"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.
Last Updated: June 10, 1999