 About the Campaign
Staff
Member Organizations
News
Roadmap
Press Room
Contact the Campaign
Report of the Presidents New Freedom Commission on Mental Health
Support the Campaign |
Contact: Bill Emmet, 703-739-9333, ext. 136 or bill.emmet@mhreform.org
Testimony by
Martha B. Knisley
Director
Department of Mental Health
District of Columbia
Before the
Senate Health, Education, Labor and Pensions Committee,
Sub-Committee on Substance Abuse and Mental Health Services
(July 15, 2003)
Mr. Chairman, Senator Kennedy, and Members of the Subcommittee:
Thank you for the opportunity to provide testimony to you this morning about
the Substance Abuse and Mental Health Services Administration (SAMHSA). My
name is Martha Knisley, and I am the Director of the Department of Mental Health
in the District of Columbia. I have worked in public mental health, substance
abuse and developmentally disabilities for over 35 years and have served as
Director of Mental Health in Ohio and Deputy Secretary for Mental Health in
Pennsylvania. I am speaking today on behalf of the National Association of
State Mental Health Program Directors, the association that represents the
public mental health authorities in the 50 states, the District of Columbia,
and the Territories.
I am particularly pleased to appear before you today in this first hearing
of the Senate Subcommittee on Substance Abuse and Mental Health Services. The
special focus of this Subcommittee reflects the critical need for improved
access to mental health services at a time when an overwhelming majority of
Americans with mental disorders do not receive appropriate treatment. This
is particularly discouraging given that great strides have been made through
medical research demonstrating the effectiveness of a range of such treatments
for these serious conditions. We are hopeful that your work, combined with
the much-anticipated release of the President’s New Freedom Commission
on Mental Health’s final report, will strengthen our nation’s commitment
to ensuring access to treatment and promoting recovery and full community participation.
Thank you for understanding the importance of this issue and recognizing the
potential to vastly improve and save lives.
I am also very pleased to present this testimony on behalf of the Campaign
for Mental Health Reform. As I am sure you understand, the President’s
Commission – even before its report has been released – has galvanized
the mental health community, which includes consumers, family members, providers,
administrators, and advocates. This community is represented by numerous organizations
with diverse interests and different perspectives. Despite these differences,
they are joining together to collaborate in an unprecedented fashion to launch
the Campaign for Mental Health Reform. Building on the work of the President’s
Commission, the Campaign will develop and promote federal policy initiatives
based on shared values and principles and will strive to advance mental health
as a national priority.
There could not be a more appropriate or exciting time to reauthorize SAMHSA
and its programs, since we can expect that the President will be turning to
this agency to formulate and coordinate an action plan stemming from the Commission’s
recommendations. Therefore, nothing could be more important than ensuring that
SAMHSA has the authority and resources to get this job done.
Charles Curie, SAMHSA’s Administrator, has expressed support for a strong
federal role in shaping mental health policy and in supporting efforts to provide
mental health services in appropriate, community-based settings efficiently
and effectively. We value the Administrator’s leadership and look forward
to continuing to work in partnership with Mr. Curie and his team. Indeed, we
are indebted to Gail Hutchings who for the past year has served with distinction
as the Center for Mental Health Services’ Acting Director, and we are
tremendously excited that Kathryn Power, the Director of Rhode Island’s
Department of Mental Health, will soon be taking the helm of CMHS.
However, SAMHSA will succeed in addressing the priorities and meeting the
goals the Administrator has laid out only if Congress empowers the agency to
do so. Too often in the past, SAMHSA has not been granted the authority or
the funding to achieve systems reform, even where there is a consensus in the
field about the obstacles and remedies.
We expect that the focus of the President’s Commission’s report
will be on the fragmentation found in the mental health system: that consumers
and family members seeking appropriate services are forced to navigate multiple
unconnected service systems, including, but not limited to, housing, substance
abuse, employment, education, criminal justice, Medicaid, child welfare, and
mental health. SAMHSA could and should play a the pivotal role in aligning
these programs to more effectively and efficiently serve adults and children
with mental health disorders and in leading an initiative for collaboration
across various federal agencies so as to create greater unity in mission, objectives,
and oversight in federal programs.
This need is particularly acute with respect to children. To address it, we
recommend that, through legislation, Congress establish an interagency body
on children’s mental health across the Departments of Health and Human
Services, Education, and Justice that would foster systems coordination, collaboration,
and joint financing across all relevant federal programs. Lead-agency responsibility
for this function would be vested in SAMHSA, which would oversee the design
and implementation of a comprehensive, interagency approach to children’s
mental health and report to Congress on those federal laws and regulations
that impede full realization of the legislation’s objectives. At Mayor
Williams’ request, the District through legislation created such an interagency
body when we established the new Department of Mental Health two years ago;
this has led to many positive outcomes. For example, since November of 2002
we have diverted over 230 children and youth from District institutional care
as a result of this action. Building a system of care for children, youth and
their families is our highest priority. We believe strongly that prevention,
early intervention and community treatment work when we commit resources and
work together with families and our partners in education, child welfare, juvenile
justice and other systems.
SAMHSA needs greater authority to promote cross-system collaboration and integration
in others areas, but two deserve particular attention.
First, we are encouraged that SAMHSA recognizes the tragic overrepresentation
of people with mental illness in the criminal justice system. According to
the U.S. Department of Justice, about 16 percent of the nation’s jail
and prison population have a mental illness. Incarceration is far costlier
than treatment and has significant negative consequences, not only for people
with mental illnesses languishing unnecessarily in jail, but for the criminal
justice system as well. We applaud Senator DeWine in particular for his leadership
on this issue and for introducing legislation to promote collaboration between
state and local mental health and criminal justice agencies. As provided in
the legislation, the Department of Justice will need to work with the Department
of Health and Human Services to administer the program; therefore, we urge
that SAMHSA be given the resources necessary to play that role.
Second, we commend SAMHSA for identifying as a priority the improvement of
services to the approximately 10 million Americans with co-occurring mental
illness and substance abuse disorders. Evidence-based treatments for these
conditions are remarkably effective. Such treatments involve integrated approaches
that address both the mental illness and the substance abuse problem concurrently.
Federal programs that isolate funding streams for mental health and substance
abuse into separate “silos” result in “parallel” or “sequential” treatment – expensive
approaches with poor outcomes for individuals with co-occurring disorders.
Unfortunately, statutory language associated with the substance abuse and mental
health block grants sends the message that these funding streams must be kept
separate and poses an obstacle to states and localities that want to furnish
the treatment that is most effective.
In the District of Columbia, Mayor Williams, Jim Buford, the Director of the
Department of Health, where substance abuse programs reside, and I recently
signed a Charter Agreement to assure that our policies, funding, program access
and all aspects of service delivery are combined to provide a single and focused
approach for treating persons with dual disorders. Yet we are forced to work
around the separateness that still exists at the federal level. We urge Congress
to modify the legislation and to promote the provision of integrated treatment
for individuals with co-occurring disorders.
Eliminating barriers to financing integrated treatment in the two block grants
will not only improve the treatment outcomes of individuals with co-occurring
disorders, but also reduce the most common adverse consequences they face,
such as criminal justice involvement, unemployment, and homelessness. In the
District, we estimate that 42% of adults who are homeless have a co-occurring
disorder. Therefore, we are encouraged that, in addition to improving integrated
treatment services, SAMSHA intends to play a key role in the Administration’s
initiative to end chronic homelessness. At the state and local level, we must
work long and hard to help persons who have been streetbound regain control
over their lives and maintain a permanent place to reside. We hope that SAMHSA
is granted both the authority and the funding to provide services in permanent
supported housing for individuals exiting chronic homelessness.
In addition to invigorating SAMHSA’s successful programs such as Projects
for Assistance in Transition from Homelessness (PATH) and the Comprehensive
Community Mental Health Services for Children and their Families Program, we
hope that Congress will give attention to the imminent conversion of the mental
health block grant to a Performance Partnership Grant. Measuring performance
and effectiveness of mental health programs and services results in more sophisticated
planning at the state level, enhanced accountability at all levels of government,
and, in short, more effective use of scarce resources. But committing to this
agenda in a meaningful way, such that performance data can be measured across
states and aggregated to present a national picture – a key goal of the
Performance Partnership – will also be very expensive to providers, states,
and SAMHSA. Most states already collect and analyze significant amounts of
data to support their own internal planning and quality improvement activities.
Under the Performance Partnership we would be required to meet national goals
for measuring performance and effectiveness, but this will require uniform
and standardized data collection, analysis, and reporting. Moreover, these
new requirements will apply to states’ entire mental health systems – not
just the block grant that is the focus of the performance partnership – even
though the block grant represents, on average, less than 2 percent of state
mental health agency operating budgets. In the District, the Block Grant represents
less than 1 percent of our budget. Therefore, to the extent Congress wishes
mental health programs to generate standardized data such that policymakers
at the federal level can better assess the effectiveness of these programs – a
goal we enthusiastically support – we urge that Congress provide the
funding to make this happen.
In addition, we want to express our support for SAMHSA’s leadership
role in reducing and ultimately eliminating the use of restraints and seclusion
among individuals with mental illnesses. SAMHSA has significant expertise and
a proven track record in spearheading successful initiatives designed to achieve
this goal.
And finally, we want to say a word about the shifting of SAMHSA’s research
functions to the National Institute for Mental Health (NIMH). We support SAMHSA’s
efforts to streamline and eliminate duplication in federal agencies, but emphasize
that services research must be continued and enhanced. This research builds
on the significant investments that NIMH traditionally has made in understanding
the science of mental illness, and ensures the cost-effectiveness of those
investments. More importantly, services research is a critical bridge across
the chasm between what we know about mental illness and what we do in providing
services; the implications of reduced attention to this research are enormous.
We are confident that this Subcommittee agrees that it must ensure that critical
support for services research is maintained and expanded.
Again, thank you for the opportunity to speak with you this morning. I am
happy to respond to any questions you may have.
|
One of every two Americans who need mental
health treatment do not receive it, and the rate is even lower —and
the quality of care poorer—for ethnic and racial minorities.
|
 |
