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Stuart Gordon on Getting the Mental Health Field Upstream Through Crisis Services Mental Health Block Grant Set-Aside

Stephanie Hepburn is a writer in New Orleans. She is the editor in chief of #CrisisTalk. You can reach her at​

Stuart Gordon, J.D., director of Policy and Communications at the National Association of State Mental Health Program Directors (NASMHPD), says it’s time that mental health move upstream, allowing people to get the services they need far earlier. “What we are experiencing in mental health is like the parable of babies in the river. We focus on pulling babies out of the river, but no one is going upstream to get to the core of the problem, stopping them from falling into the river in the first place.” Unfortunately, behavioral health crises are on the rise. In March, Trust for America’s Health and Well Being Trust released their analysis of mortality data from the U.S. Centers for Disease Control and Prevention (CDC), stating that more than 150,000 Americans died from drug- and alcohol-induced causes and suicide in 2017, with 31 percent (47,173) having died by suicide. “Behavioral health crises killed more than twice as many Americans in 2017 than a decade ago.” The trouble, says Gordon, is that intervention often doesn’t happen before people are thrown into the deep-water criminal justice or Emergency Department (ED) hospital system.

Gordon says a way to get the mental health profession to move upstream is through the Crisis Services Mental Health Block Grant set-aside, which is designed to fund crisis services, diverting people from these complex and traumatizing systems. The House of Representatives approved a Mental Health Block Grant increase of $35 million on June 19th, as part of a “minibus” of spending measures combining money for various agencies for Fiscal Year 2020, including the Substance Abuse and Mental Health Services Administration (SAMHSA) as part of the Department of Health and Human Services. The 5 percent Block Grant increase, if approved by the Senate, would be used for a set-aside for evidence-based crisis care programs to address the needs of people with Serious Mental Illness (SMI) and children with Serious Emotional Disturbance (SED). The funds would enable states to realize Crisis Now strategies that the Crisis Services Task Force of the National Action Alliance for Suicide Prevention (Action Alliance) recommends, which are shown to be highly effective in improving care and reduce costs. “The Crisis Services Mental Health Block Grant set-aside would divert people in mental health crisis from EDs, reducing ED boarding, and from the criminal justice system. It also integrates first responders, including police, fostering collaboration between stakeholders to serve the community, providing people with the services they need, at the speed they need them, and matching people with the appropriate level of care.”

Gordon and his colleagues at NASMHPD, along with allies at American Psychiatric Association and the D.C.-based Mental Health Liaison Group of more than 70 advocacy organizations, made recommendations on language that should be included in the bill, which has garnered support from policymakers as well as behavioral health organizations and advocates across the United States. He says the Committee on Appropriations attached a report to the bill that directs SAMHSA to use the $35 million to fund core crisis care elements. This is at the discretion of eligible states and territories and includes centrally-deployed 24/7 mobile crisis units, short-term residential stabilization beds, and evidence-based protocols for providing services for people with suicide risk. It also includes regional or state-wide crisis call centers that coordinate in real-time. The committee further directs SAMHSA to include a detailed table in the Fiscal Year 2021 budget that lists, at a minimum, state allotments as well as the name and short description of the funded programs. 

The Crisis Services Mental Health Block Grant set-aside language was modeled on the successful proposal by the National Alliance on Mental Illness (NAMI) in 2014 for Congress to provide a set-aside within the Community Mental Health Block Grant for states to address first episode psychosis. Initially, for the Fiscal Year 2015, Congress told states to set-aside 5 percent of the grant for early psychosis programs; Congress doubled the set-aside to 10 percent the following year. Gordon recommended language for the Crisis Services Mental Health Block Grant set-aside to ensure that states implement some or all of the previously listed crisis services. The final language didn’t mention Crisis Now but did include it’s key continuum elements. “We hope to have a similar set-aside scaling for crisis services, starting at 5 percent and increasing to 10 percent.” Gordon says there was a tactical difference between the first episode psychosis language and this one. “Our members made clear that the types of crisis services can’t be mandated because they want states to have flexibility.”

Currently, the bill is in the Senate, which Gordon says will likely have a lower ceiling for domestic spending than the House. “By September, if not earlier, we hope to know whether the Senate has passed the spending measure, and I don’t think its consideration will stretch into 2020, as spending bills have frequently done.” 

Individuals and groups interested in encouraging the U.S. Senate to include the set-aside in Senate spending should contact the members of the Senate Appropriations Labor-HHS Subcommittee or their U.S. Senators once this Labor-HHS spending has been moved to the Senate floor.

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