NAMI Idaho, through its Board of Directors, has taken formal public policy positions on the following subjects:
Consistency with NAMI National’s Public Policy Platform
NAMI Idaho’s public positions on federal, state or local legislative policy issues are consistent with NAMI National’s public policy platform that can be found at http://www.nami.org/TextTemplate.cfm?Section=NAMI_Policy_Platform&Template=/ContentManagement/ContentDisplay.cfm&ContentID=105491
Important Facts on Mental Illness
1. Mental illnesses are neither character flaws nor bad behavior, but neurobiological diseases that affect an individual’s behavior, functionality and human relationships. The prevailing scientific judgment is that “severe mental illnesses” are brain disorders, which, at the present time, are neither preventable nor curable. However they are treatable, manageable and recoverable with combinations of medication, supportive counseling, and community support services, including appropriate education and vocational training. The causes of mental illness are complex and currently not fully understood but there is clearly a genetic component to some serious mental illnesses. Although stress or drug and alcohol abuse can precipitate or aggravate mental illness episodes, they are not the primary causes of mental illness.
Mental Health Services in Idaho
1. NAMI Idaho deplores the state of Idaho’s decision to continue cuts to the mental health budget. These reductions undermine programs and services that are essential to persons living with mental illness in achieving stability, instead promoting a crisis-to-crisis approach to treatment. Such a crisis focused strategy chips away at the ability of our citizens living with mental illness to maximize their potential and craft a life of recovery, stability, meaning and hope. NAMI Idaho believes it is unconscionable for the state to effectively abandon this vulnerable segment of our population.
2. Adequate and comprehensive mental health treatment is an investment in recovery and in the human resources of our state. Mental health treatment saves lives and reduces other costs. Science tells us that “treatment outcomes for people with even the most serious mental illness are comparable to outcomes for well established general medical or surgical treatments for other chronic diseases.” (See Health care reform for Americans with severe mental illnesses: Report of the National Advisory Mental Health Council, American Journal of Psychiatry 1993; 150:1447-1465.) In addition to the enormous negative moral and social implications of not supporting those living with mental illness and their families until they are in crisis, the cost to Idaho taxpayers is increased when appropriate treatment is not available. These societal costs are simply dispersed to hospital emergency rooms, homeless shelters, police, local courts, jails and prisons. The taxpayer still gets the bill, and it is usually a bigger one.
3. Idaho citizens and their families do not have adequate access to quality, coordinated and efficient mental health and substance use disorder services. It is the right of all children and adults living with mental illness in our state to receive the right care at the right time and in the right place to maximize their potential for lives of resiliency, recovery and inclusion.
4. It is NAMI Idaho’s position that:
a) Public and private health plans should provide an essential set of effective services and supports for children, youth and adults living with mental illness and co-occurring disorders.
b) Public and private health plans should have an adequate network of primary care and specialty providers who are well-trained in effective and culturally competent services and supports for those living with mental illness and co-occurring disorders.
c) Care for mental health, addictions and other medical conditions should be integrated in all public and private health care settings.
d) Mandatory coverage and full parity for mental illnesses must be required in all health care plans. Benefits must be equal in scope and duration to coverage of other illnesses, without lifetime maximum-benefit caps and other limits more restrictive than those required for other illnesses or disorders, and covers all clinically effective treatments appropriate to the needs of individuals with mental illnesses.
5. NAMI Idaho supports transparency and accountability in the collection and publication of meaningful performance, process and outcome measures related to Idaho’s mental health system. Such data would make for better informed policy decisions and promote quality improvement. NAMI Idaho advocates for standardized statewide data collection and public reporting of process and outcomes data.
Workforce and Medicaid Reimbursement
1. In order to effectively meet the mental health needs of its residents, Idaho must establish a stable and excellent behavioral health workforce.
2. Idaho is a mental health professional shortage area; low Medicaid reimbursement rates create a disincentive for qualified mental health professionals.
3. Medicaid reimbursement rates for all mental health providers must be adequate to ensure the availability of quality services in all regions.
Revenue and Budget
1. NAMI Idaho strives to protect Idaho’s children and adults from any further deterioration in mental health services resulting from revenue shortfalls and budget cuts through its advocacy at the state legislature and at state agencies by increasing understanding of the nature and prevalence of mental illness in our state, by illustrating the costs of untreated mental illness, by illustrating consequential cost increases arising from limitation of mental health services to crisis intervention, and by emphasizing the efficacy of early treatment and the possibility of recovery.
2. NAMI Idaho is committed to the support of legislators and legislation seeking to increase state revenue specifically directed to increasing the level of services now being provided to those persons living with mental illness.
Support of Specific Concepts from the Behavioral Health Transformation Work Group Report
1. NAMI Idaho commends the BHTWG for proposing a plan to the Governor in its October 28, 2011 Report “… that commits the State of Idaho to the process of developing an efficient and effective client-centered system”.
2. Regarding the following items from the BHTWG report, NAMI Idaho:
a) Concurs in the Vision statement that “Idaho citizens and their families have appropriate access to quality services provided through the publicly funded mental health and substance abuse systems that are coordinated, efficient, accountable and focused on recovery”.
b) Concurs in the Goals statement to “Increase availability of and access to quality services; establish an infrastructure with clear responsibilities and actions; create a viable regional and/or local community delivery system; efficiently use existing and future resources; increase accountability for services and funding; and seek and include input from stakeholders and consumers”.
c) Supports a plan that “…provides the platform to improve access, enhance quality, develop consistent service delivery standards, generate outcome-based services and data-driven decision-making – all of which will increase efficiencies and accountabilities.”
d) Concurs in the BHTWG’s definition of core services “…as an array of services including those that are community based, emergent, medically necessary, and required by law. They provide a “floor” of services intended to be developed and available in each region that span prevention, intervention, treatment and recovery. With transformation, the goal is to redirect supports from the more expensive emergent and medically necessary services to the more effective and less costly prevention, intervention and recovery services. In this context, core services will be provided in accordance with statewide standards which will include, at minimum, monitoring for quality, consistency and effectiveness. These services will be delivered from a client-centered perspective. Effectiveness of service delivery will be determined by examining quality of life measures as well as other standardized outcome-based instruments.”
e) Support the BWTWG’s statement that “…it is the specific intent of transformation to emphasize prevention, intervention and recovery services in regional systems”.
f) Agree with the BWTWG’s statement that “Early intervention and prevention efforts and community supports are less expensive and more positive services than crisis, hospitalization and incarceration.”
g) Agree with the BWTWG’s statement that “By using the lack of resources as a reason to make no change, the existing situation will get predictably worse; higher cost crisis services will become the stop gap for escalating issues avoided by the availability of early intervention and prevention services”.
3. NAMI Idaho believes that successful implementation of any transformation of Idaho’s Behavioral Health system requires:
a) Greater input from those living with mental illness and their families to assure the parties directly impacted have a voice.
b) Outcome data collection and public reporting in order to ensure fiscal responsibility and accountability.
c) Adequate funding and human resources to effect the transition and to protect the interests of those living with mental illness.
4. NAMI Idaho is committed to tracking the progress of and being actively involved in any implementation process related to the BHTWG report.
1. The Managed Care System
a) The state must have specific criteria that are measurable for determining the quality of the services provided by the Managed Care Organization (MCO). This data must be available in a timely fashion for public review.
b) The program will be most cost-effective if the focus is on recovery-oriented and community-based care that promotes recovery activities in the community such as supported employment, Assertive Community Treatment teams (ACT), and supportive housing.
c) The definition of “medical necessity” is critical. It should include initial criteria (criteria for entrance to the system), concurrent criteria (criteria to stay/continue in a service), and discharge criteria (criteria to determine the end of service). People living with mental illness and their families should be involved in creating the criteria for these definitions.
d) The Medical Loss Ratio (MLR) of the MCO should be in the range of 83%-87% resulting in 83-87% of the total payment to the MCO providing direct mental health care services.
e) The standards for access to care should provide for a choice of providers, geographic access with time or mileage limits on maximum distances between providers (e.g. 60 miles or 60 minutes for inpatient services and 30 miles or 30 minutes for outpatient services), and language and cultural competency. The provider network should include well-trained mental health providers in numbers and locations adequate to provide timely and accessible services.
2. The Managed Care Organization
a) The MCO should have specific requirements for supporting consumer and family involvement such as the utilization of peer specialists, the creation of consumer advisory councils, and involvement in quality improvement initiatives.
b) The MCO should be directed to invest in evidence-based and promising practices.
c) The MCO should have clear and understandable processes for member information on coverage and services, grievances, and appeals of service decisions.
d) We are very concerned that the treatment of mental health and substance use disorders be well integrated. The MCO should specifically address how mental health services will be integrated with substance use disorder treatment and primary care services.
e) The MCO should be required to meet specific financial goals as well as quality of services goals.
f) The MCO’s pharmacological standards should include newer medications and should not be limited to cheaper but less effective medications.
3. Data Collection
a) Data must be collected in a standard format throughout the state through the MCO. It must be collected and published at least quarterly. It must be made available in a timely fashion to the public in a useful format. It must include:
1) System Performance – availability of services, utilization levels, rate of critical incidents, time between inpatient discharge and first outpatient appointment, consumer involvement in the program planning, and use of evidence-based and promising practices
2) Clinical Performance – symptom improvement, hospital diversion rates, identification of medication gaps, quality of life improvement (housing, employment, relationships), re-hospitalization level, and involvement with the criminal or juvenile justice systems
3) Administrative Performance – consumer satisfaction surveys, service appeals, service denials, complaints/grievances, call pick-up, claims payment rate, network turnover, timeliness of data reporting
Crisis Intervention Team (CIT) Training
1. NAMI Idaho supports CIT training of law enforcement officers and other emergency responders to protect their personal safety and to assist them in appropriately responding to people living with mental illness.
2. NAMI Idaho endorses the Memphis model of CIT training and the efforts of the Idaho CIT Workgroup to establish state-wide standards of law enforcement training pursuant to this model.
1. Idaho is the only state that does not have its own suicide prevention hotline. NAMI Idaho supports the creation and maintenance of a dedicated suicide prevention hotline for Idaho.