DRUG ABUSE AND MENTAL ILLNESS Question. Dr. Goodwin, a recent editorial in the Journal of the American Medical Association reports that 37 percent of people suffering from alcohol abuse are also diagnosed as having mental disorders. For people with other drug disorders, 53 percent are suffering from mental illness. This study suggests that "mental disorders must be addressed as a central part of drug abuse prevention efforts in this country." Clearly, the ADMS Block Grant is by far the best vehicle the Institute has to implement this kind of new and innovative program focus. Given the success of the Block Grant so far, and the possibility it holds for new programs, why haven't you included an increase for it in FY 1992? Answer. The structure of the ADMS Block Grant makes it nearly impossible to target funding to specific programs without a revision to the enabling legislation. This was intentionally built into the Block Grant when it was established by the Omnibus Budget Reconciliation Act of 1981 so that the States would have greater flexibility in controlling resources and addressing service needs within the State. Currently, the ADMS Block Grant funds are distributed to the States by a complex, congressionally-mandated allocation formula that uses urban population, age-weighted program factors, and total taxable resources. In lieu of increasing the ADMS Block Grant in 1992, the Administration is proposing to establish a Capacity Expansion Program that will continue the expansion of comprehensive drug abuse treatment slots as a means of closing the gap between the need for drug treatment services and current treatment capacity. The Block Grant mechanism does not allow us to target funds specifically for the expansion of drug abuse treatment capacity. Although the Capacity Expansion Program focuses on effective and comprehensive drug abuse treatment, the extensive overlap of mental health problems and alcohol and other drug abuse problems in the same individuals dictates that almost all service providers address the treatment of the co-morbid and the dually diagnosed. The Capacity Expansion Program will concentrate on the delivery of comprehensive treatment services designed to address the full spectrum of a patient's biological, psychological, and social needs. It is expected that a substantial number of patients will receive services that address their mental health problems as well as their alcohol and drug abuse problems. HOMELESS MENTALLY ILL Question. Both the newly authorized Projects for Assistance in Transition from Homelessness (PATH) and your own proposed Consolidated Homeless Program would support expanded services to homeless individuals who suffer from mental illness and related disorders. How will you assure that these services, such as case management, housing assistance, and referral to other necessary community services, will be provided by the grantees? Answer. Assurances of compliance with service guidelines will be achieved by a thorough review of PATH applications, coordinated technical assistance, and monitoring by NIMH staff. Section 528 of the PATH legislation, "Requirement of Reports by States", specifically requires each State to submit a report containing information necessary for: (1) securing a record and a description of the purposes for which amounts received under section 521 were expended during the preceding fiscal year and of the recipients of such amounts; and (2) determining whether such amounts were expended in accordance with the provisions of this part. The Act goes on to specify that the Comptroller General in cooperation with the NIMH will evaluate these expenditures at least once every three years. In addition, extensive voluntary reporting guidelines for the collection STANFORD LIBRARIES of detailed information including services provided will be reviewed by NIMH. The request for Consolidated Homeless Program applications will specify the range of services, to include case management, housing assistance, and referral to other necessary community services, for which funding will be provided. The initial review group will assess the scientific merit of the proposals and the rationale for services provided will be closely scrutinized. If selected for funding, program and grants management staff at the NIMH will provide oversight on compliance with the proposal. The projects will be required to send interim reports to the program staff for review. Question. The budget proposes to eliminate the Community Youth Activity program in OSAP, part of which goes to each State; but to expand the High-Risk Youth program and other competitively-bid prevention grant programs. Is every State likely to receive funds under this change? Answer. The new funds available for the High Risk Youth programs as well as other competitive grant programs within OSAP will provide for at least 137 new awards to organizations within States such as State and local government agencies, community-based organizations, universities, and educational institutions. Although States will not be receiving these FY 1992 funds directly, they nevertheless benefit through support of organizations within the their States. Currently, OSAP has over 600 grants within 48 States, the District of Columbia, and Puerto Rico. GEOGRAPHIC BALANCE OF OSAP PROGRAMS Question. How will ADAMHA assure geographic dispersion of the grants? Answer. All grant funding decisions within OSAP are based on award criteria set forth in the grant announcements. These criteria include, among other things, geographic distribution which is intended to ensure a reasonable distribution of OSAP programs to ensure that OSAP programs reach all populations. Specifically, within the Community Partnership program, grants are funded in the following three categories by population and relative rural/urban character: small communities and/or rural areas; medium sized communities; and larger communities. In addition, the OSAP sponsors technical assistance grant workshops at geographically disbursed locations throughout the U.S. encouraging applications from organizations located in all States. ADMS BLOCK GRANT SET-ASIDE REPORT Question. Your Agency requested an increase in the Block Grant set-aside last year to give the Office of Treatment Improvement extra funds to work on the State Systems Development Program, which will assess State treatment programs and develop a State-by-State data base on the drug abuse problem. But ADAMHA spends most of the set-aside funds on services research, which can be funded through the Institutes. I think out of the $63 million set-aside, you should be able to find a few million for the State Systems Development Program. We asked for a report on the SSDP last year, due January 14th. When will the Agency's report on the set-aside be completed? Answer. The ADAMHA Report to Congress, "ADMS Block Grant SetAside was delivered to the Chairman of the Subcommittee on Labor, Health and Human Services and Education on March 13, 1991. Question. What is the status of the State Systems Development Program? this year. Answer. The Office for Treatment Improvement will begin implementation of the State Systems Development Program The program will encompass: Voluntary State Plans 25 States participating this year. Technical Reviews - 20 States enrolled per year, developmental phase this year; field work and assessments next fiscal year. Developmental Technical Assistance - 20 States enrolled per year; implementation this fiscal year with field work starting in the fourth quarter. State Epidemiology Surveys 20 States enrolled per year; phased in this and next fiscal year. STATE MENTAL HEALTH SYSTEMS FOR CHILDREN AND ADOLESCENTS Question. In order to help States establish coordinated mental health systems for children and adolescents, the Committee has supported the Child and Adolescent Service System Program (CASSP). There seems to be a trend on the part of NIMH, however, to divert CASSP funds to research rather than the services they are intended for. Under your proposed budget, what funds would be available for basic State CASSP grants? Answer. The service system improvement grants for children and adolescents have been awarded to all 50 States. NIMH's FY 1991 estimate for these CASSP grants is $4.9 million. Based on the same proportion of available funds, the FY 1992 budget proposal includes an estimated $5.2 million for the service improvement component of CASSP. Question. What is the difference between the research demonstrations funded through this account and other services research? Answer. In the area of mental health services for children and adolescents, both research demonstration grants and research project grants focus on finding ways to improve the organization and financing of care, including access to appropriate care, and to improve the quality of care, including effectiveness of services being offered. One fundamental difference is that research demonstrations offer the applicant an opportunity to receive funding for both the intervention and the research component used to study how well it works. By contrast, research project grants support only services directly related to the research component. This distinction makes research demonstrations much more expensive, on average, but it also gives them the power to study innovative programs that in many cases could never be offered and studied in any other way. The research demonstration model provides the opportunity for testing interventions in real-world situations. Another distinction from research project grants is that CASSP research demonstrations are only available to State mental health authorities. This restriction guarantees that high-priority policy issues will be addressed, and that such areas as development of community-based services as envisioned in the State Mental Health Plan can be linked to the demonstration project. NATIONAL PLAN FOR RESEARCH ON Question. In the FY 1991 report, this Commit increase its commitment to children's mental heal significantly, and directed NIMH to fund at least mental health services research centers. Please dedicated to the National Plan for Research on Child and Adolescent Mental Disorders, and the specific allocation of funds for children's mental health services research. Of this Answer. In FY 1991, the NIMH has dedicated approximately $136.2 million to the National Plan for Research on Child and Adolescent Mental Disorders, an increase of 22.8 percent. total, the NIMH has allocated $10 million for children's mental health services research? Question. The plan for children's mental health research says that $202 million is necessary to implement the second year objectives. How much funding is proposed in your FY 1992 budget for child mental health research. Answer. The President's Budget proposes approximately $146.6 million for child mental health research for FY 1992. PREVENTION/IOM STUDY Question. This Subcommittee directed NIMH to contract with the Institute of Medicine for a report on current prevention research, and provided $1 million for that study. What is the status of that report? Answer. A contract with the Institute of Medicine (IOM) will be awarded for a two-year Prevention Study within the next two months. Individuals from IOM, NIMH, the National Prevention Coalition, and Senate committee staff all have agreed it would be best to broaden this study to include all aspects of prevention in the mental health arena. Therefore, discussions with key staff at the IOM and pertinent federal agencies (National Institutes of Health, Health Resources and Services Administration, Office of Human Development Services, Centers for Disease Control, Family Support Administration, and Departments of Justice and Education) with strong interests in prevention have taken place in the last few weeks. A meeting involving representatives from these agencies is planned with an expectation that they will be involved in this endeavor. TREATMENT IN CRIMINAL JUSTICE Question. What is the extent of substance abuse among the criminal justice population, and what is the availability of treatment? Answer. Drug Use Forecasting (DUF) data and sample surveys in a number of jails and prisons around the country show, on average, a 70 percent rate of substance abuse among the criminal justice population. Cocaine use appears to be stabilizing and there appears to be a modest decline in marijuana use. Of the three million probationers and parolees, most experts agree that 70-75 percent have moderate to severe substance abuse problems. In general, drug use appears to be stabilizing among the criminal justice population, but the vast majority of criminal offenders are substance abusers. Surveys and studies over the past two years reveal the following about the availability of treatment for criminal justice populations: Juvenile Offenders Most juvenile justice agencies conduct substance abuse assessments and basic education and most support self-help groups (AA/NA). The majority of States make referrals to community treatment agencies. However, an American Correctional Association survey notes that only 12 States have self-contained juvenile justice treatment programs within their institutions. Jails The American Jail Association survey of 1988-89 showed that 28 percent (468) of responding jails had a substance abuse treatment program other than detoxification; 18 percent of jails had funded treatment activities, and the remainder were volunteer programs (AA/NA). It is estimated that of the inmates who need treatment, 10 percent are receiving some level of treatment. Of the jails providing comprehensive treatment, average costs were $8/day per inmate. State prisons - A recent survey shows approximately 75 percent of 800,000 inmates in State and federal institutions are in need of drug treatment services; the Association of State Correctional Administrators reports only 22 percent of the prisoner population is currently receiving any level of treatment services (as of mid1990). The Association estimates, at an average cost of $10/day for intensive treatment, it would take nearly $1 billion per year for treatment for 500,000 inmates. Probation/parole clients There is no data on the number of treatment slots available, but waiting periods to community treatment agencies of 30 days up to six months are common. During the waiting periods, most offenders receive regular supervision plus urine analysis. In some States very high percentages of probationers and parolees are revoked back to prison or jail, often for substance abuse. Question. What kind of activities are being supported by OTI's grants for model treatment programs for the criminal justice population, both in and outside correctional settings? Answer. OTI is supporting three programs dealing with criminal justice populations. 1. Demonstration treatment programs for prison and jail populations are funded under the Treatment in Correctional Settings program. In FY 1990 six prison programs were funded, ranging from conversion of an entire prison to a treatment facility (Alabama), to a specialized female treatment program including a mother/infant unit (New York). A seventh prison program for co-morbid populations (mental illness and drug addiction) will be funded in the near future. In addition, three model metropolitan jail treatment projects were funded in Seattle, Chicago, and Montgomery County, Maryland. 2. In FY 1990, demonstration treatment programs for NonIncarcerated Criminal Justice Populations were funded in 10 jurisdictions. Four projects involved diversion from the court to mandatory treatment, and six projects involved intensive treatment for high risk probationers and parolees. An additional eight projects will be funded in the near future. 3. A new Adolescent/Juvenile Justice Treatment Program will be announced shortly. This program will fund drug treatment for two juvenile populations: (a) juveniles held in State institutions, based on a comprehensive treatment plan prepared by the State Juvenile Services Agency; and (b) adolescents and juvenile justice populations that will receive treatment as part of a community treatment network. OTI expects to fund 12 adolescent/juvenile justice demonstrations this fiscal year. In summary, OTI expects to fund about 40 demonstration projects ranging from diversion to treatment models through institutional and community-based treatment services over two fiscal years. The projects cover both adult and juvenile justice populations. Treatment modalities range from outpatient drug free through intensive day treatment and methadone maintenance for nonincarcerated persons, through a range of residential and modified therapeutic communities for incarcerated persons. Question. How many States are using Block Grant and related funds for services focused on this population? |