NAMI Minnesota
2018 Legislative Issues/Goals
NAMI Minnesota champions justice, dignity, and respect for all people affected by mental illnesses. Through education, support, and advocacy we strive to eliminate the pervasive stigma of mental illnesses, effect positive changes in the mental health system, and increase the public and professional understanding of mental illnesses.
To this end, NAMI advocates for policies that increase access to appropriate treatment and supports that enable children and adults to achieve their hopes and dreams.
Reports from the 2018 Legislative Issues Surveys conducted by NAMI Minnesota provided useful information used in the development of our goals. The survey was designed to target three specific groups: adults, children and providers.
Adults
The data from the Legislative Issues Adult survey indicated that almost 37% of respondents have private insurance, while almost 50% have public insurance through Medical Assistance, MinnesotaCare, and Medicare. Of the 76 respondents, only 7 individuals suggested that they had no problem getting coverage for mental health care. The treatment options that were most difficult to acquire coverage for were outpatient therapy, community support and drop-in services, employment services, and Personal Care Assistance. High deductibles, copays, and long wait times were also cited by many as a barrier to obtaining treatment.
Almost 11% of those surveyed responded that the person with a mental illness had experienced homelessness within the last year, while 23% of respondents suggested that the person with a mental illness had moved more than once, been forced to move, or were evicted due in part to a mental illness. When asked what they would change about the housing situation of the person with a mental illness, only 24% of respondents indicated that they were satisfied with their current housing situation. However, a large number of individuals skipped this question, which may be due to their satisfaction with their housing arrangements.
The primary challenges to housing identified by the survey were affordability, desire for an independent living situation, challenges finding supportive housing, and difficulty transitioning from inpatient treatment. Just under 50% of respondents reported that their housing situation negatively impacted their ability to access community activities and supports. Additionally, almost 30% responded that their housing situation is a barrier to treatment and makes it difficult to access transportation.
About 14% reported that they do not work but want to work, while 30% are working full time, almost 10% are working part time, and almost 18% are working between 1-19 hours a week. Of the respondents who are seeking employment or would like to improve their employment situation, almost 60% responded that they need assistance finding employment and 51% said they need additional support on the job. Assistance navigating the application process, transportation, and training were also identified by over 30% of respondents as significant barriers to acquiring desired employment. Those who are currently employed reported that poor transportation options, low wages, stigma, and the lack of supports in the workplace were all problems with their current job.
A majority of respondents did not have an encounter with the criminal justice system in the past year, but 14% reported being arrested or placed jail and over 13% reported a police response to a mental health crisis. When asked what respondents would like to see changed in the criminal justice system, the most frequent responses included better access to mental health care and medications when in jail and more crisis intervention training for police officers.
The most effective treatments and supports identified in the survey included regular meetings with a mental health professional, medication management, ACT teams, ARMHS, and community based supports. From the perspective of those who care for an adult living with a mental illness, the most effective treatments and supports were ARMHS, ACT teams, Crisis services, and assistance with housing and employment.
Services that are needed, but are not accessible included: accessible and affordable outpatient therapy, transportation assistance, more providers, and better housing and social opportunities.
Children
The data from the Legislative Issues Children survey revealed that more than half (59%) had private insurance through their employer, with many others receiving their coverage through Medical Assistance. When asked what important mental health services were not covered by insurance, the most important gaps were respite care, in-home services, and PCAs. Other significant barriers to accessing treatment included long waiting times for 41% of respondents and the lack of workforce and providers for almost 65% of survey responses.
A majority of the respondents were enrolled in school or some kind of education program, with 24% reporting that the youth receives special education. About 40% of respondents report that they are not satisfied with the education the youth is receiving. The problems identified in the survey include: difficulty implementing 504 plans, lack of adequate support personnel including social workers and counselors, and the need for more mental health providers in the schools.
The most effective treatments according to survey respondents were therapy and in-home services. When asked what services they need but are not receiving, respondents emphasized respite care, need for more in-home services, and better insurance coverage.
Provider
The Data from the Provider survey revealed that 70% care for adults aged 26-54, with only 30% of respondents providing services for children up to the age of 10.
Providers identified the top barriers to accessing mental health services as: long wait times, lack of insurance coverage, transportation issues, and workforce shortages. When asked what services they provide that are not covered by private insurance, the most common response were IRTS services, ACT teams, and day treatment. Respondents also noted that many of these services are technically covered, but that the high deductibles and co-pays create significant financial barriers for many to access the care they need. Over 73% of respondents also claimed that restrictive formularies and prior authorization have negatively impacted clients’ ability to access needed medications.
The most effective treatments and supports according to respondents included: ARMHS, regular therapy, and crisis services. Respondents also emphasized the importance of day treatment, housing services, and case management.
When considering potential new laws, respondents expressed an interest in higher reimbursement rates, ensuring that insurance companies follow mental health parity laws, and additional incentives like student loan forgiveness payments to develop the mental health workforce. Providers also identified the additional funding needs for IPS employment projects and the challenges caring for patients covered by PMAP.
The NAMI Minnesota Board adopts the following legislative goals for 2018.
Adult Mental Health System
Adults with mental illnesses need access to programs and supports that are not necessarily funded by insurance. NAMI will work to:
· Strengthen adult mental health infrastructure grants by dedicating some of the funds to key programs and developing outcome measures.
· Ensure funding next biennium is maintained for ACT teams, Crisis Services, IRTS facilities, and other community mental health services.
· Develop programs that more appropriately support parents with mental illnesses.
· Make Serious Mental Illness (SMI) the standard for eligibility rather than Serious and Persistent Mental Illness (SPMI).
· Fund evidence-based practices to meet the mental health needs of older adults.
· Increase funding for First Episode Programs to add six intensive programs for people experiencing their first psychotic and add that they will serve youth experiencing their first manic or depressive episode.
· Expand use of certified peer specialists throughout the mental health system.
· Eliminate host county contracts for Adult Rehabilitative Mental Health Services (ARMHS).
· Assess and monitor the quality of corporate adult foster care programs.
· Implement proposed policy changes made by NAMI’s civil commitment task force, with a focus on more access to community services; additional clarity about provisional discharges, dual commitments, and emergency holds; and reforms for 48-hour law.
Children’s Mental Health System
Children should have access to evidence-based treatments and support so that they can do well in school, home and the community. Recognizing that there are severe shortages in mental health professionals and that the outcomes for children with mental illnesses are poor, NAMI will work to:
· Embed mental health professionals in other venues such as youth shelters, day care centers, college etc.
· Address issues with the intersection of child protection and intensive children’s mental health services.
· Change requirements for respite care so children are not required to be on Targeted Case Management (TCM).
· Allow parents who are on child only MFIP to receive childcare subsidies while obtaining mental health treatment and when they need support with childcare due to their mental illness.
· Shift placement authority/funding responsibility for children’s residential treatment from counties to the state.
· Fund early childhood evidence-based treatments, mental health programs and consultation.
· Fund multigenerational mental health programs under children’s mental health grants.
· Allow higher MA reimbursement for intensive mental health outpatient treatment for pregnant and postpartum women with moderate to severe mental illness, including the baby when this therapy is provided to a postpartum woman.
· Increase school-linked mental health grants.
· Follow recommendations of the report on youth crisis homes by creating a new level of service for youths aged 5-21 with urgent mental health needs requiring rapid admission to temporary stabilization services, or more intensive services to reduce the risk of hospitalization or other longer-term residential treatment.
Education
Children with mental illnesses have high suspension and dropout rates, poor transition planning and are more likely to experience the use of seclusion and restraints. NAMI Minnesota will work to:
· Expand and continue Positive Behavioral Interventions and Supports (PBIS).
· Decrease the use of seclusion and restraints in schools and provide funding to support students with the highest needs.
· Streamline current care and treatment education laws so that there are not barriers, especially transportation, to children and youth accessing the treatment that they need and so that they obtain the education needed to stay on track.
· Improve transition services for youth with mental illnesses between school and college or employment (TIP model).
· View truancy as a school failure issue, not discipline issue and address mental health concerns.
· Decrease the school to prison pipeline, including reliance on zero-tolerance policies and juvenile justice system referrals.
· Support recommendations from the School Resource Officer (SRO) report, including mental health training for SROs.
· Increase the number of school support personnel.
· Support requiring alternatives to suspension especially for students in grades K-3.
· Support many of the recommendations developed by the Discipline Task Force.
· Allow any mental health professional to verify an ADD/ADHD diagnosis for special education.
· Co-locate mental health care providers in community colleges.
Employment
People with mental illnesses have the highest unemployment rate, yet employment is an evidence-based practice, meaning it helps people recover. Unfortunately, programs that are designed specifically for people with mental illnesses are underfunded and serve a limited amount of people. NAMI will work to:
· Expand Individual Placement and Support (IPS) employment programs with the goal of statewide coverage.
· Increase percentage of individuals who are gainfully employed.
· Require DEED, with input from stakeholders, to look at all employment support programs and require better accommodations for persons with mental illnesses.
Health Care
Too many children and adults living with a mental illness do not receive adequate coverage for their health care needs. We need to ensure that Minnesotans on both public and private insurance plans have more options, lower costs and deductibles, adequate coverage, and access to basic mental health treatment and especially community supports.
· Remove the word “constant” from the criteria for accessing the Community First Services and Supports (CFSS) program and PCA services so that people with a serious mental illness can access this program.
· Continue to increase quality and integration in the treatment of co-occurring substance use disorders and mental illnesses and encourage expansion of Integrated Dual Diagnosis Treatment (IDDT).
· Increase Medical Assistance (MA) income and asset standards for people on the program due to a disability.
· Eliminate co-payments for smoking cessation products, limits on duration and increase access to quantity and dosage levels that meet the needs of people with mental illnesses.
· Implement mental health parity.
· Provide new consumer protections for the use of prior authorization by insurance plans.
Housing
People need safe affordable housing in order to focus on recovery. NAMI will work to:
· Increase funding for the Bridges Housing program.
· Fund supportive housing grants.
· Develop housing options for youth/young adults with a mental illness.
Juvenile & Criminal Justice
Too many children and adults who live with a mental illness end up in the juvenile and criminal justice systems. NAMI will work to:
· Increase the use of jail diversion programs and mental health courts.
· Address restrictive jail formularies by changing antipsychotic drug requirements for inmates with a mental illness.
· Mandatory diagnostic assessment by mental health professional for all inmates that screen as positive for a mental illness and will be in custody for 14 or more days. Treatment plan must be developed within 7 days of diagnostic assessment and must be implemented promptly.
· Allow Sherriff to apply for commitment of inmate including involuntary administration of medications.
· Ensure that all juvenile courts operate using the principles of mental health courts.
· Change the M’Naghten Standard/insanity defense.
· Increase access to mental health services in the prisons.
· Increase the number of mental health release planners.
· Fund one mental health release planner at Red Wing.
· Require mental health training for probation officers.
· Require mental health training for 911 operators.
· Support early juvenile record expungement for youth whose involvement in the juvenile justice system was for reasons related to living with a mental illness.
· Require mental health assessments by mental health professionals for inmates within jails.
· Establish a mental health ombudsman for jails and prisons.