More $ for Mental Health Services Shows Gains for Those who Need Them

Nearly 15 years ago, California voters passed Proposition 63, now known as the Mental Health Services Act.  The proposition imposed a 1 percent tax on people earning more than $1 million annually to pay for more mental health services.  The measure raises about $2 billion each year.

Los Angeles County, which receives the largest share of the money, commissioned a study by the Rand Corporation about the results of the new services.  The study was based on data from 2012 to 2016 and interviews with participants.  Here are excerpts about the findings, as reported by Kaiser Health News.

“The money is ‘critically important’ for the community mental health system and for people who need treatment but haven’t been served well in traditional ways, said Toby Ewing, executive director of the state’s Mental Health Services Oversight & Accountability Commission. “We can only imagine the challenges we would face if those funds weren’t available.”

The funds go beyond the more basic services that counties traditionally provide, helping to pay for workers to reach out to homeless people and triage patients with mental health issues in hospitals, he said.

The report covered two main programs — one for prevention and early intervention of mental illness in young people and another aimed at improving outcomes for people with serious mental illness.

Those who participate in the second program are in and out of jails and hospitals, and really need intensive services, according to Debbie Innes-Gomberg, the department’s deputy director. She said she was pleased Rand found that the services are making a difference. ‘It is a very good investment,’ she said, adding that the county plans to add more participants this year.”

Here is the key finding from the report itself.

“The evaluation found evidence that the Los Angeles County Department of Mental Health (LAC DMH) is reaching the highly vulnerable population it seeks to reach with its FSP and youth PEI programs. Furthermore, those reached by the programs experience improvements in their mental health and life circumstances.”

Click here to read “California’s Tax on Millionaires Yields Big Benefits for Those with Mental Illness.”  Click here to read the Rand study.

Passage of the referendum in California’s tax-weary state took determination, political shrewdness, and a sense of how to sell the need for more services.  Check the next blog post for information about how advocates made their case. 

 

 

 

Voters Will Support Mental Health Funding: California Offers Lessons

Proposition 13, passed in California in 1978, restricted increases in property taxes and required that all state tax increases be approved by a two-thirds vote of the state legislature. Because of the difficulty of securing that vote, advocates for various causes  turned to the use of propositions or “ballot-box budgeting” to raise revenue.  Most of those efforts were unsuccessful, but advocates succeeded in getting a measure passed that imposed a 1 percent tax for mental health services on people earning more than #1 million a year.  

Psychiatric News published a series of articles describing the campaign.  They contain lessons for advocacy in the future.

Click here to read “Complex Strategy Leads to Success of MH Initiative.”  Among the findings: Focus groups and polling revealed a strong positive response to the question: “Have you or someone you know suffered from a serious mental illness?”  The phrase “Everyone knows someone with mental illness” became a key theme of the campaign.

Click here to read “Lawmaker’s Crusade Boosts MH Funding.”  Darrel Steinberg traveled the state and found that residents could see the link between the emptying of mental hospitals and the rise of homelessness.

Click here to read “California Voters Say Rich Should Help Fund MH Care.”  Among the conclusions of a polling and analysis firm:

(1)[The] “severely mentally ill evoke the most sympathy and compassion from voters…. Even more cynical voters who doubted the measure’s means, merits, and objectives did not question the need to provide seriously emotionally disturbed children with [treatment]….”

(2) Voters want a proven model.   The new effort was modeled on California AB 34, a pilot program approved in 1999 that funds services to mentally ill adults who are homeless or at risk of becoming homeless or incarcerated.

Following are excerpts from the article.

The Campaign for Mental Health formed a broad coalition of organizations that together represent a number of different constituencies. In addition to state and national medical and mental health associations, the CMH includes six major California unions and organizations such as the California Teachers Association, AARP-California, and the California Police Chiefs Association (CPCA).

CPCA President Cam Sanchez wrote in a letter to the San Diego Union-Tribune, “Police chiefs like me face an awful reality: 20 percent of our officers’ time is spent dealing with untreated mental illness. Too often, we must take people with mental illness to jail, not because they have done anything wrong, but because there is nowhere else to go…. Proposition 63 will finally make mental health care a priority and free law enforcement to spend more of their time and resources on public safety rather than our failed mental health system.”

City councils in Los Angeles, Oakland, Santa Barbara, and Santa Monica supported the initiative, as did the San Francisco Board of Supervisors.

The CMH gathered more than 600,000 signatures, nearly double the number required to qualify the initiative for the ballot.  Sympathetic stories in major newspapers portrayed the impact of the failed mental health system and described lives that had been reclaimed by treatment.

Click here to read “Advocates Hope Tax on Wealthy Can Fund MH Services.”

 

 

More Bipartisan Support for Regional Mental Health Crisis Centers

An editorial in the Racine Journal  supports legislation that would provide a grant program for mental health crisis restoration centers.  The bills would also allow law officers to take people with acute psychiatric needs to the closest mental health institute in the state.

The authors point out that although access to psychiatric care would be more quickly available in some parts of the state with passage of the bills, residents in the Racine area still would have to travel at least two hours for help.  Therefore, they support the funding of regional crisis centers that would be situated at hospitals.  Click here to read the editorial.  Here is an excerpt.

“So the aspect that has us enthusiastic is the proposed grants for developing regional mental health crisis centers. Given all of the facilities operated by Ascension, Aurora and United Hospital System in the Racine-Kenosha area, we see no reason why one of the area facilities couldn’t obtain a grant and establish itself as a regional center.

We want our law officers on duty within Racine County, not taking 4-plus hours out of a shift to transport someone in need of mental health care to a state-mandated facility. Especially when a facility within 40 miles of the station could be established as a regional destination for such patients.”

The bills (SB 681/AB 815) were introduced by Republican and Democratic legislators and by members from Dane County and the center of the state.  Among its supporters are: the Wisconsin Chiefs of Police Association; the League of Wisconsin Municipalities; the Dane County government; the Dane County Cities and Villages Association, and the League of Women Voters of Wisconsin.

See “Bipartisan Support for Better Access to Mental Health Institutes” on this blog for background on the legislation.

UPDATE:  Local criminal justice and other officials in St. Croix also reported problems because of the lack of crisis restoration centers.  Here is what they told Attorney General Schimel.

“Yehlik and others made clear to Schimel that it does agencies in western Wisconsin no good to open more beds on the other side of the state.

North Hudson Police Chief Mark Richert said funding issues make local hospitals hesitant to establish such facilities in western Wisconsin. That, Schimel said, is because of reimbursement issues.

But, he noted, law enforcement also isn’t getting reimbursed for the cost of transports to the state’s Winnebago Mental Health Institute, which he said can exceed $1,000. St. Croix County Sheriff Scott Knudson said his office performed 47 such transports to Winnebago last year.”

Schimel later called the issue “a gigantic drain on county and local budgets.”

The above comments come from the River Falls Journal.  Click here to read the full article.

Bipartisan Support for Better Access to Mental Health Institutes

A bipartisan group of legislators is proposing a solution to problems posed by the state’s decision in 2014 to limit access to Mendota Mental Health Institute in Madison to criminal cases.  As a result of that decision, two police officers must transport a person in a psychotic or seriously disturbed state to the Winnebago Mental Health Institute near Oshkosh.

The trip from Madison takes two hours each way.  It is a frightening and damaging trip for the person locked in a police car and a costly one for city and county governments.

From 2014 to 2016, transports to Winnebago from Dane County cost more than $330,000, including nearly $151,000 for the Dane County Sheriff’s Office and nearly $61,000 for the Madison Police Department, according to the Dane County Chiefs of Police Association.

The bill would allow law enforcement to take individuals to be detained for “emergency detention or involuntary commitment” to the most convenient mental health institute.  It has bipartisan support because counties and individuals throughout the state have suffered as a result of the state’s 2014 ruling.

The bill also proposes a program that would provide grants for hospitals for regional mental health crisis centers.   The grants would be funded in the 2019-21 legislative session.

Click here to read the proposed legislation.

David Wahlberg reports on the history of the problem and reaction by local officials in “Bill would restore mental health crisis detentions at Mendota.”

In “Crisis Cops,” Abigail Becker offers insights from the police about the Mendota restrictions.

Two Veterans Travel a Rocky Road for Help with War Trauma

Military veterans Connie Walker and her son Michael Segich fought battles that neither had anticipated.

In 2003, Connie retired as a Navy Captain after 23 years of service.  At about the same time, her son returned from Army service in Iraq.  Back at home Michael would wake up screaming and was later diagnosed with post-traumatic stress disorder, schizophrenia, and depression.

Mother and son struggled together to find mental health treatment and services that would enable him to regain a sense of stability and independence.  Now, Michael lives in his own apartment and holds a job at Metcalfe’s in Hilldale as a grocery bagger.  But, his journey included hospitalizations, failed medications and treatment, and an unhappy spell at a group home.

Michael told reporter David Wahlberg, “If I didn’t have my mom or the other people advocating for me, I could very well be homeless.”

Daniel Zimmerman, secretary of the state Department of Veterans Affairs, named Connie the Woman Veteran of the Year for her “tireless advocacy for veterans.”  She developed and will lead Homefront, a series of six classes to be offered at NAMI-Dane.  In the series, Connie will use what she learned as Michael’s advocate to help veterans with mental illness, their families, and caregivers.

Click here for more information about Homefront and a registration form.

For more information about Connie and Michael, read David Wahlberg’s article “Retired Navy Captain Helps Son and other Veterans with Mental Illness.”

NAMI Gets Answers about the Crisis Restoration Center and Raises More Questions

Check out the blog post by Lindsay Wallace, NAMI’s executive director, for excellent reporting about the psychiatric hospital/crisis restoration center proposed by Strategic Behavioral Health (SBH).  Click here for a link.

Lindsay addressed the concern that SBH is a for–profit company.   Here is what she reported:

“There are distinct differences between not-for-profit and for-profit psychiatric facilities but SBH says their approach to care delivery is the same; they ensure all referring/community professionals, consumers, caregivers, and families are involved in the consumer’s treatment and recovery plan every step of the way.

I have reached out to other NAMI affiliates across the country who have SBH facilities in their community to see what their experiences have been in regards to care coordination and quality of care. In each instance, I received positive feedback. Our hope is SBH will deliver on this promise in Dane County as well. It is, of course, something we will monitor closely.

When it comes to service to patients who are unable to pay, SBH said they provide services regardless of ability to pay. They are able to do so because of the individual mandate through the Affordable Care Act. Those who have coverage are charged higher costs for services, making it possible for SBH to not turn away uninsured and underinsured patients – a practice we understand non-profit facilities utilize as well. Of course, there are concerns around the sustainability of such a practice with current tax reform efforts that include a repeal of the individual mandate.”  NOTE: As of 12/19, the individual mandate appears over.

Lindsay also raised these questions:

Will SBH have discretion over who they accept for inpatient treatment or must they accept referrals sent to them by the county?

Will SBH be required to serve people who are court ordered into treatment?

Will the contract with SBH establish requirements for discharge planning and linkages with community services?

Will SBH have the capacity to treat the physical health needs of people they serve, including preventive health services such as smoking cessation?

Will SBH’s performance be assessed on measures such as clinical outcomes, screening for metabolic disorders, coordination of mental and physical healthcare services, use of aversive measures such as restraints and seclusion, screening and treatment for alcohol or substance use, number of patients discharged on multiple antipsychotics and justification, and how quickly patients are seen in the community after discharge?

Click here for a link to NAMI-Dane County.  Lindsay is planning a forum with SBH in the spring.

UPDATE:  JUDGE EVERETT MITCHELL WILL BE THE KEYNOTE SPEAKER AT NAMI’S ANNUAL AWARD BANQUET.  He will speak about decriminalizing people with mental illness.  Date is April 5, 2018.  Check the website for NAMI-Dane County for details.

 

 

 

 

 

 

A Crisis Restoration Center for Madison: Who will Pay?

Yesterday, Strategic Behavioral Health (SBH) announced plans for a psychiatric hospital in the Madison area to open by late summer 2019.  It would provide 72 beds, cost $15 to 20 million, and offer inpatient and outpatient services.

According to county officials, the hospital would meet the long-established need for an alternative to a trip to Winnebago State Hospital for persons suffering from a psychotic episode and the police who accompany them.  It would also provide many of the services offered by a crisis restoration center.  Click here to read David Wahlberg’s article in the Wisconsin State Journal.

SBH has an entrepreneurial and ambitious approach to mental health services.  Its website offers this invitation:

“We are currently seeking opportunities to bring services to areas where there is an identified need. We are looking for places where Strategic Behavioral Health can be a good provider and also a good community citizen. Please email our home office to discuss opportunities.”

Since 2006, Strategic Behavioral Health has opened centers in 11 cities, primarily in the south and west.  Willow Creek Behavioral Health Center in Green Bay, which opened in January 2017, was the first site in the mid-west.  According to SBH’s website, the company offers a full range of mental health and substance abuse services to just about any kind of client in need.

Funding mechanisms–the perpetual issue for mental health service providers–are less clear.  SBH offers this guidance on its website.

“With payments often times being the last item patients and their families want to address, we make it a point to keep all involved parties informed while keeping the focus on treatment and recovery. Strategic Behavioral Health works with most major insurance companies and is able to work with each individual to determine the best approach for covering the cost of treatment.”

Private insurance will not cover costs for many of the people who might need a crisis restoration center or other mental health services.  It is likely SBH will be competing with existing service providers for state and county funds.   Let’s hope it is a “good provider and good community citizen” and that competition turns out to be a good thing.