Mental Health Budgets Take Another Hit

The fiscal 2007 budget that PresidentBush proposed in early February keepsa tight lid on most domestic spendingprograms, including those at the Centersfor Mental Health Services (CMHS)and the National Institute of MentalHealth (NIMH). Budgets for both willactually decrease for the second yearin a row unless Congress steps in.

The NIMH budget cut is just shortof $9 million, dropping the overallbudget to $1.4 billion, not a cataclysmicdrop in the scheme of things. TheCMHS budget would be hit harder,losing 4%, or $35 million, almost allof that reduction coming from Programsof Regional and National Significance(PRNS). The programs hit hardestare school violence prevention andstate mental health transformation activities. The drop in funding comesprimarily from not initiating newgrants to replace older grants thatreach the end of their funding cyclein fiscal 2006.

In a statement about the proposedfiscal 2007 budget, the National MentalHealth Association cited a laundry listof expanding demands on community mental health services and added,“. . . we must accelerate our commitmentto mental health. But rather thanincreasing funding levels to addresssuch needs, this budget would retreatfurther. To illustrate, the budget for theprincipal federal agency charged withpromoting excellence in mental healthcare, the Center for Mental HealthServices (in the SAMHSA), would see its funding shrink to levels close towhere they were in FY 2002.”

The reduction in spending for mentalhealth transformation, an initiativeestablished based on recommendationsfrom President Bush's New FreedomCommission, may be mitigated to someextent if the CMHS is successful inconvincing Congress to force states touse some of their community mentalhealth block grant funds for transformationactivities. The transformationprogram seeks to help states createsystems that are more family centered,reduce reliance on institutional settings,and allow for seamless navigation andtransition through local mental healthservices.

CMHS, says the agency wants states touse the increased amount of their blockgrant over 1998 levels for transformationactivities.

The transformation grants to stateshave been somewhat controversial,owing to the criticism of some politicallyconservative groups thatthey further mental health screeningof children, which these groups oppose.No language in the grant requirementsmandates testing of anyone,however. The first 7 grants were announcedin 2005 and money wascommitted to those states for 5 years.Programs in those 7 states are servingas pilot programs.

But the CMHS transformationbudget, which is included in the PRNS,has been declining since its first yearin fiscal 2005, when it was $66.9 million.It dropped in fiscal 2006 to $48 million,and President Bush wants to cut itfurther in fiscal 2007 to $39 million.Part of that total goes to the 7 states thatwon grants in fiscal 2005. The grantsto the states would drop from $25.7million in fiscal 2006 to $19.8 million.Power said fiscal 2007 is the secondyear for the state grants, and all 7 wouldreceive what they were promised in2005. She noted that the grants aresubject to the annual approval of congressionalappropriations committeesand implied that nothing is guaranteed.

School violence prevention grantswould also fall by $17.5 million, to $75.7million. That is the result of existinggrants coming to a natural end andCMHS not using the money from thoseto fund new grants. Power alluded tothe “constrained budget environment”to explain that decision. She added thatthe CMHS is waiting to get some baselinedata on increases or decreases inschool violence in fiscal 2006 to helptarget the money.

While CMHS apparently wantsstates to use block grant funds for transformationactivities, the block grantsin fiscal 2007 would actually drop abit, to $428.4 million, a reduction of$174,000. Block grant funds are supposedto be used to help move adultsand children with mental illnesses fromcostly and restrictive inpatient hospitalcare into the community.

The CMHS would fund only 1 newprogram in fiscal 2007, an AmericanIndian/Alaska Native Youth SuicidePrevention Initiative funded at $3million. At hearings before the SenateIndian Affairs Committee on June 15,2005, Richard H. Carmona, MD,MPH, the US Surgeon General, notedthat “based upon the most recentdata from the Indian Health Service,the suicide rates for American Indiansand Alaska Natives are many timesthe national average for other populationgroups.”