Grading America’s Public Mental Health System – Cloudy Skies, Silver Lining on the Horizon? Mary Giliberti Director of Public Policy and Advocacy, NAMI National March 10, 2007

Grading the States Report released on March 1, Provides the first comprehensive survey of adult public mental health systems in every state and DC since The full report is available online at

The final report includes a report card, a narrative, and a scorecard to explain the final grade for each state. Also included in the report are policy recommendations, national trends and innovations seen across states. Grading the States

The report is intended to: –Move forward toward the vision found in the New Freedom Commission, Surgeon General, and Institute of Medicine Reports –Provide a specific action agenda –Promote dialogue –Be a baseline for future measurement –Serve as a catalyst for improving services for adults with serious mental illness Grading the States

The report card is based on 4 sources: –Responses from state mental health agencies –Public information –Interviews with consumers, families, and others –The Consumer/Family Test Drive Grades are based on 39 criteria/data points. Grading the States Methodology

Methodology, cont. Four Broad Domains: –Services (e.g. evidence-based and promising practices, access to inpatient treatment when needed, medication formularies, etc.). –Infrastructure (e.g. data, cultural competency, parity, etc.). –Information access (consumer and family test drive and involvement in the system). –Recovery supports (e.g. consumer and family education, peer services and supports, etc.).

Test of information accessibility across 10 basic items (housing, how to get help, apply for Medicaid, information in a non-English language, etc.) Consumers and families went online and made phone calls to each state mental health agency to see how easily this information could be obtained. Consumer/Family Test Drive

North Carolina’s Grade Infrastructure: Information Access Services Recovery Supports Overall Grade: C- D D B+ D+

National Trends (Positive) Increased focus on evidence-based and promising practices. Consumers and families are becoming more involved in service design and delivery Strong partnerships and even leadership from outside the mental health community, e.g. law enforcement, emergency room doctors. Pockets of creativity and innovation in every state.

Innovation and Creativity Model parity laws, including substance abuse (Connecticut, Maryland, Oregon, Minnesota and Vermont). Services to rural populations through tele-medicine (Georgia, Kentucky, Nebraska, and Oklahoma). Clinical feedback on prescribing without broad limits on access (Missouri). Strong focus on information and customer service (Indiana, Michigan, Ohio, South Carolina and Tennessee).

National Trends (Negative) Budget cuts or flat funding Changes to Medicaid (restricted eligibility, restrictions on access to medications, cost-sharing). Inpatient bed shortages, particularly acute-care beds. Cost shifting to other systems (e.g. criminal justice, emergency systems, homeless services). Long waiting lists for housing and other vital community services.

North Carolina- Strengths Legislature has shown a willingness to invest in mental health services (i.e. last year’s increase) The Division of Mental Health is actively engaged with NAMI in a dialogue on Grading the States Increased attention to outcomes from services Availability of CIT statewide Development of evidence-based practices, such as Assertive Community Treatment

North Carolina- Needs Funding Go slow, learn from changes to date Build more crisis services and alternatives to hospitalization Safety net resources Passage of mental health parity law

10 Elements of a Quality Mental Health System 1.Comprehensive Services and Supports –Affordable and supportive housing –Evidence Based Practices (ACT, Supported Employment, Integrated Dual Diagnosis Treatment, etc.). –Peer Services and Supports –Jail Diversion –Crisis Intervention Services (before criminal justice system becomes involved).

Standards, cont. 2. Integrated systems and services. –Blended funding –Comprehensive planning and coordination –Mental health system at the core. 3.Sufficient funding, tied to outcomes. 4. Consumer and family driven. –Meaningful involvement at all levels, including design, implementation, and evaluation. 5. Safe and respectful treatment environments.

Standards, cont. 6.Accessible information for consumers and family members. 7.Access to acute and long-term care treatment, including inpatient treatment when needed. 8.Cultural competence in designing and providing individualized services. 9.Health Promotion and Mortality Reduction. 10.Adequate and qualified mental health workforce.

How to Use the Report Set state policy and legislative agenda Communicate your message Educate grassroots and policymakers Ensure accountability at state and local levels. Conduct your own county or regional assessments. Learn from other states Build on your strengths

NAMI The Nation’s Voice on Mental Illness