The National Alliance on Mental Illness found challenges across the country.
| State | Innovations | Challenges |
|---|---|---|
| Alabama | Alabama has reduced the use of restraints and seclusion in state hospitals. | Alabama cut 36% of its total general fund mental health budget from 2009 to 2012. Alabama also has fewer psychiatrists, relative to its population size, than almost any state in the nation. “Hospitals are filled beyond capacity and shortages in acute-care hospital and crisis beds have reached critical levels,” the report states. |
| Alaska | Alaska uses telemedicine to help doctors reach patients in rural areas. | Alaska cut 33% of its total general fund mental health budget from 2009 to 2012. “Across the state, there is a massive workforce shortage. Even in Fairbanks, there are times when there is no psychiatrist or psychiatric nurse available in the mental health center.” |
| Arizona | Arizona has created a partnership between its mental health and housing agencies. | In 2010, Arizona eliminated nearly all services to 12,000 state residents with serious mental illnesses who aren’t on Medicaid. The report quotes one patient who said, “when I first tried to get help after attempting suicide, I was told that I wasn’t sick enough to qualify.” |
| Arkansas | Arkansas is one of a small number of states that funds mental health services for returning National Guard veterans and their families. | The state lags behind in using evidence-based practices to improve mental health care, in providing crisis services and services for the homeless. One patient said, “Anyone who wanted real care was forced to seek help in another city, usually an hour and 30 minutes away.” |
| California | The report calls California’s permanent supportive housing program for the mentally ill “the gold standard,” because it provides patients with a safe, structured place to live. | California cut 21% from its total general fund mental health budget from 2009 to 2012. Space in state hospitals for general psychiatric patients is limited, because 90% of beds are used for mentally ill suspects awaiting trial, or for sexual predators who have completed their prison sentences. |
| Colorado | Metro Denver Crisis Triage Project aims to connect the mentally ill with “crisis stabilization services” to prevent them from ending up in jail. | Access to mental health care for non-Medicaid patients is “extremely limited,” leading to “stress on other systems, such as jails and emergency rooms.” |
| Connecticut | The state created a support program for military personnel and their families. | “Many are languishing in prison or on the streets,” said one person interviewed for the report. Another said, “Trying to find a psychiatrist after being released from a hospital was nearly impossible.” |
| District of Columbia | Washington, D.C., has created “Mobile Crisis Services Teams” as part of its emergency services to help mentally ill residents. | Washington, D.C., cut 24% from its total general fund mental health budget from 2009 to 2012. “It’s like an assembly line,” according to one person interviewed for the report. “Go to hospital, be discharged after one night with just bus fare and directions to the place to get meds, and that’s it.” |
| Delaware | Community programs address patients dealing with both mental illness and substance abuse, a common problem. | Patients and their families struggle to find housing for the mentally ill, such as in group homes or “supportive apartments.” |
| Florida | Florida has made progress in including consumers and families in planning and providing services. | Florida residents face “uphill battles to get appropriate care,” the report says, partly because the state has a shortage of inpatient psychiatric beds. Many of these beds are used to “restore competency” for people facing criminal charges. |
| Georgia | Georgia is one of the leading states supporting police “crisis intervention teams,” which respond to emergency calls related to mental health. Georgia increased its state mental health budget by 22% from 2009 to 2012. | Budget cuts have “decimated” the community mental health care system, the report says. |
| Hawaii | Hawaii has tried to reduce the “criminalization” of mental illness in many ways, including police training, special mental health courts and conditional release programs, which help move people out of jail into treatment. | The mentally ill still often land in jail. Virtually all patients at Hawaii State Hospital have a history of arrest. |
| Idaho | Idaho offers a program to train and certify “peer specialists” to work with the mentally ill. | Idaho cut 18% from its total general fund mental health budget from 2009 to 2012. Idaho residents who need mental health care “often languish in jails and prisons that are ill-equipped to meet their needs.” |
| Illinois | Chicago’s police “crisis intervention teams,” which work with community mental health providers, is a “national model of excellence.” | Illinois cut 32% of its total general fund mental health budget from 2009 to 2012. Illinois has a “severe shortage” of mental health workers, especially in state psychiatric hospitals. |
| Indiana | Indiana has a strong network of community mental health centers. | People with serious mental illness, such as schizophrenia, often end up in the prison system. |
| Iowa | Assertive community treatment programs, which provide outpatient help with issues such as work, money and housing, have helped to reduce the number of mentally ill patients who are jailed or homeless. | “It takes forever to see someone unless you commit a crime,” according to one person quoted in the report. |
| Kansas | Kansas has created a “culture in which consumers and families feel valued and included as key partners in policy development.” | Kansas cut 12% from its total general fund mental health budget from 2009 to 2012. Kansas faces a growing shortage of inpatient psychiatric beds and outpatient community services. |
| Kentucky | Kentucky has expanded police “crisis intervention teams,” which respond to emergencies involving the mentally ill. | Kentucky faces a shortage of mental health professionals and supportive housing for people whose mental illness makes it difficult for them to live on their own. |
| Louisiana | Louisiana has improved training for mental health care providers. | Many people with serious mental illnesses lack access to treatment, ending up in jail or emergency rooms. “Those in the field are generally caring — just overloaded,” according to a parent quoted in the report. “Hospital stays for my daughter have been too short to assure stability, resulting in subsequent hospitalization soon after discharge.” |
| Maine | Maine has created an award-winning re-entry program for young offenders. Maine increased its state mental health budget by 15% from 2009 to 2012. | Half the people incarcerated in Maine have a mental illness; most of these prisoners do not get adequate mental health care. |
| Maryland | Maryland has emerged “as a national leader in promoting wellness and recovery” for the mentally ill. | Maryland has a fragmented, county-based mental health care system that often makes it difficult to coordinate services across county lines. |
| Massachusetts | Massachusetts has a “proud history of innovation” in mental health services, including developing alternatives to restraints in psychiatric hospitals. | “The service system is stretched to the breaking point,” according to one person quoted in the report. Prison suicides are at “crisis levels. |
| Michigan | Michigan’s prisoner re-entry programs have improved the mental health care of those in jail, as well as connecting prisoners to care after release. | Psychiatric beds for acutely ill patients are dwindling. One parent says in the report: “Emergency services said (my son) was not suicidal or threatening, so they released him in slippers, scrub pants and a hospital gown. I found my very psychotic, delusional son wandering around the parking lot in below-zero temperatures.” |
| Minnesota | Minnesota requires health plans to provide “unrestricted access” to all psychiatric medications. | Minnesota faces a workforce shortage, especially in rural areas. “We often have to wait two months for an appointment,” according to a parent quoted in the report. |
| Mississippi | Mississippi has taken preliminary steps toward providing more care to people in the community. | Mississippi cut 10% from its total general fund mental health budget from 2009 to 2012. The report finds that Mississippi’s psychiatric hospitals are filled to capacity, noting that “services are not available until people reach a point of severe crisis. Then, individuals either become the responsibility of the state hospital system or state correctional system.” |
| Missouri | Missouri has expanded its use of telemedicine for patients in rural areas. | Missouri is “the definition of a system under too much strain,” the report says. A severe shortage of psychiatric hospital beds is “related directly to the lack of community resources, housing, providers and residential supports.” |
| Montana | Montana provides good community-based services for the mentally ill. | Montana faces a severe shortage of mental health care providers. When one psychiatrist in Missoula retired, 600 patients were left without a doctor, the report says. |
| Nebraska | Nebraska provides “supported housing” to non-institutionalized mentally ill patients unable to live independently. | Nebraska faces a shortage of trained mental health care providers. One person interviewed in the report noted that patients commonly drive 100 miles each way for treatment. |
| Nevada | Nevada has established community treatment programs, medication clinics and peer counseling specialists. | Nevada cut 28% of its total general fund mental health budget from 2009 to 2012. Many of Nevada’s mentally ill seek help in emergency rooms when no other care is available. |
| New Hampshire | New Hampshire uses telemedicine to provide mental health care to people in rural areas. | The number of psychiatric hospital beds is decreasing even as the population increases. Admissions to the state hospital in Concord increased 69% from 2000 to 2009. |
| New Jersey | New Jersey offers community-based help for mentally ill patients, as well as “supportive housing” for non-institutionalized patients unable to live on their own. | New Jersey closed one of its state hospitals, the Hagedorn Psychiatric Hospital, in June, which had cared for 255 patients, most of them seniors. |
| New Mexico | New Mexico provides mental health services for returning veterans and their families. | New Mexico’s mental health care system “has many holes in it,” including lack of funding and difficulties in treating rural patients, the report says. |
| New York | New York emphasizes that mental health treatment be “evidence-based,” using well-researched practices proven to help patients. | New York has acute shortages of psychiatric hospital beds and crisis stabilization teams, which respond to emergencies involving mentally ill patients. |
| North Carolina | North Carolina trains police in responding to emergency calls involving mentally ill patients. | North Carolina’s mental health system has been in “chaos” in recent years, partly due to safety concerns at state psychiatric hospitals as well as bumpy efforts to privatize community care. |
| North Dakota | North Dakota has made some progress in providing mental health care, and does a better-than-average job of public education about mental health. North Dakota increased its total general fund mental health budget by 48% from 2009 to 2012. | North Dakota faces a “serious lack” of community mental health services, and available services are spread thin. According to one person interviewed for the report, the state’s small population makes it difficult for patients to keep their mental health issues private. “People here are proud and stoic and don’t always seek help because of the loss of privacy involved, along with the stigma of mental illness.” |
| Ohio | Ohio has done a good job keeping mentally ill people out of jail. | State hospital closures in recent years have created a shortage of psychiatric beds for acutely ill patients. |
| Oklahoma | Oklahoma has made “remarkable improvements” in mental health care in recent years. The state provides financial bonuses to community mental health centers that provide wellness activities, such as nutrition classes and smoking cessation. | Oklahoma lags behind other states in providing supportive housing for mentally ill patients. |
| Oregon | Oregon has emphasized housing for people with mental illness, “a cornerstone of recovery.” Oregon boosted its state mental health budget 21% from 2009 to 2012. | Oregon lacks “consistent and accessible” community mental health services. One person interviewed for the report notes that an uninsured female family member was able to be placed in a psychiatric facility only after she became suicidal and struggled with a police officer. |
| Pennsylvania | Pennsylvania is a “national pioneer” in reducing the use of restraints and seclusion in psychiatric hospitals. | Pennsylvania faces a “significant shortage” of community-based mental health services. One person interviewed for the report said that patients wait one to two months before seeing a psychiatrist, noting, “One month can be a long wait when you are really struggling.” |
| Rhode Island | Rhode Island offers a “211” telephone system to help people find mental health services. Rhode Island also increased its state mental health budget by 11% from 2009 to 2012. | Uninsured patients in Rhode Island who are assessed in the emergency room face long waits to be admitted. |
| South Carolina | South Carolina has police “crisis intervention teams” in many communities, which respond to emergencies involving mentally ill people. | South Carolina’s community mental health services have been “devastated” by budget cuts in recent years. South Carolina cut 39% of its total general fund mental health budget from 2009 to 2012. |
| South Dakota | South Dakota uses telemedicine to make up for psychiatrist shortages in rural areas. | South Dakota’s community mental health services “are basically starving” due to lack of resources, leading to increased demand for care at its state psychiatric hospital. |
| Tennessee | Tennessee has been a national leader in supportive housing for the mentally ill. | Budgets cuts have been “devastating” to an “already underfunded” mental health system. |
| Texas | A “jail diversion” program in San Antonio helps keep mentally ill people out of the criminal justice system, where many end up after disruptive behavior causes someone to call the police. | Lack of community services in Texas “results in significantly overcrowded emergency rooms and inappropriate use of prisons as warehouses for people with mental illness.” One person interviewed for the report suggests, “There needs to be a continuum of care — much like with the military — where records are carried with the consumer or centralized.” |
| Utah | Utah puts a great emphasis on tracking outcomes, so that officials know how patients fare after being diagnosed. | Utah’s foreign-born population has more than doubled since 1990, but its mental health services haven’t adapted to assist patients from different backgrounds. |
| Vermont | Vermont has a “Vet to Vet” program to provide mental health services to veterans. | Vermont closed its only state psychiatric hospital in 2012. |
| Virginia | Virginia broadened its commitment laws — which allow patients to be institutionalized against their will — after the Virginia Tech shootings in 2007, in which a student with a history of serious mental illness killed himself and 32 others. | Virginia has repeatedly cut funding to community service boards, which provide mental health services. A 2011 report from the state’s Office of the Inspector General found that 200 patients deemed to pose a threat to themselves or others were turned away from mental health treatment facilities due to lack of beds. |
| Washington | Washington has done a good job improving safety and reducing the use of restraints in state psychiatric hospitals. | Services for seriously mentally ill patients are “almost entirely lacking” in many parts of the state. |
| West Virginia | West Virginia has a mental health court, which helps get mentally ill offenders into treatment, rather than sending them to jail. West Virginia also increased its state mental health budget by 12% from 2009 to 2012. | West Virginia’s “already inadequate system is deteriorating.” Psychiatric hospitals are overcrowded, partly due to the lack of supportive housing and community-based mental health services. |
| Wisconsin | Wisconsin is a “national leader” in wellness and recovery, providing services such as smoking cessation in state psychiatric hospitals. | Wisconsin’s mental health system is fragmented, with care delivered on a county-by-county basis. The state has been slow to adopt evidenced-based mental health care strategies, which research shows have a high chance of success. |
| Wyoming | Wyoming offers a veteran mental health outreach program. | Mental health services are “sparse and inadequate, with many areas lacking psychiatric care.” |
State report card on mental health care
Liz Szabo, USA TODAY4:29p.m. EST January 7, 2013
Resources:
National Alliance on Mental Illness: http://www.nami.org/
USA Today. (2013). Quality of Mental Health Care. Retrieved January 11, 2013 from, http://www.usatoday.com/story/news/nation/2013/01/07/states-mental-health/1805023/.
Related articles
- State report card on mental health care (usatoday.com)
- Officials plan for boost in mental health care (mercedsunstar.com)
