PRESIDENT CLINTON AND VICE PRESIDENT GORE:
Improving Mental Health
“Let me say we must step up our efforts to treat and
prevent mental illness. No American should ever be afraid -- ever -- to address
this disease.”
– President Clinton in his State of the
Union Address, January 19, 1999
While trying to eradicate the stigma and
discrimination associated with mental illness, the Clinton-Gore Administration
is working to improve mental health treatment, enhance prevention and bolster
research. The Administration, under the leadership of President Clinton and
Vice President Gore, is committed to helping Americans with mental illnesses
live healthy, productive lives.
HELPING AMERICANS OVERCOME MENTAL ILLNESS
Supporting Fairness, Requiring Mental Health
Parity. The Clinton-Gore Administration advocated for and signed into law the
1996 Mental Health Parity Act (MHPA). In December 1997, the Administration
issued regulations to take steps to ending discrimination in health insurance
on the basis of mental illness under MHPA. As of January 1998, the law began
requiring health plans to provide the same annual and lifetime spending caps
for mental health benefits as they do for medical and surgical benefits. The
Departments of Labor (DOL), Treasury, and HHS have also established
coordination and referral systems at the federal and state levels to coordinate
investigations of alleged practices by health insurance issuers and to ensure
that workers and their families are not unjustly denied any protections
provided under MHPA.
Extending Strong Mental Health Care to Millions of
Children through the Children's Health Insurance Program (CHIP). The
President fought to ensure that the 1997 Balanced Budget Act included $24
billion -- the single largest investment in Health Care for children since 1965
-- to provide real health care coverage to millions of uninsured children. This
investment guarantees the full range of benefits -- from checkups to surgery --
that children need to grow up strong and healthy. It ensures that a strong
mental health benefit is part of this benefit.
Preparing the First Surgeon General's Report on
Mental Health. Due out by late 1999, this document will distill the most
current science to recommend approaches for promoting mental health, preventing
mental illness, and providing state-of-the-art clinical interventions across
the life cycle. The report will illustrate the similarities between mental
health and physical health and the value of prompt, appropriate treatment.
Developing a National Suicide Prevention Strategy.
In October 1998, Surgeon General David Satcher took part in a conference in
Reno, Nevada, which laid the foundation for developing a national suicide
prevention strategy -- the first time in the United States that clinicians,
researchers, survivors and activists had been gathered for this purpose.
Ensuring Medicaid Coverage of Mental Health
Services. In October 1998, HCFA issued a state Medicaid director's letter
providing guidance to all states regarding the development of Medicaid managed
care programs for persons with special needs. This guidance applies to mental
health service systems and further promotes recognition of mental health needs
by managed care organizations serving Medicaid populations.
Improving Prevention and Treatment for People with
Mental Illnesses. On January 14, 1999, the President's Mental Health
Policy Advisor, Mrs. Gore, unveiled the Administration's plan to increase
the Mental Health Services Block Grants by an unprecedented $70 million (or 24
percent), totaling $359 million for fiscal year 2000. Currently, the Mental
Health Services Block Grant provides state and territorial governments with
resources to support comprehensive community-based systems of care to serve
people with serious mental illness and their families. This additional funding
will enable states to target particularly-hard-to-reach adults and children
with severe mental illnesses.
Fighting to Pass a Strong, Enforceable
Patients' Bill of Rights. President Clinton and Vice President Gore called
on the Congress to pass a strong, enforceable Patients' Bill of Rights
that assures Americans the quality health care they need. Among its
protections, the Administration's bill ensures that consumers cannot be
discriminated against because of mental disability as they seek health care
services. Leading by example, the President directed all federal agencies to
ensure that their employees and beneficiaries have the benefits and rights
guaranteed under the President's proposed Patients' Bill of Rights.
In addition, HHS currently supports consumers by providing grants to develop
programs that advocate for the legal rights of people with mental illness and
to investigate incidents of abuse and neglect in facilities that care for such
individuals.
Protecting the Medicaid Guarantee. The Clinton-Gore
Administration rejected proposals to end the Medicaid guarantee to meaningful
health benefits. In 1995, the President vetoed the Republicans' proposal
in the 104th Congress to block grant the Medicaid program, preserving coverage
for million of persons who receive mental health services under Medicaid.
Thanks to President Clinton, the 1997 Balanced Budget Act preserved the federal
guarantee of Medicaid coverage for populations who depend on it.
Sponsoring Studies and Providing Mental Health
Information. HHS has taken a proactive approach in addressing mental health
issues by sponsoring studies to advance mental health science in areas such as
Attention Deficit Hyperactivity Disorder (ADHD) and Schizophrenia. In addition,
SAMSHA operates the National Mental Health Services Knowledge Exchange Network
(KEN) as a user-friendly, “one-stop” gateway to a wide range of
information and resources on mental health services for users of mental health
services and their families, the general public, policy makers, providers and
the news media. KEN can be reached at 1-800-789-2647 or via the Internet at
www.mentalhealth.org.
Preventing Discrimination Based on Genetic
Information both by Health Plans and Employers. The Administration has urged
Congress to pass bipartisan legislation to prohibit health plans from
inappropriately using genetic screening information to deny coverage, set
premiums or to distribute confidential information. The Clinton-Gore
Administration has also supported legislation that ensures that employers do
not use genetic information to discriminate against employees.
Supporting Brain Research and Improving Technology.
Earlier this year, the Energy Department gave a $10 million grant to establish
the first of three National Centers for Functional Brain Imaging. Moreover,
Department of Energy laboratories have developed a device that gives doctors a
“window” into how the human brain actually functions. The device
takes snapshots of the brain using a technique called magnetoencephalography
and has lead to greater insights about how the signals of the brain act or
react in individuals with mental illnesses.
EXPANDING EMPLOYMENT OPPORTUNITIES
Expanding Hiring Opportunities for People with
Psychiatric Disabilities. In January, Tipper Gore announced that the Office of
Personnel Management (OPM) would explore measures to eliminate the stricter
standards that are currently applied to federal job applicants who have
psychiatric disabilities. On June 4, 1999, President Clinton signed an
executive order ensuring that individuals with psychiatric disabilities are
given the same hiring opportunities as persons with severe physical
disabilities or mental retardation. The civil service rules will be changed to
ensure that people with psychiatric disabilities are covered by the same hiring
rules and authority used for individuals with other disabilities. The executive
order also permits people with psychiatric disabilities the same opportunity to
acquire competitive civil service status after two years of successful service.
This authority will allow adults with psychiatric disabilities the same
opportunity for conversion into the competitive civil service as employees with
other disabilities.
Working to Enact the Work Incentives Improvement
Act (WIIA). The Work Incentives Improvement Act is an historic, bipartisan bill
which removes significant barriers to work for people with disabilities,
including psychiatric disabilities. The proposed legislation improves access to
health care through Medicaid; extends Medicare coverage for people with
disabilities who return to work; and creates a new Medicaid buy-in
demonstration to help people with a specific physical or mental impairment that
is expected to lead to a severe disability without medical assistance.
Helping People with Mental Illness Return to Work.
Initiated in 1995, the Employment Intervention Demonstration Program (EIDP)
program has shown that people with serious mental illness not only can work but
also can be highly productive, given the right environment and the right
support systems. EIDP has been identifying model interventions to help people
with severe mental illnesses return to work or enter the workforce for the
first time. While not yet complete, the study already has yielded important
information about employment for people with serious mental illnesses --
information to help break through the stigma that stands between willing
workers and jobs needing to be filled.
ADDRESSING MENTAL HEALTH ISSUES FOR ALL
AGES
Meeting Special Needs of Children, Adolescents and
Families. The Clinton-Gore Administration helps fund a wide range of programs
designed to protect or improve the mental health of our children. Some programs
focus on preventive interventions that promote resilience, while other programs
reach out to children with serious emotional disturbances to help point them on
the road toward a healthier, productive adult future.
- Promoting Healthy Development. In response to President
Clinton's call to action during the White House Conference on School
Safety, the Administration creating two important grant programs for
communities around the country: (1) the Safe Schools/ Healthy Students Program;
and (2) the School Action Grant Program. Through the first program, grants
totaling more than $180 million per year will be awarded to school districts in
partnership with local mental health and law enforcement authorities to promote
healthy childhood development and prevent violence. The second program,
launched by SAMHSA's Center for Mental Health Services, complements the first
by providing funds to communities to expand school-based programs to the
broader community.
- Starting Early, Starting Smart. Research has shown
increasingly that many young children who grow up in homes where at least one
parent suffers from significant mental illness and/or substance abuse
demonstrate emotional, behavioral or relationship problems that ultimately
hinder their readiness to enter school. HHS' "Starting Early, Starting Smart"
initiative, a public-private partnership between SAMHSA and the Casey Family
Foundation, seeks to fill this gap by reaching children at their most critical
time for mental and physical development.
Meeting the Special Needs of Older Adults. The Clinton-Gore
Administration supports a range of services to meet the unique mental health
needs of older Americans.
- Studying and Treating the Mental Health Needs of Seniors.
The Administration supports a number of studies exploring the mental health
needs of elderly Americans, including treating depression and reducing the risk
of suicide. Older Americans are disproportionately more likely to commit
suicide than any other group. NIMH-supported studies have found that major
depression was the sole predictor of suicide among the elderly. These and other
NIMH findings can lead to enhanced detection and treatment of depression in
primary-care settings that reduces the risk of suicide among the elderly.
- Caring for the Caregivers. President Clinton and Vice
President Gore supported the Administration on Aging (AoA) proposal for the
National Family Caregiver Support Program to help families sustain their
efforts to care for an older relative afflicted with a chronic illness or
disability. The program would establish a multifaceted support system in each
state for family caregivers. AoA also continues to provide grants to states to
provide home and community-based, long-term care services -- important
supplements to the care already provided by family members.
ADDRESSING MENTAL HEALTH ISSUES IN ALL
COMMUNITIES
Supporting the National Resource Center on Homelessness and
Mental Illness. SAMSHA operates this center which develops and disseminates
effective approaches to providing services and housing to homeless people with
mental illness. Thanks to these resources, states have been able to improve
treatment, housing and support services for adults with severe mental illness,
so that they can carry out ordinary day-to-day activities in their communities.
In addition, the “Access to Community Care and Effective Services and
Supports” (ACCESS) program seeks to integrate fragmented public mental
health services by using proven strategies and fostering partnerships among
service agencies. ACCESS-evaluated interventions can lower days of homelessness
for seriously at-risk individuals by as much as 75 percent over a 12-month
period.
Providing Mental Health Services for the Homeless. The Health
Care for the Homeless Program provides a comprehensive approach to address the
multitude of health problems faced by homeless individuals. These services
include referring homeless persons for needed mental health services and
providing primary care and substance abuse services at locations accessible to
homeless people. In addition, the President has proposed increasing the
Projects for Assistance in Transition from Homelessness (PATH) program. PATH
provides links to community-based health, education, employment and housing
services.
Creating A Continuum of Care for America's Homeless. Under
the Clinton-Gore Administration, the Department of Housing and Urban
Development's (HUD) Continuum of Care program uses a comprehensive
approach to provide emergency, transitional and permanent housing and services
to help homeless people become self sufficient. Since 1994, the Continuum of
Care has devoted an average of $882 million each year toward solving
homelessness, and in 1998, more than half of the programs supported by homeless
funding served people with mental illnesses under the Continuum of Care's
Supportive Housing, Safe Havens and Shelter Plus Care programs. According to a
1996 Columbia University study: “The Continuum of Care approach has
resulted in significantly more assistance for homeless persons with
disabilities (including, but not limited to, severe mental illness, substance
abuse problems, HIV/AIDS, and physical disabilities). The numbers of persons
with disabilities proposed to be served in programs specifically designed for
them increased 843 percent, from 2,816 to 26,565.”
Providing Mental Health Services in Medically Underserved Areas.
The Community Health Center (CHC) Program provides primary and preventive
health care services to people living in rural and urban medically underserved
areas throughout the U.S. and its territories. CHCs offer services in 2,500
clinics and serve over 7 million people yearly. In addition, the Clinton-Gore
Administration is helping to train and recruit mental health professionals. The
National Health Service Corps (NHSC) loan repayment program is available for
behavioral and mental health professionals including clinical psychologists,
clinical social workers, psychiatric nurse specialists, and marriage and family
therapists. Through NHSC, these clinicians are placed in health professional
shortage areas to improve access to mental health services for underserved
people.
Enhancing Access and Decreasing Stigma Associated with Mental
Illness. Under the Clinton-Gore Administration, the DoD developed a pilot
program at Tinker Air Force Base in which specialty behavioral healthcare is
provided in primary care clinics, thus enhancing access to mental healthcare,
decreasing stigma associated with seeking such care, and enhancing prevention
efforts.
Helping Veterans Overcome Mental Illness. Under the Clinton
Administration, the Veterans Administration (VA) has redoubled its efforts to
provide quality mental health services. The VA instituted an accountability
system and has increased its services to special populations, including
homeless veterans and veterans with PostTraumatic Stress Disorder (PTSD). The
VA currently treats over 25,000 homeless veterans per year and outcomes of
those treated in residential facilities have improved steadily from 1993-1999
in the areas of housing, employment and clinical status. The VA also treats
over 50,000 vets per year in specialized PTSD programs and inpatient PTSD
outcomes have improved in recent years.
PROTECTING ALL CITIZENS
Caring for Victims of Violence. SAMHSA has developed a grant
program to identify, test and evaluate new, more effective programs to care for
female victims of violence and for their children. In addition, the Violence
Against Women Office supports a number of state and local efforts that include
components to provide mental health services to domestic violence victims and
their children and victims of sexual assault. And in fiscal year 1998, the
Office for Victims of Crime (OVC), through Victims of Crime Act (VOCA) funding,
supported of over 4,000 victim assistance agencies throughout the nation.
Enforcing Civil Rights Law and Ensuring Proper Care in Our
Public Residential Facilities. The Clinton Administration has worked hard to
ensure proper care in our public residential facilities. The Civil Rights
Division Special Litigation Section has ongoing work investigating allegations
of inadequate care and treatment in public residential facilities (including
mental retardation facilities and adult and juvenile correction facilities)
under the Civil Rights of Institutionalized Persons Act. Since 1993, the
Division has investigated mental health services and monitored remedial
settlements to improve the mental health services in more than 300 facilities
in 42 states. The Department of Justice's (DOJ) efforts also include an
ongoing Working Group on Mental Health and Crime and a Suicide Prevention
Program.
Addressing the Mental Health Needs of Youth. In fiscal year
1999, the Office of Juvenile Justice and Delinquency Prevention (OJJDP) is
funding a competitive grant to initiate a research and demonstration effort to
substantially increase the quality of mental health services provided to
detained and committed youth. In addition, a collaborative initiative between
the Deputy Attorney General and OJJDP focuses on the needs of children exposed
to violence, including on law enforcement and legislative reform, innovative
programs, and raising public awareness.
Working to Improve the Justice System's Response. DOJ has
supported studies that examine and analyze police response to emotionally
disturbed persons and that study the use of force in the arrest of persons with
impaired judgement, including people with mental illness. Other DOJ efforts
include: an ongoing Working Group on Mental Health and Crime, a number of
projects supported by the Bureau of Justice Assistance to improve the criminal
justice system's response, and a Suicide Prevention Program conducted by
the National Institute of Corrections' (NIC) Jails Division.
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