Winning Strategies

Best Practices and Innovations

As Demonstrated in States Across the Country

A Recent View of State Practices

• NAMI releases Grading the States in March 2006

• National report card: we eek out a “D”• Five states get a “B”; eight states flunk; two

states choose not to respond• Report focused on 39 criteria reflecting NAMI

values• Other values/priorities/opinions relevant

The Best Practice Realizes…

• Poor mental health does not occur in a vacuum

• Debate on criminal justice, education, general healthcare, and workforce development must include acknowledgement of mental health

• Maintenance is not a positive outcome

Financing

• Prop 63 (CA)• The New Mexico Behavioral Health

Purchasing Collaborative• Special tax districts that promote local-based

financing of MH services (CO & AZ)• Privatized healthcare has yet to demonstrate

comparable capacity for treating mental illness as experienced in public sector

Housing Development

• Real estate transaction fees in IL to fund housing development

• Dedicated housing initiatives through legislative process in states such as NJ (10,000 units) and NY (36,0000 units)

Jail Diversion Strategies

• Telephonic triage and screening program that support treatment and linkage to services (KY)

• Prison staff education initiatives (IN)• Mandated county diversion strategies (TX)• Post-booking jail diversion strategies through

arraignment courts (CT)

State Initiated Parity

• Best laws exist in Connecticut, Maryland, Minnesota and Vermont; to be joined by Oregon in 2007

• Inclusion of both substance abuse and mental health is critical

• Data from analysis of federal employee benefits plan supports low-fiscal impact of parity

• Healthcare transformation and the tailoring plans?

Approaches to Medication Access

• Formalized prescriber feedback approach to address poly-pharmacy and other outliers (MO)

• Strict script limits problematic – “exempting mental health drugs from count”

• Research demonstrates uniqueness of mental health medications; best approaches provide prescriber discretion

Strategies to Broaden Cultural Competency

• Expectations of monitoring efforts at the provider level (CA)

• Staff expectations for diversity in communication skills (AZ)

• Subcommittee strategy to develop approaches to unique populations based upon cultural background, living situation (WA)

Proven Practices As Cornerstone of System of

Care• Assertive community treatment• Supported employment • Family and consumer education• Peer run/peer operated programs• An emphasis on recovery• Seven state transformation: CT, MD, OH,

OK, TX, NM, & WA

Other Areas to Concentrate

• Increased use of A/V technologies to aid rural constituents

• Invest in system access supports – web infrastructure and front-end customer service

• Full health promotion beyond just treating mental illness

• Investment in peer run/peer supported services

• Efforts in reducing use of restraints and seclusion

Disaster Response Related to Mental Health Services

• Mississippi, Louisiana, Alabama, Texas mental health systems responded quickly and to differing degrees

• Mutual aid agreements appeared to activate quickly and effectively

• Medicaid provided reasonable guidance and assistance

Consumer/Family Involvement Is Essential

• Statewide planning (WV’s task force)• Medicaid advisory bodies• Mental Health Agency planning participation• Expectations for consumer/family surveys• Data collection is critical

Future Practices Related to DRA/Reform Initiatives

• Cost sharing – state option• Benefits design for expansion

programs – importance of including a mental health benefit

• Documentation standards• “Deliberate and deliberative”

(NE)

NAMI

• The Nation’s Voice on Mental Illness

• Steven Buck, Director of State Policy, 405/749-1366 or sbuck@nami.org