2007 Letters: April 2007
Dear National Council Member:
Re: Building a national service system for community mental health
As I write this letter, our nation is still trying to understand the April 16, 2007 tragedy at Virginia Tech. And while we extend our deepest condolences to the victims' families and the students, faculty, and staff at Virginia Tech and empathize with schools and communities across the country, which are once again ridden with fear and uncertainty, we must also ask what we can do.
This month, I was preparing to use my letter to update you on National Council practice improvement initiatives - we have projects underway in the areas of workforce and leadership, returning veterans, health and behavioral health integration and most recently, we rolled out continuity of care and treatment adherence projects. But it seems more timely and important to focus on what we can we do to ensure that others like Seung Hui Cho (the gunman at Virginia Tech), who are troubled by mental illness, get the care and help they need so they can live productive lives in a community that is not threatened by the consequences of their illness.
I've been listening to and reading the media coverage of the Virginia Tech tragedy as you have. And now that the initial media frenzy has abated and attention is on making policy based upon the tragedy, I've been thinking about and talking with members, staff, and Beltway colleagues about how to be helpful.
There are many individuals and organizations that are offering tips on how to deal with traumatic events and that are participating in old and new gun control, school safety, and outpatient commitment debates. But it seems most appropriate for us to try and make sense of the events surrounding the killings in the context of the treatment system as we know it and live it. I want to share some thoughts and ask for your reactions.
And while it is immensely unfortunate that it takes a tragedy of this magnitude to make public and policy makers sit up and take note, we must use this opportunity to emphasize the critical need for seamless, ongoing care for those with mental illness.
We've learned that Seung Hui Cho was diagnosed with a mental illness and ordered to get treatment. He was even briefly at a psychiatric institution. But it appears that he did not get the ongoing treatment he needed. And, our nation's laws and mental health system as a whole did not provide for anyone to reach out and draw him back into the system of care. Clearly, he fell through the cracks. And everyday there are thousands more like him. In fact, a recent study found that an astonishing 50 percent of people with schizophrenia never show up for the required treatment in community-based programs following discharge from inpatient care.
Repeatedly, national leaders point to individuals with mental illnesses - and multiple needs - having to navigate through a complex myriad of state and local bureaucracies and services before they even begin to receive the care that they need. In reports and articles and meetings, leaders offer a vision of a patient-centered system with improved collaboration at all levels as essential to move systems of care forward in the 21st century.
We have a large and strong network of community mental health organizations - run under local government or not-for-profit auspices - in communities throughout the country. Unfortunately we have no federal agency that is connected to these organizations. There is no federal government conduit of information from and to these organizations. And this has proven problematic, as revealed in incidents of national significance - the Virginia Tech tragedy, Hurricane Katrina, and responding to the mental health needs of veterans and their families.
In the aftermath of Hurricane Katrina, the Health Resources and Services Administration was able to report to the Department of Health and Human Services and to Congress both the devastation to Community Health Centers as well as their capacity to serve as a resource to hurricane survivors. But information about the devastation to mental health organizations was not uniformly collected and there is no federal government voice advocating for desperately needed mental health treatment funds - you cannot use FEMA crisis counseling dollars for treatment - to serve the adults and children in so much emotional distress as a result of Katrina.
In Montana, to meet the mental health needs of veterans and their families, the Veterans Administration has contracted with community mental health organizations. This model is a simple solution to an overwhelmed VA system and can be duplicated in other states and communities. But again, there is no federal government agency that has the authority or interest in putting the pieces together or in accessing the existing network of mental health organizations to solve a problem.
As you well know, Medicaid cannot be used for anything other than medically necessary encounters with individuals on Medicaid. And state mental health general fund dollars have been re-allocated from services to broader populations to serve as the state Medicaid match. Another issue of concern is that most states have targeted which group within Medicaid can be served by community mental health organizations - this target population is almost always individuals identified with serious and persistent mental illness. This leaves large numbers of individuals with treatable mental illnesses and those exhibiting early symptoms of serious mental illness without access to services.
Our emergency rooms are reportedly filled with people with mental illness. And a recent study concluded that up to one quarter of all persons hospitalized - for any reason - has a mental illness or addiction disorder. These are usually not people within the target population and therefore they have little access to community services such as case management, assertive community treatment, and peer support, which are designed to engage a person in treatment. So these people return repeatedly to emergency rooms or inpatient services and in some cases they might go on to hurt themselves or others.
Some community mental health organizations have endowments, their own foundations, compete for grants, or receive state or local funding for specific initiatives - jail diversion, school based services etc. And in a few cases there are special funds to support college-based services and consultation to college counseling centers. But there is little or no national attention to developing and funding services across all communities for those other than persons designated chronically mentally ill.
We know that mental health organizations, like the rest of healthcare, vary in their competencies and that unfortunately they have not had the benefit of a broad practice improvement initiative like HRSA's Heath Disparities Collaborative. But each and every one of our member organizations continually struggles to improve services; and is highly valued by and integral to their community. And they are saddened that they have been forced to give up serving and reaching out to large segments of their communities.
We can continue our patchwork approach to public mental health services and we can continue to complain about the resulting fragmentation. Or we can move towards a cohesive national service system. But right now at the national level, no one is in charge.
I'd like to hear from you - your reaction to my thoughts and your ideas about how we turn a national tragedy into an opportunity for meaningful discussions and actions. Please email me at LindaR@nccbh.org.
Best Regards,
Linda Rosenberg
President and CEO
National Council for Community Behavioral Healthcare
www.nccbh.org
Re: Building a national service system for community mental health
As I write this letter, our nation is still trying to understand the April 16, 2007 tragedy at Virginia Tech. And while we extend our deepest condolences to the victims' families and the students, faculty, and staff at Virginia Tech and empathize with schools and communities across the country, which are once again ridden with fear and uncertainty, we must also ask what we can do.
This month, I was preparing to use my letter to update you on National Council practice improvement initiatives - we have projects underway in the areas of workforce and leadership, returning veterans, health and behavioral health integration and most recently, we rolled out continuity of care and treatment adherence projects. But it seems more timely and important to focus on what we can we do to ensure that others like Seung Hui Cho (the gunman at Virginia Tech), who are troubled by mental illness, get the care and help they need so they can live productive lives in a community that is not threatened by the consequences of their illness.
I've been listening to and reading the media coverage of the Virginia Tech tragedy as you have. And now that the initial media frenzy has abated and attention is on making policy based upon the tragedy, I've been thinking about and talking with members, staff, and Beltway colleagues about how to be helpful.
There are many individuals and organizations that are offering tips on how to deal with traumatic events and that are participating in old and new gun control, school safety, and outpatient commitment debates. But it seems most appropriate for us to try and make sense of the events surrounding the killings in the context of the treatment system as we know it and live it. I want to share some thoughts and ask for your reactions.
And while it is immensely unfortunate that it takes a tragedy of this magnitude to make public and policy makers sit up and take note, we must use this opportunity to emphasize the critical need for seamless, ongoing care for those with mental illness.
We've learned that Seung Hui Cho was diagnosed with a mental illness and ordered to get treatment. He was even briefly at a psychiatric institution. But it appears that he did not get the ongoing treatment he needed. And, our nation's laws and mental health system as a whole did not provide for anyone to reach out and draw him back into the system of care. Clearly, he fell through the cracks. And everyday there are thousands more like him. In fact, a recent study found that an astonishing 50 percent of people with schizophrenia never show up for the required treatment in community-based programs following discharge from inpatient care.
Repeatedly, national leaders point to individuals with mental illnesses - and multiple needs - having to navigate through a complex myriad of state and local bureaucracies and services before they even begin to receive the care that they need. In reports and articles and meetings, leaders offer a vision of a patient-centered system with improved collaboration at all levels as essential to move systems of care forward in the 21st century.
We have a large and strong network of community mental health organizations - run under local government or not-for-profit auspices - in communities throughout the country. Unfortunately we have no federal agency that is connected to these organizations. There is no federal government conduit of information from and to these organizations. And this has proven problematic, as revealed in incidents of national significance - the Virginia Tech tragedy, Hurricane Katrina, and responding to the mental health needs of veterans and their families.
In the aftermath of Hurricane Katrina, the Health Resources and Services Administration was able to report to the Department of Health and Human Services and to Congress both the devastation to Community Health Centers as well as their capacity to serve as a resource to hurricane survivors. But information about the devastation to mental health organizations was not uniformly collected and there is no federal government voice advocating for desperately needed mental health treatment funds - you cannot use FEMA crisis counseling dollars for treatment - to serve the adults and children in so much emotional distress as a result of Katrina.
In Montana, to meet the mental health needs of veterans and their families, the Veterans Administration has contracted with community mental health organizations. This model is a simple solution to an overwhelmed VA system and can be duplicated in other states and communities. But again, there is no federal government agency that has the authority or interest in putting the pieces together or in accessing the existing network of mental health organizations to solve a problem.
As you well know, Medicaid cannot be used for anything other than medically necessary encounters with individuals on Medicaid. And state mental health general fund dollars have been re-allocated from services to broader populations to serve as the state Medicaid match. Another issue of concern is that most states have targeted which group within Medicaid can be served by community mental health organizations - this target population is almost always individuals identified with serious and persistent mental illness. This leaves large numbers of individuals with treatable mental illnesses and those exhibiting early symptoms of serious mental illness without access to services.
Our emergency rooms are reportedly filled with people with mental illness. And a recent study concluded that up to one quarter of all persons hospitalized - for any reason - has a mental illness or addiction disorder. These are usually not people within the target population and therefore they have little access to community services such as case management, assertive community treatment, and peer support, which are designed to engage a person in treatment. So these people return repeatedly to emergency rooms or inpatient services and in some cases they might go on to hurt themselves or others.
Some community mental health organizations have endowments, their own foundations, compete for grants, or receive state or local funding for specific initiatives - jail diversion, school based services etc. And in a few cases there are special funds to support college-based services and consultation to college counseling centers. But there is little or no national attention to developing and funding services across all communities for those other than persons designated chronically mentally ill.
We know that mental health organizations, like the rest of healthcare, vary in their competencies and that unfortunately they have not had the benefit of a broad practice improvement initiative like HRSA's Heath Disparities Collaborative. But each and every one of our member organizations continually struggles to improve services; and is highly valued by and integral to their community. And they are saddened that they have been forced to give up serving and reaching out to large segments of their communities.
We can continue our patchwork approach to public mental health services and we can continue to complain about the resulting fragmentation. Or we can move towards a cohesive national service system. But right now at the national level, no one is in charge.
I'd like to hear from you - your reaction to my thoughts and your ideas about how we turn a national tragedy into an opportunity for meaningful discussions and actions. Please email me at LindaR@nccbh.org.
Best Regards,
Linda Rosenberg
President and CEO
National Council for Community Behavioral Healthcare
www.nccbh.org
