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Center for Mental Health Services
National Advisory Council Meeting
Washington, D.C.
DIRECTOR'S UPDATE
April 1997
Introduction
The members of the Center for Mental Health Services (CMHS) National
Advisory Council attended the January, 1997 SAMHSA joint Councils
meeting. Before that, the group met in September, 1996, and enjoyed a
productive meeting in which Council members addressed one another and
the Center on important issues, such as the Knowledge Development and
Application agenda, startup issues experienced under the TennCare
behavioral health managed care program, observations of the effect of
managed care on mental health services for children, the new methodology
for estimating prevalence of serious emotional disorders in children and
adolescents, and baseline data from the children's mental health
services program and the Early Intervention Project.
The April, 1997 agenda focuses on the maturation of the Knowledge
Development and Application (KDA) program, which has gone from being a
concept to being a series of new grant announcements. As in the
September, 1996 meeting, the agenda focuses on hearing from Council
members on important issues facing the mental health services field and
the Federal role in those issues. The meeting includes breakout
sessions, led by CMHS staff and Advisory Council members, during which
communications, consumers, and child mental health will be discussed.
This report briefly updates activities undertaken or accomplished at
CMHS during the last quarter. As always, Center staff have worked
earnestly on programs to improve the lives of people with severe mental
illness and children with serious emotional disturbances.
Budget
Fiscal Year 1998. The FY 1998 President's Budget proposed $445.3 million
for CMHS, an increase of $99,000 over the FY 1997 appropriation. The
full-time equivalent (FTE) ceiling for FY 1997 and FY 1998 proposed in
the President's budget reflects the decision to establish new ceilings,
Government-wide, based on the FY 1996 utilization level. For CMHS, this
means the FTE ceiling was reduced from 131 to 124 for both FY 1997 and
FY 1998.
The proposed budget maintains the current Federal support to State and
community mental health systems and continues funding for an important
set of knowledge development and application activities that address
some of the most challenging current issues in mental health services.
CMHS is looking forward to building on its partnerships with State and
local governments, and with mental health consumers and their families,
to address the many changes that are occurring in the mental health
field, and to assure that good mental health services and information
reach people in need.
The Administration has not prepared or presented a bill to Congress for
the SAMHSA reauthorization. However, House hearings on the matter were
held on March 18 before the Subcommittee on Health and Environment (a
subcommittee of the House Commerce Committee), chaired by Rep. Mike
Bilirakis (R-FL).
In her remarks to the committee, Dr. Chavez described major SAMHSA
programs and the status of substance abuse treatment and prevention and
mental health services in America. She outlined proposals for the
Knowledge Development and Application program and for the Performance
Partnership Grants (PPGs) and how these programs would enable SAMHSA to
lead the Nation in its substance abuse and mental health programs.
Among the recent findings and trends she discussed were:
- Results from the National Household Survey on Drug Abuse (NHSDA) that
indicate marijuana use among youth is on the rise, although adult rates
of illicit drug use have been cut by half.
- Results from the National Treatment Improvement Evaluation Study
(NTIES), a 5-year study assessing the effect of drug and alcohol
treatment on more than 5,000 clients enrolled in SAMHSA-funded programs,
indicate that marijuana use declined 50 percent, cocaine use declined 55
percent, crack use declined 51 percent.
- NHSDA results show a clear relationship between mental health and
substance use: adolescents with psychosocial problems are more likely to
use cigarettes, marijuana, and alcohol than are their peers; adults with
depression, generalized anxiety, or panic attack are twice as likely as
others to smoke or use illicit drugs.
- The National Comorbidity Survey indicates that with co-occurring
disorders, the mental illness often occurs during adolescence and
precedes substance abuse by 5 to 10 years.
The proposals Dr. Chavez highlighted in her remarks include:
- The transition of block grants into Performance Partnership Grants,
which would consolidate 12 required State plan criteria for community
mental health services into five and would reduce the number of
mandatory requirements for substance abuse plans.
- The implementation of the KDA program, which redirects the focus of
SAMHSA's discretionary grant programs from supplementing and building
services to a targeted approach to developing and applying knowledge to
leverage Federal resources and improve service systems.
Guidance for Applicants (GFAs)
This Winter, SAMHSA introduced the first round of KDA grants and
cooperative agreements, both of which support research-oriented
programs. CMHS grants will target systems change, cooperative agreements
for treating inmates with dual diagnosis, and cooperative agreements for
managed care and adolescents.
KDA grants are:
- The Community Action Grants for Service Systems Change will award
approximately 10 or more grants, each between $50,000 and $150,000. The
program is to stimulate the adoption of exemplary practices in consensus
and community building, decision-making, overcoming barriers, and
adapting service models to meet local needs. The grants will not fund
service delivery.
- Cooperative Agreements on Criminal Justice Diversion Interventions for
Individuals with Co-Occurring Mental Illness and Substance Abuse
Disorders will support study sites and a coordinating center to evaluate
the effectiveness of a variety of pre- and post-booking police diversion
and criminal justice intervention models. Among the outcomes to be
assessed are recidivism, time incarcerated, psychiatric status,
functional status, and homelessness.
- HIV/AIDS High-Risk Behavior Prevention to fund cooperative agreements
for study sites and a coordinating center that will develop and test,
through a series of pilot studies, a model prevention and intervention
approach for adolescents (between the ages of 15 and 24) and women (25
and over) who engage in high-risk behaviors associated with HIV/AIDS
transmission.
- Housing Initiative for cooperative agreements to conduct an evaluation
study to examine the effectiveness of different housing approaches for
people with severe mental illness.
- Starting Early/Starting Smart is an ambitious program designed to
generate new empirical knowledge comparing the effectiveness of
integrating behavioral health services and primary health care service
settings or early childhood service settings for very young children and
their families with the usual standard of community care. This program
will measure whether there are detectable differences in child,
family/caregiver, and system outcomes that can be linked to primary care
or to early childhood service settings that integrate behavioral health
systems. Primary care, early childhood development, substance abuse, and
mental health providers are encouraged to apply.
The only other funding opportunity is:
- Comprehensive Community Mental Health Services for Children and Their
Families. Six to nine awards will be made for projects lasting up to
five years to build community-based, family-focused services for
children with serious emotional disturbances and their families.
Grantees are to develop truly comprehensive systems of care for
children, and are to evaluate the care implemented under the program.
Longitudinal studies will be conducted as well. Each grantee will
receive $6 to $9 million.
Major Activities and Conferences
In the last 6 months, the Information Center has supplied
information to more than 70,000 people, via phone, e-mail, World Wide
Web, and electronic bulletin board. In the last 2 1/2 years, the Information Center has
distributed 112,029 publications-almost half of these in the last 6
months. This demonstrates not only the Information Center's continued growth, but a growing
public need for information about mental health.
The Office of External Liaison (OEL) launched a new, searchable database
of mental health consumer/survivor consultants on the Information Center's World Wide Web
site. The service permits consumers/survivors to network with one
another on common interests and experience. It also enables individuals
and organizations to find information resources on 68 different topics
related to consumers, ranging from advance directives to women's issues.
OEL sponsored a national teleconference of consumers/survivors
interested in issues affecting people of color. A summary of the meeting
is available from CMHS Consumer Affairs.
To increase awareness of the damaging effects of stigma, CMHS sponsored
a workshop, "Stigma . . . In Our Work, In Our Lives." This three-hour
interactive workshop was conducted by the Anti-Stigma Project and is
designed to increase awareness of attitudes that promote stigma and
discrimination within the mental health and substance abuse community.
The goal was to help participants identify the effects of stigma on the
design, delivery, and receipt of treatment services.
Jeffrey Buck, Ph.D., Associate Director for Organization and Financing,
in collaboration with the Center for Substance Abuse Treatment (CSAT),
met with three States to develop an integrated database for substance
abuse, mental health, and Medicaid. Although these populations often
overlap, such a database has never before been developed. Also in
collaboration with CSAT, Dr. Buck met with county behavioral health
directors to support efforts to collect data within county and local
mental health and substance abuse authorities. To date, there is no good
information about the contribution of local authorities to the total
service system. For example, we have no data on the amount of local
dollars contributed to mental health services. Dr. Buck also met with
the National Association of State Alcohol and Drug Abuse Directors
(NASADAD), the National Association of State Mental Health Project
Directors (NASMHPD), county behavioral directors, and Medicaid directors
to develop a document to assist States and counties to contract with
managed care organizations.
In early April, grantees of the Child, Adolescent, and Family Branch
(CAFB) met for their annual conference and viewed the premiere of the
new CMHS video, "Voices of Strength: An Inside Look at Children's Mental
Health." This 18-minute video features families who disclose how they
have been affected by their experiences with children's mental health
problems. More than 1,500 copies will be available for distribution
through the Information Center.
The Children's Mental Health Campaign, which received its third year of
funding, received an additional $485,995 from CAFB to produce campaign
products and continue outreach activities.
The National Empowerment Center, a CMHS-funded research training and
technical assistance center, sponsored a four-day conference, "Learning
From Us: Recovery and Empowerment-Beyond Rhetoric and Into Practice."
The conference provided a unique opportunity for mental health
professionals, administrators of mental health programs, managed
behavioral healthcare organization personnel, mental health policy
makers, teachers, and others to learn more about empowerment, healing,
and recovery. The National Council on Disability, an independent agency
of the Federal Government, participated in the conference, holding its
own quarterly meeting in conjunction with "Learning From Us."
The State Planning and Systems Development Branch conducted a meeting of
State block grant planners; the meeting included focus groups with
planners. Representatives from NASMHPD and the National Association of
State Mental Health Planning Councils, eight to ten State block grant
planners, as well as representatives from other community stakeholder
groups, attended.
Participants discussed specific issues and needs of State block grant
planners and State mental health systems, Federal and State
partnerships, the relationship between performance measures and
planning, and data and accountability. From the discussion, participants
will draft an agenda that is relevant and appropriate to their needs on
issues affecting planning State systems.
The Research and Training Center for Children's Mental Health, Florida
Mental Health Institute, University of South Florida, held the Tenth
Annual Child Mental Health Research Conference in February. More than
650 child mental health researchers, program administrators, providers,
family members, and graduate students attended.
The Community Support Program Branch sponsored a meeting, "CSP Futures,"
in January, at which a group of providers, consumers, family members,
and researchers reviewed CSP successes and discussed the future of the
program in the context of the Knowledge Development and Application
agenda.
The HIV/AIDS Mental Health Services Demonstration Program Steering
Committee met in Washington, DC, in December to present the Year One
Annual Report to Dr. Arons. Copies of this report, as well as the Year
Two Report, should be available for the Advisory Council this month.
More than 70 people participated in the FEMA/Emergency Services and
Disaster Relief Branch (ESDRB) crisis counseling training held at the
FEMA Training Center in Emmitsburg, MD. Representatives from 40 States
and four FEMA regions attended, as well as representatives from SAMHSA's
Office of Extramural Activities Review and Office of Equal Employment
Opportunity.
Susan Flanigan of the Missouri Department of Mental Health, on a
two-year interagency assignment to ESDRB, revised the application
process for disaster grants and developed a pilot immediate-services
grant application that has been tested successfully in six States and
Puerto Rico.
Through the Division of State and Community Systems Development, Information Center
staff participated in the quarterly meeting of the National Coalition on
Mental Health and Aging, a coalition of more than 60 groups committed to
improving public education about mental health for older Americans.
Ongoing meetings include discussions of ways for CMHS and the American
Association of Retired Persons (AARP) to collaborate on initiatives and
publications.
The Survey and Analysis Branch will sponsor the annual Mental Health
Statistics Improvement Project (MHSIP) conference May 27-30 in
Washington, DC. The conference will focus on new policy demands and
information for a changing environment, with topics ranging from changes
in Medicaid to consumer-generated services to integrated delivery
systems to the future. The MHSIP report card has been endorsed by four
major associations: the National Association of State Mental Health
Project Directors (NASMHPD), The National Alliance on Mental Illness
(NAMI), the National Association of State Mental Health Planning
Councils, and the Association for Ambulatory Behavioral Healthcare. It
is currently being tested in 20 States; in 1997, ten more grants were
awarded to States to test the report card.
Presentations
Dr. Arons participated in the American Orthopsychiatric Association
Meeting in Toronto. The meeting's theme was "Rising to the Challenge:
Providing Quality Care for the Growing Ranks of the Underserved."
On April 13 and 14, Dr. Arons will participate in a national convention
of elementary school principals, speaking on children's mental health in
the elementary school.
Dr. Thom Bornemann participated in a session on "Caring For Every Teen's
Mental Health," at the National Association of Secondary School
Principals and Education Professionals.
Consumer Affairs Specialist Paolo del Vecchio addressed the Statewide
educational conference sponsored by Advocates Taking Action In Kentucky
against Mental Illness; this is the second annual "Open Minds, Open
Doors" conference.
Dr. Jeffrey Buck addressed the National Association of Psychiatric
Treatment Centers for Children. In late April, he will participate in a
regional seminar sponsored by the National Association of Mental Health
Information Officers. He will discuss behavioral health care issues
within State health care reform.
ESDRB staff made many key presentations around the country, including:
- "Community Crisis and the Mental Health Needs of Multiple Victims," to
the National Symposium on Victims of Federal Crime attended by Assistant
US Attorneys and victim coordinators;
- "Key Concepts of Disaster Mental Health," to the National Association
of Social Workers at the national conference held in Cleveland in
November, 1996;
- Presentations on the FEMA Crisis Counseling Program and Stress
Management Program to Army chaplains and to personnel at the US Army
Training Center; and
- Upcoming presentations for the South Carolina Psychological
Association and the National Hurricane Conference.
Personnel
SAMHSA
DeLoris L. Hunter, Ph.D., was appointed as Associate Administrator for
SAMHSA's Office for Minority Health Concerns.
Paul M. Schwab was appointed as the Deputy Administrator of SAMHSA on
February 19, 1997. For the previous year, he served as the Acting
Director of the Bureau of Health Professions in the Health Resources and
Services Administration (HRSA).
Ulonda Shamwell, M.S.W., was named as the Acting Administrator for
SAMHSA's Office for Women's Services.
CMHS
Curtis R. Austin assumed the post of Director of the Office of External
Liaison on February 3, 1997. A seasoned reporter and award-winning
columnist, Mr. Austin's previous civil service assignment was as a
Public Affairs Specialist for the Federal Aviation Administration.
Thomas Bornemann, Ed.D., the Center's Deputy Director and a Commissioned
Officer in the U.S. Public Health Service, was promoted to Rear Admiral,
on March 1, 1997.
Elaine Corrigan, Senior Health Policy Advisor in the Office of the
Associate Director for Medical Affairs, received the U.S. Public Health
Service Commissioned Corps Outstanding Service Medal on December 17,
1996.
Brian W. Flynn, Ed.D., former Chief of the Emergency Services and
Disaster Relief Branch, has been appointed as the new Director of the
Division. He succeeds James Pittman who retired on January 4, 1997.
Anne Mathews-Younes, Ed.D., is the new Chief, State Planning and Systems
Development Branch, and will lead some of the Center's key efforts,
including the Community Mental Health Services block grant, Protection
and Advocacy, and the Human Resource Planning and Development Branch.
Previously, she worked in the Office of Organization and Financing.
Shelagh Smith has been detailed to replace Dr. Mathews-Younes.
Publications
Office of External Liaison--the Information Center. Through SAMHSA's National Mental Health Information Center, the Office of External Liaison
released several new publications in early winter, including a brochure
describing the Information Center's mission and services, and the first issue of the Information Center Bulletin, an update on what is going on in CMHS branches and at the Information Center. New brochures now being distributed nationwide include:
- Before You Label People, Look at Their Contents, which discusses the
problems caused by the stigma of mental illness and what can be done to
end it.
- Mental Illness Is Not a Full-Time Job, which provides practical advice
for people with severe mental illness who are looking for employment.
- Where in the World Is the Information Center? introduces the Information Center's World Wide Web site and how to access it.
Later this spring, the Information Center will complete its first new information kit, A
Consumer Information Kit, which features a series of fact sheets on
specific disorders and their treatments, an overview of the consumer
advocacy movement, how to pay for treatment, and alternative therapies.
CMHS staff have published several important new articles and chapters:
Brian Flynn co-authored "Mental Health Consequences in Disasters," in
Public Health Aspects of Disasters, E. Noji (ed.), Oxford University
Press, 1997.
Rural Disaster Mental Health and the Crisis Counseling Program, from
CMHS' ESDRB, is due out in late June 1997.
Jeffrey Buck, Ph.D., Associate Director for Organization and Financing,
published "Do Reinvestment Proposals Signal System Problems?" in the
February 1997 issue of Behavioral Healthcare Tomorrow. Dr. Buck argues
that reinvestment programs from managed care companies are likely to be
sporadic. Dr. Buck suggests a need to review the effectiveness of a
State's managed care program. Such a review can help to identify
problems that should be corrected by means other than profit
reinvestment.
KEN97-0042
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