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NIMH is currently preparing to release a major new Program Announcement to coordinate and link efforts to develop the child and adolescent disorders research areas entitled, Implementation of the National Plan for Research on Child and Adolescent Mental Disorders. Additional activities in this coming year include a workshop to teach young or prospective investigators how to submit grants, a meeting of journal editors who impact on this field, and a conference cosponsored with other Federal funding agencies and private foundations to stimulate cooperation between Federal and private sources of funding.

Question. How do these two new research plans interface with the your ongoing blueprints for the Decade of the Brain and Schizophrenia research?

Answer. These two new research plans interface in numerous ways with The National Plan for Research on Schizophrenia and the Brain (combining the Decade of the Brain and Schizophrenia Plans) and The National Plan for Child and Adolescent Mental Disorders. These initiatives complement one another and take advantage of the process and content involved in the development of each.

The interface of the child and adolescent research blueprint and the Decade of the Brain plan is significant because the Decade of the Brain plan includes no specific plans for research on development and maturation of the brain, studies which may lead to the understanding of the etiology of mental illnesses in the early period of life. Research on the complex origins of child and adolescent mental disorders--particularly studies focusing on developmental neurobiology and the genetic control of nervous system development -is likely to clarify the biological foundations of many mental disorders that primarily affect adults, including schizophrenia. Efforts at early detection and treatment of psychopathology in young children, especially through longitudinal studies, may reveal risk factors for and predictors of disorders such as schizophrenia prior to the onset of clinical illness.

Conversely, research focused on the neuroscience of mental disorders has practical application for disorders affecting all ages and understanding the causes and treatment of disorders found primarily among adults will provide invaluable fundamental insights, technological advances, and treatment approaches that can be applied to research and clinical care with younger populations. Thus, we expect these major NIMH research initiatives to have synergistic effects in attracting talented researchers to the mental health field and in stimulating new ways to understand and overcome mental disorders in people of all ages.

Improvement in services for the severely mentally ill may be dependent on new findings in basic or clinic research. Basic research interacts directly with clinical research and vice versa. The indirect impact of the Decade of Brain plan and the Child and Adolescent Plan on the service plan is through clinical research findings, based on basic research findings translated into better treatment for mental illnesses. Although The National Plan of Research to Improve Care for Severe Mental Disorders was developed as a direct extension of the National Plan for Schizophrenia Research, the research results and services improvements it promises will also be applied to children and adolescents where appropriate. The National Advisory Mental Health Council systematically reviewed the state of knowledge and formulated recommendations to build the services research field. The recommendations of The National Plan of Research to Improve Care for severe Mental Disorders will build on the base of research in basic and clinical research laid out in the earlier plans, and extend them in the area of finding better ways to deliver needed mental health services.

HEALTH RESOURCES AND SERVICES ADMINISTRATION

STATEMENT OF DR. ROBERT G. HARMON, DIRECTOR
ACCOMPANIED BY:
DR. JAMES A. WALSH, ASSOCIATE ADMINISTRATOR FOR OPER-

ATIONS AND MANAGEMENT
DR. G. STEPHEN BOWEN, ACTING DIRECTOR, BUREAU OF HEALTH

RESOURCES DEVELOPMENT DR. FITZHUGH S.M. MULLAN, BUREAU OF HEALTH PROFESSIONS DR. MARILYN GASTON, DIRECTOR, BUREAU OF HEALTH CARE DE.

LIVERY AND ASSISTANCE DR. VINCE L. HUTCHINS, ACTING DIRECTOR, MATERNAL AND

CHILD HEALTH BUREAU DENNIS WILLIAMS, DEPUTY ASSISTANT SECRETARY, BUDGET, OF. FICE OF THE SECRETARY, DEPARTMENT OF HEALTH AND HUMAN SERVICES

BUDGET REQUEST Senator HARKIN. Our next witness is Dr. Robert Harmon, the Administrator of the Health Resources and Services Administration.

Dr. Harmon makes his second appearance before the subcommittee today to testify on the budget proposal for HRSA in fiscal year 1992. The administration requested $2.025 billion for HRSA programs, about $72 million less than in fiscal year 1991. The budget includes some funding increases for essential priorities such as reducing infant mortality. However, no funds or major cuts are proposed for other important priorities such as training doctors, nurses, and other health professionals.

AIDŚ programs would be level-funded in fiscal year 1992. This is disturbing, giving that AIDS cases continue to mount, as does the evidence that early intervention and treatment is critical. I am concerned that all the funds proposed for the healthy start infant mortality initiative in fiscal year 1991, and some from fiscal year 1992, would come from other maternal and child health programs. As I said earlier today, I simply cannot support that.

It is equally troubling to note that only some major urban areas appear to merit the attention, while no funds are proposed for the rural health outreach grants program to assure a healthy start to Americans living in the smaller communities and more rural areas of America.

I believe we need to take a comprehensive, national approach to reducing infant mortality, and Dr. Harmon, I want to hear your view of how we might best accomplish that goal. Certainly the Public Health Service has been in the forefront of this effort, and you know that better than I do.

So, Dr. Harmon, we are looking forward to your testimony. Your testimony will be made a part of the record in its entirety, and please provide as you so desire.

SUMMARY STATEMENT

Dr. HARMON. Thank you very much, Senator Harkin.

I would like to introduce the people up here at the table with me. On my far right is Dennis Williams, Deputy Assistant Secretary for Budget in the Office of the Secretary.

Next to him is Dr. Stephen Bowen, the new Director of our Bureau of Health Resources Development. To my right is Dr. Jim Walsh, who is the Associate Administrator for Operations and Management. On my left is Dr. Marilyn Gaston, the new Director of our Bureau of Health Care Delivery and Assistance. On her left is Dr. Vince Hutchins, Acting Director, Maternal and Child Health Bureau. And on my far left, Dr. Fitzhugh Mullan, who is the Director of our Bureau of Health Professions.

Mr. Chairman, our fiscal year 1992 budget for HRSA continues the agency's important role in providing health care and professional training for the underserved, disadvantaged, and minorities. This budget of over $2 billion will meet our commitments through community and migrant health centers, the MCH block grant, treatment programs for persons with HIV and AIDS, black lung, Hansen's disease, support for health professions students and institutions, and a wide variety of other activities dealing with organ transplantation, vaccine injury compensation, health care for the homeless, and the healthy start infant mortality initiative.

There are several major new or expanded activities in our 1992 budget, among which we are seeking to reduce the infant mortality rate in this country, which remains far too high, especially among minority populations.

Over 40,000 American babies die every year before their first birthday. To address this problem, our request includes a total of $171 million for high infant mortality areas, to be devoted to ag. gressive outreach and counseling of pregnant women, to be followed by intervention services, such as smoking cessation, drug and alcohol abuse treatment, nutritional assistance, and quality prenatal care, to achieve improved pregnancy outcomes.

Through these services and utilizing the recent Medicaid expansions, our goal is to reduce the infant mortality rate by 50 percent in these areas over 5 years.

We are also seeking an increase of $5 million for the National Health Service Corps NHSC) recruitment program. This will continue our revitalization of the NHSC, providing primary health care practitioners in urban and rural areas of need.

We are seeking $88 million to continue the minority health programs authorized in the Disadvantaged Minority Health Improvement Act of 1990. These activities are designed to increase the number of minority health professionals, and to reduce the health disparities between minorities and nonminorities.

We are seeking $554 million to maintain the MCH block grant. In fiscal year 1992, $9 million of the special projects of regional and national significance will be directed to the communities in the healthy start initiative.

Also, to continue our strong involvement in fighting the HIV and AIDS epidemic with programs authorized under the Ryan White Care Act of 1990, this 1992 budget continues those programs, which have been successfully initiated in fiscal year 1991, including $88 million for HIV emergency relief grants to high-incidence metro areas; $88 million for HIV care grants to States for the delivery of HIV services; and $45 million for early intervention service grants to entities that provide primary care to populations at high risk.

PREPARED STATEMENT Other HRSA AIDS programs will be continued at fiscal year 1991 levels. So in fiscal year 1992, HRSA will continue to work closely with other Federal agencies, the States, localities, and the private sector to help the disadvantaged. I believe the budget we are presenting to you will enable us to take advantage of opportunities and meet our challenges.

Mr. Chairman, I will be pleased to address any comments or questions you may have.

. [The statement follows:)

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