Funding for Serious Mental Illness to Decrease as Budget Pressures Squeeze Discretionary Programs

by Cynthia Gervais

People living with Serious Mental Illness (SMI) are often denied access to jobs and housing and have limited access to consistent and quality treatment. Barriers to treatment include increased co-payments for services, premium increases, monthly limits on prescription drugs, and capped benefit limits. Health insurance often limits treatment of mental illness to a specified number of sessions with little regard to clinical need. Short-term treatment options are no substitute for illnesses that require evidence-based longer-term processes of recovery and rehabilitation.

The National Health Ministries of the Presbyterian Church (U.S.A.) defines Serious Mental Illnesses (SMI) as diseases of the brain that cause disturbances in a person's thinking, feeling, moods and ability to relate to others. They can diminish a person's capacity for coping with regular demands of ordinary life and can place tremendous burdens on family members and loved ones.

Those suffering from SMI carry the additional onus of stigma perpetuated by fear and ignorance. This stigma leads to discrimination by insurance companies against coverage equal to other illnesses, underfunding of government programs for public mental health services, and persistent negative media portrayals.

Mental illnesses do not discriminate; these disorders affect people of every race, ethnic heritage, gender, language, age and religious affiliation. The 1999 Surgeon General's Report on Mental Health stated that one in five Americans suffers from a "diagnosable" mental disorder. The Coalition for Fairness in Mental Illness Coverage estimates direct business costs at $70 billion per year, mostly in the form of lost productivity (absenteeism and "presenteeism") and increased use of sick leave. These are our relatives, neighbors, co-workers and friends. They are members of our congregations.

How has Congress responded to the needs of those suffering from Serious Mental Illness and what can Presbyterians do to improve their ministries of caring and healing?

Federal Budget Actions

On February 6, 2006, President Bush, released his $2.77 trillion budget plan for the fiscal year (FY) 2007. Proposed were increases in Defense and Homeland Security spending and decreases - an overall 2.3 percent -- for most domestic discretionary programs. These programs represent about 16 percent of all federal spending.

The projected federal budget deficit is projected to be about $354 billion in FY 2007; resulting in increased pressure on Congress to limit spending on discretionary programs. Congress is considering enacting changes to benefits and eligibility rules to offset spending for mandatory entitlement programs such as Social Security, Medicare, and Medicaid.

As a result, it is unlikely that there will be any increases in non-defense/non-homeland security discretionary spending. Biomedical research, housing assistance, human services and veteran's medical care will all be affected. Medicare payments to hospitals and other providers would be reduced by $35.8 billion over the next five years.

Prior to adjournment in December 2005, the Senate allocated funding for labor, health, and education programs, including mental illness research at the National Institute of Mental Health (NIMH) and mental illness treatment and services at the Substance Abuse and Mental Health Services Administration (SAMHSA). This legislation (HR 3010) represents the final agreement between the House and Senate to set funding levels for all discretionary health, labor and education programs at over $142 billion for FY 2006, holding most programs at their FY 2005 levels.

However, an across-the-board funding cut of one percent for all discretionary programs threatens to cut nearly all programs below FY 2006 funding levels. This across-the-board cut will affect other government programs serving people with serious mental illness such as housing (from the National Alliance for the Mentally Ill). A 50 percent cut is set for the HUD, in the Section 811 program, with the reduction falling hardest on the production of units within the program. Funding for homeless programs, however, would be boosted by $209 million.

Though HR 3010 funds mental illness research at NIMH at $1.418 billion, this represents an increase of only $6 million above current levels. The expected one percent across-the-board increase will result in $14 million budget cut to NIMH - reducing the slight increase to an $8 million decrease from FY 2005 allocation. This represents the first reduction in mental illness research funding in twenty years (from the National Alliance for the Mentally Ill).

Most programs as SAMHSA were held at current funding levels by HR 3010. This includes the Mental Health Block Grant, PATH (services for homeless individuals with mental illness), Jail Diversion, Children's Mental Health, and protection and advocacy. However, as with NIMH funding, SAMHSA and the Center for Mental Health Services (CMHS) funding will be subject to the one percent across-the-board reduction (from the National Alliance for the Mentally Ill).

CMHS is set to receive a substantial increase for its youth suicide prevention and campus mental health programs authorized under the Garrett Lee Smith Act. Suicide prevention programs will be increased by $10.5 million to $27 million.

Mental Health Parity Act

The Mental Health Parity Act (MHPA) was signed into law on September 26, 1996. It "requires that annual or lifetime dollar limits on mental health benefits be no lower than any such dollar limits for medical and surgical benefits offered by a group health plan or health insurance issuer offering coverage in connection with a group health plan" (US Department of Labor, Employee Benefits Security Administration Fact Sheet, 12/04). In 2005, Reps. Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) introduced a bill to expand the MHPA to prohibit a covered group health plan from imposing treatment limitations or financial requirements on mental health and chemical dependency treatment benefits that differ from limitations on medical and surgical benefits. The Act applies only to those plans which opt to cover mental health benefits and is modeled after the Federal Employees Health Benefits Program. There is also a small business exemption for companies with 50 or fewer employees. Though MHPA has been extended each year since 1996; its proposed expansion languishes in Congress due to budget concerns and continued inequitable treatment suffered by those unfairly stigmatized by mental illness.

According to NAMI, 36 states have parity legislation, but federal law, as outlined above, is far from comprehensive. That leaves about 80 million people uncovered by health insurance for mental illnesses.

Call to Action

Advocate:

• Urge Congress to pass legislation to prohibit discriminatory practices by health insurers.
• Urge Congress to close loopholes in the MHPA that allow for mental health coverage to be more expensive than physical health benefits.
• Urge those states that have not enacted mental health parity laws to do so.

Educate:

• Sponsor a Presbyterian Mental Illness Awareness Week in your congregation. Contact National Health Ministries Division for educational resources and materials.
• Sponsor a NAMI Education, Training and Support Activity:

1. Family-to-Family Education Program - focuses on the emotional responses families have to the trauma of mental illnesses. Participants will gain a greater understanding of mental illness in order to better navigate health care and political systems.
2. Peer to Peer Recovery Education Course - focuses on maintaining wellness and recovery. Sessions include lectures, interactive exercises and individual relapse prevention.
3. In Our Own Voice: Living with Mental Illness - offers insight into the hope and recovery possible for people with severe mental illness.

General Assembly Action:

The 200th General Assembly (1988) approved the Resolution on The Church and Serious Mental Illness which:

• Urges sessions and governing bodies to review their current responses to those with mental illness consider or strengthen approaches and learn more about mental illness.
• Seminaries were urged to expand learning for M.Div and D.Min and continuing education programs.
• GA entities were called on to take the initiative to form an ecumenical, interfaith task force focused on the chronically mental ill and their families, consider developing educational and programmatic materials, and explore support of Presbyterian chaplains who work with the mentally ill and their families in hospitals and community settings.

The 213th General Assembly (2001) passed an overture which:

• Directed the Office of the Stated Clerk to advocate for the passage of legislation in the eighteen states lacking requirements that health insurance plans provide full coverage for mental health benefits and that such coverage be in full parity with benefits for other illnesses. (At that time states included: Alaska, Florida, Idaho, Illinois, Iowa, Kansas, Michigan, Mississippi, New York, North Dakota, Ohio, Oregon, Pennsylvania, Utah, Washington, West Virginia, Wisconsin and Wyoming.)
• Directed the Office of the Stated Clerk to advocate for passage of the federal Mental Health Equitable Treatment Act (S. 796) co-sponsored by Senators Domenici (R-NM) and Paul Wellstone (D-MN).