Mental Health Issues Reach Congressional Agenda

There has been a burst of legislative activity in Congress recently addressing the needs of children and adults with psychiatric problems.

The Senate bipartisan bill to reauthorize federal aid for special education passed the Senate Health, Education, Labor, and Pensions (HELP) Committee last month by a vote of 21-0. The bill, titled the Individuals With Disabilities Education Improvement Act of 2003 (IDEA), will move to the Senate floor for debate and a vote, although that may not occur until after Congress returns from its August recess.

Lizbet Boroughs, an associate director of APA’s Division of Government Relations, told Psychiatric News, “We were gratified that the full committee included language we proposed requiring schools to conduct behavioral assessments of children facing disciplinary actions to determine whether their behavior problems resulted from their disability.”

However, APA remains concerned that children who bring illegal drugs or weapons to school will automatically be removed from school without having the behavioral assessment, said Boroughs.

Another positive provision requires the schools to determine whether a student’s behavioral problems were a result of the failure of the child’s individualized education plan to contain positive behavioral interventions and supports. Another provision provides funding to expand special support and interventions in schools to prevent student discipline problems, according to Boroughs.

These provisions were welcomed by APA, the American Academy of Child and Adolescent Psychiatry (AACAP), and Children and Adults With Attention Deficit Disorder (CHADD).

HELP Committee Chair Sen. Judd Gregg (R-N.H.) and ranking Democrat Sen. Edward Kennedy (D-Mass.) worked for months on drafting a compromise bill to avoid a repeat of partisan clashes that occurred during the 1997 IDEA reauthorization. The senators promised to address funding levels when the bill goes to the Senate floor.

APA, AACAP, and CHADD opposed the House version of the IDEA reauthorization bill (HR 1350), which passed in April by a vote of 251-171. The primary reasons were that the bill didn’t contain the behavioral-assessment language and that, while parents could appeal a school’s decision, the bill required them to prove that their child’s behavioral problems were related to their disability, said Boroughs.

Protecting Immigrant Children

APA joined several groups, including AACAP, the Child Welfare League of America, and Physicians for Human Rights, in sending a letter to senators urging them to cosponsor the Unaccompanied Child Protection Act of 2003 (S 1129), introduced by Sen. Dianne Feinstein (D-Calif.) in May.

The letter stated, “S 1129. . . would ensure that each child is treated humanely while in federal custody, is placed in settings appropriate for their special circumstances, and is protected from those who might seek to further exploit them. In addition, S 1129 would provide an infrastructure for pro-bono legal representation of such children in their immigration proceedings that would help expedite the resolution to their immigration status, providing counsel at government expense only as a last resort.”

The bill was prompted by a recent report by Amnesty International outlining poor conditions in detention centers where undocumented immigrant children are placed while in federal custody.

Preventing Child Abuse

Congress passed legislation last month to renew the 1996 Child Abuse Prevention and Treatment Act. President George W. Bush quickly signed S 342 into law (now Public Law 108-36).

The goal of the legislation is to provide funding to local communities for outreach programs designed to prevent child abuse and encourage adoptions. The bill authorized $200 million in grants for Fiscal 2004.

The conference report passed by both the Senate and House includes a provision requiring that health care providers involved in the delivery or care of infants affected by illegal substance abuse or withdrawal symptoms notify child protective services.

“I think this initiative will go a long way toward protecting children before they are subjected to abuse,” said Rep. James Greenwood (R-Pa.) in Congressional Quarterly Today on June 18.

The conference report also includes a provision authorizing a new program to help children who witness domestic violence based on a bill introduced in 2001 by the late Sen. Paul Wellstone (D-Minn.) (Psychiatric News, November 2, 2001).

Child Mental Health Workforce

Sen. Jeff Bingaman (D-N.M.) introduced the Child Healthcare Crisis Relief Act (S 1223) last month to increase the number of child mental health care professionals in the workforce. The bill is the Senate’s version of the Child Mental Health Service Expansion Act (HR 5078), introduced in the House by Reps. Patrick Kennedy (D-R.I.) and Ileana Ros-Lehtinen (R-Fla.) last year to address the national shortage of child mental health specialists.

APA and AACAP support this legislation, which would provide educational incentives including scholarships and other training support to individuals entering the field of child mental health.

“This bill will remove one of the key barriers to treatment for children and adolescents with mental illnesses—the lack of available specialists trained in this field,” said AACAP President Marilyn Benoit, M.D., in a press release. “Enactment of this legislation will allow child and adolescent psychiatrists to receive federal support to complete their training, which will remove a significant financial burden on the hospitals and medical schools operating these training programs. It will also improve recruitment into this shortage specialty.”

Mentally Ill Offenders

Sen. Mike DeWine (R-Ohio) and Rep. Ted Strickland (D-Ohio) introduced the Mentally Ill Offender Treatment and Crime Reduction Act of 2003 (S 1123) last month.

When introducing the bill, DeWine said, “The bill provides a unique approach to treating mentally ill offenders while reducing crime. It would promote public safety by curbing the incidence of repeat offenders and public health by ensuring that individuals with a serious mental illness are treated as efficiently and effectively as possible to stop the revolving door of arrest, release, and re-arrest.”

The bills would establish a five-year grant program at the U.S. Department of Justice that states and local communities could use to establish mental health courts, provide treatment and transitional services to inmates, and provide additional training for mental health personnel, police, judges, prosecutors, and corrections officers.

Stickland, who introduced a companion bill (HR 2387) in the House of Representatives, said, “This is phase two of an effort that started in the 106th Congress when Sen. DeWine and I successfully passed America’s Law Enforcement and Mental Health Project [Public Law 106-515] in 2001. This bill created a Department of Justice grant program to assist state and local governments in establishing mental health courts.”

The 2003 bill provides incentives for the criminal justice, juvenile justice, mental health, and substance abuse treatment systems “to work together at each level of government to establish a network of services for the offender with mental illness,” according to the press release.

The bill specifically calls for the creation of an interagency task force at the federal level to include the attorney general; the secretaries of the departments of Health and Human Services, Housing and Urban Development, Labor, Education, and Veterans Affairs; and the commissioner of Social Security.

Assistance for Elderly

Reps. Patrick Kennedy and Steny Hoyer (D-Md.), the Democratic whip of the House of Representatives, introduced the Positive Aging Act in May. The bill is similar to the Advancement of Geriatric Education Act (S 1362) introduced in the Senate last year (Psychiatric News, April 5, 2002).

The bill’s goal is to integrate mental health services into primary care settings and community-based mental health treatment programs for elderly individuals, according to a press release from both congressmen.

The legislation would do the following:

• Create a competitive grant program to reward projects that integrate mental health programs for geriatric patients into primary care settings.

• Create a competitive grant program to reward public or private, nonprofit, community-based programs that deliver geriatric mental health services where senior citizens reside, such as assisted-living communities and senior-citizen centers.

• Establish a deputy director for senior mental health services within the Center for Mental Health Services. That person would be responsible for the development and implementation of initiatives to address the mental health service needs of elderly people.

The text of the bills described in this article can be accessed on the Web at http://thomas.loc.gov by searching on the bill number. ▪