Kenneth Certa, MD, DLFAPA
The dramatic abrupt cancellation of SAMHSA grants was a jolt to the system, and highlights the difficulty of providing mental health services in an era where capricious cuts from the federal government can upend careful plans. Most of the grants are to maintain services and supports at the local level so are hard to measure, but the Shapiro administration estimated $495M cuts directed at the Commonwealth. Programs such as naloxone training, case management and peer supports, and direct opioid treatment funding were all suddenly unable to spend any more money, until an outcry from congress and many organizations caused an even more dramatic reversal.
What is worrisome is that following this, on January 23, another "pause" in funding for public health infrastructure was similarly announced, this time affecting $5.1B, and then again quickly rescinded. This happened as we prepared for the big snowstorm, and mourned the death of an ICU nurse in Minnesota at the hands of Customs and Border Patrol agents, so the news about that “pause” was buried. But it shows a lack of direction at the Department of Health and Human Services. The lack of stability in health care support from the feds is taking a toll.
Not much movement in the legislature over the holidays, and many of the issues we have discussed before are still extant. Nothing more on safe prescribing/scope expansion, (HB1000) but alternative measures to increase access to care are looking brighter under the Rural Health Transformation Program, part of HR1 (the One Big ...) States will share half of the $50B pot and were invited to bid for more. Pennsylvania applied for additional funding and will receive $193M to beef up rural health care with telemedicine services, and includes a section for expansion of the Collaborative Care Model. We have been working on this for a long time, and are optimistic that it will help leverage psychiatric expertise to primary care practices.
We have been working with the legislature as it grapples with the problem of online gaming leading to gambling addiction. A resolution passed last year, HR60, directs the Joint State Government Commission to study sports betting and interactive gaming. We had supported HR60 and are developing a position statement to try to limit the damage to people's lives that gambling addiction can cause if not properly regulated.
The explosion of AI in its many manifestations worries the legislature, with many different bills now in play or contemplated to try to curb some practices which have allegedly led to highly publicized cases of suicide. We are hoping to avoid outright bans for AI use in mental health services, as some have proposed. We will work with the legislature to craft something that will at least set up definitions and standards, and perhaps a task force or commission to determine how the state can best protect its citizens in clinical practice as well as online with chatbots.
The Mental Health Procedures Act remains on our radar, with OMHSAS reviewing current practices to bring them into a degree of harmony across the state, as the legislature eyes making more substantive changes.
We will be discussing many of these topics at our annual legislative update on Wednesday, evening March 4, part of the ongoing series of PaPS educational events. I hope we will see you there.