Who Is Making the Rules for Our Mental Health Care?

Tiffany Kaszuba

Tiffany Kaszuba, Vice President Cavarocchi Ruscio Dennis Associates
Manager to the Coalition for Health Funding

We advocate for our own medical care, we advocate to our senators and representatives for laws to improve mental health care, but are we reaching everyone who has a say in mental health care policy and delivery? In fact, most policy is developed, implemented, and enforced by regulatory agencies; there are at least a half-dozen federal agencies charged with aspects of addressing mental health.

Over the next few weeks, we’ll explain the structure and roles of some of these agencies and their programs, including how they are funded. After all, if we are advocating for improvement in the mental health care system, we need to understand what works (and what doesn’t) and what it costs.

Public health is the science and art of protecting and promoting health in communities where we live, work, and learn. Federal investment in public health dates back to 1798 when Congress first authorized the Marine Hospital Service to deliver care to the merchant seamen who were disproportionately affected by disease. Today, the Public Health Service is led by the Office of the Secretary and comprised of 11 operating divisions—including the eight agencies authorized by the Public Health Service Act and three human services agencies.

Role of the Department of Health and Human Services
The activities supported by the Public Health Service are such a part of daily living they are often invisible and almost always taken for granted. The federal agencies and programs of the Department of Health and Human Services (HHS) work in partnership with state and local governments, universities, hospitals and health centers, charitable organizations, private industry, and each other to

  • Assure the safety of our food, water, drugs, and environment
  • Protect, respond, and rebuild in times of crisis
  • Prevent and treat disease and disability
  • Promote well-being and responsible choices
  • Educate the next generation of health professionals and scientists
  • Provide our nation’s most vulnerable populations access to basic care.

As can be seen, these contributions are all critical to the health and well-being of all Americans. In fact, many of the federal health agencies at HHS typically play a role in addressing any health concern. In the case of mental health

  • The National Institutes of Health invests billions of dollars each year into research to help us better understand how the brain works, what triggers mental health problems, and what treatments can be used to address mental health issues.
  • The Substance Abuse and Mental Health Administration supports a strong substance abuse and mental health workforce and assists communities in providing treatment and prevention to those in need.
  • The Indian Health Service provides healthcare services to native tribes, whose people suffer disproportionately from mental health ailments.
  • The Food and Drug Administration assures that treatments and drugs are both safe and effective for patients.
  • The Agency for Healthcare Research and Quality also contributes to the mental health of the nation by ensuring that care is safe, effective, efficient, and appropriate.
  • The Centers for Disease Control and Prevention monitor mental health trends and help identify strategies to promote strong mental health in communities across the nation.

Funding Public Health Service agencies
Protecting the mental health of the nation is far from a one-agency job. It requires all of these agencies, working in concert, to detect and respond to public mental health threats, enhance knowledge through scientific discovery, and ensure access to health services and the professionals who deliver them.

It also requires that these programs be adequately funded. However, unlike mandatory programs like Medicare and Social Security, money for the Public Health Service agencies, must be appropriated annually by Congress. This means that the number of research projects that can be completed, the number of drugs that can be reviewed for safety and efficacy, the number of clinics that can be supported, the number of public health professionals that can be trained, and the number of patients that can be treated by these agencies is dependent upon how Congress decides to distribute funding. In recent years, health programs have not fared well as austerity and policy riders have threatened funding for new and old initiatives. Stay tuned as we learn more about the precarious funding of mental health care.

Your Turn

  • How much of your mental health care do you believe is directly affected by the funding levels of federal agencies?
  • What can you do to make sure your voice is heard at these agencies?

Tiffany Kaszuba is a Vice President at Cavarocchi Ruscio Dennis Associates and serves as Manager to the Coalition for Health Funding—an alliance of 90 nonprofit organizations fighting to protect funding for the public health continuum. In her role with the Coalition, Tiffany writes a daily newsletter on budget and appropriations and has managed the production of reports on the effects of budget cuts on health programs.

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