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While national spending for mental health, alcohol, and substance abuse services has grown over the last decade, it has declined as a share of total health spending, according to a report released last month by the federal Substance Abuse and Mental Health Services Administration (SAMHSA).
"The finding that the annual growth rate of federal spending on mental health services has been less than that for health care generally raises important questions that we must pursue," Bernard Arons, M.D., director of the federal Center for Mental Health Services, said in a statement. "We need to understand to what extent this represents effective and appropriate cost-control approaches, or to what extent this represents a continuing lack of access to necessary mental health services. We also need to determine whether cost shifts are occurring to other service systems."
Congress, however, is poised to enact substantial funding increases for the National Institutes of Health (NIH), including the National Institute of Mental Health (NIMH), that could result in a doubling of the NIMH budget over five years, according to APA's Division of Government Relations (DGR). Although at press time appropriations legislation still had to go to House-Senate conference and win White House approval, a DGR analysis suggested that prospects for the increase were good.
For NIH, the House Appropriations Committee proposed a 9.1 percent increase and the Senate Appropriations Committee an approximate 15 percent increase, enough to double the NIH budget in five years. Research on mental illness, drug abuse, and alcoholism received proposed increases in the 8.9 percent to 15 percent range, while the House proposed a 50 percent increase in funding for mental health services for children at risk of violent behavior. The DGR analysis predicted "a strong increase for NIH somewhere between the House and Senate numbers."
This good news suggests that Congressional action may reverse the decade-long trend reflected in SAMHSA's report. The report shows that total spending on mental health and alcohol and substance abuse services grew by an average annual rate of 7.2 percent over the last decade, while total personal health care spending grew by an average annual rate of 8.3 percent, according to the federal Health Care Financing Administration (HCFA). During the same period, inflation averaged 3.5 percent.
The report, "National Expenditures for Mental Health, Alcohol, and Other Drug Abuse Treatment," was published in the September/October issue of Health Affairs.
In 1996, expenditures for mental health and substance abuse services were 8.1 percent of the $942.7 billion spent on personal health care and government public health activities. This compares with the 9 percent of total personal and public health spending that went to mental health and substance abuse services in 1986.
Total spending for psychiatrists grew at a rate of 7.3 percent annually from 1986 to 1996, substantially less than spending for nonpsychiatric physicians, which grew 9 percent annually. Spending for retail medications for mental health and substance abuse grew by 9.6 percent annually between 1986 and 1996, reflecting the increasing availability and use of psychotropic medications.
Of the total $79.3 billion spent on mental health and substance abuse services in 1996, 84.1 percent ($66.7 billion) went to treat mental illness, 9.6 percent ($7.6 billion) to treat drug abuse (excluding alcohol), and 6.3 percent ($5 billion) to treat alcohol abuse.
The survey, which SAMHSA intends to update annually, also reveals that the public sector, including federal, state, and local governments, has increased its share of funding for mental health and substance abuse services from 49 percent in 1986 to 54 percent in 1996 (see chart).
The report can be accessed on the Web by going to www.samhsa.gov and following the instructions. The web address for Health Affairs is www.projhope.org.