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March 5, 1999
With the announcement of three major initiatives, Tipper Gore, the White House's chief adviser on mental health issues, has once again guaranteed that those concerns retain a prominent place on the national agenda.
Gore announced at a grand rounds at Dartmouth Medical School's Hitchcock Medical Center in January that the Clinton Administration will request a $70 million increase in Fiscal 2000 funds targeted to community programs for children and adults with severe and persistent mental illnesses, the homeless mentally ill, and those with comorbid substance abuse disorders. These individuals have been a particularly difficult population for public and private agencies to reach with treatment and other needed services. The new funds will allow communities to intensify their outreach to these persons.
If Congress agrees with the White House request, which Congress would appropriate in the form of a block grant to the states, it would amount to an unprecedented 24 percent increase over this year's funds for community mental health efforts. The appropriation for FY 2000 would increase to $359 million.
The funds for this block grant remained stagnant from 1991 to 1998 and gained a modest increase for the current fiscal year. This means that with inflation taken into account, the size of the community mental health block grant has actually decreased over the last few years.
Another target of the block grant is older Americans, Gore explained, who through their long lives have witnessed the stigma that stubbornly adheres to mental illness treatment. As a result of this, when they are troubled by symptoms of a psychiatric disorder, they often respond by avoiding specialized mental health care.
APA is applauding Clinton for the sizable increase he proposed in the mental health block grant. "Because of the large numbers of uninsured individuals and continued insurance discrimination, enormous unmet needs exist for mental health services. The block grant program is a key mechanism for helping individuals access needed health care," said Jay Cutler, J.D., director of the APA Division of Government Relations.
There is also a simple dollars-and-cents issue at stake, he added. "Unless society makes a commitment to increasing access for mental health services up front, we will inevitably pay the costs-much higher costs-down the road."
Cutler pointed out that APA has for years helped lead efforts to build support for the block grant program. He emphasized, "Convincing Congress of the need to support a major increase for this program will continue to be a major priority of APA's appropriations advocacy efforts."
Asecond leg of the initiative will culminate this spring in the White House Conference on Mental Health, which will provide a forum for psychiatrists, mental health professionals, "consumers," and private sector representatives to discuss strategies for attacking the stigma attached to mental illness and for making governments and communities less discriminatory and more user friendly for people with mental illnesses.
Gore hopes that by using the conference to attack stigma and raise the visibility of mental health issues, the Clinton Administration can move lawmakers down the path to ensuring that mental disorders and the people who suffer from them will no longer be forced to take a back seat to concerns for physical illnesses.
APA President Rodrigo Muņoz, M.D., applauded the decision to hold this White House conference. "It will certainly add visibility to our struggles toward better funding for mental health research and clinical services," he said. "Mrs. Gore has given new strength to mental health advocates who want more and better care for our patients. These advocates have not always been heard before, because they haven't had an inside supporter with Mrs. Gore's resolve."
The third initiative, Gore stated, should make it easier for mentally disabled individuals to join the work world in the future. She announced that President Clinton was about to send a request to the Office of Personnel Management asking it to explore steps leading to the elimination of the stricter federal hiring standards that the government applies to individuals whose disabilities stem from psychiatric illnesses.
When applying for federal positions, psychiatrically disabled persons do not get the extra consideration or points that persons with mental retardation or physical disabilities receive in the competitive hiring process.
President Clinton also wants to ensure, Gore explained, that disabled people are not forced to make a choice between accepting a job and losing their government-funded health insurance if they return to work. Not only do many small employers offer inadequate, overly expensive, or no health insurance, but due to the absence of mandated parity laws, even large companies rarely provide workers with the comprehensive coverage for mental disorders that psychiatrically disabled persons require to function successfully at work.
President Clinton has announced his support of legislation introduced in January by Senator Ted Kennedy (D-Mass.) and Senator James Jeffords (R-Vt.) that would grant states the right to allow disabled individuals receiving federal health insurance to purchase such coverage through Medicaid once they return to work. Under this option, they would not be automatically disqualified because their earnings place them above the Medicaid income ceiling. The Senate bill is known as the Work Incentives Improvement Act of 1999.
Muņoz pointed out, "Today's diagnostic and treatment programs justify the belief that the overwhelming majority of our patients will return to gainful activities if given a chance." This goal will not be achieved, however, "until prejudice and unjustified criticism toward people with mental disabilities" are no longer allowed to influence hiring decisions, he said.
Gore, wife of Vice President Al Gore, has worked tirelessly for many years to improve the lot of individuals with mental illnesses. During the last six years, she has used her White House pulpit to fight for parity and educate the American populace about the nature and treatability of mental illnesses. She summarized her frustrations and her hopes for the Dartmouth medical students. "Despite the many advances we have made in science, research, awareness, and treatment, mental illness continues to be treated differently from physical illness, leading to more misunderstanding, greater stigma and discrimination, increased reluctance to seek help, and greater disparity in insurance coverage."
She emphasized her belief that these new initiatives "will help bridge the gap that has formed between mental health and whole health and point the way to a greater understanding of how our families, friends, and neighbors can truly live healthier, happier lives."