Mental illness causes more disability than any other class of illness in the nation. One in four Americans experience mental illness at some point in their lives; twice as many of us live with schizophrenia than live with HIV/AIDS. Yet in 2003, the presidential New Freedom Commission on Mental Health found that the service system responsible for helping those with mental illnesses was fragmented and "in shambles." In America today, the people who must rely on this system are actually being oppressed by it, and many years of bad policy decisions have left emergency rooms, the criminal justice system, and families to shoulder the burden of responding to people in crisis.
In 2006, NAMI published the first Grading the States: A Report on America’s Health Care System for Serious Mental Illness. This is our second report, building on the baseline of the first. It measures each state’s progress—or lack of progress in many cases-in providing evidence-based, cost-effective, recovery-oriented services for adults living with serious mental illnesses.
Grading the States promotes transparency and accountability in measuring our progress toward “transformation” of the nation’s system of care, as envisioned by the New Freedom Commission. In our first report, the nation’s grade was a D. Five states earned a B and eight states flunked outright. In this second report, three years later, NAMI documents marginal progress across the country, but not enough to move the nation from a D grade. Fourteen states increased their overall score over the past three years. For almost half the states (23), their grade remains unchanged since 2006, while 12 states have fallen behind. Although none of the states achieves a standard of excellence, NAMI might have been able to herald their progress as a small first step forward, except for a major dark shadow on the ground.
America today faces the greatest economic crisis since the Great Depression. Almost every state, county, and local government is facing large deficits and cutting public services across the board. State Medicaid programs are being squeezed. The budgets of state mental health agencies are being slashed. We know from experience that states often respond to fiscal crises by reducing mental health budgets. As a result, the status of each state system may already be falling below the levels documented in this report.
The challenge to our leaders across America today is to find the vision, the political will, and the funding to hold the line; to allow state mental health care systems to continue to move forward and build momentum for change. For NAMI, change means mental health care systems that are accessible, flexible, and promote continuity of care, while paying for only those services that work.
The challenge also is one of generating new ideas—creating innovative financing mechanisms or collaborations, including some described in this report. NAMI’s natural allies in this will be the National Governors Association, the National Conference of State Legislatures, the Council of State Governments, the National Association of Counties, the National Association of State Mental Health Program Directors, and the National Council for Community Behavioral Healthcare, to name a few. We see this report as a tool for engaging all of these groups—a common rallying point and the foundation for a dialogue that will bring about real change.
Crisis creates opportunities. Publication of this report coincides with the inauguration of a new President who sees health care reform as part of the nation’s broader economic challenge. Of course, mental health is part of health care. Indeed, this report highlights the need to better integrate mental health care with physical health care and wellness. Health care reform is therefore an important opportunity to strengthen the federal government’s support of state and local mental health care systems, through improvements to the Medicaid program and key policy changes. Together, at every level, we must advance, not retreat.
As we move toward publication, a temporary infusion of greater federal funding for Medicaid seems likely as part of the nation’s economic recovery plan. Federal support for building the mental health care workforce would address this system’s staffing crisis while simultaneously responding to unemployment rates that threaten to reach 10 percent or more. Our hope is that this report will stimulate creative ideas like these that can have a direct impact on multiple fronts.
NAMI thanks all of the state mental health authorities that responded to the Grading the States survey. Their willingness to have an independent third party assess their work in close detail is particularly commendable. It is worth noting that many consumer and family comments included in the report praised the caring dedication of people who work within state systems—even as they condemned the lack of adequate resources and system failures.
NAMI thanks the Stanley Family Foundation for funding the report and Dr. E. Fuller Torrey, whose vision produced state ratings reports in 1986, 1988, and 1990. Without their support, this report would not have been possible.
Above all, NAMI thanks all those individuals and families who live with serious mental illnesses who lent their voices to this report and support our work. On their behalf, let us all seek together a new mental health care system, marked by hope, opportunity, and recovery.
Michael J. Fitzpatrick
National Alliance on Mental Illness
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