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APA Testimony on Fiscal Year 2005 Appropriations for DHHS Written Testimony of Norman Anderson,
PhD Submitted to the Fiscal Year 2005 Appropriations for the Department of Health and Human Services The American Psychological Association (APA) is the largest professional society of psychologists in the world, with 150,000 members and affiliates. APA promotes psychology as a science, a practice, and a means of promoting health and human welfare. APA members work in a variety of roles-- as scientists conducting behavioral research funded by NIH and other Public Health Service agencies, as providers of health and mental health services through hospitals and other community settings, and as students or professors at our nation's colleges and universities. Many of the programs funded through the Labor-Health and Human Services-Education appropriations bill are of concern to APA members. Below are APA recommendations that were summarized by CEO Norman Anderson in public witness testimony on April 20, 2004. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services
Administration (SAMHSA) Minority Fellowship Program. Recent reports by the Institute of Medicine and the President's New Freedom Commission on Mental Health concluded that strong efforts need to be made to recruit, retain, and enhance an ethnically, culturally, and linguistically competent mental health workforce throughout the nation. Given the high cost of graduate education, federal support for the Minority Fellowship Program, which trains minority mental health professionals, is vital to ensure that minorities have access to culturally sensitive, effective mental health services. Accordingly, APA recommends that SAMHSA be provided sufficient funds to double the MFP budget to $6 million in Fiscal Year 2005. HIV/AIDS. It is critical to continue grant support for community-based providers operating in traditional and non-traditional settings who offer direct mental health services to racial and ethnic minorities suffering from HIV/AIDS. It is also essential to treat associated mental health problems, including dementia and depression, and the chronic, progressive neurological disabilities that often accompany HIV/AIDS. Persons with HIV/AIDS and co-occurring disorders present unique, unmet treatment needs necessitating specialized training. Providing $3 million for training professionals to provide integrated mental health and substance abuse services will fill a critical gap in our mental health system. Child Mental Health Services. APA strongly recommends $113 million for the Comprehensive Community Mental Health Services for Children and their Families Program to develop and evaluate mental health services for children and youth, and to further expand this program into new states and localities. Also, APA recommends $30 million for Targeted Capacity Expansion activities to develop and implement empirically based models for prevention and early intervention for children's mental health and substance abuse problems. APA recommends $125 million for the Safe Schools/Healthy Students Program to continue developing empirically supported programs to prevent youth violence, to intervene with families, schools, and communities where violence has occurred, and to expand the program into all 50 states. APA also urges the Subcommittee to provide $25 million for the Children's Traumatic Stress Initiative to continue developing research and services to address children's responses to traumatic events and to establish a National Center on Child Traumatic Stress. Older Adult Mental Health Services. People 65 years of age and older are the fastest growing segment of the U.S. population. The number of older adults with mental and behavioral health disorders will almost quadruple from 4 million in 1970 to 15 million in 2030 -- a 275% increase. Disorders such as anxiety, depression, and cognitive impairment adversely affect the physical health and ability to function of older adults. APA strongly urges the Subcommittee to retain funding for the grant program supporting mental health outreach and treatment -- the sole source of CMHS funding specifically for mental health services for older Americans. Centers for Disease Control and Prevention (CDC) Our nation faces increasingly diverse health threats from terrorism to emerging infectious diseases to violence. NCIPC is a critical component of CDC's mission as a "health protection agency," supporting public health programs that save lives. APA urges the Subcommittee to provide an increase of $30 million over FY 2004 for NCIPC to strengthen the capacity of state and local health agencies to prevent injury and support extramural public health programs to conduct research and to translate science into practice. Violence Against Women. APA supports increased research on the psychological sequelae of violence against women and expanded research on special populations, including adolescents, older women, ethnic minorities, and women with disabilities. Suicide Prevention. The President's New Freedom Commission on Mental Health states, "Suicide is a serious public health challenge that has not received the attention and degree of national priority it deserves." Suicide was the 11th leading cause of death in the United States in 2000, accounting for more deaths than from homicide or HIV/AIDS. Of great concern are the high suicide rates among certain racial and ethnic minorities, young people, and older adults. APA urges the Subcommittee to provide an increase of $5 million over the FY 2004 budget of $2.7 million for suicide prevention research and demonstration projects to examine risk and protective factors and to identify promising and effective suicide prevention strategies. National Violent Death Reporting System (NVDRS). APA urges the Subcommittee to provide an increase of $10 million over FY 2004 for NVDRS to allow approximately 20 additional states to be funded to gather and share state-level data about violent deaths. This state-based system collects data from medical examiners, coroners, police, crime labs, and death certificates to understand the circumstances surrounding violent deaths in order to develop, inform, and evaluate violence prevention programs. Health Resources and Services Administration Graduate Psychology Education (GPE) Program. Funding in the amount of $6.5 million for FY 2005 is requested to continue the Graduate Psychology Education (GPE) Program that was established in Fiscal Year 2002. GPE is the first and only federal program that supports psychology education and training. The GPE funding is awarded through a competitive grant process to train health service psychologists enrolled in APA accredited programs (doctoral, internship, and postdoctoral) to work with other health professions in the provision of health care services to underserved populations, especially in rural and urban communities, including the elderly, children, the chronically ill, and victims of abuse and trauma. Flat-funding at the FY 2003 and 2004 level of $4.5 million would allow only for con-tinuation funds for the approximate thirty projects, including the seven geropsychology training grants on a three year cycle that began in FY 2003 and the new projects from FY 2004 that have not yet been announced. The additional $2 million would allow for a new competition for hundreds of interested universities and training sites (i.e., Veterans Ad-ministrations, children's hospitals, academic science centers and public health facilities). There is a demonstrated need for mental and behavioral health professionals, especially psychologists, in our nation's underserved communities. According to the Health Resources and Services Administration, there are now over 900 Mental Health Professional Shortage areas throughout the nation (Winter 2004). [These are only the communities that requested designation; there are many more.] At the same time, there is a serious need to improve the uneven geographic distribution of the mental and behavioral health workforce and to increase the availability of appropriately trained psychologists for underserved populations. The provision of psychological services by health service psychologists is an essential component of a "seamless system" of health care, one that is comprehensive, preventive and cost-effective. Health service psychologists have developed and provided evidence-based services in the prevention, diagnosis, treatment and rehabilitation of a wide range of health problems, including mental health disorders. For example, health service psychologists provide treatments to (1) promote adherence to medical regimens, (2) decrease behavioral health risk factors (e.g., smoking, overeating, unsafe sex, sedentary lifestyle), (3) manage phys-ical problems such as pain and urinary incontinence, (4) prepare patients for stressful medical procedures, (5) promote responsible self-management in health care, (6) foster rehabilitation from illness and injury, (7) facilitate coping with illness and threat, and (8) treat psycho-physiological disorders (e.g., headache, irritable bowel syndrome). In addi-tion, health service psychologists provide diagnostic and treatment services for many mental health disorders, as well as crisis intervention and health promotion services. Geropsychologists apply psychological research and practice to help older persons and their families overcome problems, maintain wellbeing, and achieve maximum potential during later life. They use behaviorally-based treatments for depression, anxiety and for managing cognitive impairments, including Alzheimer's disease. Further, as many older adults experience multiple health conditions, non-pharmacological treatments offer an effective alternative without the risks inherent in prescribing numerous medications. Geropsychologists use psychosocial interventions to address many of the stressors that impact older adults such as decline in health, loss of loved ones, and relocation to a new living situation. Interventions include strengthening coping mechanisms, encouraging adherence to medical regimens, managing health problems and increasing behaviors that promote health. Participation in memory training programs improves memory performance in older adults. Psychological interventions also impact on the physical health of older adults. For example, persistent mild depression can lower immunity and may compromise a person's ability to fight infections and cancers. Behavioral and psychological treatment methods are successful in reducing insomnia without the adverse effects from sleep medication to which older adults are especially vulnerable. Behavioral interventions to treat incontinence are also often more effective than medication and have significant implications for the individual and his/her family, since incontinence is the second most common reason for admission to nursing homes. National Institutes of Health Behavioral research is key if our nation is to make additional progress on problems such as obesity, smoking, and substance abuse. We can't rely only on medications to improve our nation's health and quality of life, but also need to develop the knowledge to enhance the individual's own ability and desire to make healthy choices. Beyond increasing op-portunities for clinical research on these health problems, however, NIH must maintain a commitment to support basic behavioral research. Basic research conducted by psychologists with NIH support is the foundation for much of what we know about how the brain affects behavior, how humans learn and develop, how the memory works, and how the social environment affects behavior. Basic Research. Although all basic research is foundational and not disease-specific, it is necessary if we are to understand and make progress against illnesses. Basic research in bio-behavioral, cognitive, personality, emotional, and social processes that underlie behavioral functioning are important areas of research that are applicable to the prevention, diagnosis, and treatment of mental disorders. For example, basic psychological research on the nature of emotions helps us to understand the role of emotions in the development of mental illnesses like depression, bipolar disorder, and severe anxiety. Basic research that identifies psychological or behavioral factors that place individuals at risk for mental illnesses, or that help protect them from such illnesses, increase our ability to develop better treatment and prevention approaches. For this reason, APA has been urging that NIMH not redirect the funds it now invests in basic behavioral research. Similarly, APA has joined with other scientific societies to urge that the National Institute of General Medical Sciences, the basic research institute at NIH, develop a program in basic behavioral research. We are pleased that NIH Director Zerhouni has asked for a review of basic behavioral research at NIH and look forward to discussing those findings with you when they are developed this fall. Sexual health. Mr. Chairman, some in Congress have raised concerns about sexual health research funded by NIH-however, APA supports NIH's decision to conduct research on the numerous sexual health issues that humans encounter as they develop and age. Difficulties in sexual arousal are connected to infertility, heart disease, diabetes, and depression. High-risk sexual behaviors exacerbate the public health challenges of HIV/AIDS and other sexually transmitted diseases. The 2001 Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior recognized that sexual health is a public health issue. The report explicitly calls for additional federal investments in basic research in human sexual development, sexual health, reproductive health, as well as social and behavioral research on risk and protective factors for sexual health. Fortunately, NIH has taken on the task of funding this type of research. It is our hope that through educational efforts such as that undertaken by the Coalition to Protect Research, members of Congress who worry that research on sex is less important or urgent than research on other issues will come to see its importance and necessity. We encourage the House Appropriations Committee to resist efforts to limit NIH's ability to fund research on such important public health issues as HIV/AIDS, pregnancy and fertility, and adolescent risk taking. Our members are grateful for the strong support this Committee has given to NIH over the years, and expect the investment to pay dividends for years to come. We urge the Subcommittee to work toward providing a ten percent increase for NIH this year. U.S. DEPARTMENT OF EDUCATION Mental Health Support in Regular and Special Education. APA strongly urges the Subcommittee to provide $35 million for the Elementary and Secondary School Counseling Program, which offers much-needed resources to schools that promote child well being, academic achievement, and a more positive school environment. Full funding for the Individuals with Disabilities Education Act (IDEA) is also critically needed. This program ensures students with disabilities a free, appropriate public education and assists about 12 percent of public school students. APA recommends that the Subcommittee provide $100 million for Research and Innovation programs funded under IDEA National Activities (Part D) to support the development and evaluation of empirically-based practices to address the needs of children in special education, as well as research on early intervention programs for students with behavioral disorders at risk of requiring more intensive special education services. In addition, APA requests $100 million for Personnel Preparation under IDEA to increase the emphasis on training of related services providers, who provide vital assistance to enhance children's educational progress and are in short supply in many schools. Education Research. The Institute of Education Sciences is playing a crucial role in bringing the most effective science of learning into the classroom. Psychological scientists continue to make new discoveries in cognitive, developmental, educational science and neuroscience that will improve student performance. Psychological research that focuses on the key processes of attention, memory, and reasoning are essential for learning and are likely to produce substantial gains in academic achievement. While there is a great deal of research on teaching children to read, additional research is needed to increase our knowledge of how children best learn mathematics and scientific concepts. Thank you again for the opportunity to submit recommendations for Fiscal Year 2005. |
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