May 2003 NACBHDD Newsletter
The Newsletter of the National Association of County Behavioral Health and Developmental Disability Directors
In this Issue...
A Preview of the Annual Conference: Innovations in Cost Savings for Results
This year's eighth annual conference offers NACBHD members the only national forum to examine the impact of budget shortages on their systems of care, and innovative ways of addressing those shortages. As an added attraction, members will have the chance to enjoy Milwaukee area festivities that Conference Chair Kathleen Eilers characterizes as one of summer's "best kept secrets." The conference is scheduled for July 10-12, 2003 at the Hyatt Regency Milwaukee, and will precede the National Association of Counties (NACo) Annual Conference and Exposition, July 11-15, at the Midwest Airlines Center. The sections below highlight both the conference and Milwaukee area activities. Eilers urges members to attend the conference: "It's a great opportunity to hear about new ways of doing business that will sustain you through difficult times, and you'll have fun to boot."
The Program
Eilers believes the conference agenda offers members unique information on "ways to generate revenue, control costs, and serve people with disabilities." Outstanding speakers will lead the presentations and roundtable discussions focusing on the theme, Innovations in Cost Savings for Results. We are pleased to announce that we have invited former first lady Mrs. Rosalynn Carter to speak about the stigma of mental illness and the work of the Carter Center Task Force on Mental Health. Mrs. Carter is internationally recognized for her work on behalf of the mentally ill. Eilers notes that it is especially timely to hear Mrs. Carter's thoughts since she was the force behind the mental health commission during the Carter administration, and the final report of President Bush's New Freedom Commission on Mental Health may be available by the time of the conference. (See article on the President's Commission on Mental Health below.) This year's conference also includes an international perspective on cost-saving innovations - Gheel, Belgium's long-standing tradition of caring for the discharged severely mentally ill in private homes. Other "hot topics" include:
Milwaukee Area Activities And Festivities
Conference participants will be welcomed to an evening reception on July 10th in the Downtown Transit Center, a Milwaukee landmark overlooking Lake Michigan. This is a great chance to relax and informally network with colleagues from across the country! The Awards Luncheon on July 11th is honors the best in the field with the presentation of the Annual Wernert Award for Innovations in Community Behavioral Health.
Beyond the conference, Milwaukee offers a wealth of activities, that Conference Chair Eilers describes as a reason many Milwaukee residents don't go out of town in the summer. Some Milwaukee area events are:
As Eilers prepares for her "swansong" as Chair of the Conference Program and as Director of the Milwaukee County Mental Health Department, she urges members to enjoy both the conference and the festivities in Milwaukee. After 12 years as Director, she is moving on "to discover something different," but fondly describes her involvement with NACBHD as "very stimulating and a lot of fun" - and she hopes the conference will be both.
Register Today!
Don't miss out on the most important and relevant national conference designed specifically for County Behavioral Health Authority Directors. Participate in the best professional network in the public behavioral health arena.
Register on line at www.nacbhd.org, send in your registration form or contact Lauren Wolfe at the NACBHD office for more information at: (202) 234-7543; 1-800-228-6905.
President's New Freedom Commission on Mental Health: Final Report in Progress
Michael Hogan, Ph.D., Chair of the President's New Freedom Commission on Mental Health and Director of the Ohio Department of Mental Health, looks forward to the Commission's final report and the 16 subcommittee reports as "tools for change in systems, for advocacy, and for change at the state level." The Commission's final report will go to the President in the next few weeks (approximately one year after the Commission was set up by the President's Executive Order on April 29, 2002).
Hogan compares the Commission's work with that of the Commission on Mental Health during the Carter administration, saying that he believes that "seeds have been planted that took time to germinate," and those issues were picked up by advocates and by Congress. For example, many of the ideas "hatched" in the Carter Commission ended up being worked on in the National Plan for the Chronically Mentally Ill and put in place over a number of years. He sees the outcome of the current Commission's work as an "ongoing and pretty complex process of reform." While he can't comment on the specifics of the report since it is still being written, he says that there will be some areas where recommendations could be relatively immediately acted upon and other areas where recommendations require more long-term action and depend on actions in other areas. For example, with respect to Medicaid, there are things being done in some states that could be done more broadly. On the other hand, fundamental reform in Medicaid would have to be considered a more long-term process.
In terms of what may happen once the report if released, Hogan says there is an "emerging sense among advocacy organizations to work together on follow through. There are clear signals that many of the leadership groups are intending to work together on this." Chris Koyanagi, Policy Director, the Bazelon Center for Mental Health Law, says that the Bazelon Center has been working with the Mental Health Liaison Group (a coalition including NACBHD and other organizations whose interests are focused on the public mental health system). The group submitted recommendations to the Commission in the general areas of Medicare, Medicaid, education, vocation/rehabilitation, housing, criminal justice/juvenile justice issues, and workforce issues, which she thinks were very informative to the Commissioners. Koyanagi notes that this is the first report in 25 years. They are committed to following through with the Commission and trying to turn the recommendations into legislation to send to the Hill. Koyagagi says the report should be "a very nice opportunity to put mental health front and center in the press and in the Congress." She characterizes the report as a "high level blueprint for Congress to consider making changes on," probably over a number of years.
Hogan says the final report will differ from the outline in that it will provide stronger rationale with supporting documents and findings. The outline contains a vision statement of "a future in which recovery is the expected outcome and when mental illness can be prevented or cured." (The full outline of the final report is available online at www.mentalhealthcommission.gov.) Six goals, with recommendations for each, are highlighted in the outline of the final report:
In terms of specifics about where and how recommendations may be implemented, Hogan says the final report will present the "big picture." Subcommittee reports will be published after the main final report and will be more specific to particular programs and issues. (Subcommittee reports are now available online, but the final subcommittee reports will be much longer and more substantive.) He compares the final subcommittee reports to the backup documents of the Carter Commission. Final subcommittee reports probably will be available online and as published documents. Commissioners will continue to be available as resources.
Steve Mayberg, Ph.D., Chair, Subcommittee on Medicaid, and Co-Chair, Subcommittee on Children and Families, and Director, California Department of Mental Health, reports that when studying proposals commissioners did not look at them as a "quick fix" to the system, and he also compares the Commission's work to the Carter Commission recommendations, which had a "life of many years." Mayberg says there are some short-term objectives, but there are also many mid- and long-term objectives. Mayberg notes, like Hogan, that the final subcommittee reports will have more specificity in particular areas than the main final report. He says the commission tried to craft an "action-oriented" document, but it is up to the President what he does with it. He believes that constituents will have to carry on the work.
Although he also can't comment on specific recommendations in the report because it is still in process, Mayberg says that Medicaid and Medicare reform will be a recommendation, and that he is "very pleased and surprised by how far we were able to go with this" in terms of recommendations on Medicaid. Issues of parity, access to services, and how to make the system more responsive to evidence-based programs will be examined. He says that "the issue of broadening Medicaid proposals and allowing more options and technical assistance from CMS to help folks understand options" will be discussed. The relationship between state mental health authorities and state Medicaid agencies needs to be strengthened, and the match from the states will be discussed.
Input from consumers and providers was significant, and afforded commissioners the opportunity to hear "from people we might never be able to hear from," says Mayberg. Public comment was given via mail, the Internet, and some commission meetings. Commissioners were able to hear the perspectives of family members and consumers in rural areas and "people writing at 3:00 a.m. because they were taking care of an emotionally disturbed family member," as well as providers from their point of view. National experts drafted position papers and used them as jumping off point for subcommittee reports.
While Mayberg believes the commissioners worked very hard and the work has been very time-consuming, he recommends states go through a similar process and come up with systems that fit their states and counties, with some guiding principles to drive systems and processes.
Dr. Thomas E. Bryant, MD, JD, Executive Director of NACBHD, co-chaired the President's Commission on Mental Health during the Carter Administration, with former first lady Rosalynn Carter. While he agrees with Hogan and Mayberg's assessments of Commission recommendations as part of a long-term process, he notes that the Carter Commission had the tremendous advantage of the First Lady as Co-Chair and that the nonprofit Public Committee on Mental Health helped to implement the report of the Carter Commission.
Dr. Bryant thinks the report will be useful in terms of findings, and has urged the idea of the President receiving the final report publicly in a press conference. While "it has been very good for the mental health field to have its day in the sun," he believes the report needs to be "very high profile" to work.
He agrees with Mayberg's idea that states should undergo a process similar to that of the Commission, "States and counties can run with this, and do something at the local and county level." He believes the report will be "sensible" and then it's up to the field to get things done.
From the Hill
Robert Egnew, Public Policy Director
As the 108th Congress has finished the budget, it will now turn its attention to many of the policy issues related to health care, TANF, mental health and Medicaid. The first major health issue likely to be addressed is the Medicare prescription drug benefit, which has both significant political and cost implications. It is unclear how far the Administration may go in trying to create a pharmacy benefit under Medicare. Early indications are that for financial reasons, the Administration is unwilling to propose an open-ended pharmacy benefit. They continue to look at ways in which they can control costs or limit the potential number of beneficiaries.
The Medicare pharmacy debate could potentially significantly impact states. It is estimated that providing pharmaceutical benefits to dually eligible clients (Medicare/Medicaid) would save states $6.8 B annually. The Medicare pharmacy debate will also probably influence how much both the Administration and Congress are willing to tackle Medicaid Reform in this session of Congress. If the Medicare debate is long and bloody, don't look for anyone to push Medicaid Reform in this session of Congress.
When Congress comes back from their spring recess, there will be a major push to re-authorized TANF spearheaded by the Senate Finance Committee Chair, Senator Grassley (R-IA). It is not clear how different this year's Senate Finance Committee bill will be from last year. Mental Health Parity will receive another big push and there are rumors that some of the major mental health constituencies are willing to accept something less than full parity in order to get a bill signed. If the House does not pass a parity bill again this year, look for Senator Domenici (R-NM) to put a "rider" on the Senate's Health, Education, and Labor appropriation bill late in the session.
Finally, Medicaid Reform will, in all likelihood, at least get introduced as a bill during this session if for no other reason than to test the waters. I would predict that Medicaid Reform would not get serious consideration until the 109th Congress when State budgets will probably drive the debate. I think county-sponsored authorities need to be prepared to weigh-in heavily in the ensuing debate as to the future of public sector mental health and developmental disability services (both heavily dependent on Medicaid funding) will once again hang in the balance. NACBHD is spearheading efforts within the National Association of Counties (NACo) and within the Mental Health Liaison Group here in Washington, DC to prepare the field to engage in this new threat.
May is Mental Health Month
Congress has officially recognized May as Mental Health Month since 1949. NACBHD members and national organizations are taking the opportunity to raise awareness about mental health and mental illness through a wide range of activities, with emphases in various areas of mental health, including raising awareness, suicide prevention, children's issues, and recovery.
NACBHD members submitted the following information about the creative ways in which they plan to commemorate Mental Health Month, as well as some of the innovative ways they have been bringing mental health issues to the forefront in their communities throughout the year.
From Beverly Baalman, Sedgwick County, KS:
On May 6, Mayor Mayans will read the Mental Health Month and Suicide Prevention Proclamations at the City Council Meeting. Tim Kaufman, Director, Administrative Services for COMCARE (Sedgwick County's mental health center) will accept the proclamation declaring May Mental Health Month in Sedgwick County. Deputy Chief Terri Moses, Sedgwick County Suicide Prevention Task Force member, will accept the proclamation for Suicide Prevention. On May 7, Marilyn Cook, Executive Director of COMCARE, will accept from Commissioner Tim Norton the Mental Health Month Proclamation during the county commissioners' meeting. The Suicide Prevention Week Proclamation will be accepted by Liz McGinnis, Co-Chair of the Sedgwick County Suicide Prevention Task Force. Bev Baalman and Chris Collins-Thoman, Suicide Prevention Task Force members, will present the Sedgwick County Suicide Prevention web site to the county board of commissioners for the first time. After the commissioners approve the web site, it will go live to the public. Both May 6 and 7 meetings are televised and aired several times during the week. Press releases will go out prior to May 1 to all media sources in Sedgwick County. This may generate calls from the media to air stories about depression or suicide to build awareness.
From Sharri Dempsey, Tribal Liaison/OCA, North Sound Mental Health Administration, Mount Vernon, WA:
North Sound Mental Health Administration has been doing much to educate consumers, community, and family members throughout the year and during Mental Health Month.
"All Aboard" Trips
For the past several years, we have been conducting the "All Aboard" trips for our Advisory Board members and other interested consumers. These are enjoyable trips via chartered van to destinations like the Washington NAMI Conference, the Washington State Mental Health Conference, or a special meeting of the state legislature in Olympia on mental health issues. Almost monthly we visit such sites as consumer run businesses or the various inpatient, outpatient, residential, and children's facilities that compose our public mental health system. This gives our Advisory Board an up-close learning experience, not only about public mental health, but also about each other. The common interests, time together and shared meals help build strong relationships with and among our stakeholder community members, providing a platform for our motto: Vision of Hope: Recovery.
Marketing, Public, and Community Relations
Every year we undertake projects to help educate the public about the availability of public mental health services, about how to plug in to the Advisory Board mechanism, about the nature of mental illness. We believe that today people recover from mental illness, and this is another important message for reducing stigma.
From Cindy Sill, Executive Director, Tri-County MHMR, Conroe, TX:
Two candlelight vigils will be held, with consumers and elected county officials speaking. All county commissioners will be asked to adopt resolutions designating May as Mental Health Month in their counties. Articles will be sent to area newspapers.
From Lupe Torres, San Antonio, Texas:
The Center for Health Care Services in San Antonio plans to:
From Eldon Watts, Executive Director, Carroll County Core Service Agency, MD:
Carroll County will have a major community festival in the city park called "Peace of Mind - Spread the Seeds of Awareness" on May 17th. Activities for children will be highlighted in hopes that parents will bring their children, and find resources and information on mental health topics. Live broadcasts from the local radio station and a DJ in the afternoon are planned. The local access cable channel may broadcast as well. All the major provider organizations (mental health, substance abuse, somatic health, state police, health department, etc.) will have displays, screenings, and activities. The fair was first held two years ago, and was a great success. Last year's fair was flooded out, so there the local mall will serve as an alternate location this year. Ninety percent of the funding for the program is donated.
From Jean Overstreet, North Carolina Council of Area Programs:
Onslow County Behavioral Healthcare is coordinating events jointly with their local chapter of the Mental Health Association (MHA) in NC. To date, they are planning the Second Annual Clergy Breakfast on Monday, May 12, 2003. Area programs bring together faith leaders and the mental health community to discuss ways they can work together to help those in our community in need of mental health services. Senator Cecil Hargett will be the guest speaker at the breakfast. Ms. Pat Prescott, MHA Eastern Area Consultant, will be speaking to the Onslow County Human Services Council on May 27, 2003 and the Area Board will sponsor a Staff Development Day, which encourages networking and team building among the Onslow Area Program staff.
In addition, over the past year, a series of six half-hour television shows on various mental health topics (depression, a consumer panel talking about their recovery process, mental health issues in children, coping with turbulent times, co-occurring substance abuse and mental illness in children and adolescents, etc.) has been produced in conjunction with the local cable channel and will air throughout May, in addition to what has already been aired previously. In this first venture with television, the shows were nominated for two awards from the local access cable channel and won the award for "Best Community Related Programming." The TV station will submit the series in a national competition. About 40% of the funding for this project was donated, with the TV station a major contributor.
At the national level, several organizations are spearheading activities or providing resources for Mental Health Month.
New Study on Effective Treatments for Co-Occurring Disorders Now Available
"Strategies for Developing Treatment Programs for People with Co-Occurring Substance Abuse and Mental Disorders," was recently released by SAMHSA, the National Council for Community Behavioral Healthcare, and the State Associations of Addiction Services. The study, a joint effort of the three organizations, is the first time a co-occurring study of this size has been undertaken by both the mental health and substance abuse communities. Available both online and through a toll free number, the report describes programs that provide effective treatment for diverse people with co-occurring disorders, describes how to access local, state, and federal funding, and recommends additional next steps, including strengthening systems at county, state, and regional levels. To obtain the report, go to www.nccbh.org/cooccurringreport.pdf or www.saasnet.org; or call the SAMHSA clearinghouse at (800) 789-2647.
SAMHSA Has New Director of Substance Abuse Prevention
SAMHSA recently named Beverly Watts Davis Director of its Center for Substance Abuse Prevention (CSAP). CSAP works with state and local government, federal agencies, and the public and private sector to prevent illegal drug use and alcohol and tobacco use.
Previously, Watts Davis was the Senior Vice President of the United Way of San Antonio and Bexar County, and Executive Director of its San Antonio Fighting Back Anti-Drug Community Coalition. She has administered multi-site community grant and comprehensive prevention and early intervention programs targeting ethnic minorities, pregnant and postpartum women, children and adolescents, and ex-prisoners. In addition, she was a consultant and later named Director of Community Health for Travis County, Texas Health Department; and she was the Principal Investigator for the Center for Disease Control and Prevention Health Promotion Grants and a Co-Principal Investigator for the University of Texas Health Science Center's Community Outreach Partnership Center Grant. In 1988, she started her work in substance abuse prevention as the Statewide Coordinator for Texans' War on Drugs and directed the statewide Red Ribbon Campaign.
Watts Davis will lead CSAP in identifying effective prevention programs that can be replicated nationwide, as well as working on substance abuse prevention in the workplace, and promoting statewide prevention of cigarette and other tobacco sales to minors.
Reauthorizing IDEA 2003
NAMI released an E-News on March 31st about the reauthorization of IDEA. Following is a summary of the legislation and issues regarding IDEA and children with mental illness from the information provided in that E-News.
On March 19, House Republicans introduced H.R. 1350, the Improving Education Results for Children with Disabilities Act of 2003, which would reauthorize the Individuals with Disabilities Act (IDEA); the Subcommittee on Education Reform had a mark-up of the bill scheduled for April 2. The bill as drafted concentrates on reducing teacher paperwork, reducing the number of children wrongly identified for special education, and strengthening accountability and results for students. No public hearings for families or advocates were scheduled. Issues in the reauthorization include:
NAMI and other mental health and disability groups are working together to oppose special education legislation that would weaken existing IDEA protections. The full legislation can be viewed at www.thomas.loc.gov/cgi-bin/query.
Job Bank
The Behavioral Health Division (BHD) of Milwaukee County is currently seeking applicants for the position of Administrator. Candidates must possess commitment to public sector care, strong communication skills, and experience as a creative leader. The Administrator is charged with overseeing the delivery of public mental health and substance abuse treatment services to more that 20,000 people in Milwaukee County. Responsibilities include oversight of a $135 million dollar budget and staff of 900.
BHD is a government organization that includes: community-based services offering day treatment, community support, targeted case management plus contractually-provided community programs; a 300-bed facility offering acute and long term adult, gero, child and adolescent care; and crisis services offering emergency room, mobile and walk-in services. BHD is one of six health care institutions forming one of the most comprehensive teaching and research centers in the nation. Milwaukee County offers outstanding benefits and competitive salary. A Bachelors Degree in a Clinical discipline or health care administration and 10 years of progressive leadership experience is required. A Masters degree is strongly preferred. Knowledge of state-of-the-art mental health and AODA services, labor relations, advocacy, and political experience preferred. Send CV/Resume and cover letter to:
Milwaukee County Division of Human Resources
901 N. 9th Street, Room 210
Milwaukee, WI 53223
Attn: Mary Dutkiewicz
Email: mdutkiew@mcdhr.org
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Conference Announcement
NAADAC: The Association for Addiction Professionals, 2003 Annual Conference
Advancing the Addiction Profession: Facing Today's Challenges
September 14-17, 2003
Omni Shoreham Hotel, Washington, D.C.
For more information: www.NAADAC.org or 800-548-0497
Welcome to New NACBHD Members in April
Look for the NACBHD 2003 Membership Directories by early June.
The NACBHD Bulletin is published electronically six times a year by the National Association of County Behavioral Health Directors, 1555 Connecticut Avenue, NW, Suite 200, Washington, DC 20036. Articles of interest to county/local behavioral health professionals are welcome by the 15th of the month prior to publication. Please submit copy to Nancy Sydnor-Greenberg at nesydnor@erols.com. Editor-in-Chief - Dr. Sandra Naylor Goodwin, sgoodwin@cimh.org. NACBHD is an affiliate of the National Association of Counties.
