Grading the States 2006: Arkansas - Narrative
Arkansas is a case of good people trying to do good - with almost nothing.
An extremely poor state, it ranked 49th nationally in per capita income in 2003. During FY 2000-2004, service delivery increased approximately 20 percent, but with no increase in the number of employees for the Department of Behavioral Health Services (DBHS).
The state's block grant report to the federal government in 2004 clearly identifies its overwhelming need: "that Evidence-Based Practices (EBP) be more widely available throughout the system."
The state also reports "difficulty in tracking implementation, including counting how many individuals are receiving EBPs." In fact, Arkansas performs poorly incollection and evaluation of system data. To its credit, DBHS acknowledges the deficiency and is taking steps to remedy it. This is an important first step for defining and setting priorities; however, the bottom line is that funding is needed to provide services, even cost-effective, evidence-based ones.
A mental health system requires different, carefully balanced levels of care, state hospitals as well as a range of community services, such as Assertive Community Treatment (ACT). When community options are not available, the system backs up. Overcrowding and shortages arise.
For several years, advocates and providers in Arkansas raised concerns about a shortage of inpatient psychiatric beds. In response, DBHS is now increasing the number at the state hospital, while the University of Arkansas is adding psychiatric beds to its teaching hospital and expanding its psychiatric emergency capacity.
The legislature is funding both initiatives. But broader investment will be needed to advance the system. For instance, there are currently only two ACT teams in the state.
DBHS delivers services through a network of community mental health centers located in 69 of the state's 75 counties, serving residents statewide. The close relationship between DBHS and the Medicaid agency is critical to the system; 60 percent of the revenue for the centers comes from Medicaid.
Arkansas must be watched closely with regard to Medicaid. To date, the state Medicaid program has demonstrated understanding and sensitivity to the needs of people living with serious mental illnesses and has preserved open access to psychiatric medications. Nonetheless, there is pressure to impose restrictive policies. Governor Mike Huckabee, chair of the National Governors Association (NGA), is advocating at the national level for sweeping authority to be granted to the states to redesign their Medicaid systems. If he proposes radical redesigns at home, changes could follow that would weaken or eliminate some of the stronger elements of the state system.
In contrast to DBHS's earnest efforts to improve performance, the Arkansas Department of Corrections (ADC) is failing to meet the needs of individuals withserious mental illnesses. In 2004, the U.S. Department of Justice (DOJ) and ADC entered into an agreement on conditions at the Grimes and McPherson units of the state prison in Newport. The agreement was prompted by allegations of significant shortcomings in detainee health care, including mental health services. As part of the agreement, the state is required to take significant steps to enhance the quality of the prison's health services, or else face DOJ litigation. Key elements included major revisions to restraint policies, staffing, and suicide prevention procedures.
Many of the state's problems are fundamental. A person can't get access to services without services existing, nor without access to information concerning those services. Unfortunately, Arkansas received one of the lowest scores in the country in NAMI's "Consumer/ Family Test Drive" on information accessibility from DBHS.
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