Congress, State Officials Give Funding Advice

More local control is needed over the use of federal mental health and substance abuse funds, said congressional leaders, who also promised to provide more mental health assistance in future disasters and to fight growing methamphetamine addiction.

The discussion of federal priorities in mental health and substance use treatment came as Congress began its first reauthorization in seven years for the Substance Abuse and Mental Health Services Administration (SAMHSA).

“State and local communities can provide the best approach to prevention and treatment, because they are the front lines and in the best position to develop creative solutions,” said Sen. Mike Enzi (R-Wyo.), at a May hearing of the Senate Health, Education, Labor and Pensions (HELP) Committee.

Rodger McDaniel, deputy director of the Wyoming Mental Health and Substance Abuse Services Division, agreed and encouraged Congress to increase the flexibility given to local communities to spend their SAMHSA grants.

“The problems are different from community to community, and they are best addressed by local leadership.” McDaniel said.

Terry Cline, Ph.D., newly appointed administrator of the SAMHSA, told senators at the hearing that local authorities need the flexibility to tailor their programs—such as drug-treatment efforts designed to address needs of Native Americans—but he emphasized the need for increased state accountability through better information collection. Not all states have organized comprehensive data collection, and that problem needs attention, he said. “We're not yet there, but we're on our way,” he said.

SAMHSA's support of local mental health and substance abuse services must include permanent support ive housing, said Sen. Richard Burr (R-N.C.). He introduced a bill (S 593) in February establishing SAMHSA grants to fund supportive housing, which combines housing and support services such as mental health, substance abuse, and employment-assistance services for chronically homeless people. This type of program, which requires concerted effort by federal and local agencies, should serve as a model for how SAMHSA approaches all people with mental illness, he said.

Terry Lee Allebaugh, executive director of the organization Housing for New Hope in Durham, N.C., agreed that homelessness is a glaring example of how the lack of comprehensive services for those in need actually costs taxpayers much more through the emergency demands they place on public health care, law enforcement, and prisons than comprehensive treatment and related services would.

Enzi said Congress will use the reauthorization opportunity to review SAMHSA's response to natural disasters, such as Hurricane Katrina, and local emergencies, such as the Virginia Tech shootings.

SAMHSA is authorized to use 2 percent of its budget to respond to emergencies, Cline explained, although much of that funding is provided through the Federal Emergency Management Agency to state officials, who decide how it is spent. The aftermath of Hurricane Katrina showed the agency that it needs to help regions—not just states—develop emergency plans and to address the flight of local health care professionals from hard-hit areas.

Sen. Jack Reed (D-R.I.) said he wanted increased support for the network of community mental health providers through the SAMHSA reauthorization. Community mental health centers provide a range of services—including housing and social supports—focused primarily on people with serious mental illness and substance use disorders.

Reed also urged strengthening the links between housing and support services for homeless people who have substance abuse problems along with other mental health disorders. Federal leadership also is needed “to enhance the workforce pipeline in the field of mental health and substance abuse treatment,” he said.

Rep. Patrick Kennedy (D-R.I.) urged senators to support expansion of the Starting Early Starting Smart SAMHSA pilot program, which created and is testing a model of integrated behavioral health services for mental health and substance abuse prevention and treatment among children under age 8 and their families.

“You can't reach the children [with mental illness] if you don't reach their parents,” Kennedy stressed.

Senators also discussed a possible expansion of a SAMHSA grant program for people with mental health problems who are under the care of multiple health care clinicians. The grants help states coordinate overall mental and other types of medical care.

Sen. Patty Murray (D-Wash.) noted the technical assistance and grants SAMHSA has provided in recent years to combat the explosion of methamphetamine abuse in states such as hers and said SAMHSA needs to expand these efforts. Although federal statistics show the number of first-time meth users is down, there has been a large jump in the number admitted for treatment in recent years.

Some have urged Congress to merge SAMHSA's now-separate block-grant funding for mental illness and substance use, but Kennedy said that flexibility is the key. If federal guidelines ensure that local clinicians have the freedom to treat both types of problems, then funding provided under either category will help people with co-occurring mental and substance use problems, he said.

The “Services for Ending Long-Term Homelessness Act” is posted at<http://thomas.loc.gov/cgi-bin/bdquery/z?d110:s.00593:>.▪