The report came while states are recovering from the overwhelming economic recession that caused a $4.35 billion cut from the mental healthcare system. At the same time, public awareness of mental health has increased drastically amid mass shootings and the death of Robin Williams.
Both good news and bad news emerged from state legislative sessions in 2015.
The bad news
The number of states to increase their financial investment in mental health services has declined. In the wake of the Newtown tragedy three years ago, 36 states and the District of Columbia increased mental health spending in 2013. In 2014, the number dropped to 29. This year, only 23 states increased their mental health budgets.
Three states have been in steady decline over three years: Alaska, North Carolina and Wyoming.
Two states increased mental health spending in 2013, but cut down for two years in a row: Kentucky and Arkansas.
Four states, after two years of increases, saw cuts in mental health services in 2015: Arizona, Iowa, Kansas and Ohio.
Budget cuts in mental health care come with costs. The impact includes people with mental illness who often end up in emergency rooms, jail or on the street.
The good news
Despite budget cuts, many states continue to recognize the need for mental health care reforms and some have enacted legislation that can serve as models for other states. Congress has also initiated mental health care reform legislation to provide a comprehensive framework.
The report surveys legislation by topic and marks with gold stars those that NAMI considers notable, worth serving as models for other states. Thirty-five states adopted one or more measures in 2015 that received gold stars.
Five states passed bills that stood out as the top five measures of the year.
AZ HB 2488 (Housing) – Housing is pivotal to recovery for people with mental illness yet. This legislation creates a housing trust fund for rental assistance to people with serious mental illness.
MN SF 1458(First Episode Psychosis program) – Leading research shows that early intervention through First Episode Psychosis (FEP) programs enables young people to manage psychosis and get on with their lives. This legislation supplements federal dollars to support evidence-based FEP programs.
UT HB 348 (Criminal Justice and Mental Health) – People with mental illness who would gain from treatment often end up in jails and prisons. This legislation requires the state departments of corrections and mental health to collaborate on providing mental health treatment to inmates, develop alternatives to incarceration and implement sanctions and incentives.
VA HB 2118 (Psychiatric Inpatient Beds) – Finding a psychiatric bed in crisis is challenging, often due to lack of information. As a result, people with mental illness are often kept in emergency departments for unusually long periods. This legislation requires all public and private facilities to report psychiatric inpatient and crisis stabilization beds at least once daily.
WA SB 5175 (Telehealth) – Nationwide, there is an acute shortage of mental health professionals. Telehealth can make mental health expertise more available to underserved communities. This legislation defines telemedicine as a reimbursable service for the purposes of diagnosis, consultation or treatment.
Medicaid should be expanded to include all mental health care benefits that are available in traditional Medicaid. Recipients with mental illness should be exempt from cost-sharing requirements.
Health plan transparency is required regarding mental health benefits, medical necessity criteria, primary care, costs, provider networks for mental health, and consumer protections.
Early identification and intervention for children’s mental health conditions through primary care and schools to be promoted, alongside investment in the First Episode Psychosis program (FEP).
A 24/7 psychiatric response services with mobile crisis response teams or crisis response specialists, stabilization units and respite services should be available.
All local enforcement agencies should have a well-trained Crisis Intervention Team (CIT) program. Statewide availability of mental health and substance use treatment courts and other community services to be ensured for effective alternatives to sentencing and reduce the number of people with mental illness in jail.
“As a behavioral health provider that relies on commercial insurance and private pay, Sovereign does not benefit directly from state funding initiatives. However, we do benefit from the decreased stigma that is generated when states expand access to mental health alongside drug and alcohol treatment,” stated Anthony Mele, Psy.D., chief clinical officer of the Sovereign Health Group.
“The work of NAMI in reducing stigma and expanding access to behavioral health care is a national success story.”
The report is intended to serve as an advocacy tool for state leaders and all who share a desire to strengthen mental health care systems that for too long have been fragmented and in perpetual crisis. The goal is to improve lives affected by mental illness by providing a coordinated, cost-effective recovery system.
Despite considerable debate about the broken mental health system in America, the response of states, as illustrated in this report, has been uneven at most. Some states have increased funding for mental health services and passed legislation to ensure effectiveness. Other states are barely surviving or even backstepping by cutting mental health funding.
When mental health services are cut, the inevitable consequence is more spending on homelessness, criminal justice and crisis services. It is time for all states to invest in recovery.