Coalition Seeks Reforms to Improve MH System Accountability

Congress has proposed changing federal mental health and substance abuse block grants to grants that are tied to performance-based measures and outcomes.

“With so much effort and funding focused on these programs, it is crucial to understand the effectiveness of these services,” said Sen. Mike DeWine (R-Ohio) at last month's Senate hearing on performance and outcomes measures.

DeWine chairs the Health, Labor, Education, and Pensions (HELP) subcommittee that oversees the funding reauthorization of the Substance Abuse and Mental Health Services Administration (SAMHSA). DeWine also serves on the Senate Appropriations Committee.

The proposed Partnership Performance Grants (PPGs) are scheduled to replace the mental health block grants in Fiscal 2005 and substance abuse grants in Fiscal 2006. However, SAMHSA has not completed the reporting requirements for states to implement the PPGs.

Further, state officials cannot change their data systems until SAMHSA finalizes its reporting requirements, according to a June report by the Government Accounting Office.

Howard Goldman, M.D., Ph.D., testified on behalf of the Campaign for Mental Health Reform that there is widespread agreement among the various groups involved with the mental health system on the outcomes that systems and services are designed to achieve.

Goldman is a professor of psychiatry and director of mental health policy studies at the University of Maryland and editor in chief of the APA journal Psychiatric Services. He has been a consultant to the President's New Freedom Commission on Mental Health and a senior scientific editor of the Surgeon General's 1999 report on mental health.

The campaign's mission is to transform mental health care in America and“ serve as the mental health community's united voice in promoting federal policy changes,” Goldman testified. Among its members are APA, Children and Adults With Attention-Deficit/Hyperactivity Disorder, Depression and Bipolar Support Alliance, Bazelon Center for Mental Health Law, National Alliance for the Mentally Ill, National Association of State Mental Health Program Directors, and the National Mental Health Association.

The seven consensus outcomes that health systems and services are intended to achieve are symptom reduction; enhanced social supports; community participation; improvement in employment or, in the case of youth, age-appropriate functioning; reduced homelessness and inappropriate hospitalization; improved general health status; and decreased contact with the criminal justice system.

Performance and outcomes measures come with costs, however. Identifying and implementing measures for planning, budgeting, monitoring, and quality improvement is “enormously complex, expensive, and labor intensive,” Goldman said.

“Resources are necessary to update or, in some cases, create information technology systems that would enable states and counties to collect, access, link, and analyze the relevant data,” he said.

The federal government has an important role to play in expanding performance measurement systems by doing the following:

“The federal commitment to this effort has been minimal so far, with states receiving grants ranging between $100,000 and $150,000 per year to move billion-dollar systems,” Goldman testified. Only a few states—Ohio, Texas, Colorado, Washington, and Oklahoma—have developed data systems capable of measuring publicly funded mental health programs' effectiveness and patient outcomes, said Goldman

“SAMHSA must ensure that the data it is requiring the states to report are of value not only to the federal government, but also to the states and counties in planning, quality improvement, and contracts management.”

To the extent those goals are not aligned, the federal government must be prepared to cover more of the financial burden, Goldman emphasized to the Senate subcommittee.

“Transforming mental health care will require fundamental changes in all social services at the federal, state, and local levels, including Medicaid, vocational rehabilitation, and housing,” Goldman said.

“If SAMHSA is to be responsible for monitoring performance and outcomes of mental health programs, then it must be given broader authority to work collaboratively with all of the other systems and agencies whose policies affect consumers and their families. Otherwise, the fragmented public mental health system will only be perpetuated.”

Goldman's testimony is posted online at<www.mhreform.org/news/7-19-04goldmantestimony.htm>. More information about the Campaign for Mental Health Reform is posted at<www.mhreform.org/>.▪