TRANSFORMING THE MENTAL HEALTH LANDSCAPE: STATES SEEK COLLABORATION

Sarah Steverman

State legislators are starting to address one of the most important—and complex—issues in mental health care: coordinating the vast array of services and agencies that may play a role in the lives of people with mental health needs.  

Few people with mental illnesses initiate treatment by contacting a state’s mental health agency. They’re much more likely to first come into contact with state services through the criminal justice system, child welfare agencies or schools. The number of people with mental health needs is daunting. In criminal justice, for example, the Bureau of Justice Statistics reports that 56 percent of state prisoners and 64 percent of local jail inmates have a mental illness. Of those with mental illness, only one in three state prisoners and one in six local jail inmates receive mental health treatment while incarcerated.

Too frequently, people with mental health needs do not get adequate care from the agencies with which they are involved. Just as concerning is the fact that these agencies may not coordinate their services with each other—an individual may not receive needed care, simply because it is provided by an “outside” agency. This disconnect was brought to national attention in 2003, when the President’s New Freedom Commission on Mental Health called the nation’s mental health delivery system “fragmented and in disarray.” 

If state agencies are disconnected, so too may be legislative bodies. The many committees that affect those with mental illnesses—such as criminal justice, health and human services, education and training, and housing—do not always work in tandem when it comes to mental health care.

In an effort to help states coordinate the services that help people with mental illness, the Substance Abuse and Mental Health Services Administration (SAMHSA) in 2005-06 gave nine states (Connecticut, Hawaii, Maryland, Missouri, New Mexico, Ohio, Oklahoma, Texas and Washington) “Transformation-State Incentive Grants” (T-SIG) totaling about $13 million over five years.

SHN looked at how two states—Washington and New Mexico—are transforming their mental health systems.

"We Want Them Fully Participating"

Even before getting its T-SIG grant, Washington had begun efforts to coordinate mental health services. In 2004, legislators formed the Joint Legislative and Executive Task Force on Mental Health Services and Financing. The task force initiated a series of bills that began the transformation of the mental health system, according to Rep. Eileen Cody, co-chair of the task force.

During 2005, the Legislature passed E2SHB 1290, which reformed the way the state’s “regional support networks,” agencies that coordinate mental health services around the state, operate. The statute reduced disparities in the availability of mental health services throughout the state and increased the networks’ coordination with agencies outside of the Department of Social and Health Services.           

Legislators also passed E2SSB 5763, which promoted the use of screening instruments that detect co-occurring conditions; authorized pilot projects for mental health and substance abuse programs; and gave counties the authority to increase their sales taxes by one-tenth of 1 percent to pay for mental health and substance abuse courts.

SHB 1154 mandated mental health parity. Beginning in 2007, employers with more than 50 employees will be required to offer the same coverage for mental health treatment as is offered for physical health. Substitute Senate Bill 6793 supports community-based treatment alternatives to in-patient treatment, the use of evidence-based practices, the expansion of community housing for people with mental illness, protocols for ensuring appropriate levels and duration of inpatient treatment, and a review of existing involuntary commitment procedures.

In addition to promoting legislation, the task force has been instrumental in Washington’s T-SIG project. “I think that the fact that we had the joint legislative executive task force on mental health prior to applying was one of the things that helped us get the grant,” Cody reported.

One of the task force’s primary duties is monitoring the work of the T-SIG project’s working group, which spent the first year of the grant coming up with a comprehensive plan and identifying 27 outcome priorities that they would like to address over the course of the grant. “We want to see people getting the care they need and being active members of the society,” said Cody. It’s not enough, she added, that people with mental illness simply stay out of jail. “We want them fully participating.”

New Mexico

The Land of Enchantment has been using its SAMHSA grant to advance changes that were launched in 2003. The state has come a long way and, as 51st in mental health per capita spending among the 50 states and the District of Columbia, much work remains to be done. However, state officials say they do not simply want to spend more dollars on mental health care; they want to spend those dollars wisely and get the biggest possible return for their investment.   

In an effort to do this, the state established the Interagency Behavioral Health Purchasing Collaborative (HB 271) in 2004. The collaborative comprises representatives from 17 different state agencies, including human services; health; corrections; children, youth and families; and the governor’s office. The collaborative’s mission is to identify behavioral health needs and expenditures statewide, and to plan and regulate a statewide behavioral health system, encompassing mental health and substance abuse services.

After much research, the collaborative decided to partner with the private sector. In 2005, the state contracted with Value Options New Mexico to operate the entire behavioral health system in New Mexico. All of the mental health and substance abuse funds from participating agencies have been put into one pot, and local services across the state are being overseen by Value Options.

In addition, legislators have been passing bills that further transform the system. Signed into law in 2006, HB 459 allows people to establish advance directives about the mental health care they would like to receive if they are not able to make those decisions themselves. Three other 2006 laws (HB 253, HB 331 and HB 341) are designed to attract more mental health professionals to New Mexico. The statutes streamline the process of obtaining licenses for mental health professionals, authorize the replacement of outdated exams and establish continuing education requirements.

New Mexico was primed to receive its T-SIG grant by having performed the important work of forming the collaborative and assessing the state of its mental health system in an 800-page needs assessment. The T-SIG working group completed its comprehensive plan this fall. 

“It is heartening that behavioral health issues are receiving this kind of attention and are being recognized as an important topic,” said Michelle Lujan Grisham, secretary of the Department of Health.