Two years after the Sandy Hook Elementary School shooting, in Newtown, Conn., ignited a nationwide push for improving mental health care, the movement's momentum has slowed, according to the annual year-end review from the National Alliance on Mental Illness (NAMI).
“Despite much talk about the mental health crisis in America since Newtown, little of substance on mental health care has been accomplished in the sharply divided, partisan Congress in the two years that have ensued,” the group argued in its report. And the story isn't much different at the state level. The number of states pushing to restore funding to pre-recession levels has dropped, and the legislation that has passed “feels like tinkering at the edges,” according to NAMI.
Between 2009 and 2012, state mental health cuts totaled $4.35 billion. But after the school shooting in Newtown, 37 states and the District of Columbia boosted funding in 2013. In 2014, though, only 27 states increased funding.
SOURCE: National Alliance on Mental Illness
Virginia grabbed the most attention by directing another $54.9 million to crisis services, community-based therapy, telepsychiatry, hospitals and strengthening civil commitment standards. The investment came after state Sen. Creigh Deeds' 24-year-old son, who suffered from bipolar disorder, stabbed his father and later committed suicide.
While no comprehensive federal legislation aimed at boosting mental health care passed Congress, there were some continued efforts at the state level this year that mostly fell along areas of long-standing concern, such as expanding the mental health care workforce, diverting mentally ill people from jail and prison, and increasing access to telehealth.
Inpatient and Emergency Care
Inpatient treatment is for people with more severe issues but has been rapidly vanishing, leading to greater numbers of people with psychiatric emergencies being sent to ill-equipped general hospitals. There were 3,000 fewer beds available for patients who needed psychological treatment in 2012 than in 2009, and federal policies prevent Medicaid money from flowing to inpatient mental health facilities. Virginia’s H-1232 sets up a registry that provides up-to-date information on the availability of psychiatric beds in psychiatric facilities as well as residential stabilization facilities.
There’s growing evidence that creating teams of first responders who can direct some people calling 911 to appropriate mental health care helps reduce hospitalizations. With that in mind, Wisconsin passed AB-460, which gave grants to counties to implement mobile-crisis response teams, and Minnesota overhauled its existing emergency response teams in an effort to get faster response times and get patients to enter voluntary treatment when necessary.
By the federal government’s definition, it would take close to 3,000 additional psychiatrists to meet the basic level of demand for services. States have been trying to ease the shortage by expanding the role of some health professionals and bolstering educational opportunities to train more mental health professionals.
Illinois granted limited prescribing rights for psychologists who take on extra training under SB-2187. Kentucky enacted SB-7, which allows advanced practice registered nurses with a certain level of experience to prescribe drugs independently, though they still need a practice agreement with a doctor to prescribe prescription drugs that have a higher risk of dependency. Wisconsin passed a grant program through AB-454 that encourages up to 12 psychiatrists to practice in underserved areas of the state.
Through LB-901, Nebraska is requiring the University of Nebraska Medical Center to fund five one-year behavioral health doctoral internships in the next year and 10 within the next three years.
Many view telehealth as a promising way to deliver basic medical care to people, particularly in rural areas, who don't have much physical access to providers. Telehealth essentially provides examinations and other treatment electronically via a video signal and other forms of technology. But state Medicaid billing policies haven't kept up with the growth of telehealth.
Wisconsin's AB-458 allows for in-home electronic mental health consultation and treatment for children. Ohio passed HB-123, which requires the state's Medicaid program to establish billing standards for telehealth, and HB-83, which requires the state board of psychology to establish standards of treatment through telehealth.
Guns and Courts
Even though advocacy groups fight against the notion that the mentally ill are more prone to violence, states are continuing to push for greater reporting to federal background check databases to bar people with a history of mental illness from buying guns.
Federal law doesn’t force states to report mental health-related adjudications to these databases, so Rhode Island, for one, passed a law allowing federal district court to report people committed to a mental health facility to the federal background check database. The law also allows people who lose access to guns from this type of reporting to restore it through a five-member board. Similar laws passed in Alaska, Arizona, Hawaii, Massachusetts, Ohio and South Dakota.
Advocates have long argued that court systems need to find more nuanced ways to deal with the mentally ill, instead of issuing prison sentences. Mental health treatment courts, for example, focus on connecting people with housing, treatment and other forms of support.
Arizona passed HB-2457, which sets up county-level courts specializing in diversions for the mentally ill and veterans. New Hampshire passed HB-1442, which allows circuit courts and superior courts in the state to set up mental health courts.