Innovative ways to move forward during budget cuts

A guest blog by Corinna West of CorinnaWest.com

At least 46 states have now cut budgets that help vulnerable low income people, especially those of us with mental illness. In times of struggle, it’s easy to hunker down and try to keep doing the same things we have always been doing, just with less money. I personally think we need to do more than just stick out our hands out and say, “Please don’t cut us… Please.” However, another way out of our difficulty is to find radically new ways of doing things that cost significantly less money while providing even higher quality results. Here are a couple of key suggestions for how we can keep high quality community health care even during budget cuts.

* Recognize the community mental health centers as sources of innovation and progress. In Kansas and Missouri, the states in which I work, they are the only providers of medicaid billable peer support, assertive community outreach, case management, and employment services. Although many people think that private health care is preferable, in the mental health system it might not be. The public care is the only place possible to get these evidence based treatments that help move people towards recovery. Innovation should be our primary response to economic difficulties, not stagnation.

* Recognize that the alternative to community based care is often hospitalization or jail, at up to 40 times the cost. It would be a significant cost savings to keep people treated in the community rather than re-institutionalizing us.

* For every dollar spent on rehabilitating a disabled person to be able to go back to work, $10 is returned to the economy. U.S. Census Bureau, 1986

* Increasing the amount of peer support would reduce overall mental health costs by increasing people’s recovery, helping people to get more involved in their community, and decreasing reliance on the mental health system. Peer support is an evidence based practice and often peer supporters can work at lower expense than professional with a higher educational requirement.

* Respite care centers cost 1/5 as much as psychiatric hospitalization and shift funding from large institutions to small community based mental health center or local consumer run organizations. Providing people in crisis with peer run centers would save large amounts of public funding. This would also increase people’s ability to stay closer to their local communities and keep their family and native supports involved. Respite care does less to delay peoples’ recovery than does institutionalization. There are quite a few existing models in the U.S.

* Trauma-informed care involves dealing with people’s primary experiences of loss of choice, voice, and control. Increasing the use of trauma informed care in the community mental health centers will greatly decrease costs by helping people to end the revolving cycle of becoming so strongly influenced by emotions brought on by past overwhelming experiences.

* Treat sex offenders in the criminal justice system instead of leaving them indefinitely in more expensive hospital situations that take away beds from people in crisis.

* Consumer run organizations promote well-being and recovery and are very cost-effective. One study found that the more people used these programs, the greater their increase in well-being.

* Some psychiatric medications may be less effective that previously reported and may in fact worsen long term outcomes. Keeping non-medication options like peer support, employment services, and respite care available is crucial to helping people who don’t respond to meds. For depression, this may be the majority of people according to a re-review of the data from the STAR-D trial, the biggest ever government funded clinical trial of antidepressants. This data shows that only 7.7% of participants did not relapse or drop out the end of the one year trial. If we were simply to admit the existence of a large percentage of people that aren’t helped by meds, then we could as a society make other treatments the primary option for up to 40% who have negative medication effects and not the positive benefits. This would drastically reduce medication expenditures and then we wouldn’t have to resort to using preferred drug lists that limit medication choice for the people that ARE being helped by their medications. This would free up vast amounts of funding for more recovery oriented approaches to mental health treatment.

In conclusion, although budgets are very lean in almost every state, now would be the time to radically rethink our approach to funding. We could fund approaches like the ones above that have been consistently shown to be effective while have significant cost savings. Many of in the consumer movement have appreciated the move towards recovery approaches, because we know recovery is possible. We are the evidence. We would love to help bring innovation into our states to help relieve the budget shortfall.

Follow Corrina on twitter or on the web at http://corinnawest.com/

Baucus working to reduce Guard, Reserve suicides

by Jennifer Donohue (Clark Fork Chronicle)

Montana's senior U.S. Senator Max Baucus expressed deep concern about military suicides after the Army released new data today showing suicides of Army Reserve and National Guard soldiers increased significantly to 145 in 2010, including two members of the Montana Army National Guard. Baucus is working with the Pentagon to implement the law he passed in 2009 to make sure troops get the care they need and deserve by requiring the military to conduct improved assessments to help identify signs of Post Traumatic Stress Disorder (PTSD) and suicidal tendencies.


“Montana is proud to have more brave men and women volunteering for service than almost any other state in the country – many of them as citizen soldiers in the Guard and Reserves. The news of increased suicides among our citizen soldiers is deeply troubling. This issue hits home in the worst way because we have already lost too many Montana heroes to suicide. We owe it to our troops, their families and their communities to tackle this problem head on,” Baucus said. “I will continue working with military leaders at the Pentagon until I am confident every Guard and Reserve unit across the country has the tools and resources it needs to keep our troops safe while deployed and here at home.”

In 2009, Baucus wrote and passed a law to establish a new assessment program to identify post-traumatic stress disorder, suicidal tendencies, and other behavioral health conditions both before troops deploy and after they come home – including troops serving in the Guard and Reserve. Baucus is working with the Pentagon to confirm that it is in full compliance with the law and identify any additional resources that would help implement it.

Baucus modeled the law after an innovative program used by the Montana National Guard. The law requires the military to provide mental health assessments for every soldier, Marine, airman, and sailor during the 60 day period before a deployment and six, twelve, and twenty-four months after they’ve returned home. The assessments are to be provided in a private, clinical setting by licensed mental-health professionals or troops trained and certified to perform the assessments.

A recent study released in the American Journal of Psychiatry found pre-screening, like that required by Baucus’ law, to be a very effective tool in reducing mental health problems in the military. The report said pre-deployment screening helped decrease the need for clinical care for combat stress, psychiatric and behavioral disorders, and suicidal tendencies.

Baucus also plans to reintroduce his VET Act this Congress to help veterans find good-paying jobs when they come home by making it easier for businesses to get tax credits for hiring troops returning home from service.

Health Care Reform Contains Major Expansion Of Access To Mental Health Services

By Amanda Terkel

WASHINGTON -- The health care law that Republicans are targeting for repeal provides significant assistance and options for people with mental illness, an issue that has received increased attention as details emerge about the alleged shooter in Arizona on Saturday.

"The shooter was a very disturbed individual and it appears there were so many warning signs that he was going to do something horrible," Rep. Allen West (R-Fla.) wrote on his Facebook page. "We should be focusing on the mental health crisis in our country, not politics."

As Igor Volsky of ThinkProgress points out, Rep. Mike Rogers (R-Mich.) similarly told MSNBC Tuesday, "A bad guy is going to get a gun. What we have to do is "intervene earlier in that cycle of violence when they have this kind of mental disability."

Lawmakers looking for a way to boost mental health services might want to start by checking out last year's Patient Protection and Affordable Care Act, which both West and Rogers support repealing. Mental health advocates have hailed the law for its expansion of access.

In 2008, President George W. Bush signed landmark "parity" legislation requiring employers to provide mental health insurance benefits comparable to traditional medical coverage. It also barred insurance companies from setting higher co-pays or deductibles for mental health services.

That law, however, applied only to people who already have insurance. Chris Koyanagi, policy director at the Judge David L. Bazelon Center for Mental Health Law, told The Huffington Post that the Obama administration's signature health care law is at least as key.

"While the 2008 law was very important in terms of people who have insurance through their employer, the great thing about the Affordable Care is that it's everybody," said Koyanagi, whose organization has produced a report on the 2010 law's impact. "If you have a serious mental illness, you have trouble staying employed. There's a whole group of people for whom parity would never have applied without this statute. We've had a lot of people just falling right through the cracks because they don't come with any way to pay, and they're the folks with the most serious problems."
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Koyanagi highlighted two major elements of reform: More Americans are projected to be enrolled in private insurance under the 2010 law, which is required to provide coverage for mental health and substance abuse services, and it is also expected to significantly increase Medicaid availability.

"The expansion of Medicaid to people with incomes under 133 percent of poverty who would not otherwise have been able to get on the Medicaid program is going to include a lot of people with mental health needs," she said.

Before the Affordable Care Act, low-income childless adults with severe mental illnesses were not able to get Medicaid assistance, and therefore had no way to pay for mental health services. "Certainly the repeal of ACA would drastically hurt a lot of childless adults with serious mental illness who need treatment," Koyanagi said.

Acquaintances of Jared Lee Loughner, the man charged in Saturday's Arizona shootings, have described him as a troubled individual with worrisome behavior. One of his community college classmates wrote in an email about Loughner, "We have a mentally unstable person in the class that scares the living crap out of me. He is one of those whose picture you see on the news after he has come in to class with an automatic weapon."

Dr. Anthony Lehman, a professor at the University of Maryland School of Medicine, said that early reports on Loughner seem to follow a familiar pattern (with an atypical outcome) of the "failures of mental health systems to respond to young people with serious mental illness."

"As I understand, he began having problems as early as high school, dropped out of high school and was identified as someone who was having problems, and then proceeded in some of the history that we just heard about with involvement with the police and problems in college, but never received, I guess as best we know, any mental health treatment," Lehman said on PBS's "Newshour."

Despite the recent attempts to expand access and services, mental health is still woefully undertreated. In the past year, Arizona's Pima County, where Rep. Gabrielle Giffords (R-Ariz.) and 19 others were shot Saturday, has seen more than 45 percent of its mental health services recipients forced off the public rolls.

In response to the shooting, House Republican leadership postponed its vote on the Repealing the Job-Killing Health Care Law Act, which was supposed to take place Wednesday. The House is expected to pick it back up next week.

Neither West nor Rogers returned calls seeking comment.

Statement of Mental Health America on theTragedy in Arizona

Mental Health America joins Americans in mourning the loss of those killed in Saturday’s tragic and senseless attack and expressing our wishes for the full recovery of Congresswoman Gabrielle Giffords and fellow citizens who were injured. Our thoughts and prayers are with the families and loved ones of those who lost their lives and everyone who is affected by these horrific events. And we join in applauding the brave actions of individuals who prevented greater harm.

It will likely take many days to understand the reasons and motivations behind this national tragedy. Many have pointed to mental health as an issue.

It must first be emphasized that people with mental health conditions are no more likely to be violent than the rest of the population. And we have science-based methods to successfully treat persons with even the most severe mental illnesses. A very small group of individuals with a specific type of mental health symptoms are at greater risk for violence if their symptoms are untreated.

At the same time, we must recognize that the nation’s mental health system is drastically under-funded and fails to provide Americans living with mental health conditions with the effective community-based mental health services they need. Sadly, in the current environment of strained state budgets, mental health services have been cut drastically just as demand for these critical services has risen dramatically.

It is also important that, as a community, we assist persons with signs and symptoms of mental illnesses to seek treatment. Although rare, when a person becomes so ill that he/she is a danger to themselves or others state laws provide a way to get them help even if they don’t believe that they need it. The best strategy, however, is to have an accessible system of care that is easy to use.

Science has not developed tools to predict reliably individuals at risk for violence. But we can reduce the small risk of violence in those with certain mental health conditions by investing in proven intensive, coordinated community-based mental health services and making certain that they can access these services.

We do not know if the mental health system failed in this situation or if there were missed opportunities or if effective treatment might have averted this tragedy.

We do hope that we can find answers and create solutions that prevent this from ever happening again.

Mental Health America (www.mentalhealthamerica.net) is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our century of service to America and our more than 300 affiliates nationwide, we represent a national movement that promotes mental wellness for the health and well-being of the nation— everyday and in times of crisis.