NYAPRS Note: Attention has turned to how mental health services have fared in the recently released 2016 budget proposal by President Obama. Highlighted by the following articles by SAMHSA Administrator Pam Hyde and the Mental Health Weekly, there’s a particular emphasis and some increased funding for crisis response services, early intervention programs for youth and young adults, to counter rising prescription and opioid drug addiction and to enhance workforce development and services for veterans, all of which have been highlighted by the mounting debate on how best to improve the nation’s and states’ response to our most distressed Americans. There’s also continued support for the embattled Protection and Advocacy program, whose legal efforts to fight abuse and win access to needed services is often lost in the furor of the national mental health policy debate.

The budget also includes proposals to eliminate the 190-day lifetime limit for Medicare funded hospitalization, increase housing for the homeless and services to Native youth and families.

SAMHSA’s budget rose by $44.6 million to a total of $3.7 billion, partially to restore cuts connected with sequestration caps of the last few years.

 

President’s 2016 budget Increases SAMHSA Funding, Expands BH Workforce

Mental Health Weekly February 9, 2015

 

President’s 2016 budget increases SAMHSA funding, expands BH workforce President Obama has released his FY 2016 budget proposal that includes some good news for the field, such as new funding for crisis services and supports, the elimination of a discriminatory provision in Medicare and a reversal of sequestration cuts.

The president released his proposed $4 trillion budget February 2. The White House-proposed budget for the Substance Abuse and Mental Health Services Administration (SAMHSA) is $3.7 billion, which includes a $44.6 million increase for FY 2016 over the FY 2015 enacted level.

The proposed budget level funded the Mental Health Services Block Grant at $482.5 million. The budget continues to call for a 5 percent set-aside to support early intervention in psychosis.

“We’re in a very tough budget environment,” Chuck Ingoglia, senior vice president of public policy and practice improvement at the National Council for Behavioral Health, told MHW. Despite the challenges, the government continues to find ways to invest in overall behavioral health services, he said, pointing to the nearly $45 million increase in funding for SAMHSA. “We’re very appreciative of that ability to find additional money,” he said.

SAMHSA Administrator Pamela Hyde said during a budget announcement February 4 that the proposed budget represents the highest investment SAMHSA has seen historically.

Hyde pointed to the president’s investment in key behavioral health priorities that include strengthening crisis systems. The proposal includes $10 million for Increasing Crisis Access Response Efforts. The demonstration program provides grants to states and communities to build, fund and sustain crisis systems.

The program will assist states with services and support, said Ingoglia. “We think that’s critically important,” he said. It’s essential to provide ongoing crisis-related services for individuals with mental illness, he said.

 

Other SAMHSA priorities include:

• Addressing prescription drug and opioid abuse — $12 million in new funding to prevent opioid overdose–related deaths.

• Expanding the behavioral health workforce — $10 million in new funding for developing and sustaining behavioral health paraprofessional training and education programs. It adds approximately 1,200 new peer professionals.

• Educating and training the behavioral health workforce — the SAMHSA-HRSA Behavioral Health Workforce Education and Training program would receive $56 million, representing a $21 million increase.

• Fostering tribal behavioral health — the proposal includes $30 million in Tribal Behavioral Health Grants to expand critical substance abuse prevention and mental health promotion activities for youth in tribal communities.

 

Medicare

The field is pleased that the president’s proposal includes some good news for Medicare beneficiaries and their families. The proposal calls for the elimination of the so-called Medicare 190-day lifetime limit, which limits Medicare beneficiaries to just 190 days of inpatient psychiatric hospital care during their lifetime.

This proposal would eliminate the 190-day limit and more closely align the Medicare mental health care benefit with Medicare’s current inpatient physical health care benefit.

While parity is considered “the law of the land,” both Medicaid and Medicare still do not have parity related to these programs, said Mark Covall, president and CEO of the National Association of Psychiatric Health Services.

The 190-day lifetime limit for hospitals, including psychiatric hospitals under Medicare, is a “longstanding discriminatory provision,” Covall told MHW. The provision creates barriers to beneficiaries’ accessing acute short-term psychiatric care, he said.

Regarding mental health and Medicare, many of the patients are enrolled in Medicare, due to a disability and not necessarily because they’re elderly, like the vast majority of beneficiaries, he said. “A lot of the patients we see in that category are there by definition because of a lower income because they are disabled and younger,” said Covall. “It’s hard for them to pay the out-of-pocketcost required under Medicare.” Covall added, “The 190-day lifetime limit is a barrier to access coverage over the [beneficiaries’] lifetime.”

The proposal to eliminate the provision “is a very important step forward and we support it,” he said.

The proposal to eliminate the 190-day lifetime limit was a very pleasant surprise, added Andrew Sperling, director of federal legislative advocacy for the National Alliance on Mental Illness. “We’re very pleased,” Sperling told MHW. “We always felt it was discriminatory. Most of the population is not elderly. They’re young people with a disability.”

 

Discretionary spending

The most important news to come from the budget is that the president has begun negotiating discretionary spending caps that were imposed since 2011, said Sperling. “He’s specially proposing to amend or eliminate caps on discretionary spending,” Sperling said.

The president proposes to set spending at a level $74 billion above the spending cap, Sperling noted. “The president recognizes that over the [the last] two years the economy has improved,” said Sperling. “Once we’re done with the round of sequestration, we can start again and make investments in discretionary spending on health research and other priorities.”

Sperling said NAMI is also encouraged by the president’s requested increase of $345 million from FY 2015 to support housing for the homeless. The funding enables Housing and Urban Development to amend the McKinney-Vento Homeless Education Assistance Act to create permanent supportive housing for the chronically homeless population.

 

Other budget items

The budget proposal includes a total of $151.1 million, a $35 million increase, for the president’s Now is the Time Initiative, developed January 2013 following the Sandy Hook tragedy. It includes $15 million for Mental Health First Aid training. Additionally, $39.9 million in funding would be provided for Project AWARE to improve mental health awareness and increase referrals to behavioral health services and support systems.

The proposal continues Health Transitions with $20 million in funding to support youth ages 16 to 25 with mental health and/or co-occurring substance abuse problems and their families.

The president has requested $4 million for a new initiative, Mental Health First Aid for veterans. It would fund training for 55,000 more individuals, especially those who work with military service members, veterans and their families.

The proposal calls for Congress to enact a four-year extension of the Children’s Health Insurance Program at a cost of $11.9 billion. The program was set to expire this year.

The budget includes a proposed $31.3 billion increase for the National Institutes of Health, which includes the National Institute for Mental Health (NIMH). The funding includes $135 million (an increase of $70 million) for the Brain Research through Advancing Innovative Neurotechnologies Initiative, a research program to revolutionize the understanding of the human brain. “We’re very pleased that the NIMH would see a $56 million increase,” said Sperling.

The budget proposal includes reductions in a number of prevention and public health programs. The Primary Care Behavioral Health Integration grants, for example, would receive $28 million, which includes a $24 million reduction vs. FY 2015.

“We’re disappointed that the new budget once again calls for the major reduction of this program,” said Ingoglia. “This has been one of the more popular and successful SAMHSA grant programs. It supports revolutionary work around the country [in meeting] the primary care needs of people with serious mental illness.” •

 

For a copy of the budget, visit www.whitehouse.gov/sites/default/files/omb/budget/fy2016/assets/budget.pdf.

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President Obama’s Plan to Address Our Nation’s Urgent Mental Health Needs

By Pamela Hyde, J.D., SAMHSA Administrator Huffington Post  February 13, 2015

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President Obama’s recently proposed Fiscal Year (FY) 2016 Budget provides the nation with an unprecedented opportunity to address America’s urgent behavioral health needs. About 1 in 5 Americans experiences a mental illness every year, yet many struggle to access treatment and services. The FY 2016 Budget proposes improvements to the mental health system by expanding treatment for serious mental illness (SMI) and by reaching people in crisis when they need help the most.

 

Many of the president’s proposals in this area are focused within the U.S. Department of Health and Human Services and its Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA is a relatively small federal agency, but has a large effect in reducing the impact of mental illnesses and substance abuse within our nation’s communities. Three-quarters of SAMHSA’s mental health budget is dedicated to serving people with SMI. SAMHSA’s Community Mental Health Services Block Grant, Children’s Mental Health Initiative, and Primary and Behavioral Health Care Integration programs provide medical treatment and recovery support services to millions of Americans with the most serious needs. SAMHSA’s leadership, including coordination with other federal departments, is focused on enhancing our ability to help ensure that people with these disorders receive vital supports for treatment and recovery.

SAMHSA is also working with the National Institute of Mental Health at the National Institutes of Health to provide early treatment — including medical care — to those individuals experiencing the early stages of SMI. In fact, SAMHSA’s efforts address the vast spectrum of America’s behavioral healthcare needs including suicide prevention services, evidence-based programs for helping people experiencing homelessness, and helping people dealing with co-occurring mental and substance use disorders get on the road to recovery. The budget also continues support for the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program, a critical partnership with states that helps protect the rights of people with SMI against neglect and abuse and ensures that they receive appropriate and effective treatment and services.

 

These efforts are helping but, there is no question that more is needed.

 

The president’s proposed budget, if funded by Congress, would enable SAMHSA to provide expanded services to help prevent and treat mental illness. These expanded services and programs include:

• Expanding the Mental Health Workforce: The 2016 budget requests 77.7 million for workforce initiatives that includes 10 million for a new program to develop paraprofessional training for peer professionals working with people with mental and substance disorders. Also included within this total is a proposed 21 million increase for the Behavioral Health Workforce Education and Training Grant Program to expand the behavioral health workforce. This program is carried out by both SAMHSA and the Health Resources and Services Administration (HRSA).
• Meeting the Needs of Children and Youth: The president’s “Now Is The Time Initiative” is funded at 151 Million within SAMHSA, an increase of 35 million above FY 2015. The program is aimed at preventing youth violence by providing a wide range of mental health services and support, including within schools, directed toward children and youth.
• Responding to Tribal Mental Health Needs: SAMHSA proposed 30 million, an increase of 25 million above FY 2015, to promote mental health and resiliency among Native youth and their families.
• Improving Crisis Response: This new 10 million program would strengthen crisis systems to prevent and de-escalate mental health and addiction crises. It would also help mitigate the demand for inpatient beds for those with serious mental illnesses and substance use disorders by coordinating effective crisis response with ongoing outpatient services and supports.
• Supporting Veterans’ Mental Health: This program would receive an additional 4 million to provide Mental Health First Aid training to an additional 55,000 veterans, military service members and their families on how to recognize when someone is experiencing a mental health crisis and respond effectively.

 

In addition to these and other expanded programs, SAMHSA will continue to play its part in supporting the full implementation of the Affordable Care Act, and the Mental Health Parity and Addiction Equity Act — resulting in the largest expansion of mental health care insurance coverage in a generation, especially for Americans with serious mental illnesses.

The president has taken important steps to increase the capacity of the mental health system in the U.S. With the support of Congress, SAMHSA can build on its leadership and success to help all Americans — including those with SMI — lead healthy, full, and productive lives in their communities.

To learn more about SAMHSA’s efforts on the prevention, treatment and recovery of mental illness, please go to www.samhsa.gov.

Pamela S. Hyde, JD, is the Administrator of the Substance Abuse and Mental Health Services Administration

 

http://www.huffingtonpost.com/pamela-hyde/president-obamas-plan-to-_1_b_6662016.html