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(Sept. 14, 2004)—With few legislative days remaining before the November 2 election and prospects for a post-election “lame duck” session looming large, Congress has returned from its August recess to several key unresolved mental health policy priorities. Despite the findings by the President’s New Freedom Commission on Mental Health that the public mental health system is “in shambles” and various government reports highlighting the terrible consequences of unmet mental health needs, lawmakers have so far failed to pass several key mental health bills.
Spending bills, reauthorization of the Temporary Assistance for Needy Families (TANF) program and the Individuals with Disabilities Education Act (IDEA), and mental health parity legislation all await lawmakers' action, yet it appears unlikely that Congress will accomplish much for people with mental disabilities before heading home.
- House Approves Grants for System Transformation
- Mental Health Spending Escapes Budget Axe, But Remains Low
- IDEA Heads to Conference
- TANF Renewal Lingers
- Mental Health Parity Stalled
- Mental Health / Criminal Justice Collaboration Bill Poised for House Action
- Prospects Uncertain for Children's Mental Health Bills
House Approves Grants for System Transformation
The House recently approved its version of the spending bill that sets the fiscal year 2005 budget for the Center for Mental Health Services (CMHS) within the Substance Abuse and Mental Health Services Administration (SAMHSA). The bill includes funding increases, restoration of some mental health spending that the President’s budget request had cut, and some new money for mental health programs.
The House bill (H.R. 5006) provides $20 million for the new State Incentive Transformation Grants (SIGs) to help states formulate collaborative plans to transform their fragmented public mental health systems and address the unmet mental health needs of children and adults who rely on those systems.
House funding for the SIGs falls well below the $44 million requested by the President. However, the grants represent a small, but significant step in moving states to a recovery-oriented, consumer-driven system of care and building the political will necessary for long-term systemic change.
A few states have already begun to form commissions to restructure their broken systems and transform them into more efficient systems of care. Federal SIGs could support these efforts and help other states initiate such reforms.
Fourteen states would be able to receive funding if the President’s request were approved. However, to support efforts in that many states without taking away funds from other mental health programs in CMHS’s discretionary budget, lawmakers would have to increase significantly SIGs funding above the House-approved level.
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Mental Health Spending Escapes Budget Axe, But Remains Low
The House bill rejects the President's proposed spending cuts in the jail diversion and seniors mental health programs. The jail diversion program funds local initiatives to divert offenders with mental illnesses 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 2002, $6 million in FY 2003 and $7 million in FY 2004). However, new grants are needed to satisfy the demand of communities interested in improving their responses to offenders with mental illnesses.
The House also approved increases for:
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the protection and advocacy system for people with mental disorders ($1.4 million);
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the PATH grant program for outreach and services to individuals who are homeless or at risk of being homeless ($5.5 million);
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the children’s mental health program that supports comprehensive systems of care for children with serious emotional disturbance ($3.6 million); and
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the mental health block grant ($1.4 million).
The consumer-run technical assistance centers received $2 million, as proposed in the President’s budget. The table below contains a break-down on CMHS funding.
| CMHS Program Funding (In Millions Of Dollars) |
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|---|---|---|---|
| Fiscal Year 2004 | President's Budget FY 2005 | House Bill | |
| Mental Health Block Grant | 434.7 | 436.1 | 436.1 (1.4 increase from FY 2004) |
| Children's Mental Health | 102.4 | 106 | 106 (3.6 increase from FY 2004) |
| PATH | 49.8 | 55.3 | 55.3 (5.5 increase from FY 2004) |
| Jail Diversion | 7 | 3.9 | 7 |
| Seniors Mental Health Services | 5 | 0 | 5 |
| Protection and Advocacy | 34.6 | 35 | 36 (1.4 increase from FY 2004) |
While many Congress watchers expect the Senate to take up its version of the legislation in September, lawmakers may combine this and several other “must-pass” bills into a single omnibus spending package.
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IDEA Heads to Conference
If time permits, and lawmakers are able to reach consensus, the federal special education law could be reauthorized before Congress adjourns. The House approved its version of a bill to reauthorize the IDEA last year, and the Senate approved its version in May. However, work on the legislation is far from complete.
Lawmakers from each chamber must now meet in conference to reconcile differences between the House and Senate bills, which differ greatly in their language on legal protections for children with disabilities who violate school conduct codes.
The Senate bill (S. 1248)–sponsored by Senators Judd Gregg (R-NH) and Edward Kennedy (D-MA)–encourages schools to use positive behavioral supports to help address and prevent disruptive behavior. Under S. 1248 and current law, schools must also determine whether such behavior is a manifestation of a child’s disability before they may suspend or expel a child with a disability for that behavior. Schools must also determine whether a violation of its conduct code results from the school’s failure to implement the child’s individualized education plan (IEP) and to use appropriate behavioral interventions.
The Senate bill is far better than the legislation passed by the House. The House version (H.R. 1350) would allow schools to suspend or expel children with disabilities at will if they violate the “school’s code of conduct.”
Strong legal protections from school exclusion are necessary to ensure that students with disabilities get the support they need to succeed in school and beyond. If lawmakers fail to hammer out the differences between the two bills, current law—which offers stronger protections for children than either bill—will remain in place.
More Information
- Bazelon Center for Mental Health Law Statement on Senate Reauthorization of the Individuals with Disabilities Education Act (5/13/04)
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TANF Renewal Lingers
Little progress has been made on reauthorization of the 1996 welfare law that created the TANF program. The House approved its version of the bill to reauthorize TANF, but the Senate bill has yet to come up for a floor vote.
The Government Accountability Office, Congress’ investigative arm, has found that TANF recipients are three times more likely than adults not receiving program benefits to have at least one physical or mental impairment. It is critical that any final bill appropriately address barriers to self-sufficiency to help recipients with disabilities to successfully transition from welfare to work.
The House TANF bill (H.R. 4), passed last year, would erode states’ flexibility to provide appropriate assistance to recipients with disabilities and their families, who often face barriers to finding and maintaining employment.
The Senate bill (Senate Rpt.108-162) takes a less restrictive approach. It includes provisions initially proposed in the Pathways to Independence Act (S. 1523), sponsored by Senators Gordon Smith (R-OR), Jim Jeffords (I-VT) and Kent Conrad (D-ND). The Senate bill would also allow states to provide assistance to recipients with disabilities who 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. It would also enable families to care for their children or adult relatives with a disability.
Current law has been extended until September 30, 2004, giving Congress time to complete reauthorization. As with the IDEA, current law would remain should Congress fail to pass a final bill. However, lawmakers would still need to pass a bill extending the provisions in current law.
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Mental Health Parity Stalled
The Senator Paul Wellstone Mental Health Equitable Treatment Act (S. 486, H.R. 953) remains stalled in Congress. The bill would reduce discrimination by private insurers by requiring health insurance plans to provide the same coverage for mental health and medical services with respect to outpatient sessions, inpatient days, co-payments, deductibles and maximum out-of-pocket expenses.
Mental health advocates and the legislation’s sponsors—Senators Pete Dominici (R-NM) and Edward Kennedy (D-MA) and Representatives Jim Ramstad (R-MN) and Patrick Kennedy (D-RI)—remain committed to its passage. However, the bill has yet to be considered in the House committee with jurisdiction over the legislation or to come before the full Senate for a vote. The current parity law expires on December 31, 2004.
More Information
- Take Action: Support Mental Health Parity (Links to Wellstone Action)
- Return to the table of contents
Mental Health / Criminal Justice Collaboration Bill Poised for House Action
The House may consider legislation to support collaboration in state and local mental health and criminal justice systems’ responses to offenders with mental illnesses.
The Mentally Ill Offender Treatment and Crime Reduction Act (S. 1194)—introduced by Senator Mike DeWine (R-OH)—would authorize funding for grants to support pre- and post-booking interventions, including crisis intervention teams and law enforcement training, mental health courts and other court-based approaches, re-entry and transitional programs. S. 1194 provides for one-year planning grants and five-year implementation grants that would require an increasing match in state funding in later grant years.
The Senate passed the bill last year, and the House Judiciary Subcommittee on Crime is likely to consider the bill soon. Numerous mental health, disability, child, and criminal and juvenile justice advocacy organizations support the legislation. If the House Judiciary Committee acts on the bill soon, S. 1194 could become law.
More Information
- Campaign for Mental Health Reform: Advocates Praise Efforts to Address Criminalization of People with Mental Illnesses (6/22/04)
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Prospects Uncertain for Children's Mental Health Bills
As Congress approaches adjournment, the prospects for enactment of two bills to improve access to community-based children’s mental health services remain uncertain. The Keeping Families Together Act (S. 1704, H.R. 3243) and the Family Opportunity Act (S. 622, H.R. 1811) would help close gaping holes in the safety net for children with mental illnesses.
According to reports by Congressional investigators, thousands of children are warehoused in juvenile detention for lack of mental health services in the community and thousands of families have been torn apart when they relinquished custody to the state to obtain mental health services needed by their children.
The Keeping Families Together Act—introduced by Senator Susan Collins (R-ME)—would promote comprehensive interagency systems of care for children with mental or emotional disorders by providing for six-year “Family Support Grants” to help build new state-level infrastructure. It would also establish a new federal interagency task force to examine mental health issues in the child welfare and juvenile justice systems and require states to report annually on the success of their programs for children with mental health needs. Under the legislation, the Department of Health and Human Services would also be required to report to Congress on states’ success in addressing the custody-relinquishment problem.
The Family Opportunity Act would allow families with incomes up to 250 percent of the federal poverty level to buy in to Medicaid on a sliding-scale basis. The Senate passed the bill in May.
Both bills would improve children's access to community-based services by enabling states to use Medicaid’s home- and community-based waiver to pay for services for children with serious mental or emotional disorders who currently receive inpatient psychiatric services in a residential treatment center or are at risk of placement in such a facility.
The bills have bipartisan support in the House and Senate. However, it is unlikely that either bill will be acted upon before adjournment without a strong push from grassroots advocates.
More Information
- Take Action: Tell Lawmakers to Co-Sponsor the Keeping Families Together Act
- Take Action: Urge House Passage of the Family Opportunity Act
- Thousands of Children with Mental Illness Warehoused in Juvenile Detention Centers Awaiting Mental Health Services (7/7/04)
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