Grading the States 2006: Illinois - Narrative
The Land of Lincoln is a complex state. Old Abe suffered from depression. If he were alive today, the quality of his care would depend on where in Illinois he resided.
The Mental Health & Developmental Disability Service Division (MHDDSD) is located within the state Human Services Department. Mental health services are delivered through six Comprehensive Service Community Networks (CSCNs), which provide consolidated planning and coordination for inpatient and community-based services. Advocates report great disparities in the quality of services among the service regions.
The state has been moving slowly away from a grant model of contracting community services to a fee-for-service model. Because of criticism from providers and aconsultant's report by Parker, Dennison & Associates that deemed the system unprepared to absorb the change due to structural and capacity limitations, the state has delayed implementation of the approach for another year. A fee-for-service approach is potentially important for incentives to broaden evidence-based practices (EBPs), as well as enhancing accountability.
In its 2005 federal block grant report, the state Mental Health Planning Council gives priority to implementation of EBPs. The state has a long way to go, but is making progress in that area. It recently convened a task force on the challenge, and a plan is in place. A payment model that rewards providers for using evidence-based practices and addresses consumer treatment needs would expedite the progress toward this key transformation need.
In October 2005, the Office of Inspector General for the U.S. Department of Health and Human Services began a review of Illinois community mental healthservices funded by Medicaid. The scope of the review predates administrative procedures adopted by the state to strengthen billing protocols. No findings have been issued, and any concern at this time is only speculative, but the review needs to be watched cautiously. At least one other state found itself having to reimburse the federal government a large amount for past expenditures - which added an unanticipated cost to the state budget, requiring large program cuts.
Rather interestingly, MHDDSD's "culture" sometimes is raised in discussing general needs. Research during this report tended to confirm descriptions of the agency as being at times lackadaisical, and at other times confusing or difficult to deal with. In particular, during NAMI's "Consumer and Family Test Drive" of information accessibility, raters complained about MHDDSD's telephone responsiveness perhaps more than in any other state. One person called and never reached a live person, even after being connected to multiple voicemails. Another called one line seven times, but always found it busy.
Worst of all, one person called and after identifying himself as a consumer was told by an agency employee: "No, I will not help you."
Only five states scored lower than Illinois on the "test drive": Alabama, Arkansas, Missouri, New Mexico, and South Dakota.
If access to information is a problem, access to services usually isn't far behind. Employment training for people with serious mental illnesses is a major problem in the state - even though it is often critically important to recovery.
Although many consumers want to work, the state acknowledges that it is not doing enough to help them. The state's Department for Rehabilitative Services only accepted 25 percent of referrals for training from the mental health provider network and successfully found work for only 11 percent of those accepted. No formal agreement exists between the mental health and vocational rehabilitation agencies, which suggests that lack of shared priorities and bureaucratic inaction are compromising opportunities for recovery.
Over 15 years, admissions to state psychiatric hospitals have declined approximately 60 percent, and the state has reduced inpatient capacity proportionally. Unfortunately, advocates report the state has gone too far, too quickly. The system is out of balance. Availability of local inpatient care options through the CSCNs have not kept up with expectations. Replacing institutional care with community-based services should still be the goal, but when community services are lacking, access to state hospitals must be preserved for those in psychiatric crisis.
Recently, the Illinois Medicaid program implemented preferred drug lists for psychotropic medications. Open access to mental health medications is a critical issue, and restrictions to access risk severe consequences. Advocates were successful in negotiating a four-month grandfathering window that has allowed physicians to complete prior authorization requests - hopefully avoiding wholesale medication changes that might be imposed on consumers in otherwise stable treatment regimes. The state also deserves credit for eliminating co-pays for antipsychotic medications; however, consumers who take medication for co-occurring conditions will still be affected.
The state deserves special credit for taking an innovative step to address the housing needs of people living with mental illnesses. In 2005, the legislature designated a share of transaction fees on all real-estate transactions be reinvested through rental assistance programs. The new investment in low-income housing will help many Illinois residents, including those with mental illnesses.
Strong action is needed in addressing problems within the criminal justice system.
In July 2005, an agreement was reached between the state and plaintiffs represented by the MacArthur Justice Center to improve the quality of mental health services provided in the state's SuperMax prisons. Meanwhile, a class action lawsuit is pending against the Cook County Jail in Chicago. As of 2003, the jail housed an estimated 1,500 people with chronic mental health conditions and was discharging 100 people per month - without connecting them to community services.
Currently, the state lists only two active mental health courts. Kane County recently has taken the innovative step of assigning a $10 fee on all guilty judgments or grants of supervision in the 16th Judicial Circuit in order to fund a new mental health court.
The state also is behind the curve relative to many other states in establishing police Crisis Intervention Teams (CIT).
For a large state, Illinois is nowhere near meeting its potential. There are pockets of excellence and tremendous resources. But somehow it simply hasn't pulled itself together. To move forward, political leadership and long-term commitment will be required.
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