February 2002

In the wake of September 11, Public Interest Policy staff of APA's Public Policy Office (PI-PPO) continue to work closely with Congress and the executive branch to ensure that legislation and federal agency initiatives address the mental health consequences of terrorism and bioterrorism. Other public interest policy initiatives anticipated for 2002 include efforts to reauthorize both the Temporary Assistance for Needy Families program to eliminate barriers to self-sufficiency for women transitioning from welfare to work and the Individuals with Disabilities Education Act with special attention to promoting research in the areas of prevention and early intervention and personnel training reflective of evidence-based practice.

However, since this is an election year, there are only a limited number of legislative days left before October 4, when Congress is scheduled to adjourn. It is not clear that there will be the political will to devote much attention to anything other than the economy and defense. This was made clear when President Bush sent his budget, entitled "Ensuring a Safe and Healthy America," to Congress on February 4. It included a $37.7 billion "down payment" for homeland defense and cuts in vital domestic programs. PI-PPO staff will advocate for increased appropriations for domestic programs of importance to psychology.

This report provides an overview of PI-PPO activities from October through February of this year to promote psychology in the public interest. Special attention is directed to the federal response to the September 11^th terrorist attacks, as well as to activities in the following public interest issue areas: aging; children, youth and families; disability issues; ethnic minority issues; gay, lesbian, and bisexual concerns; HIV/AIDS; poverty; women; and cross-cutting initiatives. Ongoing PPO activities include interacting with members of Congress, federal agency officials, and their staffs; developing issue background materials and legislative provisions; submitting formal comments on proposed legislation and regulations; and engaging the APA membership in grassroots advocacy efforts. Additional information about PPO and its initiatives can be found on the PPO Web site (http://www.apa.org/ppo/).

• Federal Mental Health Appropriations: Advocated successfully for increased appropriations in Fiscal Year (FY) 2002 for the overall budget for the Substance Abuse and Mental Health Services Administration (SAMHSA), as well as for targeted programs in such areas as child mental health, suicide prevention, and HIV/AIDS.

• Mental Health Response to Terrorism: Assisted both House and Senate congressional offices across the political spectrum in developing legislation to address the critical need for increased mental health services, research, and training initiatives at the federal level following the September 11^th terrorist attacks and subsequent anthrax scare.

• Elementary and Secondary Education Act: Lobbied effectively for the inclusion of numerous provisions in the bill to reauthorize the Elementary and Secondary Education Act. These will provide for a range of qualified psychologists to provide mental health services in schools, better linkages between schools and community-based mental health providers, greater attention to quality and fairness in high-stakes testing, enhanced tolerance education and hate crimes prevention in schools, and other improvements.

• Other Legislative Developments: Contributed to the drafting of legislation in a wide range of areas to incorporate or enhance the focus on psychological issues. These areas include welfare reform, postpartum depression and psychosis, and the reauthorization of both the Individuals with Disabilities Education Act and the Temporary Assistance for Needy Families (TANF) program.

• Congressional Hearings and Briefings: Arranged for APA members to participate in congressional hearings and briefings on Postpartum Depression in September, Child Maltreatment in October, and Women's Mental Health in January.

• Outreach to Federal Agency Officials: Arranged a January 16th APA welcoming meeting with Charles Curie, the new Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). On February 5 and 8, PI/PPO staff presented formal remarks on behalf of APA at the National Advisory Council meetings of SAMHSA and the Center for Mental Health Services, respectively.

To address the aftermath of the September 11^th terrorist attacks, PI-PPO staff have been working closely with both House and Senate offices across the political spectrum to ensure the availability of critically needed mental health services to those individuals directly and indirectly affected. PPO heightened its related advocacy efforts in support of increased federal funding for the mental health services block grant and for a program created by the Children's Health Act of 2000 that authorizes the Center for Mental Health Services (CMHS) to provide grants to address the problems of children and youth who experience violence-related stress. Letters were also sent to Congress in support of emergency disaster relief funds for the delivery of mental health, substance abuse, and related community support services in the directly affected areas (which have since been approved).

PI-PPO staff assisted the staff of Senators Edward Kennedy (D-MA) and John Warner (R-VA) in drafting statutory provisions for the Post Terrorism Mental Health Improvement Act (S. 1729) to increase mental health and community outreach services. PPO Public Interest and Education Policy staff collaborated in developing language to support graduate and in-service training programs for mental health professionals to respond to trauma and disasters, including a special initiative for the training of minority mental health professionals to aid children and youth. Following an unsuccessful, but valiant, effort to first attach the bill to the Department of Defense authorization bill, it was scaled down significantly to only include of these provisions the in-service training program for mental health professionals when passed by the Senate.

On a related front, PI-PPO staff, in consultation with Science-PPO staff, submitted comments in November to staff of Representative Edward Markey (D-MA) and the House Energy and Commerce Committee regarding a bill to serve as a companion to the Bioterrorism Preparedness Act of 2001 (S. 1715), which was introduced by Senators Bill Frist (R-TN) and Kennedy. Public Interest Policy staff suggested language to enhance provisions related to mental health and social science research to address preparedness, safety, public communications, and other relevant concerns. The references to mental health services survived the final House-Senate negotiations in December to decide upon the final form of the Bioterrorism Response Act (H.R. 3448).

In the past few years, the Substance Abuse and Mental Health Services Administration (SAMHSA) has provided increased support for programs that focus on the mental health needs of children and adolescents. The conference report for the FY 2002 appropriations bill for the Department of Health and Human Services (DHHS) provides $96.7 million for children's mental health services, an increase of $5 million above the President's request.

The mental health impact of the September 11^th terrorist attacks was clearly acknowledged by Congress. The conference report provides $20 million, twice the amount the previous year, to support programs that provide mental health services to children and youth suffering from posttraumatic stress disorder as a result of having witnessed or experienced a traumatic event.

PI-PPO staff helped the office of Rep. Patrick Kennedy (D-RI) in drafting the Child Mental Health Training Shortage Act to increase the number of well-trained child and adolescent mental health professionals providing clinical mental health care. The bill, which is to be introduced shortly, focuses primarily on pre-service training though the use of scholarships, grants, and loan repayment provisions, with an emphasis on training in the use of evidence-based methods. It also includes grants to institutions of higher education to expand or develop child mental health tracks.

The reauthorization of the Promoting Safe and Stable Families program, which funds family preservation, short-term counseling, and other services, was completed on December 13. The new legislation authorizes increased funding for current programs and adds two new provisions. The first is a grant program to support mentors for children of prisoners. The second permanently authorizes education and training vouchers for children leaving the foster care system when they reach 18. Total authorization for the Promoting Safe and Stable Families program will increase from $305 million to $505 million for FY 2002. This is a fulfillment of the President's campaign pledge to increase funds for the prevention of child abuse.

On a related front, APA member Joann Grayson, Ph.D. (James Madison University) testified on October 17 before the House Subcommittee on Select Education in support of the Child Abuse Prevention and Treatment Act (CAPTA), which was last reauthorized in 1996 and technically expired last year. As a leader of the National Child Abuse Coalition, APA continues to work with Congress on the CAPTA reauthorization, as well as advocating increased funding for other child maltreatment programs. Paramount among these is the Title XX Social Services Block Grant, which supports a range of child welfare, child protection, and family support services. The appropriations bill provided $1.7 billion for SSBG in FY 2002, a decrease of $25 million over the prior year.

In mid-December, both chambers of Congress approved a final version of the "No Child Left Behind Act" (H.R. 1/ S. 1), a bill to reauthorize and expand the Elementary and Secondary Education Act. PPO Public Interest and Education staff, together with Practice Directorate staff, worked intently with Rep. Brian Baird (D-WA) and the offices of Senators Tom Harkin (D-IA) and Thad Cochran (R-MS) to include "other qualified psychologists," along with school psychologists, as eligible to provide counseling services to students as part of the reauthorized and expanded Elementary and Secondary School Counseling Program. The term "Other qualified psychologist" is defined as "an individual who has demonstrated competence in counseling children in a school setting, and who: 1) is licensed in psychology in the state in which the person works, and 2) practices in the scope of the individual?s training and experience with children in school settings."

Among the other provisions advocated by PPO that were included in the final version of the law are: 1) certain provisions relating to fairness and quality in high stakes educational testing; 2) support for school readiness programs (e.g., home visiting and family counseling) for at-risk children from birth to age six; 3) a new grant program to better link schools to mental health service providers in the community; 4) separate authorizations for the Safe and Drug Free Schools Program and the 21st Century Community Learning Centers Program; 5) the retention of strong language relating to tolerance education and hate crimes prevention; and 6) provisions of the Women's Educational Equity Act (WEEA) that promote gender equity in education.

PPO successfully urged the conference committee members to reject the House- and Senate-passed ESEA amendments that dealt with discipline under the Individuals with Disabilities Education Act (IDEA) and instead consider those issues in the context of the upcoming reauthorization of that legislation. Yet, the other provisions opposed by APA that granted special equal access protections to the Boy Scouts of America (which itself discriminates against gay persons) and furthered local policies concerning "parental rights" for student receipt of school-based mental health services or participation in research studies were included in the law.

Legislation (S. 1174) sponsored by Senators Patrick Leahy (D-VT) and Orrin Hatch (R-UT) to reauthorize the Juvenile Justice and Delinquency Prevention Act (JJDPA) failed to pass through the Senate Judiciary Committee. This legislation included a new grant program for states to provide protection and services for youth in adult facilities. After discussions with Sen. Joe Biden (D-DE) and others, a substitute package was put forward that contained the Leahy bill in its entirety and two provisions from a previous bill sponsored by Sen. Biden, which included a $250 million authorization for the Title V local delinquency prevention program and language protecting 50 percent of Title V funds from earmarks (pet projects inserted into a bill by a member of Congress). Unfortunately, as several members wanted more time to look at the proposal, the bill was pulled from the agenda. Consequently, there has been no JJDPA reauthorization. Senate Majority Leader Thomas A. Daschle (D-SD) has stated that the juvenile justice bill will not get Senate floor consideration this year.

On December 21, as part of President Bush?s New Freedom Initiative, DHHS Secretary Tommy Thompson submitted to the President a preliminary report on ongoing efforts of federal agencies to implement the U.S. Supreme Court's ruling in Olmstead V. L.C. (98-536) of June 1999. The Court upheld the right of people with mental disabilities to have access to the "most integrated services" (e.g., community-based services), in compliance with the Americans with Disabilities Act. PI-PPO, in coalition with mental health and disability organizations, will continue to monitor the progress of federal agencies to eliminate barriers and promote community integration for individuals with disabilities.

Among its many provisions, the New Freedom Initiative calls for the creation of a National Commission on Mental Health "to study and make recommendations for improving America's mental health service delivery system, including making recommendations on the availability and delivery of new treatments and technologies for individuals with severe mental illness." On October 17, PI-PPO and Practice Directorate Government Relations staff met at the White House with Charles Curie (since confirmed as SAMHSA Administrator), Associate Director of Presidential Personnel, and a staff member with the President's Domestic Policy Council to discuss the mission of the National Commission and possible nominees for membership. APA staff followed up the meeting with a detailed letter, reiterating the need to utilize assessments of functional impairment in determinations of severe mental illness, extend the purview of the Commission beyond the issue of severe mental illness, and focus on prevention, early intervention, and supportive services for individuals with mental disability and their families.

While legislation to enable middle-income families of children with disabilities to "buy-in" to the Medicaid Program -- the Kennedy-Grassley Family Opportunity Act (S. 321/H.R. 300) -- received considerable support from both parties, the bill remains stalled at the Senate Finance Committee awaiting further action. The Senate bill has 75 cosponsors, while the House bill has 213 cosponsors. Although funding for the proposal was included in both the House and Senate Budget Resolutions ($7.9 billion over 10 years), the events of September 11^th so altered the economic forecast and the sudden change in the national agenda that consideration was postponed indefinitely. The 300 health, disability, consumer, and provider groups that support the bill continue to press for its passage. Most recently, APA signed onto coalition letters sent to the chairmen and ranking members of the House and Senate Budget Committees to secure funding in budget resolutions if it is passed this year.

PI-PPO staff are preparing for the upcoming reauthorization of the Individuals with Disabilities Education Act (IDEA). In particular, efforts is directed to working with congressional offices to improve language for the research and personnel training provisions of the IDEA. During the recent reauthorization of ESEA (see above), APA and other advocates were able to delay congressional consideration of the "discipline amendments," which would have allowed for the expulsion of certain children with disabilities. PI-PPO staff will monitor this contentious issue and the consideration of full funding of the federal share of IDEA in the coming year.

On January 30, Gwen Puryear Keita, Ph.D., Director of the APA Women's Programs Office, spoke about women's mental health at the congressional briefing, A Profile of Women's Health: An Agenda for Change, sponsored by the Henry J. Kaiser Family Foundation and Women's Policy, Inc., in cooperation with the Congressional Caucus for Women's Issues. PI-PPO staff had advocated for the inclusion of a women's mental health focus at the briefing and for Dr. Keita's participation. To view Dr. Keita's statement, along with a transcript and webcast of the briefing, please go to the PPO Web site, http://www.apa.org/ppo/issues/pwomen.html and click on the briefing.

Upon the invitation of staff of Senator Richard Durbin (D-IL), PPO Public Interest and Science Policy staff developed and submitted comments in October concerning the "Melanie Stokes Postpartum Depression Research and Care Act" (S. 1535), a bill to provide for research on, and services for individuals with, postpartum depression and psychosis. The PPO comments focused on provisions for behavioral research and mental health services. The bill has since been referred to the Senate Health, Education, Labor, and Pensions Committee for consideration. In addition, Representative Bobby Rush (D-IL) chaired a Congressional Black Caucus workshop on postpartum depression in September. APA member Rhonda Boyd, Ph.D. (Children's Hospital of Philadelphia) presented on the impact of postpartum depression on African American children.

The 1996 "Personal Responsibility and Work Reconciliation Opportunity Act," which established the Temporary Assistance to Needy Families (TANF) block grant, expires on September 30. In anticipation of the reauthorization process, DHHS published a solicitation for comments to this welfare reform law in the Federal Register on October 17. PI-PPO and Women's Program Office staff submitted a nine-page letter in response, highlighting the multiple barriers to self-sufficiency faced by many women as they transition from welfare to work, including mental health, substance abuse, and domestic violence problems. On a related front, PI-PPO assisted staff of Rep. Patsy Mink (R-HI) in drafting the "TANF Reauthorization Act of 2001" (H.R. 3113) by submitting language to enhance the availability of mental health and substance abuse services for women leaving the welfare rolls. This bill now has 50 cosponsors and has been referred to the House Ways and Means Subcommittee on Human Resources for further consideration. PI-PPO staff represent APA on a number of coalitions that will be advocating for changes in TANF to help reduce poverty and enable women and their families to achieve self-sufficiency.

A continuing focus of PI-PPO efforts has been to secure additional funding for the Minority Fellowship Program (MFP) at SAMHSA. Public Interest Policy staff have been working closely with staff of Senator Kennedy to expand the MFP to include a new PPO-developed program that would encourage minority mental health professionals to pursue careers serving children and adolescents. PI-PPO staff are hopeful that the FY 2002 funding increase for SAMHSA Programs of Regional and National Significance will translate into enhanced support for the MFP.

The Indian Health Service (IHS) provides health care, including mental health and substance abuse services, to American Indians and Alaska Natives (AI/AN). PI-PPO staff continue to work with members of Congress and the Friends of Indian Health to secure additional funding to support effective suicide prevention programs in AI/AN country. There is a great need for such services, given that suicide is the second leading cause of death for 15- to 24-year-old American Indians and Alaska Natives. More specifically, the suicide rate for this age group is nearly triple that for all races (i.e., 31.7 versus 13.0 per 100,000).

In the FY 2002 appropriations bill, there are allocations for Indian health professions training of $50,000 each for the Indians into Psychology (InPsych) programs at the University of North Dakota and the University of Montana.

PI-PPO staff have been providing assistance to the Senate Indian Affairs Committee on sections of a bill to reauthorize the Indian Health Care Improvement Act. These programs include prevention and intervention programs for Indian women and youth, along with treatment and prevention programs for fetal alcohol syndrome. Though the Committee held hearings on the bill (S. 212), no further action has yet been taken.

PI-PPO staff have also been actively involved in advocating for hate crimes legislation through membership in the Hate Crimes Coalition. Specifically, the passage of the "Local Law Enforcement Enhancement Act" was a focus for 2001, but unfortunately was not enacted. Efforts are being made to have the bill reconsidered during this session of Congress. In light of the reported increase in hate crimes after September 11th, the APA publication, Hate crime today: An age-old foe in modern dress, is being updated to reflect the changing environment.

The response of the APA Committee on Psychology and AIDS (COPA) and other interested APA members to a PPO Action Alert in November helped garner increases in HIV/AIDS funding in FY 2002. The Ryan White Care Act received $1.8 billion, an increase of $110 million. The AIDS Drug Assistance Program was increased by $50 million over last year. Additionally, the Labor-HHS-Education appropriations bill provides $7 million for the Minority HIV/AIDS initiative at the Center for Mental Health Services.

PI-PPO staff advocated successfully for increased FY 2002 appropriations for the overall budget for SAMHSA, as well as for targeted programs in such areas as child mental health and HIV/AIDS. PI-PPO staff were also very pleased that the appropriations bill included $3 million to create a National Suicide Prevention Resource Center, whose goal will be to provide technical assistance in developing, implementing, and evaluating effective suicide prevention programs. The establishment of this center was one of Public Interest Policy's legislative goals for FY 2002.

With other members of the Mental Health Liaison Group, PI-PPO staff met with White House Office of Management and Budget (OMB) examiners on November 29 to make the case for an increased FY 2003 budget allocation for SAMHSA. Yet, the President's proposed budget failed to meet our expectations. The President has requested an additional $126 million for the Center for Substance Abuse Treatment to reach out to the 3.9 million drug users (as indicated by national survey data) who do not receive treatment and thereby reduce the "substance abuse treatment gap." However, this increase comes at the expense of the other two SAMHSA centers in the way of a $45 million cut for the Center for Substance Abuse Prevention and a mere $212,000 increase for the Center for Mental Health Services. Overall, the $3.197 billion slated for SAMHSA in the President?s budget reflects just a 1.8 percent increase of $57 million over the FY 2002 level. For more information on the administration's proposed funding for mental health and substance abuse services, please visit the PPO Web site funding page: http://www.apa.org/ppo/funding/fedapprops.html

APA's CEO and three staff (including the PI/PPO director) were granted VIP status at the February 6th farewell tribute to Surgeon General David Satcher, which was held at the National Institutes of Health and attended by over 800 people. (APA had earlier offered to host a reception in honor of the Surgeon General, which he declined in anticipation of this event.) As a means to publicly recognize the Surgeon General, a formal APA letter of appreciation (drafted by PI-PPO staff) was sent to him and an OP ED piece was prepared highlighting his many contributions to the mental health field (including squarely placing mental health in the public health arena). PI/PPO staff worked with APA's Executive Director for Public and Member Communications in developing the OP ED, which received an enthusiastic response from the Surgeon General's office and is currently being marketed to major media outlets.

On September 13, PI-PPO staff had the pleasure of meeting then SAMHSA Administrator-designate Charles Curie at a meeting of the Mental Health Liaison Group. (Curie was confirmed by the Senate in late October.) As follow-up to this meeting, PI-PPO staff arranged an official APA welcoming meeting for Curie held on January 16, which was attended by APA CEO Raymond Fowler, Ph.D., the PI-PPO director, and five other APA staff members. The purpose of the meeting was to begin a dialogue with him about SAMHSA and APA programs and priorities. On February 5 and 8, PI/PPO staff presented formal remarks on behalf of APA at the National Advisory Council meetings of SAMHSA and the Center for Mental Health Services, respectively.

The Oregon Death with Dignity Act, which enables doctors to prescribe, but not administer, potentially lethal drugs to terminally ill patients, has sparked many debates across the nation about assisted suicide, pain management, and other issues surrounding end-of-life care. Most recently, in November, U.S. Attorney General John D. Ashcroft ordered the Drug Enforcement Agency (DEA) to monitor and punish doctors who prescribe, dispense, or administer federally controlled substances to terminally ill patients for a hastened death or "assisted suicide." A federal judge has put the Justice Department order on hold pending litigation filed by terminally ill patients.

Several bills regarding end-of life issues were introduced in Congress but not acted upon in 2001. Most notably, Senator Ron Wyden (D-OR) reintroduced the Conquering Pain Act (S. 1024) to respond to the public health crisis of pain, which reflected PI-PPO efforts to expand the focus on mental health professionals and psychosocial issues. PI-PPO staff are monitoring these legislative and executive branch initiatives and are prepared to respond accordingly should Congress or the administration consider end-of-life care in a regulatory or legislative proposal.

PI-PPO staff also contributed to the development of a two-day conference on end-of-life care issues sponsored by the Society for the Psychological Study of Social Issues (SPSSI, Division 9 of APA) held in Cleveland, Ohio, on February 2 and 3. The conference focused on psychosocial issues in end-of-life research, policy, and practice. For more information, please visit the PPO Web site on end-of-life care at: http://www.apa.org/ppo/issues/eolcare.html

The four APA Congressional Fellows for 2001-2002 began their tenure on Capitol Hill during an unprecedented session of Congress in a post September 11th environment plagued by threats of terrorism and anthrax contamination. They currently work with the following members of Congress and/or congressional committees: Tamara Jackson, Ph.D., with Sen. Jeff Bingaman (D-NM); Richard McKeon, Ph.D., M.P.H., with Sen. Paul Wellstone (D-MN); Rick Ostrander, Ed.D., with Rep. Pete Stark (D-CA); and David O'Neil Washington, Ph.D., M.L.S., with the majority staff of the Senate Health, Education, Labor, and Pensions Committee chaired by Sen. Edward Kennedy (D-MA). As this coming year will undoubtedly prove challenging to policymakers, it is reassuring that mental health experts are learning first-hand how policy is formulated and how psychologists can participate effectively in this process. PI-PPO staff are now coordinating the association-wide effort to select APA members for the 2002-2003 Fellowship year.

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