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Legislation Discussed in This Update:
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December 20, 2004 —The short post-election session brought the 108th Congress to a close with some hits and misses in mental health legislation. Advocates praised recent enactment of grant programs for suicide prevention and criminal justice diversion, and new mental health funding, and secured protections in renewal of the special education law. Dismaying, however, were congressional shrugs on mental health parity legislation, bills to prevent custody relinquishment, and opportunities to assist a failing public mental health system and address adverse outcomes that result from unmet mental health treatment needs.
These issues will remain legislative priorities for mental health advocates in the 109th Congress. Advocacy efforts will likely focus also on preserving the Medicaid program's ability to adequately serve individuals with disabilities, seniors, and low-income children and pregnant women.
- Mental Health Funding Scores a Hit with State Incentive Grants
- President Signs IDEA Reauthorization
- Parity Expansion and TANF Renewal Linger to Next Congress
- Bills to Prevent Custody Relinquishment for Mental Health Services Await New Congress
- Victories on Criminal Justice Diversion and Suicide Prevention
- On Advocates' Agenda for 2005: SAMHSA Renewal and Medicaid Protection
Mental Health Funding Scores a Hit with State Incentive Grants
The final omnibus appropriations bill restored funding cuts, approved spending
increases and provided new money for mental health programs in the fiscal
year 2005 budget for the Center for Mental Health Services (CMHS) within
the Substance
Abuse and Mental Health Services Administration (SAMHSA).
A new State Incentive Transformation Grants (SIG) program received $20
million, signaling congressional support for state efforts to formulate
collaborative
plans to respond to the growing unmet mental health needs of children
and adults who now rely on a fragmented public mental health system.
The President
had
requested $44 million for the SIGs.
The grants are a first step toward reducing fragmentation—one of the main goals articulated by the New Freedom Commission on Mental Health. The SIGs could support work by the few states that have already formed commissions to transform their broken public mental health systems into efficient, integrated systems of care. The grants could also help other states with their reform plans. While minimal, this funding is a significant step toward moving states to a recovery-oriented, consumer-driven system of care and building the political will necessary for long-term systemic change.
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Jail Diversion and Seniors' Funds Restored
The bill also restored funds the President has proposed to cut in both the jail diversion program and the seniors mental health program. The jail diversion program funds community programs designed to divert mentally ill offenders from the criminal justice system into community-based mental health treatment. The program had received increases in the last three fiscal years ($4 million in FY 02, $6 million in FY 03 and $7 million in FY 04) and will continue at $7 million in FY 05. Unfortunately, the omnibus spending bill Congress passed contains no new money for the newly enacted Mentally Ill Offender Treatment and Crime Reduction Act of 2004 (P.L. 108-732).
The program to provide community-based mental health services to seniors continues at $5 million.
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Other Mental Health Programs Funded
The following received increases: PATH, the grant program for outreach and services to individuals who are homeless or at risk of being homeless ($5.5 million); the children's mental health program, providing comprehensive systems of care for children with severe emotional disturbance ($3.6 million), and the mental health block grant ($1.4 million). The protection and advocacy program was level-funded at $1.4 million.
The consumer-run technical assistance centers received $2 million, as proposed in the President's budget. Similarly, the school anti-violence program ($95 million) and the post-traumatic stress disorders program ($30 million) were essentially level-funded.
The newly enacted Garrett Lee Smith Memorial Act (P.L. 108-355), which provides for suicide-prevention grants, received $7 million, in addition to $3 million for the suicide hotline and $3 million for the resource center.
The chart below shows the funding for CMHS programs (in millions of dollars).
| Center for Mental Health Services | Fiscal Year 2004 | President's Budget FY 2005 | Final FY 05 |
|---|---|---|---|
| State Incentive Grants | n/a | 44 | 20 |
| Mental Health Block Grant | 434.7 | 436.1 | 436.1 |
| Children's Mental Health | 102.4 | 106 | 106 |
| PATH | 49.8 | 55.3 | 55.3 |
| Jail Diversion | 7 | 3.9 | 7 |
| Seniors Mental Health Services | 5 | 0 | 5 |
| Protection and Advocacy | 34.6 | 35 | 34.6 |
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President Signs IDEA Reauthorization
After several years of examining the Individuals with Disabilities Education Act (IDEA), Congress compromised on a bill (P.L. 108-446) which the President signed on December 3, 2004.
One of the key issues in reconciling the House and Senate versions was the vast difference in how each dealt with the issue of discipline. The Senate had enacted provisions that would encourage use of positive behavioral supports to help students with behavior problems and require schools to determine whether a student's behavior was a manifestation of his or her disability before suspending or expelling the student. This process would investigate whether a violation of the school's conduct code was the result of the student's disability or the school’s failure to implement the child’s individualized education plan (IEP) and to use appropriate behavioral interventions.
The House, instead, voted to loosen the protections for students with disabilities and increase schools' ability to expel children with disabilities if they violate the school's "code of conduct."
The reauthorized law maintains core protections for students in this regard and advocates are hopeful it will continue to help students with disabilities succeed in school.
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Parity Expansion and TANF Renewal Linger to Next Congress
Legislation to end health-insurance discrimination and to assist recipients of Temporary Assistance for Needy Families (TANF) with disabilities and other barriers in finding and maintaining employment stalled in the 108th Congress. The Senator Paul Wellstone Mental Health Equitable Treatment Act (S. 486, H.R. 953) failed to pass the Senate this year after being reported out of committee favorably. Despite broad bipartisan support, the bill was not considered by the appropriate House committee this year. It would require health insurance plans to provide parity for mental health in outpatient sessions, inpatient days, co-payments, deductibles and maximum out-of-pocket expenses.
Mental health advocates will continue pressing for mental health parity in the next Congress, as will Senate and House sponsors, such as Senators Pete Dominici (R-NM) and Edward Kennedy (D-MA) and Representatives Jim Ramstad (R-MN) and Patrick Kennedy (D-RI). The current law requiring limited parity, enacted in 1996, will expire on December 31, 2005.
Congress also again failed to reauthorize the TANF program. The House passed a bill that would erode the flexibility states now have to provide appropriate assistance in finding and maintaining employment to TANF recipients with disabilities and other barriers to work. Stricter work requirement would prove burdensome for these recipients. The Senate bill takes a less restrictive approach and includes provisions initially proposed in the Pathways to Independence Act, a freestanding bill (S. 1523), sponsored by Senators Gordon Smith (R-OR), Jim Jeffords (I-VT) and Kent Conrad (D-ND).
S. 1523 would help families care for a child or adult relative with a disability. Additionally, it would allow states to provide assistance to TANF recipients who have disabilities if they need mental health or substance abuse treatment beyond the limited time allowed in the House bill, as long as they also engage in some work activity. Several government studies show that TANF recipients are three times more likely to have at least one physical or mental impairment than adults not receiving program benefits. It is therefore critical for any final bill to address barriers to self-sufficiency if this population is to transition successfully to work.
The current TANF law expires on March 31, 2005. Advocates will continue to press for provisions in a final TANF bill that would help reduce barriers to employment for individuals with disabilities as they transition from TANF to work.
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Bills to Prevent Custody Relinquishment for Mental Health Services Await New Congress
Also stalled in the 108th Congress were two bipartisan bills that would help address the horrific problem many families face when they cannot get mental health treatment for a child with a serious mental illness and face having to relinquish custody to make the child eligible for Medicaid.
The Keeping Families Together Act (S. 1704, H.R. 3243) would promote comprehensive interagency systems of care for children with mental or emotional disorders by providing for six-year "Family Support Grants" to states to help build new state-level infrastructure. The bill would also establish a new federal interagency task force to examine mental health issues in the child welfare and juvenile justice systems. In addition, it would require states to report annually on the success of the programs and activities and the Department of Health and Human Services to provide a report to Congress evaluating states' success in addressing the custody-relinquishment problem.
The Family Opportunity Act (S. 622, H.R. 1811) would allow families with incomes up to 250% of the federal poverty level to buy into Medicaid on a sliding-scale basis.
Both bills would enable states to provide Medicaid home- and community-based waiver services to children with serious emotional disturbance who currently receive inpatient psychiatric services in a residential treatment center or who are at risk of such care.
Given the continuing media spotlight on this tragedy and ongoing grassroots support from advocates throughout the country, the custody-relinquishment issue will surely be a high priority for mental health advocates in the next Congress.
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Victories on Criminal Justice Diversion and Suicide Prevention
Bipartisan legislation was enacted in the final days of the 108th Congress authorizing grants to states and localities to develop collaborative mental health and criminal justice responses to mentally ill offenders. The Mentally Ill Offender Treatment and Crime Reduction Act, P.L. 108-732, sponsored by Senator Mike DeWine (R-OH) and Representative Ted Strickland (D-OH) provides for interventions by states and localities at any point in the continuum of criminal justice contact, including pre-booking, post-booking, mental health courts and other court-based approaches, re-entry and transitional programs. Crisis intervention teams and law enforcement training can also be funded.
Unfortunately, funding was not included in the omnibus bill for fiscal year 2005. It will be among the appropriations priorities for mental health advocates looking to help states provide an array of diversion programs for the growing number of adults and youth with mental disorders who come into contact with law enforcement.
The Garrett Lee Smith Memorial Act (P.L. 108-355) was a victory for all concerned about the increase in youth suicide. This new grant program (now funded at $7 million) would provide for three-year grants to help states, colleges and universities fund the development and expansion of early intervention and prevention strategies to address youth suicide. The bipartisan bill is named to honor Senator Gordon Smith’s (R-OR) son, who committed suicide.
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On Advocates' Agenda for 2005: SAMHSA Renewal and Medicaid Protection
Advocates hope that Congress will tackle the reauthorization of SAMHSA programs and services through legislation to address the many unmet treatment needs and the system fragmentation (and failings) highlighted by the President’s Commission on Mental Health. This year, Congress began the process through a series of hearings, but offered no legislation.
Medicaid is the primary source of funding for mental health services and preserving the integrity of the program is of vital importance. It remains one of state legislatures' top concerns, despite the slight easing of budget pressures. Congressional reform proposals may be introduced next year seeking to cap federal Medicaid spending. Such caps could undermine essential services and will be fiercely opposed by mental health advocates and others concerned about access to healthcare.
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