Grading the States 2006: Connecticut - Narrative
Connecticut is recognized nationally for explicit promotion of a recovery model of care which focuses on individual strengths and enhancement of the ability to function. The vision is commendable, but the state is not yet fully engaged in making it a reality. It can do better.
Credit for the vision belongs to Commissioner Thomas Kirk, Jr., who issued a policy statement in 2002 that recovery was to become the overall goal of the Department of Mental Health and Addiction Services (DMHAS). Consumer and family advocates in the state generally find his leadership to be open and respectful of their involvement, but question whether the policy statement will actually translate into better services - and most of all, outcomes.
One innovation has been the creation of a training institute with Yale University for mental health workers. DMHAS includes requirements in its contracts thatprogram staff be competent in recovery models - but the approach has not yet taken hold at the grassroots, nor been applied comprehensively. The state has increased funding for vocational support and developed pilot consumer-run programs, but the latter so far havebeen only that, small pilots, with no apparent plans to reproduce or expand them.
Over the past few years, the state has moved to improve cultural competency within the system, which in turn influences treatment effectiveness. The state has promoted cultural competency. It currently plans to increase bilingual and bicultural personnel to reduce culturally-specific barriers to treatment.
Long emergency room wait times for hospitalizations are a problem. Additional inpatient adult hospital beds are not the solution, but the state also should not reduce the supply. They are still the only intermediate level of inpatient care. The core problem is lack of ready access to outpatient care, along with shortages in decent, safe, affordable housing and effective outreach and crisis intervention services. Some state hospital beds have been made available through a new fund that last year served 42 people by supporting tailored discharge plans for people requiring intensive services who otherwise could not have left the hospital.
Grave concerns over the quality and safety of Connecticut Valley Hospital have recently surfaced. The state's largest psychiatric facility is being investigated by the US Department of Justice for concerns about safety and the use of restraint and seclusion. Additionally, the Judge David Bazelon Center has initiated a review of whether people with serious psychiatric illnesses are inappropriately admitted to locked nursing home beds in Connecticut. Issues in both settings require urgent action.
Twenty-nine Assertive Community Treatment (ACT) teams are available statewide, but previously have not met federal standards. The state is moving now to improve fidelity to standards in order to obtain Medicaid funds for the service.
Housing is a problem. As a small state with the country's highest average per capita income, safe, decent, affordable housing for people with serious mentalillnesses often is limited. The state has worked to address the problem. Approximately 2,300 units of supported housing have been added since the 1990s, and another 500 are anticipated. The state also has worked to make creation of smaller group homes easier through zoning exemptions, but ultimately, in order to meet overall needs, more investment by the legislature is needed.
There has been an increase of approximately 40 percent in the number of people with serious mental illnesses who have been placed in nursing homes. DMHA is considering the use of a state Medicaid waiver to move younger adults into more appropriate settings in the community. The state needs to move forward quickly to do so.
Criminalization of people with serious mental illnesses is also a problem. Based on information provided by the Connecticut Department of Corrections, Connecticut's adult prison population of people identified with a moderate to serious mental illness has gone from 2,200 in 2000 to 3,700 in 2005, from 12 percent of the total prison population to nearly 20 percent. Pre-booking crisis intervention teams (CIT) have been started inseveral towns with the help of federal grant funds. Jail diversion programs exist in all 20 arraignment courts in the state, but only about 40 percent of people with serious mental illnesses can be diverted, in large part due to lack of community housing and services.
Connecticut is one of seven states to receive a SAMSHA Transformation Grant. It has an excellent opportunity to examine how it can build on its successes and address some of the more disturbing trends related to incarceration and inappropriate nursing home placements.
Connecticut is moving forward and compares favorably to other states. But the state must not become complacent or content to stay in place. Many people still are not getting the help they need. One in five Americans experience mental illness at some pointin their lives. Every person in the state is potentially vulnerable to a swift reversal of fortune. If it happens, the state needs a mental healthcare system that is ready, willing, and able to help them truly recover.
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