Office of Management and Budget

Improving Mental Health Prevention and Treatment Services

The President’s Fiscal Year 2014 Budget demonstrates that we can make critical investments to strengthen the middle class, create jobs, and grow the economy while continuing to cut the deficit in a balanced way.

The President believes we must invest in the true engine of America’s economic growth – a rising and thriving middle class.  He is focused on addressing three fundamental questions: How do we attract more jobs to our shores? How do we equip our people with the skills needed to do the jobs of the 21st Century? How do we make sure hard work leads to a decent living?  The Budget presents the President’s plan to address each of these questions.

To make America once again a magnet for jobs, the Budget invests in high-tech manufacturing and innovation, clean energy, and infrastructure, while cutting red tape to help businesses grow.  To give workers the skills they need to compete in the global economy, it invests in education from pre-school to job training.  To ensure hard work is rewarded, it raises the minimum wage to $9 an hour so a hard day’s work pays more. 

The Budget does all of these things as part of a comprehensive plan that reduces the deficit and puts the Nation on a sound fiscal course.  Every new initiative in the plan is fully paid for, so they do not add a single dime to the deficit.  The Budget also incorporates the President’s compromise offer to House Speaker Boehner to achieve another $1.8 trillion in deficit reduction in a balanced way.  When combined with the deficit reduction already achieved, this will allow us to exceed the goal of $4 trillion in deficit reduction, while growing the economy and strengthening the middle class.  By including this compromise proposal in the Budget, the President is demonstrating his willingness to make tough choices and his seriousness about finding common ground to further reduce the deficit. 

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The President is committed to increasing access to mental health treatment and ensuring mental health parity.  The Budget builds on the promise of mental health parity by expanding access to services, supporting research, and ensuring care for our veterans.  The 2014 Budget will:

Expand Access to Mental Health Treatment by Implementing the Affordable Care Act.  The FY 2014 Budget includes resources for the timely and effective implementation of the Affordable Care Act, which will expand mental health and substance use disorder benefits and parity protections for 62 million Americans.  Of that group, 32 million individuals who currently have no mental health or substance use disorder benefits will gain them due to the Affordable Care Act.  Beginning in 2014, the Affordable Care Act will provide access to quality health care that includes coverage for mental health and substance use disorder services. All new small group and individual private market plans will be required to cover mental health and substance use disorder services as part of the health care law’s Essential Health Benefits categories, and mental health benefits will be covered at parity with medical and surgical benefits.  Also in 2014, insurers will no longer be able to deny anyone coverage because of a pre-existing mental health condition.  The Affordable Care Act has already ensured that new health plans cover recommended preventive benefits without cost sharing, including depression screening for adults and adolescents, and behavioral assessments for children.

Strengthen Medicaid.  Medicaid is currently the largest funder of mental health services in the country.  The 2014 Budget maintains support for millions of Americans who already have mental health coverage through Medicaid. In light of the Supreme Court’s decision to make the Medicaid expansion voluntary, the 2014 Budget focuses on sensible, targeted, reforms to make the program more efficient as States expand coverage, and does not include several Medicaid savings proposals included in the 2013 Budget. 

Ensure Mental Health Parity.  In January 2013, the Department of Health and Human Services (HHS) issued a guidance letter to state health officials making clear how Medicaid plans must comply with mental health parity requirements.  Later this year, the Administration will issue final regulations governing how existing group health plans that offer mental health services must cover them at parity with medical and surgical benefits as required under the Mental Health Parity and Addiction Equity Act of 2008.

Expand Mental Health Treatment for Youth and Families. The Budget includes a new $130 million initiative to help teachers and other adults recognize signs of mental illness in students and refer them to help if needed, support innovative state-based programs to improve mental health outcomes for young people ages 16-25, and train 5,000 more mental health professionals with a focus on serving students and young adults. 

Create Safer School Climates. The FY 2014 Budget includes $50 million to help 8,000 schools implement evidence-based behavioral practices to improve school climate and behavioral outcomes for all students.  This initiative will scale up a framework that has been shown to reduce problem behaviors, decrease bullying and peer victimization, improve the perception of school as a safe setting, and increase academic performance.

Help Schools Address Pervasive Violence.  To help schools in communities with pervasive violence break the cycle of violence, the FY 2014 Budget includes $25 million in grants to school districts to address the trauma of children who are exposed to or victims of violence, and implement conflict resolution and other school-based violence prevention strategies.

SupportResearch on Mental Health.  The FY 2014 Budget will support approximately $2.3 billion in mental health research funded by several NIH Institutes and Centers. The Budget funds research that aims to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. For example, the Budget supports the BRAIN Initiative to develop technology to explore how the brain processes information and explore the complex linkages between brain function and behavior.  This knowledge will help answer fundamental questions about brain function and behavior, which may help develop new tools to treat conditions such as depression and schizophrenia. 

Improve Mental Health Preventions and Treatment Services. The FY 2014 Budget includes over $1 billion for mental health programs, including the $460 million for the Community Mental Health Services Block Grant. This block grant provides States flexible funding to maintain community based mental health services for children and adults with serious mental illnesses, including rehabilitation, supported housing, and employment opportunities.

Provide Mental Health Services in Community-Based Health Centers. The 2014 Budget includes $3.8 billion for Health Centers, including Affordable Care Act funding. Nearly 70 percent of HRSA-supported health centers provide mental health counseling and treatment, almost 40 percent provide substance abuse counseling and treatment, and close to 20 percent offer 24-hour crisis intervention services. All health centers provide referrals to substance abuse and mental health services. About 4,000 mental/behavioral health providers work in health centers.

Improve Incentives for Mental Health Providers to Practice in the Communities that Need them Most.  Between 2008 and 2012, with funding from the Affordable Care Act and other sources, the size of the National Health Service Corps nearly tripled.  The National Health Service Corps offers loans and scholarships to health care providers who commit to practicing in those areas of the country that need them most.  The FY 2014 Budget includes $305 million in Affordable Care Act funding to support primary care providers, and psychologists, clinical social workers, counselors and marriage and family therapists.

Improve Access to Mental Health Care for American Indians and Alaska Natives (AI/AN).

The FY 2014 Budget includes $80 million for community-based mental health programs for AI/ANs that provide vital outpatient mental health counseling, case management services, and community-based prevention and health education services.

Ensure Mental Health Care for Veterans and Active Duty Service Members.  The FY 2014 Budget supports the Administration’s efforts to improve the quality of and access to mental health care services within the military and veterans communities, including the following activities:

  • Supporting continued implementation of the President’s August 31, 2012 Executive Order that directs VA, DOD, and HHS, to take a number of steps to ensure that veterans, service-members, and their families receive the mental health services and supports they need. These steps include strengthening suicide prevention efforts across military and veteran communities; enhancing access to mental health care by building partnerships between VA and community providers; increasing the number of VA mental health providers serving our Veterans; and promoting mental health research and development of more effective treatment methodologies.
     
  • Further improving the delivery of mental health care within the Department of Veterans Affairs (VA) by providing enhanced mental health services, expanding access through increased staffing and longer clinic hours, and increasing tele-mental health capabilities.
     
  • Providing specialized VA mental health treatment and proactively screening veterans to identify those who may have symptoms of depression, Post Traumatic Stress Disorder (PTSD), problem use of alcohol or who have experienced military sexual trauma (MST).
     
  • Establishing within the Department of Defense (DOD) additional Mental Health National Intrepid Centers of Excellence (NICoE) dedicated to providing cutting-edge evaluation, treatment planning, research, and education for service members and their families dealing with complex psychological health conditions.
     
  • Enhancing the delivery of DOD’s mental health services, including increasing the number of mental health care providers in its programs, embedding more mental health providers in front line units, adding mental health providers to patient-centered medical homes, and developing outreach programs to combat the stigma and discrimination surrounding psychological disorders to encourage service-members and families to seek mental health care.

Enhance the Social Security Administration’s Demonstration Authority to Allow Early Intervention.  The FY 2014 Budget proposes new enhanced demonstration authority under SSA’s disability programs to test promising, research-based interventions, including targeted early intervention efforts aimed at preserving the well-being and work ability of the individuals most at risk of becoming severely impaired.  Building off interventions like the Mental Health Treatment Study, such demonstrations could provide better access to treatment and structured support services for individuals struggling with severe mental illness.