Letters from the CEO: March 2006
Dear Member,
Please excuse the delay in receiving my March monthly letter. It has been especially busy as we prepare for the Annual Conference that begins later this week and at the same time prepare for both the National Council's second Annual Hill Day on May 3rd and the spring Board meeting that begins May 4th.
This month my letter focuses primarily on the 2007 federal budget and the findings of several newly released research studies that have the potential to impact policy and practice. But first I want to acknowledge the continued increase in the National Council's membership. With the hard work of staff and with the support of our partner state association leaders, we have already exceeded this year's ambitious membership goal. On behalf of the Board and the staff I want to welcome our new members as well as thank all of our members for their continued membership. Whenever possible I try to personally reach out to new members, but I also encourage you to call or email me with suggestions and questions, and of course I look forward to seeing and talking with both old and new members at the conference and at Hill Day. Every interaction with a member is a learning opportunity that helps us to more effectively advocate for legislation and policies that support your efforts to deliver services of the highest quality.
Join us May 3rd for Hill Day - fight threats to Medicaid and services
For the first time the spring Board meeting will not be held in conjunction with the National Council's Annual Conference, but will be held in conjunction with Hill Day. The conference is an opportunity for shared learning, networking, organizational and practice development, and celebration of member accomplishments. Although there are many opportunities to discuss public policy at the conference including at the National Council's general membership meeting, Hill Day is the chance to bring your public policy concerns directly to D.C.
Having the National Council's Board and membership demonstrate a strong public policy presence in D.C. during the Congressional session is vital to staff's year round efforts to strengthen your voice on the Hill and with the administration. The President's 2007 budget again proposes deep cuts and elimination of many safety net programs and it's important that your representatives on Capitol Hill hear directly from you how their actions affect critical services.
The Administration wants to slash reimbursement for Medicaid targeted case management services to the administrative matching rate of 50 percent. The Administration also proposed "clarifying" allowable services that can be claimed as Medicaid rehabilitation services.
The Department of Health and Human Services (HHS) would receive $3.8 billion less than last fiscal year. Within HHS, the Substance Abuse and Mental Health Services Administration (SAMHSA) would lose $67 million, of which $35 million would be subtracted from programs administered by the Center for Mental Health Services (CMHS).
Although the Administration's proposed funding for the Substance Abuse Prevention and Treatment Block Grant remains flat, funding for the Center for Substance Abuse Treatment (CSAT) is reduced by $23.5 million, to $175.4 million for FY 2007. This includes $98 million for the Access to Recovery (ATR) program, which will include a new methamphetamine Voucher Incentive Program (VIP). The VIP would provide up to 25 awards of $1 to $5 million, with preference given to applicants who voluntarily commit to use a portion of their Substance Abuse Prevention and Treatment Block Grant funds to deliver prevention and addiction treatment services through vouchers.
For a second year in a row, the President seeks to eliminate the Safe and Drug-Free Schools and Communities State Grants Program, which supports community-based prevention programs. Last year, Congress restored $346.5 million in funding to the program and the National Council advocates yet again against this program's elimination.
The Administration proposes that at least $153 million of the Mental Health Block Grant be allocated by individual states to "mental health transformation" activities. According to SAMHSA's FY 2007 Congressional Justification, two primary types of activities are required for transformation: development of infrastructure in the mental health and related systems, and provision of innovative, emerging evidence-based services that support recovery. The National Council very much appreciates SAMHSA's efforts to maintain overall block grant funding, and supports SAMHSA's promotion of transformational activities. However, we are concerned that the proposal will divert funds away from services. As more and more state mental health funds are used for the Medicaid match, the dollars available for care for those not eligible for Medicaid continue to decreases, and we must take no chances with the limited service dollars available within the program.
On March 29th, the House Budget Committee approved a $2.8 trillion budget resolution. During the House Budget Committee's mark-up of the budget resolution, Congresswoman Rosa DeLauro (D-CT) proposed an amendment to add $7 billion to health, education, and worker safety programs. This amendment, proposed by Senators Arlen Specter (R-PA), and Tom Harkin (D-IA) during the Senate's budget review, was approved by the full Senate and made a part of the Senate Budget Resolution on March 16th. However, the amendment failed during the House Budget Committee's mark-up, but it has been reported that it is still possible to include the $7 billion in the final House Resolution.
What happens in Washington directly affects your organization's ability to serve those in need in your communities. Your efforts contributed to a bruising battle over Medicaid resulted in the close margin by which the 2006 Deficit Reduction Act was passed. You put Congress on notice and I urge you to come to D.C. on May 3 to show your strength and to be heard. Please contact Allison Fort at allisonf@nccbh.org for Hill Day details.
You can read more about policy issues in a special 2006 Conference edition of National Council News, available at www.nccbh.org/SERVICE/Newsletters/nc-news.htm.
NAMI grades the states
The U.S. public mental health system is in trouble. The system gets a D grade for helping adults with serious mental illnesses recover and live with dignity, according to a state-by-state report card, "Grading the States: A Report on America's Health System for Serious Mental Illness" released in March by the National Alliance on Mental Illness (NAMI).
Although we may have disagreements about specific state grades, the National Council applauds NAMI for highlighting the inadequacies as well as strengths of the complex public mental health system. The NAMI report is testimony to the fact that you get what you pay for. Evidence based practices, although cost effective in the long run, require increased reimbursement rates in the short run. NAMI correctly identifies state mental health authorities, Medicaid bureaus, the governor's office, and legislative leadership as the entities that influence the development of a state's mental health system.
The National Council views the seemingly never ending attempts to restructure state mental health systems as political solutions to access and quality problems, problems better solved by investments in services, new technologies, a skilled workforce, and on getting resources to the ground level where recovery can become a reality.
The full NAMI report can be found at www.nami.org.
Campaign for Mental Health Reform
The NAMI report reminded us of how far we have to go and on March 29th the Campaign for Mental Health Reform helped to tell the story of recent efforts, of progress, and of potential. The Campaign, a collaboration of 16 national mental health organizations including the National Council, reconvened the members of the President's New Freedom Commission on Mental Health on Capitol Hill to discuss returning war veterans, suicide as a national priority, and mental health in the workplace. That evening the Campaign held a dinner honoring members of the Commission, consumers, and elected officials.
The day's events underscored the importance of the Commission and paid tribute to those who work to improve the service system. Kathryn Power who is tireless in her efforts to assure recovery for all consumer opened the discussions and was followed throughout the day and evening by equally committed and eloquent speakers. Betty Funk, our Board chair and Jim Dill, co-chair of our Board's public policy committee, joined us for the event. I believe all who attended were inspired by the mental health advocacy community coming together and by the personal commitment of so many.
Go to www.mhreform.org for a webcast of the proceedings and to learn more about the Campaign.
Using research findings to shape policy and practice
The release, in little more than a week, of the findings of three national studies reminds us of the importance of informed practice and policy and gives new urgency to the science to service agenda. It can be too easy to make policy and to practice based upon consensus, politics, or habit. As the true leaders of the service system - the organizations that deliver mental health and addictions treatment services in communities across the country - your credibility and your future depend upon understanding and evaluating the implications of new research.
On March 23rd The New England Journal of Medicine released the findings of the second of four phases of the largest-of-its-kind research study on depression treatments, the Sequenced Treatment Alternatives to Relieve Depression, or STAR*D. The STAR*D trials demonstrated that those with depression resistant to initial treatment can achieve remission when treated with a secondary strategy that either augments or switches medications. One in three depressed patients who previously did not achieve remission using an antidepressant became symptom-free with the help of an additional medication and one in four achieved remission after switching to a different antidepressant.
The STAR*D findings provide strong scientific support that treatment for depression works and should be provided on a tailored, individualized basis with a range of medication alternatives. The study has the potential to redefine the way the public views depression-as an illness that requires proper medical care, customized to the individual, without stigma.
These findings offer a message of hope and recovery. It is now imperative that they be put to practice. For more about STAR*D go to www.nimh.nih.gov/press/stard2.cfm or www.nimh.nih.gov/healthinformation/stard_qa_level2.cfm.
On March 30th The New England Journal of Medicine published a study commissioned by the U.S. Department of Health and Human Services (HHS), which shows that providing mental health and substance abuse coverage on par with other health coverage can achieve greater fairness and improved insurance protection without increasing health care costs. This major study evaluated the impact of the federal government's providing "mental health parity" under the Federal Employee Health Benefits Program (FEHBP) beginning in January 2001.
This exhaustive study compares both national and regional FEHB health plans with similar plans that did not provide benefits parity in the two years before mental health parity was mandated for federal employees and the two years after. Unequivocally, the data shows that parity when coupled with management of care did not cause or contribute to cost increases. But it did lead to "significant reductions in out-of-pocket spending" for many government workers and retirees.
The study is an important development in national and state debates over what insurance plans should cover. The results provide ammunition for those, including the National Council and our members, who have long advocated for mental health "parity" in Congress and state legislatures. Full study findings are available at www.aspe.hhs.gov/daltcp/reports/parity.htm.
As I write this letter, the results of phase 2 of the CATIE - Clinical Antipsychotic Trials of Intervention Effectiveness - study have just been released in the April 2006 issue of the American Journal of Psychiatry. The National Institute of Mental Health (NIMH) initiated CATIE as part of an overall NIMH effort to conduct "practical" clinical trials that address public health issues important to people affected by major mental illnesses in real-world settings. Future CATIE reports will address a number of topics, such as cost-effectiveness, quality of life, and predictors of response, and will provide a more detailed picture of the interaction between individual characteristics, medications, and outcomes.
NIMH released the first phase of CATIE in September 2005. In phase 2 of CATIE, 543 people were studied in 57 different treatment sites to provide guidance on what to do next when there is a need to change medications, a common occurrence in treating schizophrenia. Finding the right treatment is critical, as research has repeatedly shown that individuals who consistently take medication do much better than those who stop.
As we did with the results of the first phase of CATIE, we will shortly share with you our review of the phase 2 findings. Additionally those of you attending our Annual Conference in Orlando will have the opportunity to discuss the implications of CATIE in a workshop led by Dr. Herbert Meltzer, M.D.
Congratulations to the 2006 Awards of Excellence honorees
We are fortunate to work in a field and at jobs where we never stop learning. New clinical research findings, new management techniques, new information technology are among the many areas that test our ability and desire to learn and to change and to continuously improve ourselves and the services we deliver. And each year the National Council has the opportunity to honor those among us who exemplify this commitment to learning, to improvement, and to excellence.
We received so many outstanding submissions for the 2006 National Council Awards of Excellence and we thank every one that took the time to chronicle their accomplishments. As I read some of the submissions and as I had the good fortune of calling to notify and congratulate the honorees in categories ranging from "community collaboration" to "lifetime achievement" to "service excellence" to "advocacy" and "public service," I was reminded of the talent, creativity and dedication of our field. There will always be progress to be made, but we have much of which we can be proud.
This year, for the first time the National Council will host an Awards of Excellence Dinner for our honorees on April 10th at the Annual Conference in Orlando. All of us at the National Council fully share the honorees' excitement, congratulate them on their well-deserved national recognition and look forward to a celebrating their achievements on the 10th.
A full list of the award categories and the honorees is available at www.nccbh.org/service/Awards-of-Excellence.htm.
Best regards,
Linda
Please excuse the delay in receiving my March monthly letter. It has been especially busy as we prepare for the Annual Conference that begins later this week and at the same time prepare for both the National Council's second Annual Hill Day on May 3rd and the spring Board meeting that begins May 4th.
This month my letter focuses primarily on the 2007 federal budget and the findings of several newly released research studies that have the potential to impact policy and practice. But first I want to acknowledge the continued increase in the National Council's membership. With the hard work of staff and with the support of our partner state association leaders, we have already exceeded this year's ambitious membership goal. On behalf of the Board and the staff I want to welcome our new members as well as thank all of our members for their continued membership. Whenever possible I try to personally reach out to new members, but I also encourage you to call or email me with suggestions and questions, and of course I look forward to seeing and talking with both old and new members at the conference and at Hill Day. Every interaction with a member is a learning opportunity that helps us to more effectively advocate for legislation and policies that support your efforts to deliver services of the highest quality.
Join us May 3rd for Hill Day - fight threats to Medicaid and services
For the first time the spring Board meeting will not be held in conjunction with the National Council's Annual Conference, but will be held in conjunction with Hill Day. The conference is an opportunity for shared learning, networking, organizational and practice development, and celebration of member accomplishments. Although there are many opportunities to discuss public policy at the conference including at the National Council's general membership meeting, Hill Day is the chance to bring your public policy concerns directly to D.C.
Having the National Council's Board and membership demonstrate a strong public policy presence in D.C. during the Congressional session is vital to staff's year round efforts to strengthen your voice on the Hill and with the administration. The President's 2007 budget again proposes deep cuts and elimination of many safety net programs and it's important that your representatives on Capitol Hill hear directly from you how their actions affect critical services.
The Administration wants to slash reimbursement for Medicaid targeted case management services to the administrative matching rate of 50 percent. The Administration also proposed "clarifying" allowable services that can be claimed as Medicaid rehabilitation services.
The Department of Health and Human Services (HHS) would receive $3.8 billion less than last fiscal year. Within HHS, the Substance Abuse and Mental Health Services Administration (SAMHSA) would lose $67 million, of which $35 million would be subtracted from programs administered by the Center for Mental Health Services (CMHS).
Although the Administration's proposed funding for the Substance Abuse Prevention and Treatment Block Grant remains flat, funding for the Center for Substance Abuse Treatment (CSAT) is reduced by $23.5 million, to $175.4 million for FY 2007. This includes $98 million for the Access to Recovery (ATR) program, which will include a new methamphetamine Voucher Incentive Program (VIP). The VIP would provide up to 25 awards of $1 to $5 million, with preference given to applicants who voluntarily commit to use a portion of their Substance Abuse Prevention and Treatment Block Grant funds to deliver prevention and addiction treatment services through vouchers.
For a second year in a row, the President seeks to eliminate the Safe and Drug-Free Schools and Communities State Grants Program, which supports community-based prevention programs. Last year, Congress restored $346.5 million in funding to the program and the National Council advocates yet again against this program's elimination.
The Administration proposes that at least $153 million of the Mental Health Block Grant be allocated by individual states to "mental health transformation" activities. According to SAMHSA's FY 2007 Congressional Justification, two primary types of activities are required for transformation: development of infrastructure in the mental health and related systems, and provision of innovative, emerging evidence-based services that support recovery. The National Council very much appreciates SAMHSA's efforts to maintain overall block grant funding, and supports SAMHSA's promotion of transformational activities. However, we are concerned that the proposal will divert funds away from services. As more and more state mental health funds are used for the Medicaid match, the dollars available for care for those not eligible for Medicaid continue to decreases, and we must take no chances with the limited service dollars available within the program.
On March 29th, the House Budget Committee approved a $2.8 trillion budget resolution. During the House Budget Committee's mark-up of the budget resolution, Congresswoman Rosa DeLauro (D-CT) proposed an amendment to add $7 billion to health, education, and worker safety programs. This amendment, proposed by Senators Arlen Specter (R-PA), and Tom Harkin (D-IA) during the Senate's budget review, was approved by the full Senate and made a part of the Senate Budget Resolution on March 16th. However, the amendment failed during the House Budget Committee's mark-up, but it has been reported that it is still possible to include the $7 billion in the final House Resolution.
What happens in Washington directly affects your organization's ability to serve those in need in your communities. Your efforts contributed to a bruising battle over Medicaid resulted in the close margin by which the 2006 Deficit Reduction Act was passed. You put Congress on notice and I urge you to come to D.C. on May 3 to show your strength and to be heard. Please contact Allison Fort at allisonf@nccbh.org for Hill Day details.
You can read more about policy issues in a special 2006 Conference edition of National Council News, available at www.nccbh.org/SERVICE/Newsletters/nc-news.htm.
NAMI grades the states
The U.S. public mental health system is in trouble. The system gets a D grade for helping adults with serious mental illnesses recover and live with dignity, according to a state-by-state report card, "Grading the States: A Report on America's Health System for Serious Mental Illness" released in March by the National Alliance on Mental Illness (NAMI).
Although we may have disagreements about specific state grades, the National Council applauds NAMI for highlighting the inadequacies as well as strengths of the complex public mental health system. The NAMI report is testimony to the fact that you get what you pay for. Evidence based practices, although cost effective in the long run, require increased reimbursement rates in the short run. NAMI correctly identifies state mental health authorities, Medicaid bureaus, the governor's office, and legislative leadership as the entities that influence the development of a state's mental health system.
The National Council views the seemingly never ending attempts to restructure state mental health systems as political solutions to access and quality problems, problems better solved by investments in services, new technologies, a skilled workforce, and on getting resources to the ground level where recovery can become a reality.
The full NAMI report can be found at www.nami.org.
Campaign for Mental Health Reform
The NAMI report reminded us of how far we have to go and on March 29th the Campaign for Mental Health Reform helped to tell the story of recent efforts, of progress, and of potential. The Campaign, a collaboration of 16 national mental health organizations including the National Council, reconvened the members of the President's New Freedom Commission on Mental Health on Capitol Hill to discuss returning war veterans, suicide as a national priority, and mental health in the workplace. That evening the Campaign held a dinner honoring members of the Commission, consumers, and elected officials.
The day's events underscored the importance of the Commission and paid tribute to those who work to improve the service system. Kathryn Power who is tireless in her efforts to assure recovery for all consumer opened the discussions and was followed throughout the day and evening by equally committed and eloquent speakers. Betty Funk, our Board chair and Jim Dill, co-chair of our Board's public policy committee, joined us for the event. I believe all who attended were inspired by the mental health advocacy community coming together and by the personal commitment of so many.
Go to www.mhreform.org for a webcast of the proceedings and to learn more about the Campaign.
Using research findings to shape policy and practice
The release, in little more than a week, of the findings of three national studies reminds us of the importance of informed practice and policy and gives new urgency to the science to service agenda. It can be too easy to make policy and to practice based upon consensus, politics, or habit. As the true leaders of the service system - the organizations that deliver mental health and addictions treatment services in communities across the country - your credibility and your future depend upon understanding and evaluating the implications of new research.
On March 23rd The New England Journal of Medicine released the findings of the second of four phases of the largest-of-its-kind research study on depression treatments, the Sequenced Treatment Alternatives to Relieve Depression, or STAR*D. The STAR*D trials demonstrated that those with depression resistant to initial treatment can achieve remission when treated with a secondary strategy that either augments or switches medications. One in three depressed patients who previously did not achieve remission using an antidepressant became symptom-free with the help of an additional medication and one in four achieved remission after switching to a different antidepressant.
The STAR*D findings provide strong scientific support that treatment for depression works and should be provided on a tailored, individualized basis with a range of medication alternatives. The study has the potential to redefine the way the public views depression-as an illness that requires proper medical care, customized to the individual, without stigma.
These findings offer a message of hope and recovery. It is now imperative that they be put to practice. For more about STAR*D go to www.nimh.nih.gov/press/stard2.cfm or www.nimh.nih.gov/healthinformation/stard_qa_level2.cfm.
On March 30th The New England Journal of Medicine published a study commissioned by the U.S. Department of Health and Human Services (HHS), which shows that providing mental health and substance abuse coverage on par with other health coverage can achieve greater fairness and improved insurance protection without increasing health care costs. This major study evaluated the impact of the federal government's providing "mental health parity" under the Federal Employee Health Benefits Program (FEHBP) beginning in January 2001.
This exhaustive study compares both national and regional FEHB health plans with similar plans that did not provide benefits parity in the two years before mental health parity was mandated for federal employees and the two years after. Unequivocally, the data shows that parity when coupled with management of care did not cause or contribute to cost increases. But it did lead to "significant reductions in out-of-pocket spending" for many government workers and retirees.
The study is an important development in national and state debates over what insurance plans should cover. The results provide ammunition for those, including the National Council and our members, who have long advocated for mental health "parity" in Congress and state legislatures. Full study findings are available at www.aspe.hhs.gov/daltcp/reports/parity.htm.
As I write this letter, the results of phase 2 of the CATIE - Clinical Antipsychotic Trials of Intervention Effectiveness - study have just been released in the April 2006 issue of the American Journal of Psychiatry. The National Institute of Mental Health (NIMH) initiated CATIE as part of an overall NIMH effort to conduct "practical" clinical trials that address public health issues important to people affected by major mental illnesses in real-world settings. Future CATIE reports will address a number of topics, such as cost-effectiveness, quality of life, and predictors of response, and will provide a more detailed picture of the interaction between individual characteristics, medications, and outcomes.
NIMH released the first phase of CATIE in September 2005. In phase 2 of CATIE, 543 people were studied in 57 different treatment sites to provide guidance on what to do next when there is a need to change medications, a common occurrence in treating schizophrenia. Finding the right treatment is critical, as research has repeatedly shown that individuals who consistently take medication do much better than those who stop.
As we did with the results of the first phase of CATIE, we will shortly share with you our review of the phase 2 findings. Additionally those of you attending our Annual Conference in Orlando will have the opportunity to discuss the implications of CATIE in a workshop led by Dr. Herbert Meltzer, M.D.
Congratulations to the 2006 Awards of Excellence honorees
We are fortunate to work in a field and at jobs where we never stop learning. New clinical research findings, new management techniques, new information technology are among the many areas that test our ability and desire to learn and to change and to continuously improve ourselves and the services we deliver. And each year the National Council has the opportunity to honor those among us who exemplify this commitment to learning, to improvement, and to excellence.
We received so many outstanding submissions for the 2006 National Council Awards of Excellence and we thank every one that took the time to chronicle their accomplishments. As I read some of the submissions and as I had the good fortune of calling to notify and congratulate the honorees in categories ranging from "community collaboration" to "lifetime achievement" to "service excellence" to "advocacy" and "public service," I was reminded of the talent, creativity and dedication of our field. There will always be progress to be made, but we have much of which we can be proud.
This year, for the first time the National Council will host an Awards of Excellence Dinner for our honorees on April 10th at the Annual Conference in Orlando. All of us at the National Council fully share the honorees' excitement, congratulate them on their well-deserved national recognition and look forward to a celebrating their achievements on the 10th.
A full list of the award categories and the honorees is available at www.nccbh.org/service/Awards-of-Excellence.htm.
Best regards,
Linda
