Too many Americans do not recognize mental illness in themselves or others and

even if they do, treatment may not be available or affordable. The Mental Health Early Intervention, Treatment, and Prevention Act, introduced in the House of Representatives last month, is intended to change that.

The bill (H.R. 5091)—introduced by Representatives Ted Strickland (D-Ohio) and Heather Wilson (R-N.Mex.)—and the Senate companion bill (S. 2639) that was introduced in May have broad bipartisan support.

The House bill, like its Senate counterpart, calls for up to $2.5 billion over five years to fund a variety of initiatives to promote awareness of mental illness, expand treatment for the mentally ill, and train public employees to better understand and serve individuals who are mentally ill, according to a press release from Strickland’s office.

Jay Cutler, J.D., director of the APA Division of Government Relations, commented to Psychiatric News that the bill "is a most welcome bipartisan response to the urgent need to address stigma and priority setting of funding for persons suffering from mental illness and substance abuse disorders."

Specific provisions would:

• fund antistigma and suicide awareness campaigns,

• train teachers, emergency services personnel, law enforcement officers, and primary care physicians to identify and respond to mental illness among students, patients, and criminal suspects,

• establish emergency mental health centers,

• create a demonstration program to divert individuals with mental illness in the criminal justice system to community-based services,

• establish a suicide prevention program with timely assessment and referral, and

• provide grants for community mental health treatment and outreach programs.

APA is also supporting the Family Opportunity Act of 2000 (H.R. 4825) introduced in the House last month by Representative Pete Sessions (R-Tex.). The bill has garnered broad bipartisan support, with 60 cosponsors by early August. The companion bill (S. 2274) introduced by Senator Charles Grassley (R-Iowa) in March has 69 cosponsors, ensuring its passage.

The goal is to make it easier for parents of children with physical or mental disabilities to qualify for Medicaid services so the parents do not have to remain in poverty, declare bankruptcy because of expensive medical services, or give up custody of their children to obtain Medicaid services.

A recent survey conducted by the family advocacy group Family Voices in 20 states found that 64 percent of parents of disabled children had refused jobs and turned down raises and overtime so they could continue to qualify for Medicaid, according to a statement by Sessions, the bill’s primary sponsor in the House.

The Family Opportunity Act would remedy this dilemma by creating a buy-in option for parents of disabled children with incomes above a state’s Medicaid eligibility standard. Families with incomes at or below 300 percent of the federally determined poverty level would pay a maximum premium of 5 percent of their income, and families with incomes between 300 percent and 600 percent of the poverty level would pay a maximum premium of 7.5 percent of their income, according to a General Accounting Office (GAO) statement submitted to the Senate Budget Committee. That committee held a hearing on the proposed legislation in August.

The bill would also allow states to use in-home and community-based programs for Medicaid-eligible children now receiving psychiatric services in hospitals and would establish a demonstration program to extend Medicaid to children with a disability that is not severe enough to qualify them for Supplemental Security Income (SSI). This initiative will help determine whether Medicaid services can prevent disabilities from worsening and keep children off SSI rolls, according to the GAO.

Finally, the bill calls for the establishment of health information centers to provide families with information about health care programs and services available for disabled children.

David Fassler, M.D., chair of the APA Council on Children, Adolescents, and Their Families, told Psychiatric News that this legislation "would help states develop programs and expand coverage to more children and ensure continuity of care. It’s a sensible and important response to a very real problem."

He commended the efforts of Senators Grassley and Edward Kennedy (D-Mass.), Sessions, and numerous cosponsors to draw attention to this important issue.

In spite of the growth in the Children’s Health Insurance Program (CHIP) and the passage of parity legislation by an increasing number of states, many children still lack access to needed comprehensive mental health treatment services, noted Fassler.

In many cases, parents of children with psychiatric disorders have private health insurance, but the mental health coverage is often limited. Many private plans still deny coverage for specialized intensive services, such as residential-based ones, that are needed by children with severe mental illnesses, according to a fact-sheet from the National Alliance on Mental Illness (NAMI).

To remedy that situation, Medicaid’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program mandates that states pay for all medically necessary services to correct a child’s condition whether or not Medicaid covers them. These services include physical, occupational, and speech therapy, mental health and rehabilitative services, and case management, according to the GAO.