June 2007 Newsletter
The Newsletter of the National Association of County Behavioral Health and Developmental Disability Directors
In this Issue...
Meet NACBHDD's New Executive Director: Ellen Witman
NACBHDD's new Executive Director, Ellen Witman, started work June 18. Witman comes to NACBHDD after 16 years at the helm of her own Washington, DC-based consulting firm, which provided advocacy and communication services to nonprofits. In addition, Witman has over 20 years of experience in legislative affairs and public policy, including drafting Congressional legislation and developing government affairs communications, such as policy analyses, newsletters, journal articles, testimony, op-ed pieces, press releases, and statements for members of Congress. And, she has extensive successful grant writing experience. Her clients have included: Children Now, the Coalition of Voluntary Mental Health Organizations of New York, and the Greater Twin Cities United Way. Witman has an M.S. in Clinical Psychology from Hahnemann University & Medical School in Philadelphia.
Witman is very excited about combining her extensive advocacy and lobbying experience with her education in behavioral health. She describes NACBHDD as the "perfect mix" for her because it affords the opportunity to work in both fields that she loves: behavioral health and government affairs. Witman is looking forward to meeting NACBHDD's members and hearing their ideas about how to best address the important mental health, substance abuse and developmental disabilities issues confronting Americans today. Witman is thrilled to be working with a membership that shares her passion for these issues. She also wants input on how NACBHDD can serve its members better.
In addition to her work with her own firm, Witman has gained other experience in her career that will be helpful in her new role with NACBHDD and in helping NACBHDD move forward:
Witman's immediate tasks at NACBHDD will be to attend the July Board meeting in Richmond, Virginia and to work with the Board on increasing membership in NACBHDD and improving services to the members. This will include examining ways to engage more county directors of mental health, substance abuse and disabilities services in the organization. She has already attended a presentation by Trilogy about the Network of Care in New York and met with the Trilogy team to strengthen the working relationship and expand the use of Network of Care. (For more information on Trilogy and the Network of Care, see the May 2007 newsletter and www.networkofcare.org.) She has also participated in a call with the Executive Committee.
Most of all, Witman is looking forward to meeting NACBHDD members and learning about the unique situations in each of the member counties as well as the similarities among them. As she begins working to grow the organization, she wants to be sure there is a balance between mental health, substance abuse, and developmental disabilities representation in the organization. In addition, Witman is seeking out coalition partners and other behavioral health organizations to create or strengthen alliances between NACBHDD and other groups with similar goals.
Witman welcomes calls from members. She can be reached on her direct line at (202) 942-4296 or at ewitman@nacbhd.org.
NACBHDD Board Will Meet July 13 and September 6-7
The NACBHDD Board of Directors has two meetings planned in the near future. The first meeting will be held Friday, July 13, at the Berkeley Hotel in Richmond, Virginia in conjunction with the National Association of Counties' (NACo) 27th Annual Conference and Exposition. The contact information is as follows:
The Berkeley Hotel
1200 East Clay Street
Richmond, VA 23219
For reservations call 1-804-780-1300 or toll free at 1-888-780-4422. Please use NACBHDD as your group identifier to get the $165 rate. Rooms are available for Thursday July 12 and Friday July 13.
The second Board of Directors meeting is planned for September 6th and 7th in Napa Valley, California. More details will be available on the web site soon.
While all members are welcome to attend Board meetings, only Board members are eligible to vote at these meetings.
If you have questions, please contact Maeghan Gilmore at mgilmore@nacbhd.org or at 202-661-8816.
NACBHDD and NACo Plan Joint Presentation on Jail Diversion at Upcoming NACo Conference
Amy Kroll, Mental Health Forensic Program Director for the Allegheny County, Pennsylvania, Department of Human Services-Office of Behavioral Health, and a NACBHDD member, will present an educational workshop focusing on jail diversion at the National Association of Counties' (NACo) 27th Annual Conference and Exposition in Richmond, Virginia. The workshop, "Jail Diversion 101: Components That Matter" is scheduled for Monday, July 16 from 10:45 a.m. to 12:45 p.m. and will present, according to the NACo program, "a snapshot perspective of the continuum of care that is needed to deal with an individual with mental health needs who comes into contact with the criminal justice system." Kroll will discuss the continuum of jail diversion services developed in Allegheny County based on the "Sequential Intercept Model" including, police-based CIT, pre- and post-booking diversion, mental health and drug courts, and re-entry programs. Leon Evans, Executive Director of The Center for Health Care Services in San Antonio, Texas, will moderate the panel. Evans is currently NACBHDD's Vice-Chair and will assume the Chairmanship in the Fall.
Medicare Update: More on the APA Study on Critical Problems with Medication Access and Continuity
In May, NACBHDD spoke with Karen Sanders, Associate Director of Publicly Funded Services at the American Psychiatric Association (APA) about the article "Medication Access and Continuity: The Experiences of Dual-Eligible Psychiatric Patients During the First 4 Months of the Medicare Prescription Drug Benefit," released May 1 in the American Journal of Psychiatry. The article outlines the results of a study conducted by the APA's American Psychiatric Institute for Research and Education (APIRE), which monitored and described continuity and medication access among dual eligible patients with mental and addictive illnesses. The study's findings focus on data from January through April, 2006, among a nationally representative sample of 1,183 psychiatrists who treat dual eligible patients. Fifty-six percent of the patients in the study had a schizophrenia or bipolar diagnosis.
This month NACBHDD spoke with Joyce West, PhD, MPP, the APA's Director of the Psychiatric Research Network (PRN), APIRE, and Sam Muszynski, JD, Director, the APA's Office of Healthcare Systems and Financing. (West is the article's lead author and worked closely on the design of the study, and Muszynksi has been working closely on policy-related implications of the study.) The study revealed that there are ongoing critical access problems faced by the two million dual eligibles with mental and addictive illnesses, and it also revealed the serious consequences of these access and continuity problems. While the Centers for Medicare & Medicaid Services (CMS) has had policies in place to protect and cover the six protected classes of medications (antidepressants, antipsychotics, anticonvulsants, antiretrovirals, immunosuppressants, and antineoplastics), West says it appears that the Prescription Drug Plans (PDPs) are not complying with the intent of these policies. She says the PDPs do offer the potential to improve quality, but what they are doing appears to be based on cost. She elaborated on some of the findings in the study:
Policy implications
Muszynski points to three areas that the APA is following up on. First, he says the study provides a rationale for why CMS needed policies for the six protected classes of medications in the first place, and the findings of the study support an argument for continuation of the protections around continuity. Second, the utilization management procedures used by the PDPs are creating access problems. Third, the amount of administrative time clinicians are spending on access and continuity problems for their patients (45 minutes to an hour per patient) is a tremendous burden. This, in combination with the high incidence of adverse events due to medication changes, points to the need for some real change.
The utility of the study: legislation for protected classes, future discussions with CMS regarding off-label medications
As noted above, the study has demonstrated the need to have some mechanism to insure the continued protection of the six protected classes of medications. The APA is currently involved in advocating and lobbying for legislation that would provide statutory protection for the six protected classes. And, because continuity and access problems not only did not resolve after the transition period, but became worse, the APA will continue to meet with CMS to try to find some solutions to these problems.
Muszynski also identified concerns about prior authorization requirements and off-label medication use. Although off-label medications are often used successfully in treating individuals with mental illnesses, such as the use of Depakote to treat individuals with bipolar disorder, Muszynski says there are still concerns and that prior authorization is usually required. In mid-June CMS issued a letter to the PDPs stipulating that prior authorization requirements must be spelled out and that people must be informed about what they are. This is an area the APA will be discussing with CMS.
What's next?
For more details on the study, see the May newsletter.
Muszynski urges NACBHDD members with concerns about Part D-related issues to contact the APA Part D Helpline at 866-882-6227 or at PartD@psych.org.
Faces and Voices of Recovery: Upcoming Rally for Recovery Theme is "End Insurance Discrimination Now"
Pat Taylor, Executive Director of Faces and Voices of Recovery, the national organization based in Washington, DC, that advocates for recovery from alcohol and substance abuse, provided an update on the organization's activities.
September 15 Rally for Recovery theme is "End Insurance Discrimination Now"
This year's Rally for Recovery will be tied to advocacy efforts around The Paul Wellstone Mental Health and Addiction Equity Act of 2007. In the process of preparing for the Rally, new coalitions have developed around the country with some geographic areas holding their own events. Taylor estimates that there are 50 to 60 locations with 60,000 to 70,000 people involved. A Liberty Island event in New York is planned, with over 5,000 people expected.
Insurance Parity
Faces and Voices is supporting the House mental health parity bill (H.R. 1424), which would not supersede state parity laws. The organization has been working with other advocacy organizations in support of H.R. 1424, including the American Society of Addiction Medicine, the National Council on Alcoholism and Drug Dependence, the Legal Action Center, and the Johnson Institute. To view H.R. 1424, see http://www.govtrack.us/congress/bill.xpd?bill=h110-1424.
Insurance discrimination registry
Faces and Voices is collecting information about discriminatory insurance practices as part of its Addiction Recovery Insurance Equity Campaign, in order to document the difficulties individuals are having with insurance coverage. Those interested in participating can fill out a registry questionnaire at www.facesandvoicesofrecovery.org/pdf/campaigns/1.30.07_registry_form.pdf.
Second Chance Act
The organization is also working on the Second Chance Act, which according to the Faces and Voices May e-newsletter, would "help people reentering communities from jail and prison successfully transition to life in their communities in key areas including jobs, housing and treatment." Legislation may be voted on in the House in August.
HBO Addiction documentary
Taylor reports that the recent HBO documentary series Addiction was a means for recovery community organizations and advocates to mobilize, watch the series, and discuss its implications in 30 major cities around the country. She believes many families were able to receive a helpful and hopeful message about recovery during these events, and as a result, more town hall-type meetings are planned in an ongoing effort to educate communities about recovery.
Linking peer support and recovery services to the treatment and criminal justice systems
Last September, Faces and Voices led a briefing on Capitol Hill on peer support and recovery services, focusing on building bridges between the treatment, criminal justice, and recovery communities. Peer support and recovery services have been emphasized in the Institute of Medicine's report, Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series, released in November 2005.
The web site has been updated and includes the following:
Message and media training
Faces and Voices has trained over 1,000 people in communicating with the media about recovery. The most recent training was in Denver on June 22 and 23, with four more trainings scheduled by the end of the year. A shorter, four-hour training is also available. For more information, see the home page of the Faces and Voices website.
Civic engagement campaign
In August, there will be information on a civic engagement campaign posted on the website.
For more information, see www.facesandvoicesofrecovery.org.
Priced Out in 2006: Housing Report Demonstrates SSI Beneficiaries with Disabilities Unable to Afford Rentals Across the Country
From a June 4 press release from the National Alliance on Mental Illness (See www.nami.org):
Housing Update -- New Report Demonstrates Growing Affordable Housing Crisis for Non-Elderly Adults With Mental Illness Living on SSI
A newly published report once again quantifies the growing housing affordability crisis facing people with serious mental illness who depend on Supplemental Security Income (SSI) for basic support needs. This report compares monthly SSI cash benefits to local U.S. Department of Housing and Urban Development (HUD) Fair Market Rents for modestly priced one bedroom and studio/efficiency rental units. Since 1998, it has been published every two years by the Consortium for Citizens with Disabilities (CCD) Housing Task Force and the Technical Assistance Collaborative (TAC). NAMI is a member of the CCD coalition.
To view the Priced Out in 2006 report, or order a copy, go to: http://www.tacinc.org/Pubs/PricedOut.htm.
Priced Out in 2006 reveals that for the first time:
These shocking statistics mean that approximately 4 million SSI beneficiaries with disabilities - 1/3 of whom have a serious mental illness - are shut out of the rental market in every city, town and rural area of the country. For example in the Columbia, Maryland housing market, the federal Fair Market Rent for a modestly priced one-bedroom apartment was 193.2 percent of monthly SSI income - the highest level in the nation. In New Orleans, modest studio/efficiency apartments soared to $755 a month - a 45 percent increase since Hurricane Katrina. In the rural areas of Nevada, the cost of a one-bedroom unit priced at the HUD Fair Market Rent was $603 - consuming the entire monthly income of a single individual receiving SSI in that state - leaving a SSI beneficiary totally unable to pay for food, clothing, or out of pocket medical expenses.
Even more shocking is that Priced Out in 2006 found a precipitous and relentless decline in housing affordability for SSI recipients since 1998 when the first edition of Priced Out was released. During the past eight years, as funding for low income housing programs has been slashed, the cost of a modest one-bedroom rent rose from 69 percent to 113.1 percent of SSI. During that time, SSI income dropped 26 percent compared to the one-person median income.
Due to the severity of this housing affordability crisis, CCD and TAC strongly urge the federal government to commit to a multi-year plan to create a minimum of 150,000 new federal rent subsidies for people with disabilities with the lowest incomes. Specifically, we recommend that the federal government commit to provide 10,000 new Housing Choice (Section 8) Vouchers and 5,000 new Section 811 Supportive Housing for Persons with Disabilities rent subsidies each year for the next ten years.
Although this recommendation may seem unrealistic in this period of deficit reduction and pay-go rules, it would end up benefiting everyone. As Eunice Kennedy Shriver underscored in a foreword to the report, "creating and maintaining the financial and social supports to provide affordable housing for individuals with disabilities in the community is not only the right thing to do, it makes fiscal sense.... it costs 50-75% less to provide services in community-based housing rather than more institutional-type housing funded by Medicaid."
We hope that this report will shine a light on the housing affordability crisis facing the extremely low income citizens of your state and that you will help us to address this crisis. Our nation's most vulnerable citizens deserve no less.
Look for more information on the housing crisis and interviews with NACBHDD members about housing issues in their counties in the August newsletter.
The National Anti-Stigma Campaign (NASC) has been developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Ad Council to increase awareness about recovery from mental illness. A 2006 survey found that perceptions about the recovery and success of those with mental illness are grim. For example, according to the survey "one-quarter of young adults between the ages of 18-24 believe that a person with mental illness can eventually recover." The survey also revealed that, "Only 42 percent of Americans believe that a person with mental illness can be as successful at work as others."
The Campaign targets men and women 18-24 years old. Campaign materials include campaign brochures, fact sheets, SAMHSA/CDC reports, information on developing a stigma reduction initiative, information on public service announcements, and media contacts.
The NASC website has received over 1,300,000 hits, and the campaign distributes about 6,000 brochures each month. For more information on the Campaign, contact America Doria-Medina at adoriamedina@shs.net or 240-747-4955, or Elizabeth Edgar at nasc-liaison@nami.org or 703-516-7973.
For a summary of the beliefs about mental illness and recovery from mental illness, as well as facts and links to resource organizations, see: http://mentalhealth.samhsa.gov/publications/allpubs/SMA07-4257/default.asp.
For information and resources related to SAMHSA's Resource Center to Address Discrimination, including help in creating and implementing anti-stigma and anti-discrimination initiatives and best practice information related to disseminating anti-stigma practices to states and local communities, see www.stopstigma.samhsa.gov, or contact 1-800-540-0320.
From a June 4 press release:
SAMHSA Announces FY 2008 Review Priorities for New National Registry of Evidence-Based Programs and Practices
SAMHSA has announced the agency's Fiscal Year 2008 review priorities for mental health and substance use prevention and treatment programs and practices submitted to its National Registry of Evidence-Based Programs and Practices (NREPP). The notice was published in the June 4 Federal Register.
NREPP is a voluntary rating and classification system designed to provide the public with reliable information on the scientific basis and practicality of interventions that prevent and/or treat mental and substance use disorders. Under the new NREPP, minimum review criteria require interventions to demonstrate one or more positive change outcomes in mental health and/or substance use among individuals, communities or populations; have results that are published in a peer-reviewed publication or documented in a comprehensive evaluation report; and provide documentation, such as manuals, guides, or training materials, to facilitate broader public dissemination of the intervention.
Priority review areas for substance use prevention include preventing or reducing substance abuse problems such as underage drinking, inhalant abuse, use and abuse of marijuana, drug-related suicide, alcohol and drug abuse among young adults, misuse of alcohol and prescription drugs among the elderly, or HIV/substance abuse problems. Priority review areas for substance use prevention also include interventions that reduce risk factors or enhance protective factors, or address emerging substance abuse problems.
Priority review areas for substance abuse treatment include treating adolescents and adults with alcohol or drug use disorders that utilize screening, brief interventions and referral; outreach and engagement; treatment and rehabilitation; recovery support; or continuing care, self-care or aftercare.
Priority review areas for mental health include fostering consumer and family-provided mental health services; reducing the effects of trauma on the mental well-being of children, adolescents, and adults; promoting employment among those with serious mental illness; integrating or coordinating treatment of mental illnesses with primary care services; diverting adults with serious mental illness and/or children and adolescents with serious emotional disturbances from criminal and juvenile justice systems; developing alternatives to the use of seclusion and restraint for adults with serious mental illness and/or children and adolescents with serious emotional disturbances; or preventing suicide in specific age groups.
Interested parties can review the complete Federal Register notice by clicking on "National Registry of Evidence-Based Programs and Practices" on the SAMHSA home page at http://www.nrepp.samhsa.gov/.
From a June 20 press release:
Two New Briefs Outline Evidence-Based Practices and Care in Non-Traditional Settings for Those with Co-Occurring Disorders
Two new short papers from SAMHSA help treatment professionals, policymakers and others understand and address the needs of people with co-occurring substance use and mental disorders.
Addressing Co-Occurring Disorders in Non-Traditional Service Settings: Overview Paper 4 and Understanding Evidence-Based Practices for Co-Occurring Disorders: Overview Paper 5 continues a series of brief introductions to state-of-the-art knowledge from SAMHSA's Center for Co-Occurring Excellence.
Only about half of all people with a co-occurring disorder receive any substance abuse or mental health treatment, but they may come in contact with those in public health, public safety and social welfare organizations. Addressing Co-Occurring Disorders in Non-Traditional Service Settings: Overview Paper 4 describes how professionals who work in primary health care, public safety and criminal justice, and social service settings can identify and respond effectively to people with co-occurring disorders. The paper explains how these initial contacts, if handled with sensitivity, can increase the likelihood that people with co-occurring disorders will take advantage of treatment.
Understanding Evidence-Based Practices for Co-Occurring Disorders: Overview Paper 5 provides an overview of evidence-based practices and their use in treating people with co-occurring disorders. Although the treatment of co-occurring disorders is a relatively new field, several program- and treatment-level interventions have been developed and tested. This paper identifies how evidence is used to determine if a given practice should be labeled as evidence-based and provides brief examples. In addition, Overview Paper 5 clarifies the advantages of employing evidence-based practices and the meaning of related terms, such as promising practices, model programs and best practices.
SAMHSA is creating these training materials as part of its response to the November 2002 Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders. SAMHSA's Co-Occurring Center for Excellence works to expand the knowledge base about treatment advances, build treatment capacity, and foster evidence-based practices.
Previously published short papers address definitions and terms; screening, assessment and treatment planning; and overarching principles to address the needs of people with co-occurring disorders. More information about the Co-Occurring Center for Excellence and the short papers can be found on the Web at http://www.coce.samhsa.gov/.
Addressing Co-Occurring Disorders in Non-Traditional Service Settings: Overview Paper 4 is available on the Web at http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17655 and Understanding Evidence-Based Practices for Co-Occurring Disorders: Overview Paper 5 at http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=17656. Copies may be obtained free of charge by calling SAMHSA's Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727). Request inventory number SMA 07-4277 for Paper 4 and SMA 07-4278 for Paper 5. For related publications and information, visit http://www.samhsa.gov/.
From a June 11 press release:
New SAMHSA Report Provides State-Level Data on Depression
Approximately 9 percent of youths aged 12 to 17, and 7.6 percent of adults aged 18 or older, experienced at least one major depressive episode (MDE) in the past year according to data released today by SAMHSA. SAMHSA Administrator Terry Cline, Ph.D., released the findings at a Mental Health America meeting held in Washington, DC, on June 9th.
The new analysis from SAMHSA's National Survey on Drug Use and Health (NSDUH) shows that among 12 to 17 year olds, rates of past year MDE were among the highest in Idaho (10.4 percent) and Nevada (10.3 percent). The rates were among the lowest in Louisiana (7.2 percent) and South Dakota (7.4 percent).
"The complexities associated with mental health problems leave states with a heavy responsibility to provide effective and responsive mental health promotion, treatment and recovery support services. These data add to the information state mental health authorities use to plan for and allocate resources," SAMHSA Administrator Terry Cline, PhD said.
State estimates of past year MDE were produced using data from the combined 2004 and 2005 NSDUH surveys. The prevalence of MDE in each state is based on standard definitions and survey methods applied uniformly throughout the nation.
According to the survey, rates of past year MDE among adults aged 18 or older were among the highest in Utah (10.1 percent) and Rhode Island (9.9 percent). Hawaii and New Jersey had rates among the lowest (6.7 percent and 6.8 percent respectively).
The survey also showed that there were few statistically significant differences across states in the rates of past year MDE among youths and adults. The survey did not look at reasons for the interstate variances.
MDE, as defined by the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), specifies a period of two weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image.
State Estimates of Depression: 2004 and 2005 National Surveys on Drug Use and Health (NSDUH) is available on the Web at http://oas.samhsa.gov/2k7/states/depression.cfm.
From a June 4 press release:
Iowa to Receive Grant Funding for Youth Suicide Prevention, Early Intervention
SAMHSA has announced that it anticipates making awards totaling $1.2 million over three years to the state of Iowa to implement the Youth Suicide Prevention/Early Intervention Project. The first year award is $400,000. This grant will provide screening, assessment and referral to early intervention and treatment services for youth suicide prevention within educational settings.
Nationwide, someone dies by suicide every 17 minutes. "Suicide is a preventable tragedy for individuals, for families and for communities," said SAMHSA's Administrator Terry Cline, Ph.D. "This grant is an important part of the solution to preventing suicide in the state of Iowa. Education about suicide risk factors, such as depression and drug abuse, is another part of the solution. So is early intervention, such as our national suicide prevention lifeline, 1-800-273-TALK. By working with suicide prevention in schools and on athletic fields, in workplaces and places of worship, and at home, we can save thousands of lives."
Iowa's youth have a higher risk for suicide than the national average. For the years 2000-2003, suicide was the second leading cause of death for Iowa youth 10-24 years of age. The 2002 Iowa Youth Survey identified 10,560 students who admitted to one or more suicide attempts and 9,531 who admitted to having a plan. Iowa data demonstrates the need for early identification of youth at risk for suicide in Iowa's educational settings.
This project incorporates parts of the Iowa Plan for Suicide Prevention: 2005-2009, which was based on the National Strategy for Suicide Prevention. The Iowa Department of Public Health will fund grants to local high schools or educational regions. Schools and their community partners will provide early identification programs to high school youth and make appropriate referrals for services. The project also includes a public awareness campaign to promote project participation.
