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NAMI report card
gives nation a 'D' in mental health care
New England
results mixed
(May 2006
Issue)
By Nan Shnitzler
When the National Alliance for Mental Illness rated the states
on mental health care, it didn't grade on a curve. The highest score
was Ohio's 84, which earned a B. Eight states scored below 50 and
got Fs. The national average was a dismal D.
Released by NAMI in early March and funded by the Stanley Family
Foundation, "Grading the States: A Report on America's Health Care
System for Serious Mental Illness" is the first state-by-state report
of mental health care in 16 years. It calls on states to link taxpayer
funding to system performance and individual outcomes based on proven,
cost-effective, evidence-based practices.
The report scored 39 criteria in four categories: infrastructure,
information access, services and recovery supports. Four sources
provided data: surveys of state mental health authorities; public
information, such as federal grant applications, state and federal
agency reports and newspaper articles; a "Consumer and Family Test
Drive" for gauging the utility of state Web sites and telephone
systems; and interviews with consumer and family advocates and policy
experts.
"Clearly there are some serious problems in American mental health
and we wanted to make them obvious and transparent," says Ken Duckworth,
M.D., NAMI medical director and a report author. "But the report
also highlighted all the innovations happening in America." The
question going forward, Duckworth says, is how to get the good work
one state is doing replicated in another.
The six New England states were a mixed bag. Connecticut was top
with a B and Maine close behind with B-. Rhode Island got a C. Massachusetts
with all its world-class resources earned only C-, as did Maine.
Most startling, New Hampshire dropped from number two in the country
to a D since the 1990 report.
"This was a grading system of the state mental health authority,
not the providers of care," says Michael Cohen, NAMI New Hampshire
executive director. A lot of what providers are capable of doing
is dependent on state support and policies, lack of which has eroded
the mental health system, he says.
Mental health funding has remained flat over the last five years,
Cohen says. As a result, the state has not compensated for declines
in Medicaid funding. In addition, state funding to NAMI has been
cut for the first time, which also undercuts the consumer peer support
system, of which NAMI is a key supporter.
Cohen deplores the $300,000 funding cut in the highly regarded
state-university contract with Dartmouth Medical School's Psychiatric
Research Center, where evidence-based practices were invented and
are promulgated. "It's well known around the country, but not in
New Hampshire," Rep. James MacKay (R-Merrimack) says.
MacKay, a former psychotherapist, urged the legislature last year
to approve the 29-member Mental Health Study Commission, which was
not mentioned in the NAMI report.
The commission's purpose is to write a new five-year plan for
mental health services in N.H. based on tenets in the New Freedom
Commission on Mental Health, convened by President Bush, to combat
national systemic problems: the stigma around mental illness, the
fragmented service delivery system and unfair limitations and financial
requirements imposed by private health insurance.
"No one in New Hampshire was particularly happy with the [NAMI]
report," MacKay says. "I look at it as useful because the report
is a blueprint for change."
On the bright side, N.H. House Bill 1710 restores significant funding
to home care providers and the state's 10 community mental health
centers. It passed the House and now resides in the Senate Finance
Committee.
"Our fall from grace has to be viewed as temporary," Cohen says.
"I don't think we're slipping any more. But it's time for New Hampshire
to look at what it can do to support providers and consumers to
get back on track."
Robert Correll, NAMI Connecticut executive director, says, "First,
we are very happy that the national [NAMI] organization went and
did this very big task for the entire nation. Second, we're pleased,
obviously, with getting a B. And third, we still have a heck of
a lot of work to do."
Some of that work concerns Connecticut Valley Hospital in Middletown,
Connecticut's largest psychiatric facility, which is being investigated
for safety violations by the U.S. Department of Justice. The Judge
David Bazelon Center, a nonprofit legal advocacy organization based
in Washington, D.C., is looking at whether psychiatric patients
are being inappropriately admitted to locked nursing home beds,
a "hot button issue" in the current legislative session, Correll
says.
Another problem, being fought in every state, Correll says, is
the availability of safe and decent affordable housing so folks
with limited incomes have somewhere to go after inpatient treatment.
The state has made some investments in this area, but "we're nowhere
near where we need to be," he says.
"We feel good about what we're doing and how it's being perceived."
Correll says, especially the state's recovery model of care, key
to Connecticut's receiving a SAMHSA transformation grant worth $13.7
million over five years.
Massachusetts officials are acutely aware that its grade is inconsistent
with its resources. "I would say that in a state with some of the
top medical facilities in the world, a C- is certainly not acceptable,"
says Tobias Fisher, NAMI Massachusetts executive director. "If Massachusetts
got C- in cardiac care, there would be outrage. Yet the mental health
system is routinely left behind with respect to funding and infrastructure."
"The Department of Mental Health budget has taken millions of dollars
of hits over the last few years," Duckworth says, who previously
was the department's acting commissioner. Such cuts have resulted
in long waiting lists for case management, residential and support
services. But Duckworth says it's a "multi-part equation," when
the lack of outpatient services and community beds causes patient
backups in hospitals and emergency rooms.
"We have great services. The challenge is getting them," Fisher
says. "Twenty thousand people are waiting for state mental health
services. It's not so much a reflection of quality but quantity."
For more information, visit www.nami.org/grades.
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