate session in which Republicans attempted to draw attention to Democratic opposition to some of President Bush’s judicial nominees. Democrats blocked the nomination with a filibuster, preventing a vote on her confirmation. The Bazelon Center opposes Rogers Browns’ nomination due to her history of judicial activism and her outspoken criticism of New Deal-era protections like Medicaid and Social Security benefits, which are crucial to many people with disabilities.

• Action Alert: Oppose Judicial Activism Against People With Disabilities (11/5/03)

House Speaker Downplays Importance of Parity
More than a year after President Bush asked Congress to send him a mental health parity bill, Congress has yet to act on the “Senator Paul Wellstone Mental Health Equitable Treatment Act” (S. 486 and H.R. 953). The legislation, which has 242 co-sponsors in the House and 67 in the Senate, is supported by more than 260 national advocacy organizations.

Recent comments by House Speaker Dennis Hastert (R-IL) may offer some insight on the hold-up. When asked about mental health parity legislation, Hastert downplayed the importance of the bill, asking, “What mental health condition is at parity with a broken leg?” The Speaker went on to say that he was “being facetious.”

“If the Speaker was making a joke, it was in extremely poor taste,” responds Chris Koyanagi, the Bazelon Center’s policy director. “His comments make light of the devastating impact untreated mental illnesses have on this country’s economy, its communities and its citizens, and downplay the critical importance of acting now to end discrimination by private insurers against people seeking mental health services.”

The bill is sponsored by Senators Pete Domenici (R-NM) and Edward Kennedy (D-MA) and Representatives Jim Ramstad (R-MN) and Patrick Kennedy (D-RI). Senator Domenici has indicated that action on parity legislation appears unlikely before Congress adjourns for the year.

• Read Speaker Hastert’s comments
• Action Alert: End Insurance Discrimination, Support Mental Health Parity (10/24/03)

New Publications

What "Fair Housing” Means for People with Disabilities and Digest of Cases and Other Resources in Fair Housing for People with Disabilities
Updated for 2003, these popular publications explain how people with disabilities are protected from housing discrimination under three federal statutes: the Fair Housing Act as amended in 1988, the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.

• Find out more

Teaming Up: Using the IDEA and Medicaid to Secure Comprehensive Mental Health Services for Children and Youth
This publication is designed to inform practitioners—IDEA attorneys and advocates who are not familiar with Medicaid, and Medicaid attorneys and advocates who do not know the IDEA or who have little experience in using Medicaid—how they may obtain the services and supports needed by children with emotional and behavioral disorders.

• Read Teaming Up online*

* This report is in PDF format. You'll need the free Acrobat Reader to view and print it.

Recovery in the Community (Vol. II): Program and Reimbursement Strategies for Mental Health and Rehabilitative Approaches Under Medicaid
The second report of two discussing the use of the Medicaid program to fund recovery-oriented services for adults with serious mental illnesses.

• Purchase Recovery in the Community (Vol. II) from the Bazelon Center's online bookstore

Suspending Disbelief: Moving Beyond Punishment to Promote Effective Interventions for Children with Mental or Emotional Disorders
This paper examines congressional intent regarding the treatment of children with behavior problems and, by examining administrative and court decisions interpreting these provisions, compares those intentions with actual implementation of the mandate.

• Read Suspending Disbelief online