xxAACP Newsletter, Volume 15, Number 4, Fall 2001
Debate: Liberalization of Federal Funds for Faith-based Services
PRO:
LIBERALIZATION OF FEDERAL FUNDING FOR FAITH-BASED SERVICES
Faith based mental health and substance
abuse services should have liberalized access to federal funding.
This is the affirmative statement for a debate sponsored by AACP that will be
held at the Institute for Psychiatric Services in October of 2001. In January
2001, President Bush announced an initiative to reduce barriers to federal
funding for social services provided by faith-based communities. This has
resulted in a national debate. President Bush asserts that: "The
indispensable and transforming work of faith-based and other charitable service
groups must be encouraged. Government cannot be replaced by charities, but it
can and should welcome them as partners." According to a recent survey
conducted by the Pew forum on religion and public life, the majority of
Americans support increased access to federal funding for social services
provided by faith based communities. In an interview with Andy Kohut on National
Public Radio, Mr. Kohut who is the director of the Pew Research Center for
People and The Press, reported that people who have strong religious beliefs
volunteer more and help people more than people without such beliefs.
There are a number of mental health and
substance abuse services that could reasonably be offered by community minded
organizations that are faith based. Opponents to this initiative express
concerns that this funding could be used inappropriately to promote the pursuit
of particular faiths and may result in discrimination in terms of staffing and
persons served.
A common goal of community mental health is
the promotion of successful integration in a natural community setting. This
initiative presents an opportunity to enhance community supports for the
disenfranchised persons served by our professions in community mental health
centers. This may also provide increased access to services for those who are
currently unable to be served due to inadequate resources in our public mental
health service system. It should become our role as professionals to join these
efforts. Our professional expertise regarding principles of empiric evidence
based medicine and demonstrated best practices should be applied to programs
irrespective as to the person that provides the actual services.
The supporting argument presented in this
article contains three basic elements. These are: 1.The basic idea for use of
federal funding for social and mental health services is not new or radical.
There are a number of existing established faith based organizations that
perform social, mental health and substance abuse services throughout our
country with varying degrees of federal support. 2. The status quo of public
funded, social, community mental health centers and substance programs is not
acceptable. These programs are failing in their efforts to provide accessible
services to those in need. 3. The arguments raised by critics of the faith-based
initiative are significant but not insurmountable. The potential benefits to our
mental health and substance abuse consumers through increased access and choice
in mental health and substance abuse services far outweighs the minimal risk of
insignificant infringement on civil liberties.
All over our country there are faith-based organizations offering services that are funded in part by our Federal tax money. Catholic Charities is the largest private network of independent social service agencies. This organization has been in existence for nearly one hundred years and was initiated primarily to provide services for needy people, dependent children, prisoners, elders and people with disabilities.
Another example of a well-established set of
services offered by a faith-based community is the Jewish Family Services in the
San Francisco Bay Area. This organization has been inexistence for over 150
years.
A third example of a type of programming that
is more specific to severe and persistent mental illness is the story of a
program called COPE. COPE, Community Organization for Personal Enrichment, was
founded in 1975 in Tucson, Arizona by the joint efforts of the Southern Arizona
Mental Health Center and the Tucson Metropolitan Ministry of the Methodist
Church. This program was founded in response to a need for the community to
develop a place for those with mental illness to exist. The mission of the COPE
project was to "provide a supportive environment in which patients can
gather to talk, work on various projects, engage in recreational activities, and
learn from one another." The program was staffed almost entirely by
volunteers. The professional staff of the community mental health center
provided back up for mental health services. The budget for these services was
very low and was supplied by donations from the churches as well as other
community efforts. One of many benefits for consumers included access to more
natural community supports that lessened the dependency on professional mental
health services.
The second component of the argument in favor
of increased federal support for mental health and substance abuse services
through faith-based organizations is the overt failure of the current
"system". According to the National Resource Center on Homelessness
and Mental Illnesses, there are an estimated 842,000 adults and children who are
homeless in the United States. Sixty-six percent of these individuals are
reported to have some form of mental health and/or substance abuse problem, and
25% are believed to have serious mental illness. Homelessness is a national
mental health problem that we have not solved. There are increasing numbers of
individuals and families who are homeless. Homelessness is the type of community
problem with which faith based communities are interested in helping. Outreach
and support services have been demonstrated to be effective in reducing
homelessness in the mentally ill. Faith based communities are well positioned to
augment the formalized treatment role of professionals to resolve this national
problem. Our current "system" is inadequate and may not be designed
with sufficient flexibility to meet the demand placed on it.
The third component to the argument in favor of increased access to federal funding to be used by faith based communities to provide social, mental health and substance abuse services includes a recognition of the concerns about possible discrimination and overt inappropriate proselytizing. While these concerns are legitimate, they are not insurmountable. Our country has successfully solved far greater problems. The potential benefits to our consumers, which include greater access and choice of services should not be lost as a result of possible perceived infringement on rights. These issues can be successfully resolved.
With this article I have attempted to highlight some of the reasonable arguments supporting the liberalization of federal funding to be used by faith based organizations to provide evidence based social, mental health and substance abuse services. By working with these organizations on behalf of our patients, each of us can expand our ability to successfully promote recovery.
Representative-at-Large, AACP
CON:
LIBERALIZATION OF FEDERAL FUNDING FOR FAITH-BASED SERVICES
At the upcoming IPS meeting, there will be a
debate on the issue of whether access to federal funding for faith based mental
health and substance abuse service programs should be liberalized. The title of
the debate question acknowledges that faith-oriented organizations are already
involved in providing some behavioral health services. Some of them even receive
governmental support. The real question is whether their access to those funds
should be liberalized, i.e., to make it easier for them to obtain than is
currently the case.
There are two possible implications of this
question:
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that faith-based organizations should have an unfair advantage over other organizations, that the eligibility rules for these organizations to compete for federal funds should be different than those for secular organizations, or
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that other organizations already enjoy an unfair advantage such that the faith-based organizations need a form of institutional affirmative action.
If we examine the reality of how and why
funds are awarded to applicant organizations, we find that neither of these
implications is correct. Any organization can generally apply for federal funds,
depending on whether the organization qualifies based on the clinical and
administrative expectations associated with the specific grant program. The
critical factors are the evidence that the applicant program can meet the goals
of the initiative, that its methodology is effective, and that it will be likely
to do so within a reasonable budget.
The faith-based organizations that have
received federal funds for clinical services have managed to adhere to these
guidelines. They are generally reputable clinical operations, sponsored by
religious organizations, in which the clinical and religious functions are clearly
separate.
What distinguishes these providers from the
faith-based organizations that feel that they have been unfairly denied such
funds? The gist of the recent faith-based legislative initiatives is to allow
religious organizations to compete for federal funds for service contracts, but
to allow them to do so without having to "compromise" their religious
principles. In other words, these programs intend to use religious activities,
such as prayer, Bible study, or adherence to strict religiously based behavioral
regimens, as the exclusive or complementary treatment intervention.
The premise is that prayer and other
religious activities are healing. If this can be proven in scientifically valid
and reproducible ways, isolating the specific factors that seem to underlie the
treatment successes, then we should gladly support this concept. Many persons
who have suffered from serious psychiatric and substance use disorders have
reported the importance of spiritual support in the recovery process. However,
no scientific data has yet been reported which would validate the direct
therapeutic benefit of prayer. In an era when evidence-based clinical practices
are the goal, it seems rather odd that the public would be expected to accept
and fund practices that are not yet validated.
To make these prayer-based treatment
approaches work, their supporters unfortunately feel that it is necessary to
violate the very important constitutional protection of separation of church and
state by blending the direct service functions and the religious functions that
the organization operates. This means that such groups can compel unwitting and
subassertive clients (even those who don’t adhere to the group’ s religious
views or practices) to actively participate in religious activities that may be
contrary to their own values. Whether overt or subtle, coercive measures like
these are contrary to the current trend to support consumer choice in community
treatment systems. If clients choose to participate in such religious
activities, they should do so in a way that respects their choice and involves
fully informed consent.
The removal of another brick in the firewall
involves allowing the groups to violate employment discrimination prohibitions.
They contend that they should be allowed to hire only persons of their
particular religious persuasion or to fire employees simply on the grounds that
certain behaviors violate their religious tenets (e.g., being an unmarried
parent or identified as homosexual). The rationale for this form of employment
discrimination is that religious organizations should not be required to
compromise their firmly held beliefs; that being forced to employ such
non-adherents would make a mockery of their religion.
Certainly, religious organizations have the
right to exercise such discriminatory employment practices when using private
funds and for religious oriented activities, but not with public funds. If they
make the religious nature and treatment philosophy of their service program
known to prospective employees, it is very likely that most non-adherent
applicants would not pursue working for them. Those who do would do so with
their eyes wide open, probably with the hope that they could contribute
positively to the program’s intended goals. This seems a reasonable approach,
one that avoids a constitutional conflict and potentially benefits all parties
involved.
If the potential for coercive questionable
treatment practices and employment discrimination isn’t troubling enough, the
proposals also would allow such groups to use religious rather than professional
training standards for the purpose of credentialing staff. The ability to
regulate or monitor clinical services for quality or malpractice purposes would
be rendered impossible.
Therefore, even if the therapeutic benefit of
certain religious activities is eventually established in a scientifically
justified way and access to federal funds is deemed appropriate, there is no
further justification for the discriminatory practices that the initiatives’
proponents insist on.
There are a number of unanticipated or
unintended consequences of these initiatives that have worried many people and
probably doom the notion that federal funds would ever be used for such
therapeutic purposes. With such a wide array of religious organizations,
reflecting a wide variety of beliefs and practices, it is impossible to imagine
a regulatory process that could fairly identify which religious organizations
were acceptable or legitimate. How could an organization be trusted to use the
federal funds in a clinically sound way, if sound religious treatment practices
were indeed identifiable? We have already seen the consequences of these and
other concerns:
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A number of fundamental religious leaders have begun to insist that they know which groups are okay and which are undeserving. This has stirred up a great deal of conflict within the larger religious community.
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Some religious organizations have expressed suspicious opposition to these proposals on the grounds that the government would be enabled to interfere with their freedom to practice their religion, especially if they had to open their financial records to regulatory scrutiny.
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The director of the President’s faith-based initiative office recently resigned after he and others had expressed concerns about the difficulty of working through some of the more troubling implementation details.
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Many religious organizations that operate separate evidence-based clinical programs are very uncomfortable with charitable choice, fearful that they may be mistakenly associated with organizations that provide religious treatments.
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Congressional leaders are growing more restive with the proposals, many expressing that they wish the issue would just go away.
Charitable Choice, as the so-called
faith-based initiative is known in legislative parlance, is neither charitable
nor a choice, just like Spiro Agnew’s Moral Majority was neither moral nor the
reflection of the majority. This bit of fancy wordplay betrays the very nature
of the initiative: it couches a discriminatory practice in the disguise of
something reasonable and socially responsible. Individuals should indeed be free
to participate in religious and spiritual activities. They just shouldn’t be
allowed to do so with government financial support, especially if they insist on
doing so with untested and dubious treatment practices and at the expense of the
civil rights of others.
Representative-at-Large,
AACP
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