Mr. Chairman, I agree with Dr. Bromley, that even in these enlightened times, it is clear that mental illness, a problem of major proportions which adversely affects our health, well-being, and productivity as a Nation, is still shrouded in mystery, shame, and stigma. The prevalence and destructive consequence of mental illness in the U.S. is well documented. Each year, mental disorders wreak such - - havoc on over 30 million adults in this country. In fact, one in every five citizens at some point in their lives will experience debilitating conditions as schizophrenia, depression, Alzheimer's disease, manic depressive illness or anxiety disorders. Tragically, only one-fifth of all adults with a diagnosable mental illness in this country actually receive the treatment they need. In addition to this and perhaps even more alarming is the fact that some 8.1 million youngsters suffer from mental illness and often go untreated for years, even though effective help is available. But even these chilling statistics cannot measure the cost of the untold human suffering experienced by our citizens every day. Indeed, this suffering often leads vulnerable individuals to turn to suicide as a way out of continuing their frequently unnecessarily painful lives. risk factor for suicide in this country. Depression is the major The severe disability directly caused by mental disorders is also clear even if one considers only the amount of time Americans spend in treatment for them. For example, only heart disease is associated with more bed days per month than depression. Depression, in fact, has been shown to have a higher morbidity rate than many other chronic medical conditions, including heart disease, lung disease and hypertension. The direct and related costs of mental disorders add up to a staggering $129 billion each year. Mr. Chairman, I also agree with Dr. Bromley that unparalleled research opportunities exist, and, I can point with pride to the fact that NIMH has launched a concerted and powerful effort not only to overcome mental disorders but also to eliminate associated intransigent and discriminatory stigma which has further victimized I am also pleased that NIMH mental patients and their families. continues to provide leadership at the national level on the major issues involving mental illness and mental health. the As a part of its leadership role, NIMH has completed a series of four strategic plans, three of which are already being implemented. Each is designed with a separate, distinct strategy in mind, and all are aimed at attacking, through research, biggest mental health problems of our day. These are Approaching the 21st Century: Opportunities for NIMH Neuroscience Research; The National Plan for Research on Schizophrenia and the Brain; The National Plan for Research on Child and Adolescent Mental Disorders; and a new, soon to be released, and highly promising plan, Caring for People with Mental Illness: A National Plan of Research. This new research plan represents a systematic, science-based attack on the inadequacy and low quality of services provided to severely mentally ill persons in this country. I am pleased to report that NAMI is sponsoring two seminars to explain the details of this exciting plan to members and staff. Dr. Jack Burke, Director of the Division of Applied and Services Research, will direct the NIMH presentations on May 8 from 9:00 am to 11:30 am in this building, Room SD-562, and on June 6 in the Gold Room 2168 of the House Rayburn Building from 8:30 am until 11:00 am. Mr. Chairman, taken together, these four research plans provide an over-arching strategy to guide NIMH research programs throughout this decade. Unfortunately, however, despite President Kennedy's challenge over a quarter of a century ago, the unfair and unreasonable attitudes associated with illnesses of the mind and brain were carried-over into our public policies for many years. As a result, the mental health field was chronically and severely under-funded and has been struggling to catch-up. The Office of Management and Budget (OMB), and the Congress, for some time were considered as having an unhealthy tradition of inequitable support for basic biomedical research as compared to other physiological diseases. But now, with the Decade of the Brain Resolution and Proclamation generating special interest in these projects, followed by the action by your's and the House's Labor-HHS-Education Appropriations Subcommittees last year, we are hopeful Congress is now realizes it is absolutely imperative to fund more research on diseases of the brain. However, Mr. Chairman, the proposed budget for fiscal year 1992 does not indicate any change in this situation at OMB, but I hope the Congress does live up to their Decade of the Brain promises, as they did last year, making significant increases for the NIMH budget. Therefore, I come here today with optimism to advocate for an increase in research funding for NIMH. In order to take optimum advantage of existing circumstances, this Subcommittee should adopt NAMI's alternative budget which is endorsed by the Mental Health Liaison Group (MHLG). The MHLG is a Washington-based mental health coalition of over 50 national provider, professional, and citizen advocacy organizations concerned with mental illness and substance abuse problems. consumer, Although the President's budget shows a $40 million increase in funding for research activities over FY 1991 levels, the President's request is actually a reduction of $.3 million below the amount needed to maintain the current levels ( providing the same services adjusted for the rate of inflation) for all the programs in NIMH. This means the overall award rate for competing grants will decrease from 28 percent in FY 1991 to 23 percent in FY 1992, the lowest in NIMH history. and **!TOTAL NIMH - In addition to research; includes homeless 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 resources available in the current fiscal environment. 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 Subcommittee on Labor-HHS-Education Appropriations. In this 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 momentum on NIMH's major blueprints for action during the 1990's, Including the National Plans: some 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 66 million youths, açe 3 ΟΥ linder. Only one-third of these young people who nepr treatment receive it. The major initiatives are: Epidemiologic Catchment Àrea Study: Centers for Psychological and Combines Treatment Pesearch; Bxpanded Research and Research Demonstratione; Multicenter National Collaborative Creatment 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 persistent mental ail Severely mentally ill persons suffer from long tex. disorders that have a profound impact on aspects of their lives. They experience diverse, disruptive symptoms with attendant high levels of disability. Some examples of severe mertal disorders are schizophrenia, schizophrer forn delusional disorder, psychotic disorders, and ranic disorder, depression. 1) Priorities for clinical and rehabilitative care research to be detailed in the Plan include: Assessment, Treatment and Rehabilitation, and Outcome. 2) Priorities for service system and Continuity, Law and Mental research include: Coordination Health, and Financing. 3) Initiatives in research resources The National Plan a for Schizophrenia Research generated 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 NOM Neuroscience Research focuses on the increases in knowledce to be gained through clinical neuroscience, such as brain imaging. end new discoveries which have established the ability to reproduce |