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APA Medical Director Melvin Sabshin, M.D., went to Capitol Hill on April 16 to make a plea for more funding for those federal agencies that conduct research on mental illness and substance abuse.
Sabshin submitted written testimony and spoke briefly to the House Appropriations Committee's Subcommittee on Labor, Health and Human Services, and Education. Citing the importance of psychiatric research, Sabshin pointed to strides made in treating disorders ranging from alcoholism to depression.
"It's important to note that depressive illness is now eminently treatable," he told Representative Jay Dickey (R-Ark.), who presided over the hearing. "This is something that's evolved over the last few years, and now 80 percent of people with depression who are treated with a combination of medication and psychotherapy do, indeed, succeed. . . .These people may need such treatment over a lifetime, and it's important to note that this is now available."
A recent California study found that for every dollar spent on treating people with drug and alcohol problems, there was a $7 savings, "especially in the context of crime and health care costs," Sabshin noted.
Federally funded research, for example, recently confirmed a new use for an old drug, naltrexone, as an anti-alcohol agent that blocks craving and intoxication. And he added that recent animal studies suggest that soon there may be a preventive drug to combat cocaine abuse.
A better understanding is needed of the "pathways that lead to" addiction, said Sabshin. In particular, the tragedy of fetal alcohol syndrome provides a moral imperative for better understanding and combating compulsive drinking during pregnancy.
This year is the 50th anniversary of the National Institute of Mental Health (NIMH). "I'm proud of that," Sabshin said. "It's very meaningful for our field. It's also a good year [because of] the parity legislation that passed, and we're very thankful for that," Sabshin added.
This "is a year where there's been enormous publicity about mental illness," said Sabshin, referring to stories in Newsweek, Time, and U.S. News and World Report. The stories credit the federal agencies that "have done such a good job" in advancing research on mental illness, said Sabshin.
APA proposed that the research budgets for the NIMH, the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) be "increased to a level minimally appropriate to the quality of the science which merits support, as follows: $764 million for NIMH; $562 million for NIDA; and $244 million for NIAAA."
As submitted to Congress in February, President Clinton's $376 billion Fiscal 1998 budget request for the Department of Health and Human Services (HHS) proposed modest increases in discretionary funding of mental health programs. The fate of the budget remained unclear as of mid-April, with the President and the Congress still dancing around major differences.
When the President submitted his budget in early February, both Republicans and Democrats vowed to work together in a bipartisan spirit. But the goodwill quickly evaporated as Republicans focused on possible fund-raising irregularities during the President's reelection campaign. Even a brief moment of bipartisan rapport with the passage of a chemical weapons treaty in April quickly evaporated as Republicans continued to block confirmation hearings for Clinton's nominee for Secretary of Labor, Alexis Herman. The stalemate continued at press time.
Medicare and Medicaid, which are considered entitlements and not discretionary programs, make up the lion's share of the HHS budget request. The budget proposes an increase of $15.3 billion for Medicare in Fiscal 1998 for a total of $207.7 billion. The President requested $105.8 billion for Medicaid, a $7.3 billion increase over Fiscal 1997. Together the two programs make up 83 percent of the proposed Fiscal 1998 HHS budget. The requests represent a decrease in projected spending per capita by a net $100 billion over five years.
Unlike Medicare and Medicaid, funding for the federal agencies involved with research and administration of most mental health programs is discretionary.
As proposed by the President, the Fiscal 1998 budget would provide approximately $13.1 billion for the National Institutes of Health (NIH), an increase of $337 million, or 2.6 percent, over FY 1997. Of this increase, $271 million would go to funding research grants, a 3.9 percent increase in such grants, which the budget report deems "NIH's highest priority." Also within the $337 million increase is an additional $30 million for research on drug abuse and drug treatment and prevention within NIDA, representing a 9 percent increase in NIDA funding.
Samuel Guze, M.D., chair of APA's Council on Research, applauded the increased research funding reflected in the President's proposal.
"By every standard--humanitarian, incidence, prevalence, severity, disability, mortality, and ultimately cost--funding of research for mental illness and substance abuse is one of the best investments for the future," said Guze. "A sustained commitment that permits taking advantage of new techniques and insights should be our country's goal. Anything less invites questioning of our priorities and our understanding."
Also under Clinton's budget proposal, NIMH would receive $630 million, an increase of $26 million over Fiscal 1997. NIAAA would receive an additional $7 million over Fiscal 1997 for a total of $208 million. The National Institute of Neurological Diseases and Stroke would get a $21 million increase for a total of $723 million.
The Substance Abuse and Mental Health Services Administration (SAMHSA) would receive a Fiscal 1998 total of $2.2 billion, a $35 million, or 1.5 percent, increase over Fiscal 1997. The budget would cut federal prevention funding by $5 million, to $151 million, and hold federal treatment funding level at $156 million. The substance abuse block grant would receive a $10 million boost for a total of $1.32 billion, compared with $1.31 billion in the last fiscal year.
Although total SAMHSA prevention funds would fall, the budget would expand funding for the Youth Substance Abuse Prevention Initiative, which contains three components: state incentive grants of $63 million would go toward "mobilizing and leveraging federal and state resources to call upon governors to develop statewide prevention plans," according to the proposal; $4 million would go to a mass media campaign designed to "raise public awareness and counter pro-drug use messages"; and $28 million would go to expand the National Household Survey on Drug Abuse, which provides data used to evaluate the level and nature of drug use and abuse nationwide.
The budget requests $445 million to support "the federal government's role in the mental health services field." This includes federal funding for managed mental health care covering more than 124 million persons. Also in this category is level funding of the Center for Mental Health Services, including $275 million for the mental health block grant and $70 million for children's mental health services. Another category, knowledge development and application, funds a national center, the Knowledge Exchange Network, that provides up-to-date mental health research and referral services to the public.
(Psychiatric News, May 16, 1997)