REPORT OF THE GOVERNOR’S BLUE RIBBON COMMISSION ON MENTAL HEALTH CONTENTS Chairman’s Preface ......................................................................................iv Psychiatric Disabilities in Real Life..............................................................v REPORT SUMMARY.................................................................................vi Governor’s Executive Order ..............................................................xxxvi Commission and Steering Committee Members............................. xxxviii Expert Panel Members .......................................................................xxxix CHAPTER I - INTRODUCTION.................................................................1 The Blue Ribbon Commission and Expert Panels ....................................3 Content of the Report ................................................................................4 CHAPTER II - CURRENT DEVELOPMENTS IN MENTAL HEALTH ..6 Defining Mental Health and Mental Illness ..............................................6 Mental Health Problems versus Mental Illness.........................................6 Mental Health: A Report of the Surgeon General.....................................7 The Impact of Psychiatric Disabilities ......................................................8 Psychiatric Disabilities among Adults, Children and Adolescents.......8 Access to Treatment............................................................................10 Treatment is Effective .............................................................................14 The Burden of Stigma .............................................................................15 The Emerging Role of Consumers, Families and Advocates .................15 Hope for Recovery ..................................................................................16 Responding to Cultural Needs ................................................................17 Implications of the Olmstead Decision ...................................................18 The Need for a Behavioral Health Approach..........................................20 Mental Illness and Violence....................................................................22 The Criminalization of Mental Illness ....................................................24 Financing of Mental Health Care at the National Level .........................25 CHAPTER III - EVOLUTION OF MENTAL HEALTH CARE IN CONNECTICUT.........................................................................................30 A Perspective on History ........................................................................30 CHAPTER IV - MENTAL HEALTH SERVICES IN CONNECTICUT TODAY.......................................................................................................34 Connecticut’s Mental Health Services for Children, Adolescents and their Families...........................................................................................34 Adult Mental Health Services in Connecticut.........................................40 Adult Service System Components.....................................................40 DMHAS Client Characteristics...........................................................41 Trends in the Utilization of Adult Mental Health Services.................44 The General Assistance Behavioral Health Program..........................48 Financing Mental Health Services in Connecticut..................................49 Insurance Parity...................................................................................50 CHAPTER V – SUMMARY OF PRIORITY RECOMMENDATIONS...52 CHAPTER VI – MECHANISMS FOR IMPLEMENTATION .................59 Mental Health Service Enhancement (A Vehicle) ..................................59 Opportunities for Collaboration ..............................................................60 i REPORT OF THE GOVERNOR’S BLUE RIBBON COMMISSION ON MENTAL HEALTH CHAPTER VII – THE EXPERT PANEL REPORTS................................62 Advocacy and Consumer Perspectives ...................................................63 Current Efforts to Bring Consumer Perspectives into Policy and Practice................................................................................................64 Current Advocacy Resources..............................................................65 Current Need for a Better Informed, Caring Community...................67 Advocacy Panel Issue #1 – Involvement in System Design and Evaluation ...........................................................................................68 Advocacy Panel Issue #2 – Enhancing and Coordinating Advocacy Resources ............................................................................................70 Advocacy Panel Issue #3 – Enhancing Public Understanding............74 Advocacy Panel Issue #4 – Role of Kindergarten-12th Grade Education System................................................................................76 Advocacy Panel Issue #5 – Integration of Person with Behavioral Health Needs into Communities and Neighborhoods.........................78 Managing Services ..................................................................................80 M. S. Panel Issue #1 - Sufficient Funding ..........................................88 M. S. Panel Issue #2 - Local Management of Services.......................93 M. S. Panel Issue #3 - Development of Services for Young Adults...94 M. S. Panel Issue #4 - Ensuring Accountability for Services .............96 M. S. Panel Issue #5 - Supporting Professional Development ...........98 M. S. Panel Issue #6 - Cultural Competence ......................................99 Prevention .............................................................................................101 The Parameters of Prevention ...........................................................101 The Factors Facing Improving Contemporary Family Life, Learning and Safety..........................................................................................102 Values Behind Primary Prevention...................................................104 The Importance of Prevention and Health Promotion for Connecticut’s Citizens ......................................................................104 Prevention Practice Framework ........................................................105 Points of Intervention........................................................................108 Prevention Panel Issue #1 – Integrate Primary Prevention into the State System ......................................................................................112 Prevention Panel Issue #2 – Best Practices in Prevention ................114 Prevention Panel Issue #3 – Promote Mental Health as Way of Life115 Treatment and Intervention ...................................................................117 Introduction .......................................................................................117 T/I Panel Issue #1 – Treatment and Policy .......................................120 T/I Panel Issue #2 – System of Care .................................................121 T/I Panel Issue #3 – Quality of Services...........................................122 T/I Panel Issue #4 – Persons with Mental Illness in the Criminal Justice System ...................................................................................123 T/I Panel Issue #5 – The Problem of Fragmented Care ....................127 T/I Panel Issue #6 – Gridlock in the Delivery of Acute Care Services for Children .......................................................................................129 ii REPORT OF THE GOVERNOR’S BLUE RIBBON COMMISSION ON MENTAL HEALTH T/I Panel Issue #7 – The Needs of Youth Transitioning Into The Adult System ...............................................................................................131 CHAPTER VIII – CONCLUSION...........................................................134 REFERENCES..........................................................................................135 APPENDICES...........................................................................................141 TABLE OF FIGURES Figure 2-1: Percent of Adults with Behavioral Health Disorders During One Year ..............................................................................................9 Figure 2-2: Estimate of Adults with Mental Illness in Connecticut in One Year ....................................................................................................10 Figure 2-3a: Annual Prevalence of Mental/Addiction Disorders and Services for Adults.............................................................................12 Figure 2-3b: Annual Prevalence of Mental/Addictive Disorders and Services for Adults.............................................................................12 Figure 2-4a: Annual Prevalence of Mental/Addictive Disorders and Services for Children..........................................................................13 Figure 2-4b: Annual Prevalence of Mental/Addictive Disorders and Services for Children..........................................................................13 Figure 2-5: Effectiveness of Treatment for Various Disorders..................14 Figure 2-6: Connecticut Behavioral Health Model....................................21 Figure 2-7: DMHAS Clients with Co-occurring Disorders .......................22 Figure 4-1: DMHAS Mental Health Clients