NAMI test: states score poorly
By Herb Drill
Barb and I have friends in
whose younger son is schizophrenic. Almost needless to say, his parents are involved actively in the efforts of the National Alliance on Mental Illness (NAMI) to improve care and the quality of life for the mentally ill.
Our friends, let’s refer to them as “Max” and “Rita,” weren’t cheered - or surprised - by NAMI's Grading the States 2006 Report revealing an overall U.S. grade of “D” and a Pennsylvania grade of D+.
NAMI contends this is the “first comprehensive state-by-state analysis of mental healthcare systems in 15 years. Each state has been scored on 39 specific criteria resulting in an overall grade and four sub-category grades for each state. Five states receive grades in the B range, eight got Fs, none earned an A.
’s overall grade was C+. The category grades were: Infrastructure, C; Information Access, B; Services, C-, and Recovery Supports, A. Wisconsin had an overall grade of B-. Its category grades were: Infrastructure, C; Information Access, D; Services, B+, and Recovery Supports, B+.
’s per-capita mental health spending of $119.07 ranked it No. 12 and total mental health spending of $602 million ranked it No. 13. Thank goodness, the state’s suicide rank was way down at No. 40. Meanwhile, NAMI asserts there has been “collaboration between
’s Mental Health Authority and multiple agencies to provide services and evidence-based practices, particularly Assertive Community Treatment (ACT) and supported employment. The urgent needs are funding for direct mental health services and related services, such as vocational rehabilitation; preserve access to medications, and ensure adequate in-patient beds while making transition to county-run, community-based services.
has a “reputation for independence and innovation and may compare well with other states, but its mental healthcare system has problems. During fiscal year 2004-05, with a budget deficit of approximately $4 billion, mental health services escaped direct cuts - but related programs, such as vocational rehabilitation, weren’t as lucky. In addition, for the first time, the state Medicaid program instituted prior authorization requirements and co-payments for medications. Although psychiatric medications were excluded, the state should be seen as moving toward restrictions on access to care, requiring vigilance by family and consumer advocates. Because of reduced state dollars, counties - which share responsibility for helping people with serious mental illnesses - in turn have reduced local services.”
The study states that
’s Mental Health Authority (SMHA) has launched an Adult Mental Health Initiative (AMHI) intended to replace regional treatment centers with 16-bed community inpatient hospitals in an “overall transition to community-based care. Unfortunately, this initiative is taking place when the lack of inpatient acute care beds in many parts of the state has reached crisis proportions. Community hospitals have been eliminating psychiatric beds and replacing them with more lucrative medical-surgical beds. NAMI suggests that “in densely populated Minneapolis/St. Paul, emergency rooms are overflowing with people experiencing acute psychiatric emergencies and with no place to go. Ultimately, if the conversion to a community-based system of care is to be successful, it will be very important to maintain adequate numbers of acute care beds, intermediate and long-term care beds for those who need them, and supportive housing units for people ready to re-enter the community.”
In this conversion, MHA is working with adult residential treatment providers to transform into shorter-term programs providing an array of services, including crisis stabilization, integrated treatment, self-management of illness, and supported employment, NAMI states. “These can be positive steps, as long as the needs of people requiring longer-term residential services and supports are adequately addressed,” NAMI adds. “MHA has worked hard to implement evidence-based practices, [with] 25 Assertive Community Treatment teams in the state. Four of them serve 18 counties in the rural southwestern area; greater statewide penetration of ACT is needed. MHA is collaborating with the state agency responsible for alcohol and substance abuse services to provide training and other technical assistance for integrated mental health and substance abuse treatment for people with co-occurring disorders.”
While NAMI believes
is beginning to focus on alternatives to incarceration, “there is a long way to go. Mental health courts and jail diversion programs are located only in Hennepin and Ramsey counties. These programs should be replicated in other parts of the state. Preliminary discussions have taken place about implementing a state prison diversion program for individuals with serious mental illnesses convicted of felonies, but this is far from operational. Increasingly, cultural competency is a necessity for the mental health system. A quarter of the state's federal mental health block grant allocation is targeted to Native American tribal government. The state has a growing Laotian Hmong population.”
needs, NAMI observes, “is to make careful choices. It faces an equal prospect of moving upward or downward in the years ahead. It will be smart to continue to invest in the mental healthcare system, and to build on existing strengths. It may take time and money to build a good system. Unfortunately, it doesn't take long to wreck one.”
, its suicide rank was No. 28, which tied it with
. NAMI credited the
with statewide expansion of community support programs (CSP) for clients between CSP and traditional outpatient care. “Broad community services reduce the need for state hospitalization,” NAMI noted, but “urgent needs” include “outcome studies of CSPs and managed care; commitment and monitoring over time, and state support and coordination for counties with underdeveloped service systems.”