News

SAMHSA FY 2013 Budget Proposal – Not a Good Day for Children’s Mental Health

February 14, 2012

The SAMHSA budget proposal (Budget in Brief / Full Budget) is out and the news for children’s mental health services and the Child Mental Health Initiative (CMHI)  is not good – The proposal calls for a 29 million dollar reduction in funding for 2013. This “savings” would be achieved through grants “coming to a natural end.” This is chilling language for many reasons, which I will detail below. But for those who want to cut to the chase, here are three key points for you to share with SAMHSA and your elected representatives. Sure, there are more, but let’s start with these three:

  • Do not curb the progress made for children with mental health needs and their families. Do not allow the hard work and years of federal investments to be lost through faulty assumptions that the states are ready and able to just pick it up from here. The impressive track record of the CMHI speaks for itself, but the work is not done. The six-year demonstration efforts of improving children’s mental health services and supports through a system of care approach needs to continue in some form and not be phased out.
  • Heighten attention and oversight to ensure that the values and principles of a system of care approach guide implementation efforts at the state level, whatever the outcome for the final SAMHSA budget.
  • On average, state funding for children’s mental health services amounts to a mere 22% of a states total mental health budget (click here for a closer look at the numbers). “Going to scale” will require a commitment to funding technical assistance and administrative support to help state children’s mental health efforts achieve their objectives.

Making sense of it all…

Okay, now for the background, which I strongly encourage you to read. First, let’s recap the rationalization for SAMHSA choosing the approach they are taking as we understand it from reading the Budget Proposal. There are three primary strategic premises in SAMHSA’s approach:

  • Using competitive grants to identify and test innovative prevention and treatment interventions;
  • Leveraging state, territorial and tribal funding mechanisms to foster widespread implementation of proven practices; and
  • Reducing funding for tested competitive grant activities that will now be brought to scale through state-level funding streams.

Okay, got it. Makes sense, right? You give competitive grants, develop robust evaluation to test out the treatment interventions to see what works and then leverage state and tribal funding mechanisms to foster widespread implementation of proven practices. Perfect, right? In fact, the Child Mental Health Initiative (CMHI) is a great example of this very approach and in many ways is a flagship example of the importance of ensuring that the values and principles of a system of care approach drive implementation efforts.

So why should this budget proposal be a concern to us? Shouldn’t we be celebrating the fact that the CMHI has done what it said it would do? Shouldn’t we be rejoicing in the “natural ending” of a successful evaluation rich initiative? Well, no we should not – and here is why:

  • The one-year expansion planning grants that were implemented this year (as opposed to the six-year cooperative agreements that in this budget proposal will phase out) are not enough in and of themselves to do what SAMHSA has championed over the past 20 years – and that is to be the beacon of light on the importance of a family-driven, youth guided, culturally and linguistically competent approach to implementing services and supports that best meet the needs of children and youth with emotional and behavioral challenges and their families.
  • We have grave concern that the values and principles of a systems of care approach that SAMHSA has championed over the past 20 years will be lost in an approach that supports grant efforts coming to a “natural end.” This approach makes a huge assumption that the “what works” part of demonstration grant efforts over the years have stuck sufficiently so that we can feel comfortable letting initiatives like those that are a part of the CMHI come to their “natural end.” I don’t think we are there yet – not even close. To declare victory and walk away from this comprehensive initiative is short-sighted.

However, SAMHSA is in a difficult position and needs our support. Cuts have to come from somewhere, that much we know. The questions we need to ask ourselves as children’s mental health advocates are simple:

  • Do we think that the values and principles of a system of care approach has stuck sufficiently to the point that we can let the CMHI come to a “natural end” and declare victory that states across America have taken the important step of embracing a system of care approach in the development of services and supports for children with emotional and behavioral challenges and their families?
  • Do we think that states across America will embrace a system of care approach and honor the significance of children’s mental health in budget planning and block grant discussions, showing a level of support for children’s mental health that is commensurate to that given to adult populations?

If the answer is yes, then we are all set – victory is ours. If the answer is no, we have much work to do. I think the answer is no. So here is some homework for all of us:

  • Recognize the challenge that SAMHSA is in with the current budget crisis. This is not an exercise without significant pain attached. Cuts are a reality and need to come from somewhere, and that does not nor should not exclude children’s mental health.
  • A prime SAMHSA strategy for going forward appears to involve bringing grant activities “to scale through state-level funding streams”, as evidenced by the move from the six-year cooperative agreements to the one-year expansion planning grants. We as advocates cannot just ask SAMHSA to make sure that the values and principles of a system of care approach drive the concept of “going to scale.” We need to shine a very bright light on what this looks like state by state. The Children’s Mental Health Network will be doing this and we are sure other children’s mental health partners will be as well.
  • The point is, before the current fiscal crisis it was easier and probably more comfortable to rely on SAMHSA to “keep the light on.” And for 20 years and multiple administrations, both Republican and Democrat, they have done that. But now, in the worst economic crisis our nation has seen in decades, they need our help. This budget proposal reflects the hard work of really smart people who have to make cuts somewhere. They are doing the best they can based on research about best practice, content experts and the voices of constituents like us. If we do not mobilize and speak up more loudly than we have been about the importance of a strong focus on children’s mental health, then that’s on us.

What do we do next?

So, what next? Here are three key points for you to share with SAMHSA and your elected representatives. Again, there are more, but let’s start with these three:

  • Do not curb the progress made for children with mental health needs and their families. Do not allow the hard work and years of federal investments to be lost through faulty assumptions that the states are ready and able to just pick it up from here. The impressive track record of the CMHI speaks for itself, but the work is not done. The six-year demonstration efforts of improving children’s mental health services and supports through a system of care approach needs to continue in some form and not be phased out.
  • Heighten attention and oversight to ensure that the values and principles of a system of care approach guide implementation efforts at the state level, whatever the outcome for the final SAMHSA budget.
  • On average, state funding for children’s mental health services amounts to a mere 22% of a states total mental health budget (click here for a closer look at the numbers). “Going to scale” will require a commitment to funding technical assistance and administrative support to help state children’s mental health efforts achieve their objectives.

Join us and get involved

  • SAMHSA cannot do this alone. We need to do our part to provide information, research, education and personal testimony about the importance of a system of care approach. Click here if you want to be part of our campaign to strengthen, not diminish, system of care development efforts across the country. 
  • I urge you to express your thoughts to those who serve you at the local, state and national level about the importance of maintaining a strong focus on children’s mental health as the national discussion of the federal budget moves forward.
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