Special News for Indian Country |
|
Congress Approves Substance Abuse and Mental Health Services Administration 2022 Funding – Opportunities For Tribes |
|
This bill funds SAMHSA at $6.5 billion, approximately $530 million over the FY 2021 enacted level. However, this does not provide the robust and bold funding levels required to address severe behavioral and mental health disparities in Tribal communities and rather, essentially exacerbate these disparities in Indian Country.
Background
SAMHSA is the federal agency tasked to advance behavioral and mental health, prevent suicides, and improve the quality of life for individuals living with mental, and substance use disorders, and their families. This agency is responsible for providing funding to Tribal, state, and local health departments and community-based organizations for mental and behavioral health, and substance abuse services.
Tribes receive around $120 million in direct SAMHSA funding - and are eligible to apply for an additional $158.8 million for their behavioral health systems and programs. This direct funding to Tribes accounts for only 1.9 percent of SAMHSA’s total budget – which is neither an equitable nor a proportional level of direct funding. The only significant funding increase directly impacting Tribes came from the Tribal Opioid Response (TOR) grants, which saw a $5 million increase (9 percent increase from FY 21).
The National Indian Health Board (NIHB) fought for Tribal set-asides and non-competitive funding mechanisms, alongside the SAMHSA Tribal Technical Advisory Committee (TTAC) – an official body comprised of 14 elected Tribal leaders, which aims to provide guidance and recommendations on issues that affect Tribal communities. NIHB provides technical assistance and subject matter expertise to members of the SAMHSA TTAC – work that goes unfunded by the agency. NIHB and the TTAC also continue to fight to reduce burdensome reporting requirements on Tribal nations that receive funding (this policy priority is discussed in detail in both the NIHB 2021 and 2022 Legislative and Policy Agenda). These administrative requests went unanswered in 2021, but NIHB will continue fighting for these Tribal needs and priorities.
|
|
|
|
Mental and Behavioral Health Disparities
Tribal communities are strong and resilient but are still plagued with disparate rates of suicide and depression. According to a recent Centers for Disease Control and Prevention (CDC) report titled, “Changes in Suicide Rates – United States, 2019 and 2020,” American Indian and Alaska Natives (AI/ANs) experience an age-adjusted suicide rate of 23.9 per 100,000, the highest rate of any demographic group – nearly 30% higher than their non-Hispanic white counterparts.
SAMHSA Block Grants and Tribal Ineligibility
The vast majority of SAMHSA funds are distributed through two block grants: the Community Mental Health Services Block Grant (MHBG) and the Substance Abuse Prevention and Treatment Block Grant (SABG). Tribes are ineligible for the MHBG, which is funded at $860 million for FY 22 — a $35 million increase from FY 21 levels. Only 1 Tribe is eligible for the SABG and receives roughly $550,000 each year through this funding mechanism, resulting in just 0.034% of funding going directly to Tribes.
These two block grants also represent the largest increase in SAMHSA's 2022 budget, making it nearly impossible for Tribes to benefit from the funding increase. Tribal Nations, as separate and distinct domestic sovereign governments, should be eligible for any direct, flexible funding streams, such as through block grants. Receiving funds filtered through States’ block grants does not honor the government-to-government relationship between the U.S and Tribal Nations, nor does it honor a Tribe’s right to self-determination.
When taken together with the gross and alarming mental health disparities in Indian Country, the fact that Tribes cannot access most of the federal dollars earmarked for this care is an abandonment of the Federal Trust Responsibility for our Peoples’ mental health. These funding inequities track with the disparities we see in Indian Country. For example, opioid overdose deaths among AI/ANs are the second among all US demographic groups (15.7 per 100,000) according to 2017 data published by the Indian Health Service. Furthermore, the 2020 Behavioral Health Barometer report detailed that among people 12 and older in the U.S., during the past-year opioid use disorders decreased for Whites, Blacks, Native Hawaiians, and Hispanics from 2015-2017; but, for AI/ANs, the past-year opioid use disorder increased during that time period. These troubling statistics highlight the importance of prioritizing Tribal communities for mental and behavioral health funding and the 2022 appropriations bill demonstrates that we are not making needed progress, which is very disappointing.
Tribal Eligibility for Competitive Grants
Upon initial review, Tribes appear eligible for Project AWARE (Advancing Wellness and Resilience in Education) and Garrett Lee Smith Youth Suicide Prevention grants, which total $158.8 million. However, Tribes will have to compete with each other and state and local health departments for these funds.
Next Steps
NIHB stands ready to continue the fight to secure the Tribal Nations we serve equitable funding to support their public and behavioral health systems. This year marks NIHB's 50th anniversary, which only fuels our commitment to reinforce Tribal sovereignty, strengthen Tribal health systems, secure resources, and build capacity to achieve the highest level of health and well-being for our People.
To read the full text of the bill, click here.
To read the Joint Explanatory Statement of the bill, click here.
For questions regarding FY 2022 appropriations, please contact Erin Morris, Congressional Relations Manager, at [email protected], or Tyler M. Dougherty, Director of Public Health Policy and Programs, at [email protected].
|
|
|
|
Visit the NIHB COVID-19 Tribal Resource Center at:
|
|
|
|
|
|
|
