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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 ༢ ΟΥ under. Only one-third of these young people who neeċ treatment receive it. The major initiatives are: Epidemiologic Catchment Area Study; Centers for Psychological and Combined Preatment Pesearch; Expanded Research and Research Demonstrations; 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

Severely mentally ill persons suffer from long term, 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 mertal disorders are schizophrenia, schizophreriform delusional disorder, psychotic disorders, and ranic



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 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 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 NIV 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 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 part of this process in all cases.

The process is now entering into its second, most crucial 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 monitor, evaluate, and revise existing planning and implementation activities. We therefore urge the Subcommittee to appropriate the full $5 million for these grants.


members to

overarching goal of

conclusion, Mr. Chairman, if the 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 research opportunity, from basic

neuroscience and behavioral

Now is the time for this

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."

Senator HARKIN. Thank you very much, Dr. Judd. This subcommittee, and this Senator in particular, has been very supportive. The National Institute of Mental Health, last year, we increased by $101 million, $398 million to $491 million, almost a 30percent increase.

Dr. JUDD. Yes; for which we were very grateful, Mr. Chairman. Senator HARKIN. You wound up pretty good. We wound up with $458 million. We had to come down from that, we had to compromise with the House on that, so we have a record of strong support. We want to continue that strong support as much as the budget will allow us to take advantage of the increased focus the decade will bring, and to make sure that we fulfill those objectives that were set out during this decade. So by the year 2000, we will have made some giant strides toward unlocking some of the secrets that we know are there.

Dr. JUDD. Exactly.

Senator HARKIN. We need the research done. We are getting closer all the time to unlocking some of those doors, and now is not the time to back off.

Dr. JUDD. Wonderful.

Senator HARKIN. Thank you, Dr. Judd.

Dr. JUDD. Delighted to hear that. Thank you very much, Mr. Chairman.


Senator HARKIN. Our next witness is Daniel T. Bross, executive director of the AIDS Action Council.

Mr. Bross, welcome to the subcommittee. And your statement will be made a part of the record in its entirety. Please summarize it.

Mr. BROSS. Thank you, Mr. Chairman, Senator Gorton, members of the subcommittee staff.

I am Dan Bross, executive director of the AIDS Action Council. The council represents more than 500 community-based AIDS service organizations at the front lines of the AIDS epidemic. I want to thank you for the opportunity to testify this morning, and to convey the AIDS community's appreciation for your leadership, and particularly your efforts last year in providing funding for the Ryan White CARE Act.

Unfortunately, once again this year, AIDS Action must come before you again with an urgent appeal for increased AIDS funding. Ten years after the reports of a strange new illness, AIDS has killed more than 100,000 Americans. There will be 60,000 newly diagnosed cases of AIDS this year alone. Every single day, 125 people die of AIDS, and 110 more become infected with HIV.

As someone who has worked for the last 5 years at the community-base level, I can tell you that the suffering out there is real, it is terrible, and it is getting worse. AIDS Action Council convenes the Coalition of National Organizations responding to AIDS, representing more than 150 national groups, actively fighting the virus.

In the coalition's expert judgment, it would take $3 billion in 1992, or $1 billion above the President's request to adequately ad

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