Legislative Update: 2000 SAMHSA Reauthorization
Summary of Important Mental Health Programs
The programs operated by the Substance Abuse and Mental Health Services Administration
(SAMHSA) were renewed on October 17, 2000, when the President signed into law
the Child Health Act of 2000, Public Law No 106-310, which incorporated the
SAMHSA reauthorization bill, "The Youth Drug and Mental Health Services Act
of 1999." The reauthorization changes existing programs and creates a number
of new programs to improve mental health and substance abuse treatment services.
Reauthorized Programs
All of the following programs were reauthorized for three more years (fiscal
years 2001- 2003):
- Community Mental Health
Services Performance Partnership Block Grant
Known as the mental health block grant, this formula-grant program provides
funds to states to provide comprehensive community-based services for
adults with serious mental illnesses and children with severe emotional
disturbance. States had been required to identify and meet 12 performance
criteria, now reduced to five categories: comprehensive community-based
mental health systems; mental health system data and epidemiology; children's
services; targeted services to rural and homeless populations; and management
systems.
Although the restructure covers basically the same issues, the change
allows states to reduce administrative costs and gives them more flexibility
in how they can use funds. The Secretary of the Department of Health
and Human Services (HHS) is required to submit to Congress, within two
years, a plan on performance measures that would hold states accountable
for how block grant funds are spent.
Competitive grants are available to assist states in creating the data
infrastructure they will need to be accountable for the use of block
grant funds. A minimum $6 million is set aside (from funds appropriated
for SAMHSA's discretionary grant authority) for this purpose and up to
10% of all funds appropriated for the discretionary grant program above
$100 million may be used for improving state data systems.
Other notable changes to the block grant include an expanded responsibility
for state mental health planning councils to comment on and review outcome
activities included in the state annual reports.
- Comprehensive Community
Mental Health Services for Children with Serious Emotional Disturbance
The children's mental health services program provides for the development
of local interagency systems of care to meet the complex needs of children
and adolescents with serious emotional disturbance. With the reauthorization,
grants to localities may now run for six years instead of the prior five.
Current grantees in their fifth year can receive a sixth year of funding
from CMHS. Matching funds are still required for the sixth year. This
extension will allow local programs an additional year to build their
base of support for sustaining the program after federal funds are terminated.
- Projects for Assistance
in Transition from Homelessness (PATH)
This formula-grant program provides mental health and substance abuse
services to individuals with serious mental illnesses who are homeless
or at risk of becoming homeless. A range of comprehensive services is
available, including housing services, educational services, job training,
case management, rehabilitation and community mental health services.
- Protection and
Advocacy for Mentally Ill Individuals Act (PAIMI Act)
The federal authority for protection and advocacy (P&A) systems to protect
the legal rights of individuals with mental illnesses, including investigation
of neglect and abuse, was revised. Public Law 106-310 creates an expanded
role for the P&As to serve individuals living in the community (including
at home) once the programs' appropriation exceeds $30 million. Under
the prior law, P&As were limited to assisting individuals in institutions
or those recently discharged from an institution. That provision was
a significant barrier to helping individuals in the community, such as
children who need special education and related services under the Individuals
with Disabilities Education Act (IDEA) or adults who are homeless or
facing housing discrimination.
- General Authority
The reauthorization renames and redesigns CMHS' demonstration Knowledge,
Development and Application program (KDA) as a program for "Priority
Mental Health Needs of Regional and National Significance." This change
will broaden the agency's ability to respond effectively to the service
needs of individuals with mental disabilities by authorizing not only
KDAs but also training, targeted capacity response and system-change
grants (including grants to statewide family networks and consumer-run
self-help networks). The change is important because it gives SAMHSA
the flexibility to fund more programs and services intended to facilitate
systems' change, rather than strictly services research.
New Mental Health Programs and Services
- Child Anti-Violence Initiatives
The new law codifies the youth anti-violence initiative that Congress
started through the appropriations process in response to the shootings
at Columbine High School shootings in Littleton, Colorado. This program
seeks to prevent violence and help children deal with violence through
a collaborative effort between the Departments of HHS, Justice and Education.
Grants are awarded to local community collaborations between education,
law enforcement, mental health and substance abuse to address six activities:
security; educational reform to deal with violence; alcohol and drug
abuse prevention and early intervention; mental health prevention and
treatment services; review and updating of school policies to deal with
violence; and early childhood development and psychosocial services.
The initiative is authorized at $100 million.
Other violence-related programs include a $50-million authorization
for grants to public and nonprofit private entities to develop knowledge
on best practice for treating psychiatric disorders of children and adolescents
resulting from witnessing or experiencing traumatic events, including
violence.
SAMHSA is given discretion to use up to 2.5% of appropriated discretionary
funding to respond to mental health or substance abuse emergencies in
local communities (such as the Littleton school shootings).
- Services for Juvenile
Offenders with Serious Emotional Disturbances
This new grant program will assist state and local juvenile justice agencies
in providing "wraparound" aftercare services to discharged juvenile offenders
who are at risk of or have a serious emotional disturbance. SAMHSA is required
to submit a report to Congress within three years on what services were provided
under the grants. The program is authorized for $40 million and will be awarded
to public and nonprofit private entities.
Another $4 million is authorized through SAMHSA to provide up to four centers
of excellence to assist states and localities in providing appropriate care
to adolescents involved with the juvenile justice system who are diagnosed
with a serious emotional disturbance.
- Jail Diversion Programs
A new $10 million grant program has been authorized for states and localities
to work collaboratively across criminal justice, mental health and substance
abuse systems to divert adults with serious mental illnesses from the criminal
justice system and provide them access to community-based mental health
services. Funds can be used to develop jail diversion programs, which can
include the creation or expansion of community-based mental health services
and services for those with co-occurring mental illness and substance abuse.
Funds may also be used for training of law enforcement officers, attorneys
and judges and for community outreach and crisis intervention services.
Up to 125 grants can be awarded.
- Integrated Treatment Programs
for Co-Occurring Disorders
A new $40-million grant program is authorized to develop or expand integrated
treatment programs for individuals with a co-occurring mental illness and
substance abuse disorder. If the program is funded, grants will be awarded
to states, localities and nonprofit private organizations, with priority
to programs that would serve people who (1) are homeless, (2) have a history
of contact with the criminal justice system, (3) have recently been incarcerated,
(4) have a history of failed treatment or (5) have not remained engaged in
outpatient services.
SAMHSA is also required to report to Congress in two years on evidence-based
practices for individuals with co-occurring disorders, describing what services
are currently being provided to this population and what improvements are
needed to ensure service delivery.
- Emergency Mental Health
Centers
Included in Public Law 106-310 is authorization of $25 million for funding
of states and localities to designate hospitals and health care centers (including
community mental health centers) as Emergency Mental Health Centers for individuals
in need of emergency mental health services. These grants can also be used
to establish or train mobile crisis intervention teams. Crisis teams have
been used successfully in a variety of communities to respond to individuals
with a mental illness who have come in contact with law enforcement.
- Suicide Prevention
Seventy-five million dollars is the amount authorized for efforts to reduce
youth suicide deaths. Grants would be awarded to states, localities and
public and nonprofit private organizations to provide assessment and treatment
of youth at risk of suicide, to disseminate evidence-based information
on suicide prevention and to raise awareness of the problem. Programs should
be integrated within the existing community health care system and involve
other systems that address the needs of youth, including education, child
welfare and juvenile justice.
Within one year of program operation, HHS must begin a study analyzing data
on children (under age 13 and between the ages of 13 and 21 who attempt or
commit suicide and what services are available for such children.
- Mental Illness Awareness
Training
A new program is included to provide grants to states, localities and nonprofit
private entities to increase awareness of child and adult mental disorders.
Funds under the program would be used to train teachers and other school
personnel to recognize child mental disorders, to train emergency services
personnel (paramedics, firefighters and emergency medical technicians) to
identify and appropriately respond to a person with a mental illness, and
to provide necessary education on community resources and referral information
to family members, teachers and emergency services personnel. The program
is authorized at $25 million.
- Restraint and Seclusion
Public Law 106-310 requires HHS to develop and promulgate national standards
for the use of restraint and seclusion in mental health programs. These
standards will not preempt more protective federal or state laws or regulations,
such as the rule for Medicare and Medicaid facilities promulgated by the
Health Care Financing Administration in 1999.
Public Law 106-310 requires separate standards for "health facilities that
receive federally appropriated funds" (such as private or public general
hospitals) and for special entities referred to as "non-medical community
treatment facilities for children." These "non-medical" settings will be
defined in the regulations, but are likely to cover settings such as group
homes and non- medical residential placements.
Under the new law, restraint (including chemical restraint) and seclusion
can only be used when physical safety is at risk and only under a written
order from a physician or independent licensed practitioner. In the "non-medical" child
facilities, restraint and seclusion can only be used in emergency situations
by an individual trained and certified by a state-recognized body. Until
certification and training exist, this requirement can be fulfilled by a
supervisory or senior staff person trained in restraint and seclusion and
competent to make a face-to-face evaluation. The use of any chemical and
mechanical restraints on children is prohibited in these "non-medical" settings.
All facilities are required to report restraint-related deaths within 24
hours.
Within one year of the law's enactment (October 17, 2000), the HHS Secretary
must issue regulations on adequate staffing for the "health facilities" described
under the legislation. However, within six months, the Secretary must release
regulations that support the development of national training standards and
require licensing rules and monitoring requirements for behavior management
to be developed by States that certify the "non-medical" facilities for children.
- Child
Welfare and Mental Health Service Integration
A new grant program is established for states and localities to provide
integrated child welfare and mental health services for youth under age 19
years who are at risk of entering the child welfare system. Funds will be
used for integrated mental health and substance abuse treatment, coordinated
child welfare and mental health services, training and technical assistance
to child welfare and mental health professionals and agencies, and other
efforts. Services are also available for parents or caregivers who have a
mental illness or co-occurring mental health and addictive disorder. The
program is authorized for $10 million.
The programs outlined in this section are newly authorized programs. These
programs must receive a federal appropriation before SAMHSA can begin to
administer grants under the specific program. Please refer to the Bazelon
Center's January 2001 Legislative Update on
fiscal year 2001 funding for mental health programs to learn more about
the funding levels for existing SAMHSA mental health programs and funding
earmarks associated with a few of these new initiatives.
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