LEGISLATIVE UPDATE

SAMHSA Reauthorization

On July 17, 2000, a coalition of Democrats in the U.S. House of Representatives introduced legislation (H.R. 4867) to reauthorize the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Similar legislation (S. 976) passed the U.S. Senate late last year. SAMHSA reauthorization thus far has not moved forward in the House, where critical differences exist about funding for "integrated treatment" of mental illness and substance abuse. FY 2001 Budget

Both the U.S. House of Representatives and Senate have passed spending bills for FY 2001 that include important increases for mental illness research and services programs. Funding for these programs is part of the massive $352 billion Labor, Health and Human Services (HHS) and Education Appropriations bill (H.R. 4577). The Senate passed its version of the bill on June 30, 2000, by a margin of 52-43; the House cleared its version on June 14, 2000, by a margin of 217-214. A House-Senate conference committee will work out the differences between the two sets of spending bills. Overall, the CMHS budget receives a modest increase in both the House and Senate bills, but in different areas. The House bill fully funds the President's recommended increase for the Mental Health Block Grant of $60 million above the FY 2000 level of $356 million, bringing funding up to $416 million. In contrast, the Senate bill increases the Mental Health Block Grant by only $10 million, up to $366 million. Instead, the Senate bill directs an additional $50 million to the CMHS Knowledge, Development and Application (KDA) program for school violence prevention. This would bring total spending for the CMHS school violence initiative up to $90 million. The House bill would trim the CMHS KDA program by more than $4 million.

Other CMHS programs receive either a freeze or a modest increase under both bills. The Projects for Assistance in Transition from Homelessness (PATH) program is increased by $5 million in the Senate bill and is frozen in the House bill. The Children's Mental Health Program is increased by $4 million in both bills, up to $86.8 million. Finally, the Protection and Advocacy (PAIMI) program is increased by $1 million in the Senate bill and is frozen in the House bill.

Both the House and Senate bills declined to separately fund the Clinton Administration's $30 million request for "Targeted Capacity Expansion." This initiative would have directed funds to services in non-mental health settings to foster healthy families and communities. Instead, the House bill contains report language urging CMHS to collaborate with the U.S. Department of Justice (DOJ) in efforts to help local communities divert criminal offenders with severe mental illnesses out of jails and into treatment programs.

Parity

The Mental Health Parity Act of 1996 addressed the issue of insurance discrimination, but required only that annual and lifetime dollar limits for mental health coverage be the same as for other types of health coverage. The law did not address other categories of benefits.

In an attempt to expand and renew the Mental Health Parity Act of 1996, U.S. Senators Pete Domenici (R-NM) and Paul Wellstone (D-MN) introduced a new bill in April 1999, called the Mental Health Equitable Treatment Act (S.796). S. 796 would expand the 1996 Mental Health Parity Act to full parity by barring health plans from imposing limits on coverage for treatment of severe mental illness that do not apply to all other diseases. On May 18, 2000, the Senate Committee on Health, Education, Labor, and Pensions held the first Congressional hearing on the legislation. While the Domenici-Wellstone bill does expand parity, it provides full parity for only certain mental illnesses.

Mental Health Courts

On September 26, 2000, the U.S. Senate passed a bill that will provide grants to States, State and local courts, units of local government, and Indian tribal governments to establish mental health courts to hear suits involving non-violent criminal charges brought against defendants with mental illness or co-occurring disorders. The purpose of the bill is to divert as many of these individuals as possible away from criminal incarceration into appropriate mental health treatment and services. The bill, titled America's Law Enforcement and Mental Health Project (S. 1865), provides judicial supervision and the coordinated delivery of services, including specialized training of law enforcement and judicial personnel, voluntary outpatient or inpatient mental health treatment, centralized case management, and the coordination of all mental health treatment plans and social services. On November 13, 2000, the bill was signed by President Clinton and became public law.

Restraint and Seclusion Legislation

The U.S. Senate has twice approved a bill that would establish the first set of national standards for all psychiatric settings on the use of seclusion and restraints. A bill introduced last year in the U.S. Senate is now an amendment to two bills under consideration in the U.S. House of Representatives. The legislation would impose a national standard on restraint use in all psychiatric facilities that receive Federal funding. It is designed to protect residents of public and private psychiatric hospitals, nursing facilities, residential treatment centers, and intermediate-care facilities from the inappropriate use of physical restraints and seclusion.

The bill, introduced last year by U.S. Senator Christopher J. Dodd (D-CT), would limit the use of restraints to situations in which the safety of the patient or staff is at stake; require a physician's written order for restraint use; require that any death resulting from restraint use or seclusion be reported to the State's Protection and Advocacy agency within 7 days; and require facilities to train staff annually on the appropriate use of restraints and on alternatives to their use.

The bill passed the Senate last November as an amendment to the reauthorization bill for the U.S. Substance Abuse and Mental Health Services Administration (S. 976). The House Commerce Committee did not act on the bill. On June 30, 2000, the U.S. Senate again approved the bill, this time as part of the FY 2001 Labor, HHS and Education appropriations bill.

Go To Report

Page One: Year-end Report

Page Two: Legislative Update

Page Three: Program Activities and Initiatives

Page Four: Division of Knowledge Development and Systems Change

Page Five: Division of Program Development, Special Populations, and Projects

Page Six: Division of State and Community Systems Develpment

Page Seven: CMHS Staff Notes