NAMI Minnesota Legislative Update

March 13, 2016

Governor Dayton State of the State Address Governor Dayton gave his "state of the state" address on Wednesday. He began by saying that when he took office five years ago, he pledged "A Better Minnesota" and believes that our state is better today than back then.

He outlined a number of priorities including extending unemployment benefits for workers on the Iron Range; reducing the economic and other disparities in our state based upon race, religion, nationality, or disability status; transportation; and early childhood care and education, providing all-day kindergarten.

He went on to say, "We will have to manage these and other priorities within a new Budget Forecast, which is not as robust as before. We have today a remaining $900 million budget surplus for this current biennium, which ends June 30, 2017. It does not count an additional $600 million of the surplus, which was deposited in our Budget Reserve, after last November's forecast, boosting that reserve to an unprecedented $1.6 billion."

He spoke against tax cuts saying that when it was done during the last decade it did not improve our economy or investments. He went on to say, "The state avoided facing and funding its growing responsibilities for child care assistance, for mental health services, and for elderly care. Growing problems at St. Peter and Anoka state hospitals continued to fester and plague us still."

He ended his address with the following: "Minnesota has always been at its best when we work together. We are better when we recognize and anticipate the challenges ahead, and come together as One Minnesota to create opportunities for every child, every family, every person to succeed. That is the Minnesota, which has built our success. That is the Minnesota that you and I must work together to achieve.”

To read the full address, click here. The Governor's budget will likely be released on Tuesday.

Your Advocacy Matters! On Friday, March 11, Rep. Hausman held a press conference on affordable housing and the $130 million bonding bill she is carrying this session (HF2784). During the press conference Rep. Hausman cited a NAMI house party she attended in Roseville reporting that her constituents that attended that evening were the ones who informed her of the true difficulties of securing and maintaining stable and affordable housing. Click here for the KSTP report of the press conference.

We want to take this opportunity to thank NAMI supporters and advocates and remind everyone that you can and do make a difference. Contact Your Legislators The 2016 session began Tuesday, March 8, 2016. We encourage members to continue to carefully read NAMI Minnesota's weekly legislative updates for summaries of committee hearings, updates on bills pertaining to mental health and our legislative initiatives and calls to action.

We are urging everyone to send an initial letter or email to your state representative and senator as soon as possible. They need to hear that funding mental health must continue to be a high priority. Make these points in your letter:  We made huge gains last session by funding a wide array of community-based services and addressing our workforce shortages.  We need to continue to build our mental health system by investing in what we know works.  Our work isn't done. We still need to increase our capacity to serve all children and adults with mental illnesses through services and programs such as school linked, ACT teams, ARMHS and CTSS services, supportive housing, crisis teams and more. Be sure and state that you are a NAMI member, include a paragraph about you or your family's personal story (or the needs you are seeing in your agency) and then thank them. To learn who your legislators are and how to contact them, see the box below (Not Sure Who Represents You). Thanks everyone - remember we need to make our voices heard!

Mental Health Day on the Hill - March 31st The annual Mental Health Day on the Hill is set for Thursday, March 31st. Due to construction at the Capitol the legislative briefing and rally will be held from 10:00 AM to Noon at Christ Lutheran Church on Capitol Hill, 105 University Ave. W., St. Paul and followed by meetings with legislators. Bus rides are available from a number of stops throughout the state. Buses are free, but please register ahead of time to reserve a space.

When you schedule meetings with your legislators please contact Lynn Sando at [email protected] or 651-645- 2948 ext. 107. She will be keeping a list of meetings and to help coordinate the day of.

Not sure who represents you?

Senate Committee Hearings Committee on Judiciary The Senate Committee on Judiciary met following the first senate floor session of the year. All bills during this committee hearing had already received full hearings in the Senate Judiciary Committee last session so no additional testimony was taken. Sen. Latz, chair of the Judiciary Committee reminded members and the public that the committee took testimony last spring and there would be further opportunity on the House side. Sen. Champion offered two technical amendments to reflect statute changes from last year for SF355 (convicted felons civil right to vote after incarceration restoration). SF355 was passed as amended and sent to the Senate floor. Sen. Latz also had a technical amendment to his bill SF498 (police body cameras) and then the bill passed as amended and was sent to the Senate floor. The bill makes the videos private data unless the incident is in a public place, involves a weapon, the person wants it to be public, and under other circumstances. Click here for audio of this brief committee. Higher Education Committee The Senate Higher Education and Workforce Development Committee received a presentation from the Office of the Legislative Auditor on its progress on the legislated report on the use of human subjects in research at the University of Minnesota. The OLA is looking at people's vulnerability, ability to give consent, treatment of family members, delegation of tasks, oversight of the IRB and documentation of adverse events. President Kaler provided an overview of his commitment to change and was followed by Dr. Herman, VP for Research at the U of M. They updated the committee on the various committees that have been established to provide oversight and how the Clinical Translational Science Institute has taken over management of the clinical trials at the Department of Pscychiatry. Of the 264 standards, they have been found to only not meet 2 of them. The committee then voted on SF 2412 (with a technical amendment) which would prohibit people on a hold from participating in research. Due to the time, they did not take testimony. The bill passed. Click here for video of the entire hearing.

Judiciary Committee SF2227, authored by Sen. Latz calls for the clarification of the offense of fourth degree assault against a peace officer. There are concerns about the statue not being interpreted in the way the Supreme Court originally intended. Dennis Flaherty, executive director of Minnesota Police and Peace Officers Association opposes the interpretation that physical harm needs to occur before assault with bodily fluids for an offender to be charged with the 3-year sentence. As a result, the amendment defines the meaning of a peace officer, separates the punishments for physical harm and assault with bodily fluids. Sen.Goodwin raised concerns pertaining to people who are experiencing a psychotic episode and whether or not they would be charged under this amendment, to which Sen. Latz pointed to the statement in the amendment that requires the individual to have the intention to harm. The bill passed and was re-referred to the Senate Floor.

SF 2504, authored by Sen. Latz requires a peace officer to be notified is someone is released or discharged before a 72 hour hold is up. Chief of Police John Ohl testified in support of the requirement stating that hospitals he has been in contact with want to comply with this, but are unable to due to lack of clarity in the statute.

Dr. Trisha Stark testified on the behalf of the Minnesota Psychological Association and explained that notifying the police would be in violation of HIPAA standards. Senate counsel stated, that in her opinion, it does not violate HIPAA. Testimony from Roberta Opheim, from the Office of the Ombudsman for Mental Health and Developmental Disabilities, expressed concerns about this amendment further stigmatizing and criminalizing people with mental illnesses. She believes that the statue implies that individuals brought in by law enforcement are dangerous, it forces coercion and will not improve public safety in any significant way. She also pointed out that there is no clear legislation that states when 72-hour hold starts and as a result, there are cases of individuals being held in transport hold at the ER for days on end, before the 72-hour hold and admission to the hospital. Despite multiple public objections, Sen. Latz explained that while testifier's statements were valid, that they did not pertain directly to the new bill language. The bill passed committee and was sent to the Senate Floor.

S.F. 2251, presented by Sen. Goodwin calls for the prohibition of Electronic Incapacitation Handcuffs on those who are in custody for a criminal offense. Sen. Goodwin explained that there are concerns with the possibility of lawsuit and long-term health issues. The use of these handcuffs could potentially cause defendants to be perceived as guilty in the procession of a court case, when they should be perceived as innocent until guilty and she points out that there are many other options of controlling individuals that may be unruly.

Eric Heimer from the Minnesota Sheriff Association stated that there are currently only two departments using this technology in Minnesota, the use is sporadic and used most of the time after defendant has been convicted and is saved for worst-case scenarios. Deputy Commissioner Carlson from the Department of Corrections stated that these handcuffs are not in use in correctional facilities and that it was evaluated and decided that there are less "lethal" restraints. Deputy Carlson also emphasized the importance of upholding care, dignity and respect of inmates and it is the responsibility of the government to ensure that inappropriate force is not being used. Senators Hall and Newman expressed concern for the safety of the officers and that this form of restraint is needed and should not be prohibited. Sen. Newman stated that this technology is especially needed for those with mental illnesses experiencing psychotic episodes. Sen. Goodwin explained the importance of protecting citizens: "When does it stop that we look to protect officers over citizens that the same officers have sworn to protect." The bill passed and was re-referred to the senate floor.

House Committee Hearings HHS Reform The Health and Human Services Reform Committee heard testimony on three bills including HF2609 regarding certified community behavioral health clinic (CCBHC) requirements. The bill's chief author, Rep. Kiel expressed her support in passing this legislation to ensure that Minnesota would have the chance to be one of the eight CCBHC demonstration states. Dr. Pahoua Yang, from the Wilder Foundation, testified stating we "have not built the system of care," and passage of HF2609 would lend incredible opportunity to Minnesota in transforming the delivery of mental health services. Rep. Loeffler questioned how CCBHCs would fit in with our current systems of health care; a topic she recommended be further examined.

Mary Krinkie, from the Minnesota Hospital Association (MHA), testified in support of HF2609. She explained that CCBHCs would positively impact hospital systems and MHA is in support of "stable mental health infrastructure at a community level." Rep. Mullery and Rep. Loeffler stated concerns with the lack of language regarding culturally specific services. Dr. Yang noted that the bill does call for mental health professionals and staff who are culturally and linguistically trained to meet the needs of the communities they serve.

HF2609 passed unanimously and was re-referred to the Health and Human Services Finance. (Click here for audio of the full hearing from the HHS Reform Committee.

Two Action Alerts - Calls Needed Monday! The Senate Committee on Education will be hearing SF 2470 on Wednesday, March 16th. The companion bill will be heard in the House Education Innovation Policy Committee on Tuesday, March 15th. If you senator or representative serves on one of these committees, please make a short call (or send an email) on Monday.

Your message is simple. I am a NAMI member and it is critical that teachers understand the warning signs of suicide. Please support HF 2622/ SF 2470 that would require one of hour suicide prevention training every three years. (add any personal notes or stories) Thank you.

Here is the link to the House Education Committee and the Senate Education Committee. Sen. Wiger is the chair of the senate committee so if he is your senator please take the time to make a call to him at 651-296-6820. Rep Sondra Erickson is the chair of the house committee and if she is your representative please call her at 651-296-6746. If your representative or senator is on the committee, please call.

In addition the House Health and Human Services Finance Committee is hearing HF 2609 on Wednesday, March 16, which would move our Certified Community Behavioral Health Clinics (CCBHC) forward. Please make a phone call or send a short email on Monday to members of the committee.

Your message is simple. I am a NAMI member and I urge you to support HF 2609 which create a "one stop shopping" for mental health, health and substance use disorder services. It's very hard to navigate the mental health system and this will help. Thank you.

Representative Matt Dean is the chair of the committee and if he is your legislator be sure to call him at 651-295-3018. To see if your representative is on the committee, click here.

Remember - only contact your OWN legislators!

Upcoming Legislative Hearings of Interest Senate Committees Committee on HHS and Housing - Mar. 14 at 12:00 noon Room 1200 Minnesota Senate Building SF2549 (Wiklund) CCBHCs SF2378 (Hayden) Reform of substance use disorder system; MA and MinnesotaCare modifications.

Committee on Education - Mar. 15 at 8:30 AM Room 1100 Minnesota Senate Building SFXXXX (Clausen) MN homelessness work group recommendations.

Committee on Education- Mar. 16 at 8:30 AM Room 2412 Minnesota Senate Building SF2470 (Clausen) Suicide prevention training for teachers.

Committee on Education - Mar. 17 at 8:30 AM Room 2412 Minnesota Senate Building

SF 1364 (Kent) Student Support Services Personnel Act

House Committees Education Innovation Policy - Mar. 15 at 8:15 AM Basement Hearing Room State Office Building HF2622 (Selcer) Suicide prevention training for teachers.

HHS Finance - Mar. 16 at 12:45 PM 200 State Office Building HF2609 (Kiel) CCBHCs

HHS Finance - Mar. 17 at 12:45 PM 200 State Office Building Update on Anoka Regional Treatment Center. Presentations by DHS, unions and the Minnesota Hospital Association

Prior Authorizations Delay Care It was noted, in an alert issued by the APA's Psychiatric News that child and adolescent psychiatric patients in need of immediate hospitalization often wait an hour before being admitted. According to the Dr. Funkenstein, author of the report Prior Authorization for Child and Adolescent Psychiatric Patients Deemed to be in Need on Inpatient Admission, delays place a burden on clinicians and can create safety risks for both patient and provider.

Aaron Levin published an article Emergency Department Finds Successful Formula For Psychiatric Cases which cites "engaging psychiatric patients and beginning treatment in the emergency department is a step towards reducing boarding." Prior authorizations prevent immediate engagement from occurring and make accessing psychiatric care even more difficult especially those who are experiencing a mental health crisis or emergency.

Openings for State Boards, Councils and Committees Last week, The Office of the Minnesota Secretary of State today released the March 2016 notice of vacancies for various state boards, councils and committees that are accepting applications, due March 29, 2016. The full list of vacancies and instructions on how to apply can be found here.

Juvenile Justice Advisory Committee The committee is the supervisory board for the federal Juvenile Justice Program appointed by the Governor. One vacancy is currently open. Members must have training, experience, or special knowledge concerning the prevention and treatment of juvenile delinquency or the administration of juvenile justice. Meetings are held monthly.

Special Review Board Six vacancies to be appointed by the Commissioner of Human Services (DHS). Vacancies for one attorney member; one person with experience in the mental health field; and four psychiatrist of doctorate level psychologist members. The board hears reduction in custody petitions involving individuals civilly committed as Mentally Ill and Dangerous, as a Sexually Dangerous Person, or as a Sexual Psychopathic Personality. Update From the State Advisory Council on Mental Health Alice Nichols, DHS, gave a brief update on DHS activities. She noted the department is very busy with requests for proposals following on the 2015 legislative activities and report that the RFP for First Episode Psychosis program providers is currently being vetted with legal, and is expected to be issued in the next two weeks. She indicated that the RFP for Certified Community Behavioral Health Clinics (CCBHCs) is in the contract phase and an announcement will be coming soon.

The State Department of Health mentioned that the department was finalizing a report on health and incarceration. Mental health is a recurring theme in the report.

The Council subcommittees identified areas of focus. The Integrated Care work group indicated that it supported more advanced training for "mid-level" therapists, noting that many individuals seek treatment from their general practitioners, and more training for non- psychiatrists would be beneficial. The work group also supports improved crisis intervention training for peace officers. The Multi-Generational Work Group supports increased home visit programs. NAMI's work supporting childcare for mental health visits was also noted. The recommendations of the other work groups will continue to take shape in the coming weeks, culminating in a draft report of the Advisory Counsel in May. The full report will be completed and sent to DHS staff in late summer. The Advisory Council chair committed to a transparent drafting process, so council members will be aware of the contents of the report as it takes shape.

NAMI Key Issues - Police Training Mental illnesses should be treated as any other illness. Thus, when someone is having a mental health crisis, the appropriate responder should be a mental health professional. Unfortunately, all too often it is a police officer. To address this in Minnesota we have been increasing funding to develop mobile mental health crisis teams thus creating an appropriate response and an alternative to calling police. These teams have the preferred outcomes of preventing hospitalizations and connecting people with mental illnesses to treatment. Depending on the situation, police sometimes partner with the crisis teams to address a mental health crisis.

When there are alternatives to using police, fewer people are brought to jails. Most importantly people can be linked to mental health services and treatment sooner. We also know that when police are trained on mental illnesses, de-escalation and community resources that more people are brought to treatment instead of jails.

Crisis Intervention Team Training (CIT) is the gold standard for police training and is a model for community policing that brings together law enforcement, mental health providers, hospital emergency departments and individuals with mental illness and their families to improve responses to people in crisis. CIT programs enhance communication, identify mental health resources for assisting people in crisis and ensure that officers get the training and support that they need.

CIT is 40 hours and includes learning from mental health professionals and experienced officers in the community; personal interaction with people who have experienced and recovered from mental health crisis and with family members who have cared for loved ones with mental illness; Verbal de-escalation skills; Scenario-based training on responding to crises.

There is no doubt that police and criminal justice staff who have training on mental illnesses and how to deal with a crisis have better outcomes for themselves and the individuals with mental illnesses. Police often share their story of the first time they utilized what they had learned through mental health and crisis training and what a difference it made.

While police have received CIT training in Minnesota, it's only a small percentage. NAMI has introduced bills over time to require all officers to receive CIT training but they never moved forward. To make at least some progress, NAMI Minnesota is working with legislators to pass legislation requiring police officers to receive at least four hours of training every three years on a variety of topics related to responding to a mental health crisis. Senator Marty and Representative Norton are currently chief authors of SF2753 and HF2756. We hope to make progress this session. See a KSTP story on the issue here.

What's Happening in Congress CARA is Approved! The U.S. Senate approved the Comprehensive Addictions and Recovery Act (S.524) also known as CARA. The legislation authorizes $600 million in grant funding for evidence-based prevention, treatment and recovery program for persons with substance use disorders. Click here for more from Govtrack.us.

In the News HCMHC Adds Primary Care Physician Hennepin County Mental Health Center added a primary care physician to work just two days per week at their mental health clinic in hopes to provide integrated care which will reduce emergency department visits for basic medical needs, reduce inpatient hospitalizations and improve patients' physical health. Now patients are able to access their physician, psychiatrist, nurses, care coordinators and pharmacist all in one setting. Due to the positive demand for the service, the center now plans to add another primary care physician so one is available 40 hours per week.

Police Oversight Commission Concerned about Body Camera Policy The Minneapolis Police Oversight Commission released comments regarding the proposed policy on the use of police body camera and raised concerns about potential violations of privacy. Click here for more from MPRNews and KSTP.

US Senate Action on Mental Health Reform Act National NAMI submitted comments to the Senate Health, Education, Labor & Pensions (HELP) Committee on the draft Mental Health Reform Act of 2016. NAMI noted that the bill represents a bipartisan consensus to address challenges in our mental health system. NAMI believes the bill is a positive start, but more needs to be done to ensure meaningful mental health reform. A brief summary of NAMI's major comments and recommendations are below.

Mental health insurance parity NAMI strongly supports language in the bill to improve federal enforcement of parity requirements and called for implementing a one-stop portal for submitting parity complaints.

Privacy and confidentiality of mental health and substance use disorder records NAMI supports the bill's requirement to develop easily understandable resources on HIPAA. NAMI recommended that persons living with mental illness and families should be involved in the development and delivery of HIPAA resources, including training programs. NAMI also called for clarification in the rule regarding permissible communications with families and other caregivers.

Mental Health Block Grant NAMI recommends requiring states to use 10% of block grant funds for early treatment of serious mental illness and for $50 million in funding to support these programs. NAMI also calls for a technical assistance center for early and first episode psychosis programs.

Promoting Access to Mental Health and Substance Use Disorder Care NAMI supports the bill's recognition of the need for behavioral health workforce development, including peer support specialists. NAMI also supports requirements to report on important outcomes such as rates of arrest and incarceration, suicide, emergency psychiatric hospitalizations and emergency room boarding, homelessness, joblessness, employment and education. NAMI recommends adoption of language that would require development of criteria or incentives for programs and providers receiving federal funding to serve and retain the most difficult-to-engage persons living with mental health, substance use or co-occurring disorders and those at high risk for not achieving positive outcomes.

Serious Mental Illness Coordinating Committee NAMI recommends that the bill include language requiring development of a plan to end incarceration of individuals with serious mental illness or serious emotional disturbance for non-violent offenses within 10 years.

Establish a National Mental Health Caregiver Support Program NAMI recommends that the Committee adopt language to create a National Mental Health Caregiver Support Program.

There are several items that were in the original bill that were not included because they should be addressed in the Finance Committee and not the HELP committee. These include the following:  Authorizing Medicaid funding for short term, acute inpatient psychiatric care in Institutions for Mental Diseases (IMDs);  Eliminating the prohibition on same-day billing in Medicaid for mental health and primary health care;  Eliminating the 190-day lifetime limit for inpatient psychiatric care in Medicare; and  Expanding the availability of resources in Medicaid and Medicare to finance meaningful use of Electronic Health Records (EHRs) for the full range mental health and substance use providers. NAMI Minnesota appreciates the work of Senator Franken's staff who reached out to NAMI Minnesota and other mental health groups for our feedback and thoughts on the bill.

Updates from DHS Housing with Supports for Adults with Serious Mental Illness RFP DHS is currently accepting proposals for the housing with supports for adults with serious mental illness grant program (HSASMI). Qualified responders are able to provide supportive services for adults with serious mental illnesses who are experiencing homelessness, long term homelessness, or exiting institutions who have complex needs and face high barriers to obtaining and maintaining housing. All proposals must be submitted by 4:00 PM CST on April 15, 2016.

Development of a Forensic ACT Team RFP The Mental Health Division of DHS is seeking proposals from qualified responders to develop a forensic assertive community treatment (FACT) program in the Metro (either Ramsey or Hennepin County). The purpose of this program is to better transition adults with serious mental illnesses from correctional facilities back into the community. FACT teams will apply a multi-disciplinary ACT team approach incorporating clinical, rehabilitative and peer staff. They will also have a integrated and collaborative approach with probation and parole departments. Proposals must be submitted by 4:00 PM CST on April 18, 2016. Click here for the full RFP.

Updates from NAMI Minnesota Confidential Health Care Communications Health insurance plans frequently send communications related to health services, such as an explanation of benefits (EOB), to an insurance policyholder every time an enrollee uses health insurance to pay for healthcare. These communications often contain protected health information such as the type of health service received, who provided the service, and when the service was received.

This risk of exposure is problematic for insured dependents who do not want their health information disclosed to their insurance policyholder (e.g., spouse, ex-spouse, or other family member), perhaps because they fear abuse, harassment, embarrassment, or are simply not ready to talk about sensitive health issues like mental health or HIV/AIDS diagnoses. Many individuals with these concerns will decide to not use their health insurance to pay for healthcare. Some will enroll in a public program (if available) or pay for care out of pocket, but many will forgo seeking care altogether.

We are looking for stories from individuals who did not use their health insurance to pay for care because they had concerns that their health plan would disclose the visit to their insurance policyholder. We would also like to know whether the individual still received care, but paid for it through another means, or decided not to get care at all. These can be individuals insured as dependents under a commercial insurance plan, or those insured under another's MinnesotaCare/MA policy. Email [email protected]

Supportive Housing We are looking for individuals who have experienced difficulty with obtaining and maintaining stable housing to share their stories with legislators. At NAMI's last legislative house party we spoke with legislators about the barriers to securing stable housing even for persons with housing vouchers or subsidies, many times due to long waitlists and overall lack of availability. Email [email protected]

Opportunities to Advocate and Share Your Story NAMI Minnesota is currently looking for individuals with mental illnesses and/or family members who want to share their personal stories and experiences with state law makers. Once session begins in March, NAMI and advocates will deliver these stories to legislators to better educate them on the successes a person with a mental illness can achieve given the right opportunity, proper resources and supports.

NAMI Legislative Committee Meetings are generally held the second Tuesday of every month. Our next committee meeting is Tuesday, April 12th at 6:00 PM at the NAMI Minnesota office.

For more information, to apply or register for any of the opportunities listed above please contact Lynn Sando at [email protected] or 651-645-2948 ext. 107.

Bill Summaries Senate Bills S.F. 2228 (Cohen) referred to the Committee on Judiciary. Adds to the list of who cannot own a gun a person with a mental illness who had been involuntarily confined or involuntarily hospitalized and committed (even if the order was stayed). NAMI is assuming that this would mean anyone put under a 72 hour hold. Would require that someone who is trying to restore their ability to own a gun after a commitment or involuntary hospitalization prove by clear and convincing evidence that the person is safe to own a gun again. A chief or sheriff can deny a permit if they believe a person is a danger to self or others based on past police contact.

S.F. 2239 (Lourey) referred to the HHS and Housing Committee. Require the commissioner of DHS to develop a program by 2017 to make discount prescription drugs from Canada available to Minnesotans.

S.F. 2256 (Nelson) referred to the Committee on Finance. Provides funding to implement a recovery program at the University of Minnesota's Rochester campus to support students in recovery from addiction.

S.F. 2269 (Cohen; Dziedzic) referred to the Committee on Judiciary. Increases the time to issue or deny a gun permit from 7 to 28 days. Adds to the firearm instruction course information on safe storage. Requires people who own guns to store them safely, with a locking device and stored separately from the ammunition.

S.F. 2284 (Hoffman) referred to Committee on Finance. Increases the MA eligibility limit on what an individual owns in assets from $3000 to $10,000, increases from $6000 to $18,000 for a two person household and remove the limit for $200 for each legal dependent. The spenddown would be changed from 80% to 100% of the federal poverty guidelines.

S.F. 2305 (Koenen) referred to Committee on Finance. Appropriates $600,000 for a rural demonstration project for children's mental health collaboratives that assist transition-aged youth and young adults with mental illnesses in making a successful transition into adulthood. This includes education, living arrangements, employment, personal effectiveness and community life functioning. (See companion bill S.F. 2305). NAMI Minnesota supports this bill.

S.F. 2308 (Chamberlain; Stumpf; Wiger; Anderson) referred to Committee on Education. Adds and provides funding for a dyslexia specialist to centers of excellence which assist schools in reducing the achievement gap. The specialist will be highly trained in dyslexia and related disorders.

S.F. 2310 (Eken; Rosen; Sheran; Hoffman; Hann) referred to the HHS and Housing Committee. Increases the reimbursement rates by 5% for a number of home and community- based (HCBS) services (CADI waiver, PCA services, etc.) and grant and some specific residential programs for people with developmental disabilities. The five percent rates will consist of three percent for workforce compensation, one percent for providers who identify and implement a quality improvement project and one percent for incorporating person- centered thinking into services. (Duplicate, see S.F. 2324 and S.F. 2455, see companion bill H.F. 2706).

S.F. 2317 (Saxhaug) referred to the Committee on Finance. One time grant allocated from the state's general fund to Lutheran Social Services to provide mental health services to veterans through the Veterans C.O.R.E. (case management, outreach, referral and education) program. The commissioner of veterans affairs will later report on the use of the grant money as well as a detailed plan on how to further meet veterans' mental health needs.

S.F. 2323 (Brown; Nienow; Wiger; Chamberlain) referred to the Committee on Education. Requires a school board to expel a student who assaults a teacher. The duration of the expulsion is up to the school board and the student cannot enter the classroom without consent of the assaulted teacher.

S.F. 2324 (Hayden; Eaton; Nienow; Kent; Hall) referred to the HHS and Housing Committee. (Duplicate, see S.F. 2310 and S.F. 2455, see companion bill H.F. 2706).

S.F. 2346 (Franzen; Kent; Eaton; Dziedzic; Dibble) referred to the Committee on Finance. Appropriates $1.75 million to the commissioner of public safety for youth intervention programs to provide community-based early intervention for youth experiencing personal, familial, school, legal, or chemical problems.

S.F. 2355 (Torres Ray; Champion; Latz; Hayden) referred to the Committee on Finance. Appropriates $350,000 to a non-profit organ

March 5, 2016

OLA Report on Mental Health Services in the Jails The Senate Health, Human Services and Housing Committee met to review the report from the Office of the Legislative Auditor (OLA) on Mental Health Services in County Jails. Jim Nobles, OLA Commissioner and Joel Alter presented the report. "Ultimately the issue here is people, people with mental illness and people in law enforcement. People with mental illness face challenges everyday that the rest of us probably will never experience. And when a person with mental illness is taken into custody by law enforcement those challenges can escalate dramatically and rapidly." stated Mr. Nobles in his opening remarks. Mr. Alter reported, "When someone with mental illness is taken into custody, law enforcement faces a dilemma. If a person needs care or treatment rather than jail, there are limited service options, sometime available, but often not."

The report contains these key findings:  Problems with service availability in Minnesota's adult mental health system have persisted for years, limiting peace officers' options for referring persons with mental illness they take into custody.  The Department of Corrections has not collected reliable data from jails on the number of inmates assessed for mental illness. However, our surveys of sheriffs suggest that one-third of jail inmates may be on medications for a mental illness. (Note: NAMI wrote the bill to require mental health screenings)  State rules do not adequately address some important areas of jail-based services, including mental health assessment of inmates following admission to jail.  Most sheriffs and county human services directors believe that jail inmates should have better access to psychiatric services, counseling, and case management than they now have. In addition, these officials widely believe that the number of beds in Minnesota's mental health facilities-particularly secure inpatient beds-is inadequate to meet current needs.  There is limited compliance with a state law that requires discharge planning for sentenced jail inmates with mental illness. (Note: A bill NAMI wrote)  Contrary to law, some Minnesota defendants deemed mentally incompetent to stand trial remain in jail while awaiting court action on their possible civil commitment to competency treatment. Many incompetent defendants do not ultimately receive treatment to restore their competency.  A 2013 law (the "48-hour law") that gives jail inmates priority for placement into Department of Human Services (DHS) facilities has not always worked as intended, and it has limited the access of other patients to the Anoka-Metro Regional Treatment Center. Key Recommendations:  The Legislature, DHS, and counties should fund and implement a more comprehensive set of community-based mental health services.  DHS, with legislative support, should relocate some Anoka-Metro Regional Treatment Center patients who do not need hospital care so that this facility can better serve patients with challenging behaviors. The Legislature should fund DHS's community behavioral health hospitals so they can use more of their licensed beds and provide a better resource for law enforcement.  The Legislature should authorize a streamlined judicial process for individuals deemed incompetent to stand trial to be placed into treatment or referred to county social services. If the Legislature retains the current process, however, it should specify a time limit in law for incompetent inmates to remain in jail while awaiting commitment.  The Legislature should amend state law to require mental health assessments of persons who remain in jail at least 14 days.  The Legislature should amend state law to allow jails that have proper staffing and training to administer medications involuntarily, pursuant to a court order. NAMI Minnesota is not surprised by the findings. We have heard from many people who were not provided adequate mental health treatment in the jails, including not being provided with their medication. These are issues that we have examined and researched. The 48-hour rule has backed up the community system and there has not been a careful assessment as to whether these individuals could be served in the community or if they even need the level of care provided at Anoka.

Our hope is that the legislature will continue to build on what works by increasing funding for the wide array of community services that were funded last year. We also hope that jails will be held more accountable for providing treatment in the jails. We've been told that the average time someone is held in a jail is 7 days, so that they can't do much for people. However, the average length of stay in an inpatient psychiatric unit is 8 days. With counties paying 100% of the cost at Anoka once someone doesn't need to be there anymore ($1309 a day), and knowing that over 50% of the people don't need to be there anymore, you have to begin to ask if those county funds couldn't be used better to treat people in the jails and to develop community services. The truth is that jails are not the largest mental health treatment facilities, because they are not providing very much treatment. Stay tuned for more on this topic in the weeks ahead.

Click for an article on the hearing from MPRNews, Grand Forks Herald, Mpls Star Tribune, St Paul Pioneer Press, KSTP

February 2016 Budget & Economic Forecast Twice per year, Minnesota Management and Budget (MMB) prepares a state forecast as required by state law. The projected balance for FY 2016-17 is a surplus of $900 million, $306 million lower than the $1.2 billion surplus estimate released in November 2015. The surplus reduction may be attributed to an overall slowing U.S. economy. MMB Commissioner Myron Frans said that Minnesota is prepared to weather a global slowdown and stay the course in order to build the surplus back up.

The legislature has already been developing plans and proposals on how to use the surplus for transportation improvements, tax relief and creation of early education programs. With the most recent forecast, in addition to a short session, coming to an agreement will be more difficult than legislators may have predicted last year. A number of legislators including Sen. Bakk and House Speaker Rep. Daudt expressed concern with the new $900 million projection.

Click here for video of MMB presentation on the February forecast. Click here for details on the budget forecast from MMB. Read more from the StarTribune, MPR, MinnPost, and Grand Forks Herald.

Contact Legislators This Week The 2016 session begins Tuesday, March 8, 2016. Carefully read NAMI Minnesota's weekly legislative updates for summaries of committee hearings, updates on bills pertaining to mental health and our legislative initiatives and calls to action. Click here for House committee schedules and here for Senate committee schedules.

We are urging everyone to send an initial letter or email to your state representative and senator before March 8th. They need to hear that funding mental health must continue to be a high priority. Make these points in your letter:  We made huge gains last session by funding a wide array of community-based services and addressing our workforce shortages.  We need to continue to build our mental health system by investing in what we know works.  Our work isn't done. We still need to increase our capacity to serve all children and adults with mental illnesses through services and programs such as school linked, ACT teams, ARMHS and CTSS services, supportive housing, crisis teams and more. Be sure and state that you are a NAMI member, include a paragraph about you or your family's personal story (or the needs you are seeing in your agency) and then thank them. To learn who your legislators are and how to contact them, see the box below (Not Sure Who Represents You). Thanks everyone - remember we need to make our voices heard!

Mental Health Day on the Hill - March 31st The annual Mental Health Day on the Hill is set for Thursday, March 31st. Due to construction at the Capitol the legislative briefing and rally will be held from 10:00 AM to Noon at Christ Lutheran Church on Capitol Hill, 105 University Ave. W., St. Paul and followed by meetings with legislators. Bus rides are available from a number of stops throughout the state. Buses are free, but please register ahead of time to reserve a space.

When you schedule meetings with your legislators please contact Lynn Sando at [email protected] or 651-645- 2948 ext. 107. She will be keeping a list of meetings and to help coordinate the day of.

Not sure who represents you?

Senate Committee Hearings Joint HHS and Education Committee - Feb. 23 - Overlap of Services A joint meeting was held for members of the Senate Education Committee; Committee on Health, Human Services and Housing; and Health and Human Services Budget Division. The committee reviewed the overlap of services for children birth to age five relating to education and health and human services policy/finance. Among the several testifiers was Superintendent Lewandowski, Intermediate School District 287, who spoke on behalf of all three ISDs in Minnesota. Superintendent Lewandowski explained her testimony was to stress the health crisis occurring in these programs. She stated that "we [public schools] are now the de facto mental health system for our most serious youth," and called on legislators for solutions.

Education Committee - Feb. 29 - Advocate Session Priorities The Senate Education Committee met to hear from advocates on their session priorities. Over 35 people testified including the teachers union, school board association, administrators, principles and NAMI Minnesota. Supt. John Christiansen, Intermediate School District 917 testified to the need to increase funding for special education and mental health services. He stated that public schools have become the "de facto mental health system during the school day" and explained schools do not have the necessary funding for training, staff support or specialized mental health services to meet the needs. Leah Kent, Minnesota School Counselors Association presented on the Supporting our Students Act (SF 1364/HF 2045): funding to invest in professionals including psychologists and chemical dependency counselors. Lynn Sando, public policy coordinator from NAMI Minnesota, provided an overview of NAMI's legislative initiatives related to the education system including: alternatives to suspension for students K-3, funding for experts to reduce the use of seclusion and restraints and requirements for teachers to receive continuing education on suicide prevention. Click here to watch the video of this committee.

House Committee Hearings Capital Investment - Mar. 3 - Overview of Bonding Proposals The House Capital Investment Committee convened to review bonding proposals for the upcoming session. Click here to listen to the day long hearing.

Terry Carlson, Department of Corrections (DOC) deputy commissioner of facility services explained that there are about 400 to 500 inmates housed in county jails as a result of overcrowding in the prisons and as a result 3 of their 7 priorities are focused on adding beds to the Willow River, Togo and Lino Lakes prisons. She emphasized the importance of creating space at these prisons because of the lack of rehabilitation services inmates are receiving. The DOC is looking to add 45 more beds for the Challenge Incarceration Program (CIP), increasing the total to 225. This priority also looks to provide a chemical dependency treatment space for those in the CIP. Mary Tingerthal, commissioner of the Minnesota Housing Finance Agency (MHFA) reported on Governor Dayton's bonding proposal of $90 million for housing infrastructure and rehabilitation. Commissioner Tingerthal reported that a portion of the bonds would go towards supportive housing for youth and veterans who have experienced homelessness as well as individuals and families. Rep. Hausman asked "what is the cost of not doing something?" and noted that, at a recent NAMI legislative house party in Roseville, her constituents talked about the difficulties of obtaining and maintaining stable housing in addition to caring for their mental health needs. Even with supports, voucher or subsidies, people are still waiting for housing. Commissioner Tingerthal responded with wait lists have been increasing.

The Department of Human Services (DHS) presented on their capital budget recommendation, which included improvements and renovations to the Minnesota Security Hospital and Anoka Metro Regional Treatment Center (AMRTC). Commissioner Emily Johnson Piper reported there is a critical need for improvement to Minnesota's direct care and treatment facilities. She explained the need for improved safety and to create a more therapeutic environment. "Our challenges relate to sometimes the age of the building, but also dealing with the increasing mix of patient populations between our state sex offender program and the people in our state security hospital, some really vulnerable people, who are committed to me as mentally ill and dangerous." reported Commissioner Johnson Piper.

Commissioner Johnson Piper referenced the hearing on the mental health treatment in jails report by OLA explaining that taking patients from jail is one of the challenges at AMRTC. She stated "as a result, in part of this new influx over the last couple years of patient in jails we're seeing higher levels of aggression and feel very strongly we need to improve security of that hospital [AMRTC]." She noted that although AMRTC is designed to be a hospital, "we are seeing an increase in violence we feel very strongly we need to make some security improvements."

Rep. Dehn questioned whether the state is looking at improvements to treatment methodology in additional to addressing security concern and stated "the security takes care of today, but doesn't necessarily take care of the future. Is there anything out there on the horizon relative to how treatment might actually reduce some of the safety concerns as well?" Commissioner Johnson Piper explained that while she is focused on security, she is also focused on creating more a therapeutic environment; "they do go hand in hand with the security and the therapy." Click here to view the commissioner's testimony.

Prison Population Task Force On March 2, the Prison Population Task Force met to discuss proposals offered by members of the task force. Sen. Latz gave an overview of his proposals for the upcoming session. He reported that Governor Dayton has offered bonding proposals to increase funding for the Challenge Incarceration Program (CIP) and to increase the number of prison beds (total of 135 new beds). "I would like to see those beds be dedicated to mental health and chemical dependency treatment specifically." stated Sen. Latz. He continued, stating he would like to see that CIP be expanded in efforts to reduce recidivism and the DOC employment program to be expanded as well. Sen. Latz proposed appropriation for more Rule 25 coordinators to assist in connecting ex-offenders and parolees with housing, treatment programs and community resources to "transition them safely and effectively into the community". Click here for the press release on Sen. Latz's prison population reform package from the Minnesota Senate DFL.

Support for mental health and chemical health treatment within the corrections system was echoed by a number of agencies, Robina Institute, MN Association of Community Corrections Act Counties, MN Coalition of Battered Women, MN Association of Criminal Defense Lawyers/Minnesota Second Chance Coalition/Council on Crime and Justice as well as by Sen. Newman and Rep. O'Neill. Senator Newman supported Crisis Intervention Team (CIT) training and mental health treatment in lieu of arrest and jails and drug treatment in lieu of incarceration for low level drug possession convictions.

The task force came to some consensus that additional funding for increasing treatment capacity is needed and an current treatment efficacy needs to be evaluated. A number of members offered verbal support for the Prison Population Legislative Task Force to continue and be mandated. Click here for the video archive of this hearing.

Click here for the article from the House of Representatives Session Daily. SAMHSA just released a new publication on screening and assessment of adults in the criminal justice system.

Upcoming Legislative Hearings of Interest House Committees Health and Human Services Reform - Mar. 8 at 2:45 PM 200 State Office Building HF2609 (Kiel) Certified Community Behavioral Health Clinic (CCBHCs) requirements modified.

Education Innovation Policy - Mar. 10 at 8:15 AM Basement Hearing Room State Office Building Presentations from the Minnesota Department of Education on World's Best Workforce, the Innovation Pilot Project, and ESSA.

Education Finance - Mar. 10 at 12:45 PM 5 State Office Building Office of Legislator Auditor Report - Minnesota Teacher Licensing System

Senate Committees Committee on Judiciary - Mar. 8 at 12:00 PM or immediately following session Room 1100 MSB SF 498 (Latz) Portable recording system data classification, destruction and regulation (Body cameras) S.F. 355 (Champion) Convicted felons civil right to vote after incarceration restoration

Committee on Higher Education and Workforce Development - March 10 2 PM Room 1100 Minnesota Senate Bldg. Update and Review of Human Subjects Research Standards at the University of Minnesota

New Approach for 911 Crisis Calls in Ramsey County Last Tuesday marked the beginning of pilot program in Ramsey County aimed at preventing situations that could lead to a police officer using harmful or deadly force, particularly in interactions with individuals with mental illnesses. Sue Abderholden, executive director of NAMI Minnesota explained that under the pilot program, people might get help from a mental health professional before the crisis becomes severe enough to warrant a police response. "A mental health professional really does know how to de-escalate, how to engage the person and how to support them," said Abderholden. She explained that the pilot program is a good starting point, but more needs to be done to train officers responding to calls about people in crisis.

NAMI Minnesota advocated for legislative changes regarding how 911 calls are routed. In 2009, Minnesota statute was amended to so that 911 systems may include a referral to mental health crisis teams, where available. There is no evidence to support that this legislation has increased referrals from 911 centers to mental health crisis teams.

Click here for the full report from the Twin Cities Pioneer Press. Click here for the news brief from WCCO.

Ramsey County's 24/7 adult mental health crisis line is 651-266-7900. NAMI Key Issues - First Episode Psychosis Programs Individuals experiencing their first psychotic or manic episode are not receiving the intensive treatment they need to foster recovery. On average a person waits 74 weeks to receive treatment. Our mental health system has relied on a "fail-first" model of care that essentially requires people experiencing psychosis to be hospitalized or be committed multiple times before they can access intensive treatment and supports. This costs our system a great deal and costs the individual even more. There is compelling evidence that intensive early intervention can foster recovery and prevent adverse outcomes frequently associated with untreated psychosis.

In 2009, NIMH launched the Recovery After an Initial Schizophrenia Episode (RAISE) initiative to determine the best approaches for providing coordinated care to people experiencing first episode psychosis. This model uses a collaborative, recovery-oriented approach resembling the Assertive Community Treatment (ACT) model of community-based care because it combines evidence-based services into an effective package. Components include cognitive behavioral therapy (CBT), supported employment and education, case management, family psychoeducation, peer and family supports, and low dosage medications. It emphasizes shared decision-making with the recipient of services taking an active role in determining treatment preferences and recovery goals.

To address the need in Minnesota we estimate that eight teams would be needed and each would serve 30 young people at one time. People stay with the team an average of two to three years. Each team, based on calculations used in New York, would cost roughly $250,000, in addition to reimbursement by insurance.

During the 2015 legislative session funding of $260,000, in addition to the ten percent from the federal mental health block grant, was made available to create evidence-based interventions for youth at risk of developing and experiencing a first episode of psychosis. These programs provide intensive treatment right away for someone experiencing symptoms of psychosis.

On Thursday March 3rd, Nev Jones came to Minnesota to speak. Click here for the article by the Pioneer Press. Click here for the full interview with Nev Jones from MinnPost.

NAMI Minnesota supports and advocates for an increase in the number of first episode psychosis (FEP) programs so that young people experiencing their first psychotic or first manic episode receive intensive treatment.

What's Happening in Congress Legislation to Expand the Excellence in Mental Health Act has been introduced in the House and Senate. In October 2015, SAMHSA announced the 24 states that would receive planning grants to prepare for possible participation in the demonstration program for Certified Community Behavioral Health Clinics (CCBHCs). CCBHCs aim to establish an integrated system of treatment for individuals with mental illnesses. Of the 24 states only 8 will be chosen as demonstration states and receive continued funding for CCBHCs. Minnesota is one of those 24 states and we believe that ALL 24 should be able to explore this option, not just eight.

This new legislation (S. 2525/H.R. 4567) would expand this initiative to all 24 states. We are calling on advocates across the country to take action and urge your legislators to support this critical cause. Please take time to contact your Members of Congress today and urge them to sign on as cosponsors to the Expand Excellence in Mental Health Act (S. 2525/ H.R. 4567). Click here for their phone numbers.

Congress is moving on major mental health bills this year and we are hopeful that big reforms will be passed. Read more here.

Statement by Chuck Ingoglia, Senior Vice President of the National Council for Behavioral Health: Yesterday, the Medicare Payment Advisory Commission (MedPAC) released a draft recommendation that would remove two classes of drugs from the six protected classes under Medicare Part D. The proposed changes would restrict access to immunosuppressants and antidepressants for a group of people we should be working together to protect.

Congress has long supported protections for patients with conditions that require such therapies, including patients with severe and persistent mental illness, epilepsy and AIDS.

In fact, two years ago the Centers for Medicare and Medicaid Services (CMS) proposed this same action and every member of the Senate Finance Committee expressed opposition to the proposed restrictions. The community uproar was deafening and the Administration shelved it, choosing instead to continue providing access to these important medications.

It is highly irresponsible for MedPAC to recommend this action, which doesn't serve to save federal dollars or lives. In fact, plans already have the ability to manage drug benefits, and they already require fail first and prior authorization, even for protected classes.

The only thing this recommendation will do is make it harder for our most vulnerable citizens to get the treatment they need and for our providers to deliver that treatment to them.

Restricting timely access to medicine jeopardizes patient health, puts patients at greater risk for poor clinical outcomes and increases costs for patients and taxpayers. These are essential medicines for the people who need them. Congress should stand by its previous support of the six protected classes.

In the News A press conference was held this week for a bill that is named a "Dedication Amendment to the Constitution" that would set aside funding to care for people with disabilities and older adults. To read more, click here.

There has been a series of reports on KSTP about Anoka Regional Treatment Center and police shootings involving people with mental illnesses and demands for reform by advocates. This week they interviewed Governor Dayton on the issue. Click here to view the clip.

Mental Health Parity A new report from the University of Colorado found that the Mental Health Parity law had very little effect on access or utilization of mental health services for people with depression, bipolar disorder or schizophrenia. Clearly more must be done to strengthen enforcement of this important law. NAMI Minnesota wants to hear your parity stories. Email us at [email protected]

Certified Peer Specialist Webinar The Peer Specialists: Improving Mental Health Care Transitions webinar will be held on Tuesday, March 15th from 12:15 PM to 1:00 PM by presenter Jode Freyholtz-London, Executive Director, Wellness in the Woods. Learn more about certification, how Peer Specialists are utilized, which services are reimbursable and what people who access peer specialist services are saying. The webinar is free. Click