Mental Health Introduction

States that Stand Out

SUCCESS STORIES

Alabama
Alabama is closing six of its 14 state hospitals but is working hard to move patients to community-based care. To ease fears that rural areas could be bereft of mental health resources, four new regional treatment areas will retain a team of specializing physicians, nurses, psychiatrists and dentists. The state is also adding 40 beds for acute, short-term inpatient stays, split between two state psychiatric hospitals.

Arizona
Worried that providers will leave its mental health care system, as is happening in numerous other states, Arizona has chosen to combat the problem by making its reimbursement system more competitive. In 2001, the state adjusted provider reimbursement rates upwards for the first time in 10 years.

Nevada
The state’s mental health department budget was increased this year by 31 percent. It needed to be raised: Nevada has just six state hospital beds for every 100,000 residents, far below the national average of 33. The new money is bankrolling a new state hospital with 150 additional adult beds and mobile mental health teams.

Oregon and Texas
These states are leaders in implementing “evidence-based practices,” requiring rigorous documentation on treatment results as a condition for increased funding. By the 2009-2011 budget, 75 percent of Oregon’s mental health funds will go toward programs that can point to evidence-based achievement, while Texas is phasing in a policy of designating 100 percent of its funding to support the practices.

Texas
Eight years ago, Texas introduced its “Medication Algorithm Program” to add consistency to psychotropic prescriptions by ascertaining more precisely the real benefits of various combinations of drugs. TMAP has not only led to improved patient outcomes but has become the model for other states developing prescription formulas.

Vermont
Vermont’s comprehensive parity law covers both mental illness and substance abuse treatment. A study found promising results: Employers didn’t drop coverage as a result of the law, access to outpatient mental health services improved, consumer spending on mental health treatment declined and health plan spending rose only slightly.

TROUBLE SPOTS

Georgia
Georgia’s mental health system has been plagued by confusion and corruption. Two of the state’s 25 community service boards, which deliver mental health services on a regional basis, are under investigation for Medicaid fraud, and the state hired a consultant to fix a projected $6.5 million deficit in a third. Oversight of the boards has reverted back to the state from regional governing boards, and Governor Sonny Perdue has ordered audits of every community service board.

Maine
Last October, a judge accused the state of failing to comply with a 13-year mandate to improve state mental health care and imposed receivership on the major state hospital. The state has until March to make progress, or a receiver will also be imposed on the community-based portions of the system.

Michigan
The state closed 11 state hospitals between 1991 and 1999, and the community-based system has never managed to pick up the load. Problems in Wayne County’s mental health board have grabbed the biggest headlines, but several other regional boards are unable to balance their books. A special commission on mental health care is just now getting underway.

New York
The state’s adult homes suffer from widespread and long-standing problems. They are licensed by the state Department of Health, not the state Office of Mental Health, and negative reports by the Commission on Quality of Care for the Mentally Disabled were ignored through the 1990s. A class action suit was brought against the state last year, alleging that residents of large adult homes were being unlawfully segregated from the community.

South Carolina
Last year, 70 people were confined to jail because they couldn’t access court-ordered treatment. The mental health director blamed staff and bed shortages for a backup in the state’s forensic unit. Finally, a state Supreme Court justice ordered the mental health department to find space for them.

Vermont
The state hospital lost its federal funding last year when inspections revealed numerous systemic problems. Vermont’s mental health commissioner agreed too little attention had been paid to the hospital, and the hospital’s budget has been increased to add staff and improve treatment.

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