NAMI Minnesota Legislative Update

November 20, 2016

Governor's Task Force on Mental Health Report Released Last week, the Department of Human Services released the Governor's Task Force on Mental Health final report. The task force was the result of an executive order issued by Governor Dayton in April of this year. Appointed members, including NAMI Minnesota's executive director Sue Abderholden, have met as a full group nearly twice monthly since July to develop recommendations to build a comprehensive continuum of mental health care in Minnesota. Smaller formulation teams also met outside of the full group meetings to address crisis response, inpatient bed capacity and levels of care transitions, redefining and transforming the continuum of care, governance structure, and using a cultural lens to reduce mental health disparities.

There were 29 principles that guided the task force's work including resilience & recovery, person and family centered care, community-based, coordinated, integrated, cultural responsiveness, evidence-based, housing, employment, transportation, prevention, early intervention and suicide prevention. The vision statement was as follows:

Minnesota will have a comprehensive, sustainable mental health continuum of care that includes mental health promotion and prevention, early intervention, basic clinical treatment, inpatient and residential treatment, community supports, and crisis services to promote resilience and recovery. These services and activities will be person- and family-centered, integrated, culturally-responsive, timely, and community-based, It will rely on public/private partnerships to meet the mental health needs of all Minnesotans in order for them to live, work, learn, participate in community life and reach their full potential.

The report includes recommendations covering the following nine topics:  Create a comprehensive mental health continuum of care  Strengthen governance of Minnesota's mental health system  Use a cultural lens to reduce mental health disparities  Develop Minnesota's mental health workforce  Achieve parity  Promote mental health and prevent mental illnesses  Achieve housing stability  Implement short-term improvements to acute care capacity and level-of-care transitions  Implement short-term improvements to crisis response The chart showing the continuum of care in MN shows that there are lot of services in MN - it's just that private insurance doesn't pay for many community services and they are not accessible across the state. (the chart is also on page 25 of the report). The task force recommended that the regions of the state be defined and then an expectation of accessibility of those services be developed. Recommendations related to increasing access, eliminating disparities, promoting early intervention (first episode programs), and fighting NIMBY (not in my back yard) are included.

There wasn't enough time to address a key issue - governance. Whose responsibility is it to ensure services are developed - the county? Region? State? Providers? A work group will be developed to continue this conversation.

To address disparities the report includes recommendations related to trauma informed systems, supporting well-being and health promotion, paying for cultural consultations, bringing more people from different cultural backgrounds into the peer specialist programs, and allowing more time to provide treatment and support before a diagnostic assessment is completed.

The work force recommendations are largely from the 2015 Mental Health Worforce Report and include expanding loan forgiveness programs, addressing supervision issues and increasing residency programs to name a few.

Probably the most important recommendation for NAMI Minnesota is the emphasis on mental health parity. As you can see from the continuum of care chart, private insurance largely does not cover the community supports that help people in their recovery. The report recommends greater responsibility and accountability in enforcing the current provisions under mental health parity.

There were many provisions under mental health promotion and prevention - 12 to be exact. Many are around health promotion, screening, fighting stigma, increasing emotional literacy and trauma informed communities along with early childhood and mother/baby programs.

Housing is a huge issue - as NAMI members know. Lack of affordable and supportive housing leads to homelessness, jail or being "stuck" in high levels of care. The task force recommended supporting existing efforts around building affordable housing, increasing rent subsidies, and expanding programs that prevent people from losing housing.

The lack of access to acute care section had several recommendations and the group understood that simply increasing beds wouldn't resolve the issue. They recommended increasing housing supports, improving local coordination around crisis response, expanding community based competency restoration programs, strengthening discharge planning, increasing access to residential and crisis residential services, changing the commitment act to allow for dual commitments and more commitments to the community, expanding options for mothers and their babies, supporting efforts to reform substance use disorder treatment, and assessing the impact of the increase in county share.

They also recommended the formation of another group to coordinate work on inpatient capacity that would gather and examine data, explore the impact of the 48 hour rule, discuss role of state hospitals and community hospitals, and address other issues.

To improve crisis services the report includes recommendations to expand pre-service crisis intervention training for peace officers, co-locate mental health center staff in critical access hospitals, create urgent cares for mental health and substance use disorder treatment, increase co-responder models, expand diversion models for juvenile justice, improve data sharing and collaboration, and improve telehealth capabilities.

NAMI thanks the DHS staff who worked hard on this report, especially Susan Koch. It wasn't easy to conduct this amount of work in such a short period of time.

The big question now is what will happen with these recommendations. Many of the recommendations are issues that NAMI Minnesota and others have been working on and will be introduced next session especially around access and mental health parity. The rumor is that the Governor will not be asking for much of an increase in the Human Services Budget which is where much of the funding would come from. We don't know if the groups that were recommended to continue pieces of the work will be established by the Department or others. What we do know, is that regardless of any report, NAMI will continue its work to build our mental health system to meet the needs of all children and adults with mental illnesses and their families.

Facing Addition in America The Surgeon General's Report on Alcohol, Drugs, and Health The U.S. Surgeon General Vivek Murthy has released a reported dedicated to substance misuse and related disorders, the first ever report of its kind. He was quoted in USA Today as saying "Solving this [addiction] problem is not going to take place if we just pass a few laws or if public health experts just start a few more programs. It's actually going to take all of us coming together to do our part." It was 1999 when the U.S. Surgeon General released its first report on mental health and it led to many substantive changes across the country and here in Minnesota.

From his press release: Nearly 21 million people in America have a substance use disorder involving alcohol or drugs, an astonishing figure that is comparable to the number of people in our country with diabetes and higher than the total number of Americans suffering from all cancers combined. But in spite of the massive scope of this problem, only 1 in 10 people with a substance use disorder receives treatment.

The societal cost of alcohol misuse is $249 billion, and for illicit drug use it is $193 billion. What we cannot quantify is the human toll on individuals, families, and communities affected not only by addiction, but also by alcohol and drug-related crime, violence, abuse, and child neglect.

Though this challenge is daunting, there is much reason to be hopeful. That's because we know how to solve the problem. We know that prevention works, treatment is effective, and recovery is possible for everyone. We know that we cannot incarcerate our way out of this situation; instead, we need to apply an evidence-based public health approach that brings together all sectors of our society to end this crisis. And we know that addiction is not a moral failing. It is a chronic illness that must be treated with skill, urgency, and compassion.

The new report includes key findings related to substance use disorders, prevention programs and policies, early intervention and treatment, recovery and healthcare systems. In summarizing the research the report finds:  The problems caused by substance misuse are not limited to substance use disorders, but include many other possible health and safety problems that can result from substance misuse even in the absence of a disorder  Substance use has complex biological and social determinants, and substance use disorders are medical conditions involving disruption of key brain circuits  Prevention programs and policies that are based on sound evidence-based principles have been shown to reduce substance misuse and related harms significantly  Evidence-based behavioral and medication-assisted treatments (MAT) applied using a chronic-illness-management approach have been shown to facilitate recovery from substance use disorders, prevent relapse, and improve other outcomes, such as reducing criminal behavior and the spread of infectious diseases  A chronic-illness-management approach may be needed to treat the most severe substance use disorders  Access to recovery support services can help former substance users achieve and sustain long-term wellness There is an emphasis on changing the culture around chemical health and creating a space for people to feel comfortable seeking help, broader access points for services, investments in prevention services, compassion from health care professionals in treating substance use disorders, and encouragement for individuals at every stage of recovery. The last chapter presents visions for the future including specific recommendations for stakeholders:

 Both substance misuse and substance use disorders harm the health and well-being of individuals and communities. Addressing them requires implementation of effective strategies.  Highly effective community-based prevention programs and policies exist and should be widely implemented.  Full integration of the continuum of services for substance use disorders with the rest of health care could significantly improve the quality, effectiveness, and safety of all health care.  Coordination and implementation of recent health reform and parity laws will help ensure increased access to services for people with substance use disorders.  A large body of research has clarified the biological, psychological, and social underpinnings of substance misuse and related disorders and described effective prevention, treatment, and recovery support services. Future research is needed to guide the new public health approach to substance misuse and substance use disorder. For the full report, click here.

What's Happening at a State Level Draft Proposal for Police Body Cameras The city of St. Paul has released its current draft of policy on police worn body cameras. The current draft allows for police officers to view video footage before it is made public and prior to writing their reports. An exception is made for officers who are involved in incidents where deadly force is used including the use of a gun or when force is used that causes "great bodily harm or death." Public members who have participated in the conversations around body cameras have objected to officers having the ability to see the footage before writing their reports.

At the end of the 2016 legislative session Governor Dayton signed a final bill that did limit how and when the public could view video recorded by police body cameras, but left it up to local government to determine when an officer could review the video. Click here to read more from MinnPost. What's Happening In State Operated Programs DHS Commissioner Piper sent out a memo this week with the following information: Dr. Steven Pratt, who has been the Direct Care and Treatment executive medical director since 2013, has submitted his resignation. Forensic Medical Director Dr. KyleeAnn Stevens will serve as interim DCT executive medical director. They will be working together closely to make sure we have a smooth transition across all of our programs.

As medical director, Dr. Pratt brought a broad range of knowledge - both from his prior work within DCT, as well as his experience from county systems, community providers and private healthcare. Before becoming DCT's executive medical director, he served as medical director for Forensic Services in St. Peter. He also worked as the medical director for five Community Behavioral Health Hospitals and at the Anoka-Metro Regional Treatment Center. He has always been a strong advocate for trauma informed care and person-centeredness. Please join me in thanking Dr. Pratt for his more than 14 years of service to the people we serve and the State of Minnesota.

Dr. Stevens is board certified in general and forensic psychiatry. Before joining DHS she was the director of forensic services at St. Elizabeth’s Hospital in Washington, D.C. She has worked in both public institutions and private practice. She also taught at hospitals and medical schools on the East coast and is currently on faculty at the University of Minnesota. I hope you will all join me in giving Dr. Stevens our full support as she takes on this new role.

An article in the Mpls Star Tribune included some additional information. We have heard several rumors about the difficulty of staff at Anoka to carry out the recommendations of the MN Hospital Association in order to address licensing issues including not having electronic medical records.

Add this change in leadership to the fact that the state is paying a lot of money to overtime (see article) and NAMI questions the management of the state operated programs. The Department recently released its now required quarterly report (thanks to language passed by NAMI Minnesota) and we found troubling trends. A big one - especially in light of the delays in getting into Anoka - is that only 94 of the 110 budgeted beds are occupied and only 85.1% of the clinical positions and 86.8% of the direct care staff positions are filled. At the Community Behavioral Health Hospitals only 61 of the 84 beds are filled and only 89.8% of the clinical staff and 83.2% of the direct care positions are filled.

News from the National Level National NAMI Issues Report on Parity The National Alliance on Mental Illness (NAMI) office revealed earlier last week new information about the gap between health insurance coverage of mental health and substance abuse conditions and that of other medical conditions.

Out-of-Network, Out-of-Pocket, Out-of-Options: The Unfulfilled Promise of Parity focuses specifically on the limits of in-network mental health care providers and excessive out-of- pocket costs for people seeking mental health care.

"Despite federal law, discrimination still exists in health insurance coverage of mental health conditions when compared to other medical conditions," said NAMI CEO Mary Giliberti. "When you have cancer or heart disease, you expect to find specialists in your insurance network. Mental illness should be no different. The 64 million children and adults who experience mental health conditions in any given year deserve better."

Conducted in winter 2015, the report is based on a survey of 3,081 individuals with mental health conditions and mental health caregivers. Its findings include:  One in four people did not have a mental health therapist in their insurance network.  People were 2.5 times more likely to have problems finding a psychiatric hospital that would accept their insurance compared to other types of hospital care.  One in four individuals had difficulty finding a residential mental health facility that would accept their insurance.  Eight in ten people were confronted with out-of-pocket costs of over $200 for psychiatric hospital or residential mental health care compared to fewer than six in ten for general hospital care.  State Medicaid programs had higher rates of using in-network providers than people with private health insurance plans-contrary to common beliefs. One major problem facing expansion of the insurance networks for mental health care is the fact that about 45% of psychiatrists do not participate in insurance plans. Reasons include low reimbursement rates, heavy administrative burdens, and the fact that mental health providers spend more time with patients than other providers. Many operate small or solo practices.

Another problem is the fact that people have difficulty getting accurate information about mental health professionals who participate in insurance networks. Survey respondents complained about making multiple phone calls only to find that listed providers were not accepting new patients, no longer accepted their insurance, were no longer in practice or were deceased.

NAMI recommends that insurance companies be required to take the following steps to improve coverage under federal parity law:  Maintain accurate, up-to-date directories of mental health professionals  Provide easy-to-understand information about mental health benefits  Promote integration of mental health and other medical care  Expand networks of mental health providers  Cover out-of-network care to fill gaps in providers NAMI Minnesota is working on state legislation to address parity issues in Minnesota. If you have a personal story related to parity, please email us at [email protected]

Updates from DHS Mental Health Rate Study Extension DHS has narrowed the scope of the state's mental health rate study and extended the due date of the report until January 13, 2017. The report will focus on outpatient, rehabilitation, crisis services and diagnostic assessments for ACT, IRTS, and Children's Residential Treatment. DHS will be conducting a second technical assistance meeting to provide immediate feedback to participants. The meeting will be held on Monday, November 21st from 2:00 to 5:00 p.m. For questions contact [email protected].

RFP for Person & Family-Centered Approaches in Mental Health DHS has released a RFP from a qualified contractor to provide training and develop an e- curriculum on person & family-centered approaches in mental health and co-occurring disorders.

Live, in-person training will be delivered to Mental Health Targeted Case Management (MH- TCM) lead agencies (counties, tribes and managed care organizations) in a train-the-trainer format, an e-curriculum will be made available and assessment and planning templates and will be created for MH-TCM.

In addition to providing training to MH-TCM lead agencies, the following providers, services and settings are included in this effort and design of the e-curriculum: Certified Community Behavioral Health Clinics (CCBHCs), Psychiatric Residential Treatment Facilities (PRTFs), Alcohol and Drug Abuse Division (ADAD) lead agencies, people receiving mental health and co-occurring services and supports, mental health advocacy organizations, Disability Services Division (DSD) lead agencies, Behavioral Health Homes (BHHs) and others.

For more information please go to the SWIFT supplier portal and search for Event ID 2000006172 or contact Amanda Calmbacher ([email protected]), 651-431- 2627. This RFP will close on November 21, 2016 at 4:00 pm.

RFP for PATH Program DHS, through its Mental Health Division is seeking proposals for the Project for Assistance in Transition from Homelessness (PATH) program. Selected grantees will provide outreach, case management services and other supportive services for persons with serious mental illness or with serious mental illness and a co-occurring substance use disorder, who are experiencing homelessness, long-term homeless, or at imminent risk of losing housing including persons who do not have stable housing upon exit from an institutional setting. Click here for the full RFP. This RFP will close on December 2, 2016 at 4:00 pm.

Does MA Cover Mental Health Services Provider Costs?

DHS is extending the time period for participation for analysis of Medical Assistance (MA) rate-setting for mental health services and is seeking mental health providers to give input about their costs. DHS is looking for providers of all types of mental health and substance use services including culturally specific, outpatient, rehabilitation, residential, and crisis services. The information will be used to determine reimbursement rates that are adequate to sustain community-based mental health services and inform potential improvements to the rate setting methodology. Cost reports will be collected until December 2, 2016. Click here for more information. If you have questions, please contact Joseph Drummond at [email protected].

Case Management Redesign Since April of this year, a small group of internal and external collaborators have reviewed past work to inform a series of background documents that will be a basis for a draft to redesign case management. DHS also asked partners and stakeholders to develop their own vision statements for the future of case management and improvements needed to realize that vision. You can find these documents, referred to as set-up documents, on the DHS Case Management Redesign page.

On Jan. 31, 2017, DHS and the Future Services Institute will host a one-day gathering at the Humphrey Institute where a draft Roadmap to Case Management Reform will be further discussed. The goal of the event is to offer another forum to engage partners and stakeholder to provide feedback and inform this work moving forward. The gathering will mark the end of the information-gathering phase and the beginning of our next phase of work together. Please watch for a "Save the Date". Click here for more information.

Updates from NAMI Minnesota NAMI Minnesota Celebrates 40 Years "40 Years of Change" is a free presentation by NAMI's executive director Sue Abderholden, which will cover the history of the mental health system in Minnesota and the many positive changes NAMI Minnesota has helped to create. We will also seek input from community members about their current needs and hopes for the future. Open to the public. Click the cities below to register.

 Savage, Nov. 28, 8:00-9:30 a.m., Savage City Hall Main Room, 6000 McColl Drive

 Minnetonka, Nov. 28, 12:00-1:30, Minnetonka School District Community Room, 5621 County Road 101

 Buffalo, Nov. 28, 6:00-7:30 p.m., Buffalo Community Center, 206 Central Ave

 Duluth, Nov. 29, 12:00-1:30 p.m., Duluth Public Library Green Room, 520 W Superior St

 Winona, Dec. 8, 12:00-1:30 p.m., Winona City Hall Council Chambers (3rd floor), 207 Lafayette St

 Rochester, Dec. 8, 6:00-7:30 p.m., Rochester Area Foundation, 12 Elton Hills Drive NW

 Eagan, Dec. 14 6:00-7:30 p.m., Horizons CSP, Minnesota Mental Health Clinics, 3450 O'Leary Lane Policy Internships with NAMI Minnesota Advocacy efforts are a major part of NAMI Minnesota's work. NAMI Minnesota is an active participant on work groups and committees that address issues related to mental illnesses. NAMI Minnesota maintains a strong presence at the Minnesota Legislature by advocating and supporting issues important to people living with mental illness and their families.

The Policy and Grassroots Advocacy Intern will assist NAMI Minnesota's executive director and public policy coordinator with advocacy by researching and tracking bills, attending and summarizing meetings, and participating in grassroots organizing. Now accepting applications for the 2017 session. Click here to apply! Personal Stories for the 2017 Legislative Session NAMI Minnesota is currently accepting applications from individuals with mental illnesses who want to share their personal stories and experiences with state law makers. Once session begins in January, 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. Next scheduled meeting is December 13, 2016 from 6:00 to 8:00 p.m. here at the NAMI Minnesota office. For more information on how to become a member of the NAMI Legislative Committee please contact Lynn Sando at [email protected] or 651-645-2948 ext. 107. Legislative Training Workshop NAMI Minnesota has scheduled two legislative advocacy training opportunities. Participants will gain knowledge about the legislative process, ways to take legislative action, and how to get involved with public policy and be an advocate for NAMI Minnesota's legislative initiatives. This workshop is for anyone who has an interest in learning more about the legislative process and/or public policy, or who would like to strengthen their skills as a mental health advocate. Both will be held at the NAMI Minnesota office in St. Paul. Click the dates below for more information and to register.

Saturday, December 10, 2016 from 10:00 a.m. to 12:00 p.m. Saturday, January 14, 2017 from 10:00 a.m. to 12:00 p.m. Still Time to Fundraise for NAMIWalks! Thanks to all of the Walkers, sponsors, volunteers, family members and friends who have helped make NAMIWalks Minnesota 2016 a success! With you on our team we raised more funds for NAMI Minnesota than any other Walk in history. And the best part is: we aren't finished yet.

We will continue to receive donations for NAMIWalks Minnesota in our office until Tuesday, November 22nd. Online giving for NAMIWalks Minnesota will remain open until Wednesday, November 23rd. Keep sharing your Walk stories and experiences to help us reach our goal of $450,000!

Not sure who represents you?

Stay Connected

NAMI Minnesota | 800 Transfer Road, Suite 31 | St. Paul, MN 55114 [email protected]| http://www.namihelps.org 651-645-2948 | 1-888-NAMI-HELPS

Copyright © 2014. All Rights Reserved.

Copyright © 2014. All Rights Reserved.