Congressional Budget Bill a Mixed Bag

This past weekend Congress passed the “Continuing Resolution – Omnibus” spending bill (HR 83) for the remaining months of fiscal year 2015 which runs through Sept. 30, 2015. The measure is now waiting for the President’s signature. This bill contains good news and bad news for mental health. The good news: HR 83 provides a small increase in funding for mental illness research. Bad news: the bill includes a small reduction for mental health services.

Mental Illness Research Funding

The omnibus bill prevents any further cuts to funding at the National Institute of Mental Health (NIMH). Overall the National Institutes of Health (NIH) budget for 2015 will be increased by almost $150 million. NIMH received a budget increase of almost $17 million for a total budget of $1.463 billion for 2015. The bill also allocates funding to the NIMH as part of the President’s Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative. Multiple federal agencies and a number of foundations collaborate in the BRAIN Initiative designed to release new technologies and undertake basic mapping of circuits and neurons in the brain.

Mental Health Services Funding

The Substance Abuse and Mental Health Services Administration (SAMHSA) will receive a $39 million increase over fiscal year 2014 levels, for a total budget of $3.62 billion. However, most of this increase is directed to the Center for Substance Abuse Treatment to address the growing crisis of opiate addiction in America. Funding at the SAMHSA Center for Mental Health Services (CMHS) will actually be reduced for 2015 – a reduction of $9.4 million out of total CMHS funding level of $1.079 billion. Almost every line item in the CMHS budget endures a small reduction, in most cases, less than 0.5%. Among the highlights of the final CMHS budget for 2015 are:

• $481.5 million for the Mental Health Block Grant (MHBG) – a $1.2 million reduction. The MHBG is dedicated to building and supporting the community-based public mental health system across the country. Despite this reduction the bill does continue the 5% set aside for early intervention in first break psychosis that Congress put in place last year. This requires each state and territory to direct 5% of the block grant funds for evidence-based programs that address the needs of young adults experiencing first break psychosis. NIMH will continue its role of validating evidence-based approaches for early intervention and psychosis.
• $64.6 million is allocated for the PATH program, a $100,000 reduction from its 2014 level. The PATH program is a state grant program for outreach and engagement for individuals with serious mental illness who are homeless.
• $117 million is allocated for the Children’s Mental Health program, $300,000 belowthe current level.

Most programs under the CMHS “Programs of Regional and National Significance” (PRNS) would continue at levels slightly below their 2014 level. The total amount for 2015 for PRNS is $366.6 million which is a $7.7 million reduction. Among these line items are:

• $49.8 million for the Primary-Behavioral Health Care Integration (PBHCI) program, which supports the co-location of services in behavioral health and primary care settings.
• $54.9 million for suicide prevention activities, including the Garrett Lee Smith state and campus grant programs.
• $39.9 million for new Project AWARE (Advancing Wellness and Resilience in Education) grants.
• $14.9 million for Mental Health First Aid training.
• $30.7 million for homelessness prevention programs.

Supportive Housing Funding

This bill regrettably does not include the increases put forward in President Obama’s 2015 budget proposal for supportive housing programs. Back in February, the President proposed $301 million in additional funding for development of new permanent supportive housing (PSH). These new funds were projected to continue the program on a trajectory to end chronic homelessness by 2017. The President’s budget also called for a $25 million increase for the HUD Section 811 Project-Based Rental Assistance (PRA) program which supports the lowest income people with long-term disabilities to live independently in the community. The spending bill did not include either of these requests and instead provides only enough funding to renew the operating subsidies associated with existing PSH units in both programs. The bill does include an additional $75 million in funding for new rental vouchers for supportive housing for veterans experiencing homelessness under the Veterans Affairs Supportive Housing (VASH) program.

Veterans Funding

The U.S. Department of Veterans Affairs (VA) medical services are funded for 2015 at $45.2 billion – which will provide care and treatment for about 6.7 million veterans.

This funding includes:

• $7.2 billion in mental health care services.
• $133 million in suicide prevention activities.
• $229 million for traumatic brain injury treatment.
• $7.4 billion in homeless veterans’ treatment, services, housing and job training.
• $250 million in rural health initiatives.

The bill also includes $209 million to help address new costs related to the Veterans Access, Choice, and Accountability Act of 2014 (VACAA) – such as hiring medical staff and expanding facility capacity – and to implement the Caregivers Act, which provides stipends and other assistance to families of seriously wounded veterans.

To assist the VA in meeting its goal of ending the disability compensation claims backlog by the end of 2015, the bill includes $2.5 billion for the costs of processing disability claims. This level is a $69 million increase from last year. Language is also included directing that $40 million of the increase should be used to support digital scanning of claims, to hire additional claims processors in regional offices, and for the centralized mail initiative. Funding for the Board of Veterans Appeals is increased by $11 million for a total of $99 million to address the looming appeals backlog.

Finally, the bill contains $58.7 billion in advance fiscal year 2016 funding for the VA – the same level provided in the House budget resolution. This funding will provide for medical services, medical support and compliance, and medical facilities, and ensure that our veterans have continued, full access to their medical care.

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