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current fiscal environment.

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Subcommittee on

Dollars in Millions)

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Child and Adolescent Disorders
Care For Serious Mental Illness


Decade of the Brain

New Combined Plan


FY 92

**[TOTAL NIMH In addition to research; includes homeless and state planning grants; CSP/CASSP, homeless and prevention demonstrations; protection and advocacy; clinical training]

The NAMI/MHLG alternative budget would increase the total NIMH budget to $867.9 million. The difference ($113.6 million) between the President's request for research and the NAMI/MHLG recommendations, as compared to the shortfall ($271.9 million) you will note in the table concerning the major National Plans, is due to our understanding of the limited


FY 92









Dollars in Thousands)

357 790

However, this Subcommittee, as soon as additional resources become available, should implement the NAMI/MHLG recommendations to fully meet the budget requirerents called for in the National Plans which I know are of high priority to this and the House Labor-HHS-Education Appropriations.

regard, it is important to emphasize, only with the NAMI/MHLG budget proposal that I present to you today, would NIMH be able to fund four new basic and clinical Research Centers; two new organization and financing Research Centers; and maintain some momentum on NIMH's major blueprints for action during the 1990's, including the National Plans:

(National Plans

resources available in the

Our Proposal

FY 92







FY 92






In this

Shortfall 56,150





The National Plan for Research on Child and Adolescent Mental Disorders

NIMH is moving vigorously ahead with the Child and Adolescent research strategy as requested by the Congress. The Plan is a systematic, science-based attack on the mental disorders that affect 8.1 million, or 12%, of the country's 68 million youths, açe Only one-third of these young people whe neer The major initiatives are: Epićemiologic

1.3 Or under.

treatment receive it.

Catchrent area Study: Centers
Psychological and Combined
Treatment Pesearch; Expanded Research and Research Demonstrations;
Multicenter National Collaborative Treatment Trials; Multicenter
Collaborative Treatment Study: Prevention of Mental Disorders and
Behavioral Problems; and Research Training and Career Development.

The National Plan of Research to Improve Care For
Severe Mental Disorders


Severely mentally ill persons suffer from long term,

persistent mental

disorders that have a profound impact on all aspects of their lives. They experience diverse, disruptive symptoms with attendant high levels of disability. Some examples of severe mental disorders are schizophrenia, schizophreriform delusional disorder. psychotic disorders, and

1) Priorities for clinical and rehabilitative care

depression. research to be detailed in the Plan include: Assessment, Treatment and Rehabilitation, and Outcome. 2) Priorities for service system and Continuity, Law and Mental Health, and Financing. 3) Initiatives in research include: Knowledge Transfer and Exchange, and Research Training. The National Plan for Research_on_Schizophrenia And the Brain

The National Plan for Schizophrenia Research generated a

research include: Coordination




number of initiatives including advances in molecular genetic linkage techniques as well as imaging, electrophysiology, and the development of new treatments. The report on Opportunities for NINH Neuroscience Research focuses on the increases in knowledge to be gained through clinical neuroscience, such as brain imaging, and new discoveries which have established the ability to reproduce

and grow human brain cell cultures.

Planning for these research strategies revealed complementary and shared elements that led to combining the plans into a single, cost-efficient initiative including: Therapeutic Medications Development, Diagnostic Centers for Psychiatric Linkage, Integration of Basic and Clinical Approaches, Regional Imaging Centers for the Study of Mental Disorders, and Molecular Neurobiology.



In recent years, researchers have discovered that many individuals with serious mental illnesses also suffer from abuse disorders, particularly during acute phases of their mental illnesses. This is something, Mr. Chairman, which many of our family members who have experienced the mental illness of a loved one can vouch for. Unfortunately, most mental health providers in the community are not equipped to treat substance abuse disorders. Similarly, most substance abuse providers are not knowledgeable about or willing to treat mental illnesses. As it is currently structured, the Alcoholism, Drug Abuse, and Mental Health Administration (ADAMHA) Block Grant is an ideal mechanism for focusing federal resources into the comprehensive treatment needs of individuals with mental illnesses and substance abuse disorders. Mr. Chairman, we look to your Subcommittee for leadership in emphasizing the importance of dual planning and coordinated efforts by Block Grant recipients in treating individuals with these dual diagnoses.


Mr. Chairman, it is conservatively estimated that 35% of all homeless individuals are seriously mentally ill. Many of these individuals also suffer from substance abuse disorders. Last year, Congress passed important legislation designed to address the needs of this population called "Projects to Aid the Transition from Homelessness" or PATH.

The intent of PATH is to link housing and services for persons who are homeless and mentally ill, including those who suffer from

substance abuse disorders. 80% of the monies dispersed to community providers by states must be used for purposes such as community mental health services, case management services, substance or alcohol abuse treatment, and referrals for primary health services. 20% of the monies may be used for housing purpo purposes such as minor renovations, security deposits, one-time rental payments, and coordinating between housing and service providers. States are required to contribute $1.00 for every $3.00 of Federal funds

received under PATH.

The Budget submitted by the President targets $42 million for PATH. This is far below the $75 million authorized for the program by Congress last year. This despite the fact that PATH builds upon an approach which has already proven successful under the Stewart B. McKinney Act, the Mental Health Services Block Grant program. NAMI members familiar with the implementation of that program agree that its only shortcoming was that not enough monies were available on an annual basis to begin to meet the needs of this vulnerable and highly deserving population. PATH represents a significant step forward towards addressing this problem. We therefore respectfully urge the Subcommittee to appropriate the full $75 million for this important program.


Mr. Chairman, in 1986, Congress passed the Comprehensive Mental Health Planning Act (P.L. 99-660) As a result of this Act, all States were required to develop a comprehensive plan for addressing the treatment and services needs of persons with mental illnesses in the community. The Act further mandated that mental health planning Councils be developed in all States, with at least 50% of all members comprised of individuals with mental illnesses and their families. Today, all 50 states, the District of Columbia, and seven territories have developed such plans, in many of them the first long-range blueprints for addressing the needs of this population in a coordinated, cohesive fashion ever developed. The

mental health planning Councils were an integral

process in all cases.


The process is now entering into its stage, implementation of these plans. The work of the Councils in overseeing implementation will be crucial to this process. Recognizing this, Congress last year authorized $5 million for these Councils as part of the Mental Health Amendments of 1990 (P.L. 101-639). Although a relatively small amount, these monies are used productively to enable Planning Council members to monitor, evaluate, and revise existing planning and implementation activities. We therefore urge the Subcommittee to appropriate the full $5 million for these grants.

In conclusion, Mr. Chairman, if the overarching goal of conquering mental illness by the year 2000 is to be met, it is essential that the elements which could be supported by the NAMI/MHLG budget proposed here be put into place now. As I have tried to emphasize in this short space and time, the entire spectrum of fields related to mental illness are ripe with genuine


neuroscience and behavioral

Now is the time for this

opportunity, from basic science to health care systems. Subcommittee and the Congress to come out in strong support of these critical endeavors, and ensure that the future of this nation will receive the full benefit of today's potential So that this does not become the "Decade of Mediocrity."

part of this

most crucial

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