Alexander: Federal Government Must Make It Easier for States Like Tennessee to Help the Nearly 1 in 5 American Adults with Mental Illness

Asks if Washington is “putting up any roadblocks” that make it harder for states and doctors to help those with mental illness

Posted on October 29, 2015

WASHINGTON, D.C., Oct. 29 – Senate health committee Chairman Lamar Alexander (R-Tenn.) today said that the federal government must make it easier for states and communities to identify and help the nearly one in five American adults suffering from mental illness.

“In Tennessee, about 21 percent of adults reported having a mental illness in 2013 – that’s more than a million Tennesseans—according to the Tennessee Department of Mental Health and Substance Abuse Services,” Alexander said. “About 5 percent had a severe mental illness – that’s nearly a quarter of a million Tennesseans. About 41,000 Tennesseans had a major depressive episode.”

“Already, there is an enormous response to try to help: at the state level, through the private sector, and from the federal government. As a former Governor, I know that states have traditionally been on the forefront, with their departments of mental health, their treatment facilities, and community-based services. States have the primary responsibility for behavioral health and provide community-based programs that often include counseling, case management, and social work, and provide screening, diagnosis and treatment for children.”

“Today’s hearing is really to better understand the federal government’s role in mental health treatment and how it can help states like Tennessee meet such high need and deliver such critical care. …Are there administrative things we can do, are there programmatic things we can do – are we putting up any roadblocks that make it harder for states and doctors to provide services? We know that mental health and substance use disorders are frequently co-occurring disorders.  How are our federal programs working together?” 

Alexander said he is holding this hearing in the Senate health committee—which just last month passed the bipartisan Mental Health Awareness and Improvement Act—to “better understand the federal government’s role in mental health treatment and how it can help states like Tennessee meet such high need and deliver such critical care.”

The chairman’s full prepared remarks follow:

Today we are discussing the important issue of mental health and substance use disorders.

Mental illness affects a great many Americans. 

According to a 2013 report from the National Survey of Drug Use and Health, nearly 1 in 5 adults over the age of 26 reported suffering from a mental illness.

In that same time period, nearly 1 in 10 Americans between the age of 12 and 17 reported having at least one major depressive episode.

In Tennessee, about 21 percent of adults reported having a mental illness in 2013 – that’s more than a million Tennesseans—according to the Tennessee Department of Mental Health and Substance Abuse Services.

About 5 percent had a severe mental illness, that’s nearly a quarter of a million Tennesseans.

About 41,000 Tennesseans had a major depressive episode.

Already, there is an enormous response to try to help: at the state level, through the private sector, and from the federal government.

As a former Governor, I know that states have traditionally been on the forefront, with their departments of mental health, their treatment facilities, and community-based services.

States have the primary responsibility for behavioral health and provide community-based programs that often include counseling, case management, and social work, and provide screening, diagnosis and treatment for children.

And in the private sector, there are many private hospitals, non-profits, mental health professionals and others working to help those in need.  

Efforts from the private sector totaled about $67 billion in 2009, or 39 percent of total dollars spent for behavioral health, which includes mental health and substance use services.

Government spending totaled about $105 billion in 2009—or 61 percent of total dollars spent—and includes Medicaid, Medicare, and other efforts on the local, state, and federal levels.

One role the federal government plays is through its agencies.

The Substance Abuse and Mental Health Services Administration is an agency within the U.S. Department of Health and Human Services. Its role in supporting mental health programs is relatively small—compared to the responsibility that states have and the role of Medicaid—but also critically important.

This agency supports states, behavioral health care providers, and others by improving the availability and quality of prevention and treatment services, collecting behavioral health data, and sharing best practices through evidence-based initiatives.

It should be looked to as a leader in the field.

It receives about $3.5 billion each year through the discretionary appropriations process.

But the biggest government role is the amount of money spent through Medicaid, which is a federal-state partnership.

In 2009, Medicaid spending on behavioral health totaled about $44.2 billion—26 percent of total dollars spent.

These Medicaid dollars can be used to provide care from community behavioral health professionals, in-patient or residential treatment for children and seniors with mental illness, and to help those with severe mental illnesses get the prescription drugs they need.

In Tennessee last year, state spending for mental health and substance use disorder programs and services totaled about $555 million.

$230 million of that was spent on the state’s share of Medicaid related to mental health. $325 million was spent on mental health by the Tennessee State Department of Mental Health and Substance Abuse Services.

The federal government’s Medicare spending also plays a role, financing 7 percent of total expenditures to treat mental illness at about $21 billion dollars a year.

Medicare dollars can help seniors get the prescription drugs they need to treat mental illness—or can be used for doctors’ appointments, out-patient therapy, and a small fraction of in-patient treatment.

This federal support is a significant amount of money.

So one question for today is: should we be spending these federal dollars differently? Or should we be spending more of it—and if so, in what ways?

There are calls for the federal government to act differently to help those in need and to do more.

Twice the Senate health committee has passed different versions of the Mental Health Awareness and Improvement Act—once last Congress in 2013 and again just last month.

This bipartisan legislation supports suicide prevention and intervention programs, helps train teachers and school personnel to recognize and understand mental illness, works to reduce the stigma against those struggling with mental illness, and helps children recover from traumatic events.

I hope the Mental Health Awareness and Improvement Act will be passed by the Senate and become law this Congress.

Other senators are also tackling the issue of how to improve mental health treatment.

Members of this committee—Senators Cassidy and Murphy—have a mental health bill they introduced in August.

Senator Cornyn has a bill that he is working on in the Senate Judiciary Committee.

I expect to see the HELP Committee report additional legislation in the upcoming months that better supports states in addressing mental health and substance use disorder programs in their communities.

Today’s hearing is really to better understand the federal government’s role in mental health treatment and how it can help states like Tennessee meet such high need and deliver such critical care.

I am looking forward to hearing from today’s witnesses their thoughts on how the federal government’s role could be improved so that we are making it easier for states and communities to identify those who need help and get them the help they need.

Are there administrative things we can do, are there programmatic things we can do – are we putting up any roadblocks that make it harder for states and doctors to provide services? We know that mental health and substance use disorders are frequently co-occurring disorders.  How are our federal programs working together? 

I am particularly interested in your thoughts on mental health research.

I believe that one of the things that the federal government does most effectively to enable individuals in this big, complex society of ours to look toward the future is research.

We’re not such good managers. Sometimes we are not even good regulators. But the research that we have funded and encouraged has enabled enormous breakthroughs in the country. So I’d like your thoughts on the state of mental health research as well.

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