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Grading the States 2009: Frequently Asked Questions

Q. What are the report's recommendations?

The federal government, governors, and state legislators must take action in five key areas:

Increase Public Funding for Mental Health Care Services

  • Institute modest tax increases
  • Reallocate resources
  • Establish dedicated trusts

Improve Data Collection, Outcomes Measurement, and Accountability

  • Standardize data collection
  • Report on evidence-based practices
  • Track wait times in emergency rooms

Integrate Mental and Physical Health Care

  • Expand programs that link physical and mental health
  • Co-locate primary care physicians and psychiatrists in clinics
  • Increase use of health and wellness programs

Promote Recovery and Respect

  • Employ peer specialists and fund peer-run services and peer-education programs
  • Provide culturally and linguistically competent services
  • Invest resources in reducing human rights violations
  • Increase employment opportunities
  • Increase housing opportunities

Increase Services for People with Serious Mental Illnesses Who are Most at Risk

  • Eliminate the "Institutions for Mental Diseases" (IMD) exclusion
  • Implement a coherent response on non-adherence to treatment
  • Adopt incentives to increase the qualified mental health workforce

Q. How will states pay for reforms?

Several strategies exist. One is to simply increase investment. Anothers is reinvestment i.e. in which costs are shifted into the mental health care system from other areas where they may be currently imposed (such as jails). Another is to insist on investment in proven, cost-effective services within the system. That's one reason the report emphasizes the importance of standardized data collection, including measurement of outcomes.

The report discusses several innovations states are pursuing to help fund mental health care. They include:

  • California's 1% tax on annual income exceeding $1 million.
  • Washington state's law authorizing counties to impose a one-tenth of one percent sales tax to fund mental health care.
  • Portions of so-called "sin taxes" on cigarettes or alcohol.
  • Alaska's "trust in perpetuity" to promote systems improvement and fund new and innovative programs.
  • Oregon's housing trust fund for people with mental illnesses created by the sale of property-a state hospital.
  • Connecticut's and Florida's programs to reinvest dollars from the criminal justice system to community-based services.
  • Kentucky's jail mental health triage program funded by DWI fines.

Q. How does mental health care fit into President Obama's health care reform initiative?

Mental health care and physical health care are inseparable. Health care reform should include mental health care reform. During the 2008 campaign, the President expressed support for mental health needs.

The President's health care proposals emphasize preventive care and equity. That should include preventing unnecessary hospitalizations, homelessness, and other costly outcomes that result in the existing mental health care system.

The President's proposals also include collection of cost and outcome data to support cost-effective, evidence-based practices. That's consistent with a main theme of the report. Health care reform is an opportunity to help transform the mental health care system. The federal government has a role to play. The states cannot do it alone.

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"[Recovery means] functioning normally within society without mental health issues proving to be a barrier."

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