2020118 Legislative Issues€¦ · Subcommittee on Children’s Mental Health Vail Place Wellness...
Transcript of 2020118 Legislative Issues€¦ · Subcommittee on Children’s Mental Health Vail Place Wellness...
Mental Health Legislative Network of Minnesota
201 Legislative Issues 2018 Legislative Issues
MentalHealthLegislativeNetwork2018TheMentalHealthLegislativeNetwork(MHLN)isabroadcoalitionthatadvocatesforastatewidementalhealthsystemthatisofhighquality,accessibleandhasstablefunding.TheorganizationsintheMHLNallworktogethertocreatevisibilityonmentalhealthissues,actasaclearinghouseonpublicpolicyissuesandtopoolourknowledge,resourcesandstrengthstocreatechange.
ThisbookletwaspreparedtoprovideimportantinformationtolegislatorsandotherelectedofficialsonhowtoimprovethelivesofchildrenandadultswithmentalillnessesandtheirfamiliesandhowtobuildMinnesota’smentalhealthsystem.
ThefollowingorganizationsaremembersoftheMentalHealthLegislativeNetwork:
AmherstH.WilderFoundationAspireMNAutismOpportunitiesAvivoBarbaraSchneiderFoundationCanvasHealthCatholicCharitiesofSt.PaulandMinneapolisChildren’sHealthCareMinnesotaCommunityInvolvementProgramsEmilyProgramFoundationFraserGoodwillEasterSealsGuildIncorporatedLutheranSocialServiceofMinnesotaMentalHealthMinnesotaMentalHealthProvidersAssociationofMinnesotaMinnesotaDisabilityLawCenterMinnesotaAssociationforChildren’sMentalHealthMinnesotaAssociationofCommunityMentalHealthProgramsMinnesotaAutismCenter
MinnesotaBehavioralHealthNetworkMinnesotaCoalitionofLicensedSocialWorkersMinnesotaDepartmentofHumanServicesMinnesotaOrganizationonFetalAlcoholSyndromeMinnesotaPsychiatricSocietyMinnesotaPsychologicalAssociationMinnesotaRecoveryConnectionMinnesotaSocietyforClinicalSocialWorkNAMIMinnesotaNationalAssociationofSocialWorkers,MinnesotaChapterOmbudsman-MHDDPeopleIncorporatedResource,Inc.RiseStateAdvisoryCouncilonMentalHealthSubcommitteeonChildren’sMentalHealthVailPlaceWellnessintheWoodsWilder
IfyouhavequestionsabouttheMentalHealthLegislativeNetworkoraboutpoliciesrelatedtothementalhealthsystem,pleasefeelfreetocontactMentalHealthMinnesotaat651-493-6634orNAMIMinnesotaat651-645-2948.Thesetwoorganizationsco-chairtheMentalHealthLegislativeNetwork.
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TableofContents� MentalIllnessandtheMentalHealthSystem.......................................Page3KeyIssuesforthe2017LegislativeSession........................................Page7AdultMentalHealthServicesandSupports........................................Page8
Housing................................................................Page8Employment............................................................Page9SupportingParentswithMentalIllnesses................................Page9ClubhouseServices......................................................Page10PersonalCareAssistanceServices.......................................Page10
AccesstoMentalHealthTreatment................................................Page12
CrisisResponse..........................................................Page12PatientFlow.............................................................Page12MentalHealthParity.....................................................Page13AccesstoMedication....................................................Page15EarlyIntervention/FirstEpisodePrograms..............................Page16
MentalHealthServices............................................................Page18
ReimbursementRatesforMentalHealthServices........................Page18MedicalAssistancePaymentsUnderManagedCare.......................Page18MentalHealthWorkforceShortages......................................Page19ExpandedUseofTelemedicine...........................................Page19LicensureandSupervisoryRequirements.................................Page20DutytoWarn.............................................................Page20
Children’sMentalHealth..........................................................Page21
EarlyChildhoodConsultation............................................Page21School-LinkedMentalHealth............................................Page21Children’sResidentialTreatmentFunding................................Page22PsychiatricResidentialTreatmentFacilities..............................Page22TransportationtoChildren’sMentalHealthServices......................Page23AlternativestoSuspension...............................................Page23EducationinCareandTreatmentMentalHealthPrograms................Page23KognitoSuicidePreventionTraining.....................................Page24
CriminalJustice..................................................................Page25
AdministrativeandDisciplinarySegregationinPrison....................Page25InvoluntaryAdministrationofMedicationinJails.........................Page25MedicationsandAssessmentsinJails.....................................Page26OmbudsmanforMentalHealthServicesinCorrections....................Page26CommunityMentalHealthServicesintheCriminalJusticeSystem........Page27
OtherIssues......................................................................Page29
ImprovingCareCoordinationThroughHealthIT..........................Page29 CivilCommitment........................................................Page29
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MentalIllnessesandtheMentalHealthSystem
MentalIllnesses
Mentalillnessesaremedicalconditionsthatdisruptaperson'sthinking,feeling,mood,abilitytorelatetoothersanddailyfunctioning.Mentalillnessesaffectaboutoneinfivepeopleinagivenyear.Peopleaffectedmoreseriouslybymentalillnessnumberabout1in25.Thereisacontinuum,withgoodmentalhealthononeendandseriousmentalillnessesontheotherend.
Examplesofseriousmentalillnessesincludemajordepression,schizophrenia,bipolardisorder,obsessivecompulsivedisorder(OCD),generalizedanxietydisorder,panicdisorder,post-traumaticstressdisorder(PTSD),eatingdisordersandborderlinepersonalitydisorder.
Mentalillnessescanaffectpersonsofanyage,race,religion,politicalpartyorincome.Mentalillnessesaretreatable.Mostpeoplediagnosedwithaseriousmentalillnesscangetbetterwitheffectivetreatmentandsupports.Medicationaloneisnotenough.Therapy,support,gooddiet,exercise,stablehousing,meaningfulactivities(school,work,volunteering)allhelppeoplerecover.
Somepeopleneedaccesstobasicmentalhealthtreatment.Othersneedmentalhealthsupportservicessuchascasemanagement(and/orcarecoordination)toassisttheminlocatingandmaintainingmentalhealthandsocialservices.Stillothersneedmoreintensive,flexibleservicestohelpthemliveinthecommunity.
Dependingontheseverityofmentalillnessandwhethertimelyaccesstoeffectivetreatmentandsupportservicesareavailable,mentalillnessmaysignificantlyimpactallfacetsoflivingincludinglearning,working,housingstability,andlivingindependently.Furthermore,socialrelationshipslikefamilyandfriendsalongwithsocialintegrationintothecommunitymaybeaffected.Somepersonswithmentalillnessexperiencearevolvingdoorrelationshipwiththecriminaljusticesystemwhileotherscycleinandoutofthesheltersystem.Povertyiscommonplaceamongstthoselivingwithseverementalillness.Althoughwehaveeffectivetreatmentsandrehabilitation,thecurrentmentalhealthsystemfailstorespondtotheneedsoftoomanychildren,adultsandtheirfamilies.Timelyaccesstothefullpanoplyofnecessarymentalhealthbenefitsandservices,whethertreatmentorrehabilitation,isoftenlimitedduetoinsuranceorpublicprogramaccessissues,unavailabilityofmentalhealthprovidersorcommunitybasedbeds,orgeographicaldisparities.Therearelongstandingstructuralbarriersinthesystemthatimpedestheflowofpatientsfromoneproviderbasedservicetoanother.Toooftenaperson’smentalhealthwillworsenastheywaitforhelp.Ensuringtimelierhandoffsinthecontinuityofcarecontinuumwillleadtomoreeffectiveprovisionofserviceresultinginenhancedqualityoflifeforthosepersonswhomustnavigatethecomplexmentalhealthcaresystem.
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TheFederalHHSAdministration,SAMHSA,hasestablishedaworkingdefinitionofrecoverythatdefinesrecoveryasaprocessofchangethroughwhichindividualsimprovetheirhealthandwellness,liveself-directedlives,andstrivetoreachtheirfullpotential.Theadoptionoftherecoveryapproachbymentalhealthcaresystemsinrecentyearshassignaledadramaticshiftintheexpectationforpositiveoutcomesforindividuals.Recoveryisbuiltonaccesstoevidence-basedclinicaltreatmentandrecoverysupportservices.Recoveryischaracterizedbycontinualgrowthandimprovementinone’shealthandwellnessthatmayalsoinvolvesetbacks.Resiliencebecomesakeycomponentofrecovery.Thevalueofrecovery-orientedmentalhealthcaresystemsiswidelyacceptedbystates,communities,providers,families,researchers,andadvocatesincludingtheU.S.SurgeonGeneralandtheInstituteofMedicine.
Therangeofservicesrequiredforapersontorealizerecoveryfrommentalillnessinthehopesofachievinggreatermentalhealthvariesdependingonahostoffactors.Therangeofservicesisasvariedastherangeofmentalhealthconditionsandco-occurringdisordersthatmaybepresentinanyoneperson.Somepeoplemayonlyneedaccesstostandardmentalhealthtreatmentinahealthcaresettingwhileothersmayneed,inaddition,afullerspectrumofintensive,flexiblerehabilitationandrecoveryservices.Abroadrangeofeffectiveandadequateservicecomponentsacrossthecontinuumarerequiredtomakerecoverypossibleforpersonslivingwithmentalillness.
Minnesota’sMentalHealthSystem
InsuranceCoverage:Themainaccesstothementalhealthsystemisthroughinsurance–eitherprivatehealthplansorastateprogramsuchasMedicalAssistance(MA)orMinnesotaCare.Forthosewhohavenoinsuranceorpoorcoverage,accessisthenthroughthecountyoracommunitymentalhealthcenter.MAisaninvaluableprogramforchildrenandadultswithmentalillnessesandtheirfamilies.Formany,itistheonlywaytoobtainaccesstotreatmentandsupports.
Coverageformentalhealthtreatmentisnotcurrentlymandatedforself-insuredplansorcommercialorprivateinsurance.MentalhealthparityonlyrequiresplanstoensureparityIFtheycovermentalhealthorsubstanceusedisordertreatment.Thereareexemptionsforindividualpoliciesandsmallbusinesses,althougheveryplanofferedthroughMNSuremustcovermentalhealthandsubstanceusedisordertreatmentandfollowmentalhealthparitylaws.
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AccesstoBenefits:Ifmentalhealthtreatmentiscoveredunderprivateinsurance,whatiscoveredisvariable.FewprivateplanscoverthemodelmentalhealthbenefitsetwhichisincludedunderMedicalAssistanceandMinnesotaCare.Themodelmentalhealthbenefitsetisbaseduponresearchandevidenceofeffectivenessandincludeservicesuchascrisisservices,AssertiveCommunityTreatment(ACT),IntensiveResidentialTreatmentServices(IRTS),Children’sTherapeuticServicesandSupports(CTSS),etc.
CommunityServices:Somepeoplewhohavethemostseriousmentalillnessesneedadditionalservicesinthecommunitysuchasaffordablesupportivehousing,communitysupports,employmentsupports,educationalservices,respitecareandin-homesupports.Grantfundingwascutover$52millionbetween2009and2011whichnegativelyaffectedpeoplewithmentalillnessesandthusgreatlyreducedpeople’sabilitytoaccessneededsupportstolivewellinthecommunity.
Workforce:Psychiatry,psychology,clinicalsocialwork,psychiatricnursing,marriageandfamilytherapyandprofessionalclinicalcounselingareconsideredthe“core”mentalhealthprofessions.Formanyyears,Minnesotahasexperiencedashortageofprovidersofmentalhealthservices.Thisshortagehasbeenfeltmostprofoundlyintheruralareasofthestate.Thereisalsoanongoing-shortageofculturallycompetentandculturallyspecificproviders.
ReimbursementRates:Historically,poorreimbursementratesinpublicmentalhealthprogramshavecontributedtotheproblemsofattractingandretainingmentalhealthprofessionals.Improvedpaymenttomentalhealthprovidersincreasesconsumerpurchasingpower,attractsqualifiedprofessionalstoservice,improvesearlieraccesstotreatment,andsupportssavingmoneyandtime.Increasedreimbursementenablesagenciestohireandsupervisequalifiedworkers,whichreducesturnoverandsavestimeandmoney.Withoutadequatesalaries,qualifiedmentalhealthprofessionalsleavetheircareers.RatespaidthroughmanagedcareMedicalAssistanceareoftenlowerthanfee-for-servicerates.
LookingtotheFuture
Morethaneverbefore,weknowwhatworks.Earlyintervention,evidence-basedpracticesanda“modelmentalhealthbenefitset”havecreatedthefoundationforagoodmentalhealthsysteminMinnesota.Unfortunately,workforceshortages,poorreimbursementrates,andlackofcoveragebyprivateplanshaveresultedinafragilesystemthatisnotavailablestatewideandisnotthereforeabletomeetthedemand.
Peopleoftenlookfor“quickfixes”suchasmorebeds.Childrenandadultswithmentalillnessesspendthemajorityoftheirlivesinthecommunity.Thus,the“fix”ismorecomplexinthatweneedtoworktoensurethattheservicesthatsupportpeopleinthecommunityarereadilyavailabletoprovideearlyidentificationandintervention,addressamentalhealthcrisis,andprovideongoingsupportsinthecommunity.
Whilethefocustendstobeonthedeliveryofmentalhealthtreatment,otherareasneedattentionaswell.PeoplewithmentalillnessesrelyontheCADIWaiver(CommunityAlternativesforPeoplewithDisabilities)oronCommunityFirstServicesandSupports(whichwillreplacetheoldPCAprogram)forday-to-dayhelpintheirhomes.Yetchangestobothoftheseprogramshaveresultedinthembeinglessavailable.
Affordableandsupportivehousingareveryimportanttorecovery.Ifyouarehomelessorhaveunstableorunsafehousing,itisdifficulttofocusongettingbetter.Everyoneneedsareasontogetupinthemorningandyetpeoplewithseriousmentalillnesseshaveoneofthehighestunemploymentrates.
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Graduatingfromhighschoolisimportanttofuturesuccess.Manyyoungpeoplewithseriousmentalillnessesdropoutofschool.Oftentheylagbehindtheirpeersduetobeingindayorresidentialtreatmentandyetcannotaccesssummerschool.Thesestudentsfacetheuseofseclusionandrestraintsmorefrequentlyandschoolsareoftenatalossastowhattodo.
Ourjuvenilejusticeandcriminaljusticesystemhavebeenusedforover50yearstocareforyouthandadultswithmentalillnesseswhohavecommittedlargelynonviolentcrimes.Stepshavebeentakentoaddressthisincludingtrainingofpublicsafetyofficers,thedevelopmentofmentalhealthcourtsandthecreationofmentalhealthcrisisteams.
SuicideratesareincreasinginMinnesota.Thedata,whichismorethantwoyearsold,tellusthat726peoplediedbysuicidein2015.
Lowratesandworkforceshortagesaddtothestressorsonthesystem.Providersarenotpaidforwhattheyarerequiredtodo.Lowratesmakeitdifficulttoattractnewpeopletothefield.Workforceshortagesmakeitdifficulttohireenoughpeopletomeettheneeds.
OnthefederallevelthereisdiscussionaboutrepealingtheAffordableCareActandblock-grantingMedicaid.LegislatorsshouldknowthattheACAprovidedanopportunityforpeopletohaveinsurancetocovertheirneededmentalhealthtreatmentforthefirsttimebynotallowingdenialofcoverageduetoapre-existingcondition,byallowingyoungadults(akeyagetodevelopamentalillness)tostayontheirparents’planuntilage26,byexpandingMedicaidtolow-incomechildlessadultssothattheydon’thavetosaytotheSocialSecurityAdministrationthattheywillneverworkagainandbyrequiringpoliciesofferedthroughMNSuretocovermentalhealthandsubstanceusedisordertreatmentandfollowmentalhealthparity.Thementalhealthsystemwasnotbuiltduetodependenceonfundingthatwasturnedintoafederalblockgrantthatgavefundingtostateswithfewstringsattached.WebegantoseriouslybuildourmentalhealthserviceswhentreatmentandserviceswerebilledthroughMedicaidandMNCare.Weareveryconcernedabouthowactionsonthefederallevelcoulddestroywhatwehavebuiltthelastdecade.
TheMentalHealthLegislativeNetworkbelievesthesechallenges,thoughverysignificant,arenotinsurmountable.Again,weknowwhatworks.Let’sbuildonthis.
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KeyIssuesforthe2018LegislativeSession
• Stabilizingandincreasingaccesstoeffectivementalhealthcarethroughoutthestatebyincreasingratesandfundingandeliminatingbarrierstodevelopment
• Expandingthementalhealthworkforce• Providingsupportsandeducationthatenablechildrentolivewiththeirfamilies• Endingtheinappropriateuseofthecriminalandjuvenilejusticesystemsforchildrenand
adultswithmentalillnessesandprovidingadequatementalhealthcareinthesesystems.• Helpingpeoplelivingwithmentalillnessesobtainhomesandjobs.• Expandingaccesstohomeandcommunitysupportsthroughwaiversandin-homeservices.• Expandingaccesstointensivetreatmentandsupports.• IncreaseenforcementofMentalHealthParitylaws.
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AdultMentalHealthServicesandSupports
Housing
Issue:Thereislimitedaccesstoaffordableandsupportivehousing.
Background:Peoplewithmentalillnessescannotachieverecoverywithoutstablehousing.Theshortageofaffordablehousing,includingsupportivehousing,hasledtopeopleremainingattheAnokaMetroRegionalTreatmentCenterlongerthannecessaryandresultedinpeoplebeingdischargedfromhospitalsandIntensiveResidentialTreatmentServices(IRTS)toshelters.
BridgesprovideshousingsubsidiestopeoplelivingwithseriousmentalillnesseswhiletheyareonthewaitinglistforfederalSection8housingassistance.AswithSection8,peopleonBridgesrentanapartmentattheregularmarket-rateandpay30%oftheirincomeforrent.Theprogramprovidesvoucherstocoverthebalance.BridgesisadministeredbylocalhousingauthoritiesorotherentitieswhomanageSection8programs.
Thelegislaturein2013approvedanadditional$400,000fortheBridgesprogram.MHFAprovidedacompetitiveRFPforthefundsandreceived12proposals,requestingatotalamountof$1.4millioninordertoserve187householdspermonthatfullutilization.Onegranteeacceptedapplicationsforonedayonlyandreceivedabout100applicationsforonly12vouchers.Thereareanestimated1366householdsonwaitinglistsforBridgesasofJuly2014.Itwouldtakeanestimated$17.147millioninbiennialbudgetjusttoserveallhouseholdsonthewaitinglist.ThisfiguredoesnotincludeservingareaswithoutcurrentaccesstoBridgesfunding.
ThegrantprogramcalledHousingwithSupportsforAdultswithSeriousMentalIllnessprovidesgrantstohousingdevelopers,countymentalhealthauthoritiesandtribestoincreasetheavailabilityofsupportivehousingoptions.Supportivehousingisaneffectiveandinexpensivewaytoassistpeoplewithseriousmentalillnessestoliveinthecommunity.Supportivehousingoftenprovideshousingstability,preventshomelessnessandevenhospitalizations.Inthe2017LegislativeSession,supportivehousingfundingwasincreasedby$2.15milliondollars.
HousingSupport(formerlyknownasGroupResidentialHousing,orGRH))paysforroomandboardcostsforadultswithlow-incomewhohavedisablingcondition.RecipientsofHousingSupportliveinlicensedfacilities(e.g.AdultFosterCare,BoardandLodge,AssistedLiving)orintheirownhomewithasignedlease.Ineithercase,aprovideror“vendor”managestheroomandboardexpensesonbehalfoftheindividual.However,somepeopleprefernottoliveinalicensedfacilityand/orhaveavendormanagingtheirroomandboardneeds,andwouldrathermanagetheirownbudgettomeettheirneeds.
MinnesotaSupplementalAid(MSA)HousingAssistanceprovidesadirectbenefittoindividualswithdisabilitiestohelpthemaffordhousing.However,theamountofMSAHousingAssistanceisnotenoughsupportmorepeopletoliveinthecommunityandisnotavailabletopeopleonGRHwhowanttomoveoutofagroupsettingand/ormanagetheirownroomandboardneeds.
InJune2015,theCentersforMedicareandMedicaidServices(CMS)issuedanInformationalBulletinregardingthecoverageofhousing-relatedactivitiesandservicesforindividualsunderMedicaid.Thebulletinidentifieshowhousing-relatedactivitiesandservicescanbeincorporatedintoaMedicaidbenefitsetforindividualstoachieveoptimalcommunityintegration.The2016legislaturedirectedDHStodesignahousingsupportservicetohelppeoplewithdisabilitieslocateandsecurestablehousingaswellasmaintainhousingthroughsupportservices.
Recommendations:
• IncreasefundingfortheBridgesProgram.
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• Increasefundingforhousingsupportsforadultswithseriousmentalillnesses.• IncreasetheMSA-HousingAssistancebenefitandexpandeligibilitytopeopleleaving
HousingSupport(formerlyknownasGroupResidentialHousing,orGRH).• PursueaHousingSupportServicesMedicaidbenefit
Employment
Issue:Personswithmentalillnesseshavethehighestunemploymentrateandyetemploymentisanevidence-basedpractice,meaningithelpspeoplerecover.Programsthataredesignedspecificallyforpersonswithmentalillnessesareunderfundedandservealimitedamountofpeople.
Background:Peoplelivingwithmentalillnessesfaceanumberofbarrierstofindingandkeepingajob.Theyoftenfacestigmaanddiscriminationwhenapplyingforjobsandmayfaceotherobstaclessuchaslosinghealthinsurancecoveragefortheirmentalhealthtreatmentandmedicationsorlackoftransportation.Inaddition,fewreceivethesupportedemploymentopportunitiesshowntobeeffectiveforpeoplewithmentalillnesses.
Duringthe2013legislativesession,Minnesotalawmakersmadeanumberofimportantchangestothelawgoverningsupportedemploymentprogramsforpeoplewithmentalillnessestoreflecttheevidenced-basedmodelofIndividualPlacementandSupport(IPS).ChangeswerealsomadetoMinnesota’sAdultMentalHealthActtounderscoretheimportanceofcompetitiveemploymentandtoencouragecountiestofundIPSprograms.Inthe2015specialsessionIPSemploymentreceivedanadditional$1millionayeartocontinuetheprojectsthatwereconvertedtoIPSlastyear.Thenextstepistoprovideon-goingfundingandtoincreasethenumberofIPSprogramstohelpallMinnesotanswithamentalillnesswhowanttoworkfindameaningfulandwell-payingjobandmakesureDEEDprogramsknowhowtohelp.
PolicyRecommendations:HF1783/SF1441
• RequirethecommissionerofDEEDto,inconsultationwithstakeholders,identifybarriersthatpeoplewithmentalillnessesfaceinobtainingemployment,identifyallcurrentprogramsthatassistpeoplewithmentalillnessesinobtainingemploymentandsubmitadetailedplantothelegislature.
• RequireDEEDtofundworktrainingprogramsforpeoplewithmentalillnessestoassisttheminsecuringemploymentoftheirchoicethatpaysatorabovethefederalminimumwage.
• Fundprograms,suchasIPS,thatprovideemploymentsupportservicestopersonswithmentalillnesses.
SupportingParentswithMentalIllnesses
Issue:Parentswithamentalillnessfaceuniquechallengesascaregivers.Thiscanincludedevelopingahealthyattachmentwiththeirchild,treatmentchallengesforfamilieswherethechildandparentbothhaveamentalillness,andadditionalburdensaccessingandcoordinatingservices.
Background:InaDHSreportfrom2013,therewere13,000parentswithaseriousmentalillnesscurrentlycaringfortheirchildren,withover60%offamiliesinthechildprotectionsystemhavingissueswithmentalhealthandorsubstanceusedisorder.Theseparentsrequireadditionalsupportsandservicestocarefortheirchildren.
Familieswhoareonchild-onlyMFIP,wheretheparentisdeemeddisabledandisonSupplementalSecurityIncome(SSI)/SocialSecurityDisabilityInsurance(SSDI),donothaveaccesstochildcare.Itisverydifficultforaparenttoengageintreatmentwithoutdependableandqualitychildcare.A
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personmayneedintensivetreatmentthatcouldpotentiallyinvolveattendingtreatmentdailyduringaweektoproperlyaddressandfullymanagementalhealthsymptoms.Parentsshouldnothavetochoosebetweencaringfortheirchildrenandaddressingtheirownmentalhealthneeds.
Anumberofwellsupportedstudies,suchastheAdverseChildhoodExperiences(ACEs)study,identifythathavingaparentwithamentalillnessisariskfactorforpoorqualityoflifeinthefuture.Parentswhohaveaccesstosubsidizedchildcarecanaccessmentalhealthtreatmentandchildrencanhaveastableadultintheirlives.
Multigenerationaltreatmentsareanevidence-basedpracticedesignedtoincreasesupportiveandresponsivecaregivingofparentswithseriousmentalillnessandtoconductanindependentevaluationoftheeffectivenessoftheseinterventions.Researchhasshownthatmanyparentswhohaveaseriousmentalillnessalsohaveachildwithmentalhealthchallengesandthismodelseekstoaddresstheneedsofboththeparentandtheirchildreninanintegratedfashion.
Thementalhealthblockgrantwasusedtofundmulti-generationalgrantsinDuluth,St.Cloud,andSt.Paulwithgreatsuccess.Unfortunately,theblockgrantcannotbetappedagainasafundingsource.Thatmeansthatstatefundsmustnowbeutilizedtobeginofferingthesehighlyeffectiveservicesagain.
PolicyRecommendations:HF2101/SF1978
§ Expandchildcareassistancetofamilieswhohaveachildundertheageofsixandareonchild-onlyMFIPforupto20hoursofchildcareperweekasrecommendedbythetreatingmentalhealthprofessional.
§ Appropriate$575,000tofundmultigenerationalmentalhealthprogramsforthreeyears.§ IncreasetherateforMotherBabyprogram.Thereimbursementrateforintensive
outpatientservicesdoesnotreflectthelevelofcareprovidedaswellasthefactthattreatmentisprovidedtoboththemotherandthechild.
Fundearlychildhoodmentalhealthconsultation.
ClubhouseServices
Issue:IncreaseaccesstoClubhouseservicesacrossthestate
Background:Clubhouseprogramshelppeoplewithmentalillnessesstayoutofhospitalswhileachievingsocial,financial,educational,andvocationalgoals.Peoplearemembers,notclients.StudiesshowthatClubhousemembersaremorelikelytoreportthattheyhaveclosefriendshipsandsomeonetheycouldrelyonwhentheyneededhelp,meaningthatClubhouseprogramsreducedisconnectedness.“Clubhousemembers(versusclients)appearedtoexperiencetheWOD(WordOrderedDay)asmeaningfulbecauseithelpsthem,atitsbest,reconstructalife,developtheiroccupationalselfandskillsetsandexperientiallylearnandlivewhatparallelsagoodlifeinthegeneralcommunity.Itappearsthattheseexperiences,interconnectingwiththefundamentalhumanneedsforautonomyandrelationship,pointtowellbeingandrecoveryaspartofpersonalgrowth”(Tanaka,K.&Davidson,L.(2014)PsychiatricQuarterly.)Thereareover12clubhousesinMinnesota,althoughonlyoneiscurrentlyaccredited.Thisisonemodel,butitisnotdesignedtoreplacecommunitysupportcenters.
CommunitySupportPrograms,includingthoserunbyClubhouseprograms,relyonalimitedfundingstream:CommunitySupportGrants(partoftheStateAdultMentalHealthgrants)andlocalcountydollars.Relianceonthisoftenat-riskfundingrestrictsthefurtherdispersionofClubhouseprogramsacrosstheStateofMinnesota,despitethefactthattheyareamongthemostcost-efficientcommunitysupportservicesavailable,andhavebeenproveneffective–reviewedandacceptedbySAMHSAforinclusionontheUSANationalRegistryofEvidenceBasedProgramsandPractices(NREPP).Thisisonemodelandisnotdesignedtoreplacedrop-incenters.
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Recommendation:Ensurethatstatefundingtocountiesisusedtosupportclubhouses
PersonalCareAssistanceServices
Issue:Forapersonaltobeeligibleforpersonalcareassistanceservicestheymustrequirecuingandconstantsupervisiontocompletedailytask.Personslivingwithmentalillnessescanbenefitfromthisservice,butdonotnecessarilyrequireconstantsupervisionandthus,mayhaveverylimitedeligibilityforPCAservices.
Background:Personalcareassistance(PCA)isahomecareservice.Personalcareassistantsprovideservicesandsupporttohelppeoplewhoneedassistanceinactivitiesofdailyliving,health-relatedtasks,observationandredirection.
In2009,MinnesotapassedPCAreformlegislationwhichincludedchangestotheassessmentandauthorizationprocessrequiredtoaccessPCAservices.Asaresult,individualswhowerenotconstantlydependentonaPCAworkertocompleteatleastondailytasklostthisservice.Ina2010,areportfromtheDepartmentofHumanServicesoutlinedarequirementthat“DHSmustimplementanalternativeserviceforpersonswithmentalhealthandotherbehavioralchallengeswhocanbenefitfromotherservicesthatmoreappropriatelymeettheirneedsandassisttheminlivingindependentlyinthecommunity.”
Duringthe2011specialsession,legislationwaspassedtorestorelimitedeligibilityofahalfhourperdaytosomechildrenandadultswhowouldhavebeenterminatedfromPCAservicesunderthecutsadoptedin2009.However,therearestillindividualswhoeitherlostorcannotaccessservicesbecauseofcurrentstatutelanguage.
ThelegislaturedirectedDHSin2015tolookatwholostservices.Theirreportestimatedthat1,877peoplecoulduseCFSSiftheword“constant”wasremoved.
PolicyRecommendation:Removetheword“constant”fromthePCAstatutesothatindividualswhowouldbenefit,butwhodonotneedconstantsupervisioncanstillaccesstheseservices.HF1132/SF1102
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AccesstoMentalHealthTreatment
CrisisResponseServices
Issue:Minnesotaresidentsdonothavetheappropriatelevelofmentalhealthcrisisservicesavailabletotheminanappropriateoreffectivetimeframe
Background:Existingservicesarespottyacrossthestatewithmentalhealthcrisisresponseservicesavailablemostlyinthemetroarea.Countiesallhaveacrisisnumberbutnotallhaveamobilecrisisresponse.Anappropriatecontinuumofcrisisresponsecareshouldincludeataminimum:
• 24/7crisisphone• Mobilecrisisresponse• Residentialandfostercarecrisisbeds• Urgentcareorwalkinclinics• 911andemergencydepartmentcollaborationwithcrisisteams• Crisishomes
Crisisservicespreventmorecostlyhospitalizations.Overthepastseveralyearsdatashowthatforbothchildrenandadultsover80%ofthoseservedbycrisisteamswereabletoavoidhospitalizations.Providingamentalhealthresponsealsolimitsinteractionswithpolice.
PolicyRecommendations:ContinuetobuildMobileCrisisResponsetoachieve24/7coverageacrossthestateby2018.Tostabilizeandexpandmobilecrisisservices,twokeyissuesneedtobeaddressed–workforceshortagesandfunding.
Manyruralandevenmetroteamsstrugglewithhiringappropriatelevelofstafffortheirteams.Thenatureofcrisisservicesmakesitanunattractiveopportunityandmanycrisisteamsarestaffedwithnewandinexperiencedstaff.Increasingpaytoemployeesprovidingthisservicewouldassistinkeepingandhiringstaff.Buildingteamsaroundmentalhealthpractitionersandcertifiedpeerspecialistswillalsocreatealargerpoolofresources.
StategrantsweredevelopedtocovertheuninsuredpopulationandMedicaidratesareinsufficienttocoverthecostsofmobilecrisisteams.Somecountiessubsidizetheteams,butnotall.PrivateinsuranceinMinnesotaisrequiredtocovercrisisteamsastheydoforambulanceservicesbutithasnotbeenimplemented,leavingalargepartofthepopulationnotcoveredordependingonthepublicsystemtocovertheirshare.Mostifnotallmobilecrisisteamsarestrugglingtocovertheirbottomlines.Thisalsomakesitdifficultforproviderstopayhigherratestoattractmoreexperiencedstaff.
TheLegislatureincreasedstatefundingby$800,000inonetimefundingforthebienniumtoexpandcrisisservices,includingco-locatingcrisisservicesinurgentcareclinicsandtodeveloppsychiatricemergencyrooms.
Statefundingshouldmakethisincreasepermanentandcontinuetogrowinthefuture.
PatientFlow�
Issue:PeoplearewaitingintheemergencyroomforabedandincommunityhospitalstogetintoAnokaMetroRegionalTreatmentCenter(AMRTC)oranIntensiveResidentialTreatmentServices(IRTS)facility.The‘48hourrule”givesjailinmateswhoarecommittedprioritytoaccessstate
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facilities,inparticularAMRTC.Asaresult,patientsinthecommunitywhomaybemoreillandneedtocontinuetheircareatAMRTCareunabletotransitionoutofcommunityinpatientbedsandintoAMRTC.Thishascreatedasignificantbedflowproblemforcommunitypsychiatricunits.Tomakethesituationworse,alargepercentageofpeople–rangingfrom20%to50%-ofpeopleatAMRTCdonotneedthatlevelofcareandarewaitingtotransitionintothecommunity.TheMinnesotaHospitalAssociationreportsthatroughly20%ofthepeopleinaninpatientunitarewaitingforanotherlevelofservice.
Background:InMinnesota,thereare1,124inpatientcommunitymentalhealthbedsstatewide:960foradults,164forchildren/adolescentsincommunityhospitals.Therearealso646availablebedsatIntensiveResidentialTreatment(IRTS)andcrisisfacilitiesandseven16-bedCommunityBehavioralHealthHospitals.
Inpatientcommunitymentalhealthbedsarenottheonlywaytotreatpeoplewithaseriousmentalillness,buttheyareanimportantpartoftheservicecontinuum.Currently,thelackofinpatientpsychiatricbedshasbecomesoextremethatpatientsareessentiallybeingboardedinemergencyroomforweeksorevenmonthswhiletheywaitforanopening.Thisneedhasbecomesodirethatitisnecessarytoprovidemoreoptionsandnewincentivestoencouragethedevelopmentofinpatientmentalhealthbeds.
Minnesotaalsoneedstoaddmentalhealthcaretocurrenturgentcarecenterstoproviderapidaccesstotreatmentwhenitisneededinaverycost-effectiveway.WealsoneedtoincreasesupportforpsychiatricEDservices,whichcanofferafasterhand-offwhenpolicebringsomeoneintotheED;crisisteams;crisishomes;andmoresupportivehousingforpeopletotransitionoutofAMRTC.The2013LegislaturecreatedtheTransitiontoCommunityInitiativetohelppeoplebeingservedatAnokaMetroRegionalTreatmentCenter(AMRTC)andtheMinnesotaSecurityHospital(MSH)whonolongerrequirethelevelofcareprovidedatthesefacilities,totransitiontothecommunity.Theinitiativeprovidesaccesstoarangeofservices,includinghomeandcommunitybasedserviceswaivers,tohelppeopleleavethesefacilitiesandlivesuccessfullyinthecommunity.
Severaladditionalgroupsofpeoplewouldbenefitgreatlyfromtheinitiative.Theyincludepeopleoverage65,individualsatastate-operatedCommunityBehavioralHealthHospital(CBHH),andadultswhoarewaitinginourcommunityhospitalsand/orontheAMRTCwaitlist.AswithpeoplecurrentlyservedatAMRTCandMSH,manyoftheseindividualsfaceseriousbarriersthatpreventthemfromtransitioningbacktothecommunitywhentheynolongerneedthelevelofcareprovidedinthosefacilities.
Peopleoverage65faceanadditionalsetofuniquechallenges.Formanyindividualsage65andolderwhoaretransitioningbackintothecommunity,theindividualbudgetsavailablethroughtheElderlyWaiver(EW)arenotsufficienttomeettheircomplexneeds.Individualsage65andoverwhowerebeingservedonBrainInjury(BI)waiverorCommunityAlternativesforDisabledIndividuals(CADI)priortoturning65cancontinuetobeservedunderthesewaivers,buttheycannotentertheseprogramsafterturning65.Thelackofsufficientresourcesforhomeandcommunity-basedservicescreatesabarriertoanappropriateandtimelydischargeforthispopulation.
PolicyRecommendation:Addressthe“flowissues”thatarebackingupouremergencyrooms,hospitalsandAnokaMetroRegionalTreatmentCenter(AMRTC)by:
§ Repealthe48hourruleandprovidefundingformentalhealthtreatmenttoinmatesinjail.• ExpandingtheTransitiontoCommunityInitiativetoservepeopleoverage65,peoplein
CommunityBehavioralHealthHospitals(CBHHs),andpeopleincommunityhospitalsseekingadmissiontoAMRTC.
• Reworkhospitalconstructionmoratoriumtoeliminatebarrierstothedevelopmentofadditionalin-patientpsychiatricbeds.
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• CreateapilotprojectforspecializedIRTSfacilitiestoservepeoplefromthecriminaljusticesystemtopreventpeopleenteringandtoassisttheminleavingAMRTC.
• RemoverequirementsplaceduponnewandexistingproviderstoexecutehostcountycontractsinordertoenrollasaMHCPproviderforvariousbehavioralhealthservices—specificallyACTservices,IRTS,andResidentialCrisisStabilizationServices.
• Removerequirementsplaceduponneworexpandingsubstanceusedisordertreatmentprovidertoprovethatneedforsuchservicesexistwithinaspecificgeographicarea,andinsteadallowneworexpandingproviderstoproceedwiththelicensureprocessandbelicensedabsentaspecificfindingbyDHSthatcurrentservicesaresufficientandadditionalserviceswouldbedetrimentaltoindividualsseekingsuchservices.
• Allow,underlimitedcircumstances,foratransferofalicenseorcertificationofcertainbehavioralhealthproviderssothatcontinuityofcareandcontinuedaccesstoservicescanbemaintainedincircumstanceswhereexistingprovidersareunabletocontinueexistingoperationsshortofutilizingthevoluntaryreceivershipprocessescurrentlyavailableinstatute.
MentalHealthParity
Issue:Mentalhealthservicesarenotcoveredbyinsuranceinthesamewayasmedicalhealthservices.
Background:TheMentalHealthParityandAddictionEquityActof2008(MHPAEA)isafederallawaimedatpreventinggrouphealthplansandhealthinsuranceagenciesthatprovidementalhealthorsubstanceusedisorderservicesfromimposinglessfavorablelimitationsonmentalhealthandsubstanceusedisorderservicesthanonothermedicalservices.
Thethreepillarsofmentalhealthparityare:
• OutofPocketCosts:mentalhealthparityrequires,withfewexceptions,thatcopaymentscannotbehigherformentalhealthcarethanothermedicalsurgicalbenefits,norcantherebeadifferentdeductibleorhigherout-of-pocketmaximumsformentalhealthcare.
• TreatmentLimits:Healthplanscannotestablishdifferentquantitativelimitsformentalhealthcarethanothermedicalbenefits.Forexample,itisaparityviolationtoofferunlimitedprimarycareappointmentsbutonlythreementalhealththerapyappointments.
• NQTL: A Non-Quantitative Treatment Limitation (NQTL) makes non-numerical limitations to the scope or duration of benefits for treatment. An NQTL can take the form of step-therapy for a medication, different standards for a provider to enter a network including reimbursement rates, or other limits based on facility type or provider specialty that limit the scope or duration of health plan benefits. Mental health parity stipulates that the standards that a health plan uses when making an NQTL cannot be any more stringent or restrictive for mental health and substance use disorder treatment than it is for other categories of health care.
Whileallthreeoftheseparityviolationsstilloccur,themostcommonformofdiscriminationthatmentalhealthandsubstanceusedisorderpatientsexperienceisthroughNQTLsfromtheirhealthplan.
Forexample,manyplanspayforrehabinanursinghomeafterahipreplacementbutwon’tpayforrehabinanIntensiveResidentialTreatmentProgramforsomeonewithaseriousmentalillnessleavingthehospital.
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PolicyRecommendations:
HF1974/SF2028
• Annual reporting: Require health plans that offer mental health and or substance use disorder services to submit an annual report to the commissioner that documents every NQTL applied to mental health or substance use disorder benefits and medical and surgical benefits, as well as an analysis that confirms that the standards for determining an NQTL for mental health and substance use disorder treatment are not more stringent or restrictive than for other medical or surgical benefits.
• Enforcement: Department of Commerce and the Department of Health should monitor the implementation of mental health parity and ensure that health care plans are following mental health parity requirements.
• Regular market analysis: Because there often substantial differences in access to in-network mental health care and out-of-pocket costs when compared with coverage for other medical conditions, it is very important for the Department of Commerce to conduct regular audits of the health insurance market to ensure compliance with federal parity regulations.
AccesstoMedication
Issue:Individualsexperiencebarrierstoobtainingprescribedbest-choicemedicationduetofrustratingandproblematicregulations.
Background:Findingtherightmedicationandtreatmentforamentalillnesscanbedifficult.Adherencetoatreatmentplancanbeevenmoredifficult.Researchhasshownthatwhenanindividualwithamentalillnessisengagedindevelopingthetreatmentplanandwhenthereisshareddecisionmaking,theoutcomesarebetter.Theindividualandtheirphysicianshouldworktogethertodetermineabest-choicemedicationbasedupontreatmentgoalsandriskofside-effects.
Steptherapy,whereyoumuststartwithtypicallythecheapestandoldestmedicationandmust“fail”beforetryinganothermedication,doesnotallowforbestpracticesintermsoftreatmentengagementnordoesitallowthephysiciantorecommendwhichmedicationmayworkbestbasedonanumberofitemsincludingresearchandfamilyhistory.Somesideeffectsaremoretolerablethanothers,whichmeansitiscriticalthattheindividualbeinvolvedinthedecisionmaking.Mentalillnesseshaveageneticcomponent.Ifafamilymemberhas,forexample,depressionandhasfoundamedicationthatworkswell,itmaybeappropriateforanotherfamilymembertotrythatmedicationfirst.
Controllingcoststhroughfail-firstapproachesconflictswithmostclinicaltreatmentguidelinesformentalillnesses.Bylimitingthearrayofmedicationoptionstopeoplewithmentalillnesses,bothphysiciansandindividualsareforcedtocompromisetheirtreatmentdecisions.Whilestudiesmayshowthatthereisrelativelylittledifferenceintheeffectivenessofaclassofmedication,thesestudiesprovidenoinformationondiscontinuationofmedicationsorintolerablesideeffectsorfailuretoadequatelycontrolsymptoms.These“costsavingmeasures”oftenplacepeoplewithmentalillnessesatriskofpooroutcomessuchaspsychiatricdecompensationandre-hospitalization,withlittleevidencethattheysavemoneyorimprovequalityofcareoverthelong-term.
Anindividualmayalsohavetochangeamedicationthathasbeenworkingforthemshouldtheydecidetoswitchtoaninsuranceplanthatbettermeetstheirneeds.Peopleshouldnotbelimitedtocertainhealthcareinsuranceplansforfeartheymightloseaccesstotheirprescribedmedication.
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Often,apersonwithamentalillnesswillhavetofailononeormoremedicationsbeforetheyareallowedaccesstothemedicationtheywouldhavetriedasaninitialtreatment.Itispoorclinicalcaretodelaythestartofeffectivetreatmentandexposeapersonwithmentalillnesstoincreasedrisks.
PolicyRecommendation:Advocatethatstatelawsdonotinterferewithpeopleobtainingthemosteffectivemedication.
HF747/SF593
• AnypriorauthorizationforaprescriptiondrugmustremainvalidforthedurationofthecontractyearunlessthedrughasbeendeemedunsafebytheFDA,thereisevidenceofenrolleesabuseormistreatmentofthedrug,
• Ahealthplanthatprovidesprescriptiondrugcoverageandusesaformularymustdiscloseitsformularyandrelatedbenefitinformationatleast30dayspriortoannualrenewaldates.
• Onceaformularyisestablished,ahealthplancanonlyremoveabrandnamedrugorplaceitinahighercostbenefitcategoryifthisdrugisreplacedwithagenericdrugdeemedtherapeuticallyequivalentorabiologicdrugratedasinterchangeableaccordingtotheFDA.
StepTherapyLegislation
• Thelegislationallowssteptherapyonlyifcertainrequirementsarefollowedindevelopingthesteptherapytool.
• Thelegislationalsoallowsaprescriberorpatienttorequestanoverrideoftheprotocolinspecificcircumstanceswhennon-prescribeddrugislikelynotmedicallyappropriateforthepatient.
EarlyInterventionandFirstEpisodePsychosisPrograms
Issue:Therearelimitedprogramsandservicesavailableforpeopleexperiencingtheirfirstpsychoticepisode.Theresultsareadverseoutcomesanddisabilitycausedbytheiruntreatedmentalillness.
Background:Individualsexperiencingtheirfirstpsychoticormanicepisodearenotreceivingtheintensivetreatmenttheyneedtofosterrecovery.Onaverageapersonwaits74weekstoreceivetreatment.Ourmentalhealthsystemhasreliedona“fail-first”modelofcarethatessentiallyrequirespeopleexperiencingpsychosistobehospitalizedorbecommittedmultipletimesbeforetheycanaccessintensivetreatmentandsupports.Thiscostsoursystemagreatdealandcoststheindividualevenmore.Thereiscompellingevidencethatintensiveearlyinterventioncanfosterrecoveryandpreventadverseoutcomesfrequentlyassociatedwithuntreatedpsychosis.
ToaddresstheneedinMinnesotaweestimatethateightteamswouldbeneededandeachwouldserve30youngpeopleatonetime.Peoplestaywiththeteamanaverageoftwotothreeyears.Eachteam,basedoncalculationsusedinNewYork,wouldcostroughly$250,000,inadditiontoreimbursementbyinsurance.
Duringthe2015legislativesessionfundingof$260,000,inadditiontothetenpercentfromthefederalmentalhealthblockgrant,wasmadeavailabletocreateevidence-basedinterventionsforyouthatriskofdevelopingandexperiencingafirstepisodeofpsychosis.Projectswilloffercoordinatedspecialtycareincludingcasemanagement,psychotherapy,psychoeducation,supportforfamilies,cognitiveremediation,andsupportedemploymentand/oreducation.Theseprogramsprovideintensivetreatmentrightawayforsomeoneexperiencingsymptomsofpsychosis.IngreaterMinnesotathegeographiccatchmentareatoreachtheneededpopulationwillbegreat
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meaningthathousingmustbemadeavailablefortheyoungpersonandtheirfamilytoaccessthisoutpatienttreatmentprogram.CurrentlythereareonlythreeprogramsinMinnesota.
In2017,thelegislatureappropriatedanadditional$1illiondollarsinonetimedollarsforthebienniumtofundfirstepisodeprograms,includingtheuseoffundstoensurethatindividualswholiveinruralareascanaccesstheprogrambypayingfortravel,housing,andadditionalbarrierstoaccess.
PolicyRecommendations:
• Increasethenumberoffirstepisodepsychosis(FEP)programssothatyoungpeopleexperiencingtheirfirstpsychoticorfirstmanicepisodereceiveintensivetreatment.Wewillrequire8FEPprogramstoadequatelymeetstatewidedemandforthisevidence-basedpractice.
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MentalHealthServices
ReimbursementRatesforMentalHealthServices
Issue:Existingpublicprogram(MedicalAssistanceandMinnesotaCare)ratespaidtomentalhealthprovidersareinsufficient.Asaresult,communitymentalhealthprovidersarehemorrhagingfinancially.Theexistingrates,andinadequateratesettingprocess,threatenstheon-goingoperationofmentalhealthservices,particularlysafetynetservices.Background:ExistingmentalhealthreimbursementratesaretoolowandnotsufficienttosustainMinnesota’smentalhealthsafetynetnetwork.Planningrelatedtobuildingamoresustainable,integratedbehavioralhealthcaresystempromisestoenhancethefunding,accessibility,andqualityofmentalhealthservicesstatewide.Thesereforms,however,taketimetoshapeandimplement.Tosustaincoreservicesforthelow-incomeindividualsandtheuninsuredintheshortterm,thereisanurgentneedtoincreasereimbursementratesformentalhealthproviders.Thenegativeimpactofhistoricallylowratesiscompoundedbyincreasesintheminimumwage,newfederalovertimemandates,increaseddemandforservices,andmuchhigherwagesofferedbycertainfor-profitprivateprovidersandgovernmentagencies.Withsomecurrentratestoprovidersbetween0.37to0.50centsonthedollar,thisisnotsustainable.
PolicyRecommendation:Reviewfederalregulationsformanagedcaretoensurethattheseplansofferadequateratesandaccessformentalhealthtreatment.
MedicalAssistancePaymentsUnderManagedCareIssue:ThefinancialdistressbeingexperiencedbycommunitymentalhealthprovidersisfueledinpartbyPMAPsnotpayingthefull,approvedMAfee-for-serviceratesforsomeorallservices.Background:Inthewordsofoneprovider,“nothingisconsistentwithanyofthepaymentsfromanyofthePMAPs.”In2016,theplanspaidbelowMAratestothemajorityoftheproviderswhorespondedanonymouslytoasurveyconductedbyMACMHP.Thesameinconsistentpaymentsaresimilarforthenewcodesandrecentlegislationmandatingafivepercent(5%)increaseforMAservices.
MinnesotaAssociationofCommunityMentalHealthPrograms(MACMHP)memberssurveyedexpecttoloserevenueasaresultofthenewmanagedcarecontractsin2016.Providersareinvestingasignificantamountoftimeinreprocessingclaimsandinappealingrejectedclaims.Inaddition,thereareinconsistentdecisionsaroundstaffcredentials.Overall,theinconsistency,lackofclearinformation,longdelayinreimbursementandhighlevelofadministrativeeffortismakingthebusinessrelationshipwithaManagedCareOrganizationanunsustainableproposition.
PolicyRecommendation:Ensureaccuratereimbursementsarepaidtoprovidersforservicescontractedundermanagedcare-paymentratesequaltooraboveMAfee-for-servicerates.
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MentalHealthWorkforceShortages
Issue:Therearenotenoughmentalhealthpractitionersandprofessionalstomeettheneedsofthechildrenandadultsrequiringmentalhealthservices.
Background:Psychiatry,psychology,clinicalsocialwork,psychiatricnursing,marriageandfamilytherapyandprofessionalclinicalcounselingareconsideredthe“core”mentalhealthprofessions.Formanyyears,Minnesotahasexperiencedashortageofprovidersofmentalhealthservices.Thisshortagehasbeenfeltmostprofoundlyintheruralareasofthestate.Thereisalsoanongoing-shortageofculturallycompetentandculturallyspecificproviders.
NineofelevengeographicregionsinMinnesotaaredesignatedmentalhealthshortageareasbytheHealthResourcesandServicesAdministration(HRSA).Asmorepeopleseekmentalhealthtreatmentandasweworktoexpandaccesstomentalhealthservicesacrossthestate,thereisagreaturgencytoincreasethesupplyofcommunitymentalhealthprofessionals.
Addingtothis,reimbursementratesformentalhealthservicesthathavenotkeptpacewithotherhealthcareservicesorhealthcareinflation.Overthepasttenyearstherehavebeeninconsistentincreasesamountingtominorincreasesformentalhealthservicewhenaveragedovertime.
The2013legislaturepassedabillrequiringMinnesotaStateCollegesandUniversities(MnSCU)toholdamentalhealthsummitanddevelopacomprehensiveplantoincreasethenumberofqualifiedpeopleworkingatalllevelsofourmentalhealthsystem,ensureappropriatecourseworkandtrainingandcreateamoreculturallydiversementalhealthworkforce.
In2015theMentalHealthWorkforcereleasedthereportwithrecommendationstoaddressworkforceshortagesbyincreasingthenumberofqualifiedpeopleworkingatalllevelsofourmentalhealthsystem,ensureappropriatecourseworkandtrainingformentalhealthprofessionalsandcreateamoreculturallydiversementalhealthworkforce.In2016aworkforcesummitwasheldtofurtheraddressworkforceshortages,especiallyinthedirectsupportandcarefields.
PolicyRecommendations:
• Ensureaccesstoaffordablesupervisoryhoursformentalhealthcertificationandlicensure.• Reducebarrierstomentalhealthworkersobtainingsupervisionhoursrequiredtobea
mentalhealthpractitioner.• Increasefundingfortheruralhealthprofessionaleducationloanforgivenessprogramand
setasidefundsforpeopleworkinginmetroareaprogramswheremorethan50%ofthepatientsareonMedicaidoruninsured.SF1452
• Requireinsurancetocovertreatmentandservicesprovidedbyaclinicaltrainee. HF871/SF1577
• Reviseexperienceandcredentialingrequirementsforthreeentry-levelworkermentalhealthpositions.Thisreformofcredentialingrequirementsforentry-levelworkersmustbecoupledwithanincreaseinwagesfortheseworkers.
• AddLMFTsandLPCCstotheMERCprogram. HF 1749/SF1626• Providegrantfundingforculturallycompetentmentalhealthproviderconsultation.HF
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ExpandUseofTelemedicineIssue:Currentstatutelimitsthefrequencyandtypeofproviderswhocanusetelemedicinetoservepeopleexperiencingmentalillness.
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Background:Telemedicinehasemergedasaviable,costeffective,andappropriatevehiclefordeliveringarangeofmentalhealthservicesinthecommunity.Statepolicyandstatutesneedtobeupdatedtosupporttheexpansionandaccessibilityofthiscaredeliverymodel.Morepeoplewillhaveaccesstoqualitycareconsistentlywhentherangeofprovidersandhoursofcareprovidedviatelemedicineareexpanded.PolicyRecommendation:Increasethecaponthenumberofencounterspermittedinaweekfromthreetoten.
LicensureandSupervisoryRequirements
Issue:PsychologistsandapplicantsforlicensureareexperiencingchallengesrelatedtothechangingimplementationofthePsychologyPracticeAct
Background:RecentlytherehavebeenconcernsraisedaboutthePsychologyPracticeActorlicensurestatuteforpsychologists.Concernshavebeenraisedabouttheclarityofstatedrequirementsforsupervisionwhicharebeingfurtherspecified.Thisrevisionstreamlinesmobilityoflicensureforindividualslicensedatthedoctorallevelinotherjurisdictions,whichhelpstoaddressworkforceissues..
PolicyRecommendations:SupportthebilltoupdateandclarifythePsychologyPracticeActtoimproveaccesstocare.
DutytoWarn�
Issue:CurrentMinnesotastatutecoversonlycertainmentalhealthprofessionalorpractitionertraineesunderdutytowarnprotectionandliability.
Background:Minnesotastatutedefinesdutytowarnasthedutytopredict,warnof,ortakereasonableprecautionstoprovideprotectionfromviolentbehaviorwhenaclientorotherpersonhascommunicatedtothelicenseeaspecific,seriousthreatofphysicalviolenceagainstaspecific,clearlyidentifiedoridentifiablepotentialvictim.Ifadutytowarnarises,thedutyisdischargedbythelicenseeifheorshemakes“reasonableefforts”(communicatingtheserious,specificthreattothepotentialvictimandifunabletomakecontactwiththepotentialvictim,communicatingtheserious,specificthreattothelawenforcementagencyclosesttothepotentialvictimortheclient.)tocommunicatethethreat.
Legislationwaschangedin2016toprovidedutytowarnprotectionfortraineesinthedisciplinesofPsychology,MarriageandFamilyTherapy,andLicensedAlcoholandDrugCounseling.SocialWorkandLicensedProfessionalClinicalCounselortraineeswerenotcoveredinthelegislation.Thesegroupsmaywishtoconsiderinclusionoftheirtraineesinthedutytowarnprotections.
PolicyRecommendation:Expanddutytowarntootherappropriatementalhealthtrainees.
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Children’sMentalHealth
EarlyChildhoodConsultation
Issue:Childcareprovidersandeducatorsdonothavethenecessarytrainingorskillstoadequatelysupportchildrenwithmentalhealthneeds.Childrenaregettingkickedoutofchildcareinsteadofreceivingthesupportsandtreatmenttheyneed.
Background:Since2007,Minnesotahasinvestedinbuildinginfrastructuretoaddressearlychildhoodmentalhealththroughgrantstosupportanddeveloptheavailabilityofandaccesstodevelopmentallyandculturallyappropriateservicesforyoungchildren.Theseinfrastructuregrantsareusedtostrengtheninfrastructureandsupportdevelopmentallyandculturallyappropriateservicesforyoungchildren.
Earlychildhoodmentalhealthconsultationgrantssupporthavingamentalhealthprofessional,withknowledgeandexperienceinearlychildhood,providetrainingandregularonsiteconsultationtostaffservinghighriskandlow-incomefamilies,aswellasreferralstoclinicalservicesforparentsandchildrenstrugglingwithmentalhealthconditions.Earlychildhoodmentalhealthconsultationwouldhavethreemaincomponents:
• On-sitementalhealthconsultationandsupportforchildcareagencystaff.Mentalhealthagencieswillalsoworkdirectlywithfamiliesasappropriate.
• Referralforchildrenandtheirfamilieswhoneedmentalhealthservices.• Trainingforchildcarestaffinchilddevelopment;trauma/resilience;workingwithfamilies
whohavetheirownhavementalhealthissues;andskillstobettersupporttheemotionalhealthanddevelopmentofchildrentheyworkwith.ThesetrainingswouldbebuiltintotheParentAwareratingsofparticipatingchildcareagencies.
Somechildren,particularlywhenexposedtotrauma,wouldgreatlybenefitfromobtainingimmediatetreatment.Childrenfromculturallyspecificcommunitiesoftendonotbecomeinvolvedintreatmentduetotheneedforthefamiliestodeveloptrustandarelationshipwiththementalhealthprofessional.Therequirementthatadiagnosticassessmentbecompletedbeforetreatmentbeginshampersourabilitytoimmediatelyassistachildwhohasexperiencedtraumaandtodeveloparelationshipwithfamilies.Allowinganexceptioncouldprovideearlytreatmentandpreventdisability.PolicyRecommendations:
• AppropriatefundstoexpandearlychildhoodmentalhealthconsultationgrantsHF2101/SF1978
School-LinkedMentalHealthGrants
Issue:ExpandSchool-linkedMentalHealth(SLMH)Grants.
Background:Since2008,grantshavebeenmadetocommunitymentalhealthproviderstocollaboratewithschoolstoprovidementalhealthtreatmenttochildren.Thisprogramhasproducedwonderfuloutcomesandhasreducedbarrierstoaccesssuchastransportation,insurancecoverage,andfindingproviders.Itwassosuccessfulthatthelegislatureincreasedfundingin2013and2016.
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Followingtheincreasedfundingin2013SLMHwasexpandedtoallbuteightcountiesinMinnesota.Onaverage15,000studentsareservedduringtheschoolyear.Thereare36SLMHgrantees,serving872schoolswithinmorethan230schooldistricts.Thismeansservicesin85%oftheschooldistrictsinthestateand45%oftotalschoolbuilding.
Thisprogramworkshand-in-handwithschoolsupportpersonnelsuchasschoolnurses,schoolpsychologists,schoolsocialworkersandschoolcounselors.Effortsmustbemadetoensurethattherearesufficientschoolsupportpersonneltohelpthosechildrenwhodonothaveamentalhealthdiagnosis.
PolicyRecommendations:
§ Increasefundingforschool-linkedmentalhealthgrants HF 960/SF1369• Streamlinegrantapplicationstoallowpreviousgranteesthathavegoodoutcomesand
demonstratesupportfromtheircurrentschoolpartners• Creategrantsfor“community-college”linkedmentalhealthservices.
Children’sResidentialTreatmentFunding
Issue:Since2001,withapprovalfromCMS,MinnesotahasusedMedicalAssistancetopayforthetreatmentportionoftheperdiemforresidentialtreatmentservices.Recently,CMShasdirectedDHStorevieweachofthesefacilitiestodeterminewhethertheymeetthedefinitionofInstitutionsofMentalDisease(IMDs)whichwouldmakethemineligibleforfederalMedicaidfunding.
Background:Programsthatarelargerthan16bedsthatprovidementalhealthtreatmentareconsideredIMDsundertheCMSdefinitionandmostoftheservicesinMinnesotaareprovidedinlargerprograms.ChildrenresidinginIMDswouldalsolosetheirMedicalAssistanceeligibility.Thislossoffederalfundingwouldaffectstateandlocalbudgetsandwouldimpactaccesstotheseprogramsforchildrenandadolescents.Minnesotahasover800bedsinthecontinuumofcarethatwouldbeaffectedbythislossoffunding.
PolicyRecommendation:TheLegislaturedidprovidefundingtoreplacethelossoffederalfinancialparticipationthroughMedicaid.However,thestatefundingmustbeextendedinordertobeavailablethroughJune20,2021.
PsychiatricResidentialTreatmentFacilities
Issue:APsychiatricResidentialTreatmentFacility(PRTF)broadensthecontinuumofcarebyofferingservicesthatarelessintensivethaninpatienthospitalcarebutmoreintensivethanourcurrentresidentialprograms.
Background:PsychiatricResidentialTreatmentFacilities(PRTFs)wereestablishedunderMAforthefirsttimein2015withtheintentionofenrollingupto150PRTFbedsatamaximumof6sites.APRTFservesyouthsuptotheageof22(solongastheyenteredtheprogramwhiletheywere21).Thisprogramprovidesactivetreatmentratherthanrehabilitationmusthaveapsychiatristorphysicianasamedicaldirector,andrequire24hournursing.TheratesincluderoomandboardunderMAandthusparentsdon’tneedtogotocountiesandthroughcountychildprotection/voluntaryplacementprocess.Additionally,PRTFsareexemptedfromtheInstituteforMentalDisease(IMD)exclusion,whichprohibitsMedicaidfundingformentalhealthtreatmentinanyfacilitygreaterthan16beds.Thisfundedupto150newbedsinuptosixsitestobeopenedin2017,withadditionalbedsinsubsequentyears.
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PolicyRecommendation:
• IncreasenumberofPRTFbedsfrom150to200beds.Ensurethatthisincreaseisnotmadebyremovingbedsfromanotherservice.
TransportationtoChildren’sMentalHealthServices
Issue:Childrenarebeingtransportedinasystemthatisdesignedandregulatedtorespondtotheneedsofadults.
Background:Non-emergencymedicaltransportationisanessentialservicetoensureaccesstomentalhealthservices.Childrenrepresentauniquepopulationandareoftenbeingtransportedtoearlychildhoodmentalservicesthatshouldrequirethetransportationprovidertohavetherightequipment,likecarseats,andtrainingsothatdrivershavetheinformationandskillsneededtosafelydealwithchildrenwithspecialneeds.
PolicyRecommendation:Thecommissionershouldbedirectedtoconsultstakeholdersandadvocatestodeveloprecommendationsforstandardsandfundingfortransportationproviderswhotransportchildren.
AlternativestoSuspensioninK-3
Background:Duringthe2014schoolyearchildreningradesK-3wereoutofschool8,102daysduetosuspensions.Around3,000childreninthesegradesaresuspendedeveryyear.Suspendingchildreninthisagegroupiscounter-productive.Theydonotlearnanythingwhenoutoftheclassroomandanyunderlyingissues–suchasexposuretotrauma,earlyonsetmentalillness,lagginginsocialemotionalskills–arenotaddressed.Someresearchdemonstratesthatthemoredaysachildmissesupthroughthirdgradethegreaterlikelihoodthatheorshewilldrop-outofschool.
PolicyRecommendations:
• SchoolsshouldnotbeallowedtosuspendstudentsingradesK-3andfundingshouldbemadeavailabletoaddressthesocialemotionalneedsofthesechildren.
• Requireareportonachildinjuringateachertoonlybeforwardedtothenextteacherforoneyear.
EducationinCareandTreatmentMentalHealthPrograms
Issue:Childrenandadolescentswhoneedmoreintensivementalhealthservicesindaytreatmentandresidentialtreatmentprogramsareoftenbehindintheireducationduetotheirmentalillnessesandcurrentlawlimitswhocanprovideeducationservicesinthesesettings.
Background:Currentlawonlyallowsthelocaldistricttoprovideeducationservicesintheseprogramsaccordingtothedistrict’sschedule.Forsomedistrictsthatmeansthattheeducationhoursarelimited,noeducationisprovidedduringthesummer,andeducationstaffarenotabletobeintegratedintothetherapeuticmilieuonaconsistentbasis.Moreoptionsneedtobeavailabletomeettheneedsofthesechildrenwhenthelocaldistrictisunabletoprovidetheneededservices.
PolicyRecommendation:ChangethestatutetoallowMDEtoapproveothermodelsofeducationservicesinthesesettingsincludingcharterschools,contractsforservicesorprogramoperationoftheeducationservices.
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KognitoSuicidePreventionTraining
Issue:Suicideisthethirdleadingcauseofdeathforyouthbetweentheagesof18and24,withanunderlyingmentalillnessbeingpresentin90%oftheyouthwhohavecompletedsuicide.Accordingtothe2016MinnesotaDepartmentofEducationSurvey,9,35211thgraders,9,6789thgraders,and8,6708thgradepublicschoolstudentsseriouslyconsideredsuicide.InMinnesota,48youthaged10-19completedsuicidein2016.Properlytrainedteacherscanplayaninvaluableroleinengagingyouthwithmentalillnessesandreducingtheriskofsuicide.
Background:TheMinnesotaLegislaturepassedalawin2016requiringallteacherstotakeone-hourofnationallyrecognizedsuicidepreventiontrainingaspartofrenewingtheirteacher’slicense.Changesinteacherlicensurein2017keptthisrequirementforallTierIVandVlicenses.TheMinnesotaDepartmentofHealthhassupplementedthiseffortthroughagrantthatallowsschoolstoapplytohaveaccesstotheonlineKognitoSuicidePreventionTraining.Throughthisgrant,administeredbyNAMIMinnesota,30schooldistrictsandover1,000teachersreceivedsuicidepreventiontraining.
Kognito’sonlinetrainingisaSAMHSArecognizedevidence-basedpracticethatcontainsrole-playingsimulationswhereteachersinteractwithanimatedstudentsexhibitingsymptomsofmentaldistress.Teacherslearntouseevidence-basedtechniquestoengageinaconversationwithastudentexperiencingamentalhealthcrisisandtoencouragethatstudenttoseekadditionalhelpwhennecessary.Thistrainingcanbecompletedinanhourandisavailable24/7toanyonewithinternetaccess.Inadditiontoprovidingtheteacherwithevidence-basedtechniquestointeractwiththeirstudents,theKognitoplatformalsoprovidesalinktoinformationaboutlocalmentalhealthresources.
PolicyRecommendation:MakeKognitotrainingavailableineveryschooldistrictinMinnesota.
• A 2-year contract with Kognito for the State of Minnesota would be $273,000, or about $44 per school.
• A 1-year contract with Kognito costs $183,000, or about $56 per school.
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CriminalJustice
AdministrativeandDisciplinarySegregation
Issue:Segregationandisolationhavenegativeimpactonaperson’smentalhealth.Giventhehighrateofpeoplewithmentalillnessesinprison,theuseofsegregationandisolationpreventspeoplefromreceivingadequatetreatmentwhenthereislimitedtreatmentinthefirstplace.
Background:"Disciplinarysegregation"meansthestatusassignedaninmatefollowingahearinginwhichtheinmatewasfoundinviolationofafacilityruleorstateorfederallaworthestatusassignedaninmatebeforeahearingwhensegregatingtheinmateisdeterminedtobenecessaryinordertoreasonablyensurethesecurityofthefacility.
Thereisresearchtosupportthepsychologicalstressandstrainthatresultfromtheuseofdisciplinarysegregationinprisons,especiallyforpersonswithmentalillnesses.Individualswhoareheldinsolitaryconfinementspendnearlyeveryhourofthedayinasmallwindowlesscellwithnocontactwithothers.Theuseofsegregationandisolationisalsoextremelyexpensiveandcounterproductiveifthehopeistosupportrehabilitationbackintothecommunity.
InMinnesota,limitedinformationisavailableabouttheuseofsegregation;butwhatwedoknowisthatthispracticeisoftenusedonyoungadults,involvesundulyharshphysicalconditions,andcanbeextendedoverlongperiodsoftime.Disciplinarysegregationmaybeimposedforrelativelyminorviolationsofprisonrules.Therearealsodischargesdirectlyfromsolitaryconfinementbacktothecommunity,asituationwhichimposesenormousadaptivestrainsontheindividualsinvolved.
PolicyRecommendations:
HF742/SF608
• RequiretheDepartmentofCorrectionstodevelopgraduatedsanctionsforruleviolations,sothatsegregationbecomesthelastresort.
• Establishappropriatephysicalconditionsofsegregatedunits,includingreducedlightingduringnighttimehours,rightsofcommunicationandvisitation,andfurnishedcells.
• Requiremandatoryreviewofdisciplinarysegregationstatusevery15daysbythewardenofinstitutionandevery15daysthereafter.Onceaninmateserves60daysindisciplinarysegregation,theinmate’ssegregationstatusmustbereviewedbythecommissionerordeputyorassistantcommissionerandthenevery30days.
• Notallowreleasinganinmatetothecommunitydirectlyfromsegregatedhousing.Requireinmatestoserveatleast30daysinthegeneralpopulationbeforetheirrelease.
• Ifaninmatehasbeenplacedinsegregatedhousingfor30ormoredays,theirtransfertothegeneralpopulationmustbereviewedbyamentalhealthprofessionalbeforethistransferismade.
• RequiretheDepartmentofCorrectionstoissueayearlyreporttothelegislaturethatdocumentstheuseofsolitaryconfinementincludingthenumberofinmatesinsolitary,theirages,thenumberofinmatestransferredfromsegregationtothementalhealthunit,thenatureofinfractionsleadingtosegregation.
InvoluntaryAdministrationofMedicationinJails
Issue:Apersonwhohasamentalillnessandisdetainedinajailmaynotbewillingtotaketheirprescribedantipsychoticmedication.Therearefewplacesworsethanjailtosuddenlystopan
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antipsychoticmedicationandbecausethereisalackofmentalhealthserviceswithinthejailstheoutcomecanbedevastating.
Background:Therearenotenoughcommunity-basedmentalhealthservicestomeettheneed.Unfortunately,thismeansthatpeoplewithseriousmentalillnessoftenencounterthecriminaljusticesystembeforegettingappropriatementalhealthtreatment.Thecriminaljusticesystemisnotcurrentlyequippedtoprovideadequatementalhealthservices,supportorresourcesforinmateswithmentalillnesses.
AccordingtostatisticfromtheSteppingUpInitiativetherearenearly2millionpeoplewithseriousmentalillnessesadmittedtojailsacrossthenationeachyear.Onceincarcerated,individualswithmentalillnesseshavelongerstaysinjailandareatahigherriskofreturningtojailcomparedtoindividualswithoutmentalillnesses.Inaddition,thecostsacquiredbyjailsaretwotothreetimeshigherforadultswithmentalillnesses.
Thejailsarenotsetuptotreatmentalillnesses.Theyshould,however,berequiredtofollowsensibleproceduressothatthementalhealthconditionsofpeopleinjaildonotgodownhillwhiletheyareinthecustodyofthecounty.Insomecases,throughevaluation,stabilization,anddischargeplanning,theindividualmaybebetteroffatdischargethantheywereatbooking.
Inothercases,apersoninjailwhoisnottakingmedicationsmaydecompensateandbecomeadangertohimorherself.Inthesesituations,asheriffmaycontactprepetitionscreeningandseekacourtorderforcommitmenttoadministernecessarymedicationinvoluntarily.
PolicyRecommendation:
• Authorizethesherifftoseekcommitmentandinvoluntaryadministrationofantipsychoticmedicationtoapersonwhoisincustodyandwasadmittedwithavalidprescriptionforanantipsychoticmedication,butrefusesmedication.
• AuthorizethejailhealthcarestafftoimplementacurrentJarvisorder.
MedicationsandAssessmentsinJails
Issue:Jailsfollowaformularyandarenotrequiredtoprovideapersonwhoisdetainedwiththeexactpsychotropicmedicationstheyareprescribed.Althoughjailsrequirementalhealthscreeningsduringintake,mentalhealthassessmentsandfollowupforongoingmentalhealthservicesoftendonothappen.ALegislativeAuditor’sreport(March,2016)showedvastlydifferentpracticesinthesetwoareas,aroundthestate.
Background:Althoughjailsarerequiredtoadministersimplementalhealthscreeningsduringthebookingprocess,thereisnorequirementtofollowupforthosewhoscreen“positive,”witheitheradiagnosticassessmentortheimplementationofacareplan.Asaresult,jailsacrossthestatehaveverydifferentpracticesinrespondingtonewinmateswithmentalhealthissues.
Maintaininghealthcarecostsinjailsclaimsalargeportionofthecorrectionalbudget.Inordertocutcosts,manyfacilitiescontractwithanexternalhealthcarecompanytocontrolcosts.Thesecompaniesoftenhaveextremelylimitedformularies,orapproveddruglists.Aformularytypicallycontainsonlythemostcost-effectiveversionofamedication.Jailphysiciansmayonlyprescribemedicationsfromthislist,regardlessofmedicationstheinmateiscurrentlytakingormayhaveutilizedinthepastandchangingaperson’spsychotropicmedicationwhiletheyareinjailissimplynotagoodidea.
InthestateofMinnesota,individualscomingintothejailshavetheircurrentmedicationsswitchedtoformulary-approvedmedicationsbyjailphysicians.Ifapersongetsapprovalforanon-formularymedicationwhileinjail,Minnesotahasnosupplementalprotocolsinplacewhilewaiting
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forthemedicationtobeapproved.Ifanon-formularymedicationweretobeapproved,theinmatewouldstillbetemporarilyswitchedtoadifferentmedication.Evenashort-termchangeinmedicationcancausesignificantsetbackstoaperson’smentalhealth.
Forthoseinmateswhoareabletoaccesstheirmentalhealthmedicationwhileinjail,itcanbeachallengetocontinuereceivingtheirmedicationsfollowingdischarge.Onepotentialsolutionistohavethejailscontractwithalocalcommunitymentalhealthprovider.Notonlywillthisallowexpertstomanagementalhealthmedicationsforinmateswhiletheyareinprison,acommunitymentalhealthprovidercanalsocontinuetoservetheindividualfollowingtheirrelease.
Inaddition,theprovisionofmedicationtopeopletopeoplebeingdischargedfromjailsisextremelyinconsistentfromcountytocounty.
PolicyRecommendations:
HF982/SF1323
• Requireacountyofregionaljailtoprovideaprisonerwhohasavalidprescriptionforapsychotropicmedicationthesamepsychotropicmedicationwhileincarcerated.
• Requirethatanadequatesupplyofthemedicationbegiventotheinmateatdischarge.• Requirethatprisonerswhohavescreenedpositiveformentalillness,whowillbeincustody
for14daysormore,haveaassessmentbyamentalhealthprofessional(unlessthishasbeendonerecently),andthatatreatmentplanisdevelopedandimplemented.
• Contractwithlocalcommunitymentalhealthprovidertooffermentalhealthservicesandprescribemedicationsinjail.
OmbudsmanforMentalHealthServicesinCorrections
Issue:Thereisnocentralofficeoreasilyaccessiblegrievanceprocedureforindividualswithamentalillnesswhohavebeenincarcerated.Inthecountyjails,oversightisprovidedonlybyasmallstaffofstatejailinspectors,whoinspectajaileverytwoyears.Recently(March,2016),theLegislativeAuditorfoundthatmanyjailsareunderstaffed,andunabletoprovidestafftraining,andneededprogramsforinmates.
Background:Ina2016OLAreportthereisdirectandindirectsupportforthecreationofanombudsmanofficetofocusonissuesrelatedtomentalhealthservicesincorrectionalfacilities.Theindirectsupportconsistsofthemesthatrunthroughthewholereport:lackofconsistentpracticesaroundthestate,andabsenceofoversightastohowjailsactuallyapplytherulesthatdoexist.Besideshelpingindividualswithspecificissues,anOmbudsmanforMentalHealthServiceswouldbeaforceforgreateradherencetostatutesandrules.
PolicyRecommendation:
HF982/SF1323
• Establishastateombudsmanspecificallyfocusedoninvestigatingissuesrelatedtomentalhealthservicesincorrectionalordetentionfacilities.
• AuthorizetheOmbudsmantoreportsystemicproblemtotheGovernorandLegislature.
CommunityMentalHealthServicestoSupportPeopleintheCriminalJusticeSystemIssue:AnumberofindividualswhoarecivillycommittedforcompetencyrestorationreceivetreatmentattheAnokaMetroRegionalTreatmentCenter(AMRTC),whichisastate-operated
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hospital.OftentimestheseindividualsreachapointintheirtreatmentwheretheynolongerneedthelevelofcareprovidedatAMRTCbutstillneedon-goingcompetencyrestorationservices.Inaddition,someindividualswhoarefoundtobenotcompetenttostandtrialarenoteligibleforcivilcommitment.Asaresult,thereareindividualswhoeitherhavenomeansofreceivingcompetencyrestorationservicesorreceivetheseservicesinahigherlevelofcarethantheyneed,preventingpeoplewhodoneedthatlevelofcarefromaccessingit.
Background:TheOfficeoftheLegislativeAuditor(OLA)issuedareportinFebruary2016onmentalhealthservicesincountyjails.Twofindingsfromthereportinclude:(1)aneedtodevelopabroadercontinuumofoptionstosupportindividualswhohavebeenfound“notcompetenttostandtrial”andneed“competencyrestoration”servicesinordertoparticipateintheirdefenseand(2)aneedtoexpandtheavailabilityofcommunitymentalhealthservicesthataresupportpeopleinvolvedinthecriminaljusticesystem,includingForensicAssertiveCommunityTreatment(FACT)teams.
PolicyRecommendations:• Providegrantstocounties,regionalcountypartnerships,and/orcommunity-basedmental
healthproviderstodeveloplocal,community-based,competencyrestorationservices.• Providestart-upgrantfundingtoestablishnewFACTteamsaswellasfundingtoincrease
thecapacityofMinnesota’sexistingtraditionalACTteamstoserveindividualswithextensivelegal/criminaljusticehistories
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OtherIssues
ImprovingCareCoordinationThroughHealthIT
Issue:Betterinformationatthepointofcareleadstobetterhealthcareoutcomes.Individualswithmentalillnessoftenreceivepoorlyintegratedcarebecausetheyreceiveservicesfromavarietyofdiversesettings.Electronicmechanismsnowavailablecanimprovecareintegration.
Background:HospitalsandphysicianpracticeshavewidespreadadoptionofElectronicHealthRecords,butmuchofthecarereceivedbyindividualswithmentalillnessoccursincommunitysettings.Manyofthesesettingsalsohaveelectronicrecords,butthereisafailuretoconnectthedotsandlinkallinformation.Behavioralhealthsettingshavestruggledbecausetheyhavebeenineligibleforresources.Stigmaandothermisinformationhaveworkedagainsttheintegrationofmentalhealthinformationthatisvitaltocare.Individualsmustalwaysgiveconsentforinformationtobeshared.Imagineaworldwhereacasemanagergetsanalertwhenanindividualisbeingdischargedfromthehospitalsothatimmediatefollowupcanprovidetheneededresourcestomaintaintheminthecommunityandavoidreadmission.Orwhereanindividual’sadvancepsychiatricdirectiveisavailablewhentheycheckintotheEmergencyDepartment,socaregiversknowtheirhistoryandpreferenceswithregardtodifferenttreatments.EMTscanknowtheindividual’sdiagnosisandmedicationlist,tointerveneswiftlyandeffectively.Anationalstudyestimatesunnecessaryofcostsof$65billionannuallyduetoafailuretocoordinatecare.SixtypercentofroutineoutpatientmentalhealthservicesarenotcapturedinthePrimaryCareProvider’sElectronicHealthRecordbecauseservicesareprovidedoffsite.RecordsofacutepsychiatricservicesaremissingfromthePrimaryCareProvider’srecord89%ofthetime.Allprovidersmusthaveaccesstokeymentalhealthinformation.
Policyrecommendations:
• Makesmallstrategicinvestmentsinelectronichealthrecordsanddataexchangetosupportcommunicationbetweencommunitymentalhealthandacutecaresettings.
• Encouragebighealthsystemstoexchangeinformationwiththecommunitythroughalerts(admission,discharge,ortransitionincare),caresummaries,anddirectmessagingtocareteammembers.
CivilCommitment
Issue:Thecivilcommitmentstatuteneedstobereviewedandrecommendationsonpossiblechangesreportedtothelegislature.
Background:Civilcommitmentisthelegalprocessbywhichacourtordersmentalhealthtreatmentwiththegoalofprovidingnecessarycare.PatientrightsaremandatedunderMinnesotalawundertheCommitmentandTreatmentAct,MinnesotaStatute253B.
In2001,theMinnesotaLegislaturechangedthecommitmentlawbyremovingthewords“imminent”or“immediate”fromthestatuteinordertoallowcourtsorfamiliestointerveneearlierwhenapersondoesnotrecognizehismentalillnessandneedstreatmenttopreventfurtherdeteriorationorcrisis.Assoonasadangerisposedtothepersonwithmentalillnessorothersaroundher,theCivilCommitmentprocesscanbestarted.However,aformalreviewoftheentirecivilcommitmentstatutehasnotbeencompletedinover20years.
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PolicyRecommendation:ThecivilcommitmentstatuteisoutdatedanddoesnotreflectthewayMinnesotacurrentlytreatspeoplewithaseriousmentalillnessinthecommitmentprocess.Stakeholderscametogethertoaddressthecivilcommitmentstatuteinamorecomprehensiveway.
Theupdatedcommitmenttaskforcebillwill:
• Removeoutdatedlanguage.• Provideadditionalclarityforemergencyholds,transportationholds,andwhohas
responsibilitythroughoutthecommitmentprocess.• Createagraceperiodsothatacivilcommitmentdoesnotendduetoapaper-workerroror
misseddeadline.
For additional copies or if you have questions, please contact NAMI Minnesota at
651-645-2948, 1-888-NAMI HELPS
or Mental Health Minnesota at 651-493-6634, 1-800-862-1799.