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Grading the States 2009: Frequently Asked Questions

Q. Why has NAMI published the Grading the States' report?

The first Grading the States report was published in 2006. This is the second. They are intended to measure progress in transforming the nation's public mental health care system and provide "checklists for change" for each state's policies and programs.

In 2003, a presidential New Freedom Commission on Mental Health delared the existing mental healthy care system to be fragmented, inadequate and out-of-date, and recommended elements for an evidence-based, cost-effective system.

The reports are the only comprehensive assessment of the nation's mental health care system, grading each state according to specific criteria. The 2006 report provided a baseline against which all subsequent reports can track improvement or decline.

Q. Why is the report important?

One in four Americans experience mental illness at some point in their lives. Ten million Americans live with the most serious conditions. Mental illness can strike anyone-including you, your family, or friends.

Mental illness is the number one cause of disability in the nation; more than any other illness. On average, individuals who live with serious mental illness die 25 years younger than the rest of the population. More than twice as many Americans live with schizophrenia than those HIV/AIDS.

Not everyone gets help through the public mental health care system. But overall, less than a third get any treatment at all. The costs of untreated mental illness get compounded. Money doesn't get spent in the right places. Tragedies occur. People end up in emergency rooms, hospitalized, on the street, in jail or prison-or dead. There is an urgent need for modernization.

Q. What does the report say?

Mental health care in America is in crisis-in part because the nation's severe economic crisis in 2009, resulting in state budget shortfalls and cuts, threatens to erode a system that is already extremely inadequate. Ironically, budget cuts come at a time when, because of the economic crisis, demand for mental health services are rising.

Many dedicated, caring people work in state mental health care system. But they aren't being given the resources and support they need. We need leadership, political will, and investment from governors, legislatures, and other champions.

Besides the grades, the report makes specific findings and recommendations, which are outlined below.

Q. What grades have been given?

Overall, the nation gets no better than a D. The national average has not budged between 2006 and 2009.

Fourteen states improved their grades, Twelve had them fall. Twenty-three stayed the same. We gave six Bs; eighteen Cs; 21 Ds; and six Fs. There were no As. The report includes narratives for each state.

Q. What are the grades based on?

Each state was graded by scoring a total of 65 criteria in four categories. State mental health agencies provided most of the information on which the scoring was based. Next to each state narrative, the scores for the state on each criteria appear on a bar chart. They are compared to the total possible score and the national average on the each criteria.

Q. What is the "Consumer/Family Test Drive"?

One of the criteria used in determining each state's grade involved a "test drive" of the state mental health agency's telephone responses and Web site in providing specific information. NAMI consumer and family volunteers conducted the survey. It reflects the importance for people to be able to receive the right information quickly as a first step in getting help when they need it.

Q. What are some of the key findings?

The report's findings are organized into four categories in which each state was graded. Among them are:

Health Promotion & Management

  • States are not focusing on wellness and survival for people with serious mental illnesses.
  • States do not have adequate data on critical mental health services.
  • Most states have inadequate plans for developing and maintaining the mental health workforce.

Financing & Core Treatment/Recovery Services

  • State mental health-financing decisions are often pennywise and pound -foolish.
  • States are not adequately providing services that are the lynchpins of a comprehensive system of care.
  • States are not ensuring that their service delivery is culturally competent.

Consumer & Family Empowerment

  • Information from state mental health agencies is not readily accessible.
  • States are not creating a culture of respect. Efforts to promote peer-based services and educate providers are inadequate.
  • Consumers and family members do not have sufficient opportunities to help monitor the performance of mental health systems.

Community Integration & Social Inclusion

  • Few states are developing plans or investing the resources to address long-term housing needs for people with serious mental illnesses.
  • Effective diversion from the criminal justice system is more common, but remains scattershot without state-level leadership.
  • Most states are beginning to provide public education on mental illness, but stigma remains a major concern.

Continue to Frequently Asked Questions page 2  >>

"Recovery is a team effort…It takes 'a village' as they say to assist an individual in recovery. A psychiatrist and medications alone are not the answer."

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