Legislative Priorities 2008

I. Restore Funding to the Department of Mental Health: We must increase community-based services for individuals with serious psychiatric conditions whose lives depend upon residential, community support services and at times acute services. Roughly 20,000 chronically mentally ill individuals are desperately waiting for DMH services, of which ove r 3,645 of them are waiting for residential placement. The lack of available DMH services severely impacts the care of individuals with mental illness, gravely affecting families and communities. Governor Deval Patrick has in fact stated that “Increasing access to mental health treatment and support for children and adults” is one of his core Principles for Health and Human Services. CLICK HERE FOR MORE INFORMATION.

II. Preserve Access to Appropriate Medications: Mental health patients often do not experience similar therapeutic effects from similar medications. Therefore, all anti-psychotics, anti-depressants and anti-convulsants used in the treatment of mental illness must be made available to optimize successful treatment. Restricting access to mental health medications and medical treatments, especially. CLICK HERE FOR MORE INFORMATION.

III. Promote Housing for People with Mental Illness: Safe and affordable housing for the mentally ill is crucial for recovery. State hospitals were originally intended to serve the mentally ill, and with the advent of more cost effective, humane, community-based services, it is now possible to consolidate hospitals and save valuable tax dollars. Housing for the mentally ill must be established when state surplus land use legislation is passed: 1) 10% of Medfield Hospital should be converted into subsidized housing for the mentally ill 2) The construction of Heritage House will provide much needed social support for the mentally ill . CLICK HERE FOR MORE INFORMATION.

IV. Encourage Jail Diversion and Coordinated Re-Entry Services From the Criminal Justice System . Incarceration of the mentally ill is detrimental to both the individual who does not receive proper treatment and taxpayers who must pay the cost of unjust imprisonment. Jail diversion has been shown to be an effective way to provide appropriate treatment for the mentally ill and ensure a safer community. CLICK HERE FOR MORE INFORMATION.

V. Establish a Comprehensive Children's Mental Health Service System: About 1 in 10 children in the U.S. suffers from a mental illness severe enough to cause impairment. Research shows that reaching children with mental illnesses early with appropriate treatment significantly improves their long-term prognosis. Conversely, the failure to provide treatment has tragic consequences. Families know all too well that the system is failing children and adolescents with mental illnesses. NAMI-Mass must focus attention on systems reform and to help and support families so that no child or family is left behind as the state works to be in compliance with Rosie D. v. Patrick. CLICK HERE FOR MORE INFORMATION.

National Alliance on Mental Illness of Massachusetts

400 West Cummings Park* Suite 6650* Woburn* MA *01801

1-781-938-4048 www.namimass.org

DMH Funding Page - The Impact of Inadequate Funding

The National Alliance on Mental Illness of Massachusetts is a family-based grassroots organization gravely concerned for the thousands of people with chronic mental illness. Our families are desperate to find services for loved ones experiencing the symptoms of a serious mental illness. Most heart wrenching are the numerous cries of parents of mentally ill children seeking help. The lack of available services severely impacts the care of individuals with mental illness and gravely increases the pain and stress to their families. Currently close to 20,000 mentally disabled people are waiting indefinitely for DMH services. This number will continue to grow if steps are not taken to remedy this heinous situation. According the United States Supreme Court “Olmstead Decision”, the waiting list for these services must move at a “reasonable pace”, yet the numbers waiting for desperately needed services continues to grow. Mental health consumers who rely on these services are being abandoned and may become a greater risk to themselves and others if this lack of services is not resolved. After several years of cutbacks and service reductions, the DMH budget did restore vital research funding and provided crucial funding for under-paid mental health workers, yet there is still a dire shortage of mental health services. The Budget is basically a maintenance budget. It does stop the bleeding that has taken place from past years' cuts. Most overall increases were mostly for contractual rates increases and annualized costs of community services going.

Department of Mental Health Wait List

Citizens of the Commonwealth with chronic mental illnesses still languish waiting for community based services, wander our streets homeless, fill up emergency rooms when preventive treatment should have been provided, and needlessly end up in the criminal just system. This is a human travesty that is avoidable with adequate funding and services. Treatment means the difference between hope and despair, struggle and recovery, and even life and death. Limiting mental health treatment does not save tax-payers dollars. Instead limiting mental health treatment results in tragic unintended consequences and cost shifting. While this chart is from 2000, the list has only marginally reduced and is the most comprehensive analysis currently available to NAMI

DMH Service Needed	1st Quarter 2000	2nd Quarter 2000	3rd Quarter 2000	4th Quarter 2000	Change
Adult Residential	3381	3339	3163	3320	+157
Child/Adolescent Residential	170	247	177	220	+ 43
Adult Case Management	13687	14,123	14,103	14,164	+ 61
Child/Adolescent Case Management	1938	2076	2224	2497	+273
Supported Employment	226	252	258	256	- 2
Turning 22 Services	100	100	100	100	0
Totals	19502	20,137	20,025	20,457	532

NAMI-Mass Recomenadtions

• Increase DMH Base Funding Levels for adults children and adolescent services: DMH has reduced its Full Time Employees count by 1,031 (21%) since FY 2002. No agency or organization in or outside of government can sustain quality in its programs and services if it continues to reduce personnel at this rate. We believe DMH sustained an inordinate amount of reductions during economic slow downs. Moreover, it did not prosper to the extent of other EOHHS agencies during the better economic times. Therefore, we request that at a minimum DMH receive appropriations that will allow it to maintain its base and current services.

• Rental Assistance ($ 1,000,000): We also recommend and urge you to support another $1,000,000 to Account 7004-9033 (Department of Housing and Community Development). This would provide rental assistance to approximately 85 additional clients of the Department of Mental Health.

• Adult Mental health Services (line Item 5046-000): We recommend and urge support adding an additional $5 Million to the Adult Mental Health Services Account (5046-000). The waiting lists at DMH are the result of more than a decade of under funding, which has only been addressed in the past three years. An additional $5 Million will allow the Department to provide housing and residential support services to adults as well as youth who are transitioning into the adult system

• Increase Children and Adolescent services by $5,000 (line item 5042-5000 to bring Massachusetts in compliance with the Rosie D lawsuit. About 1 in 10 children in the U.S. suffers from a mental illness severe enough to cause impairment. Research shows that reaching children with mental illnesses early with appropriate treatment significantly improves their long-term prognosis. Conversely, the failure to provide treatment has tragic consequences. Families know all too well that the system is failing children and adolescents with mental illnesses. NAMI-Mass must focus attention on systems reform and to help and support families so that no child or family is left behind as the state works to be in compliance with Rosie D. v. Romney

• We also wish to preserve consumer choice in health plans for MassHealth members and to urge your support for its inclusion in the FY 2008 budget. The language was adopted as part of the FY 2007 budget and the Senate Budget Recommendations, and it is enclosed for your reference. “; and provided further, that notwithstanding any general or special law to the contrary, the secretary of health and human services shall not reassign to a managed care plan under contract with the office of MassHealth the behavioral health benefit of any eligible person when the benefit is managed by MassHealth's specialty behavioral health managed care contactor, after the benefit is elected by or initially assigned to that person, unless the person provides written or verbal consent to the reassignment.”

Access to Medications Page

Appropriate Use of Medication: For the vast majority of individuals with severe mental disorders, medication is the cornerstone of treatment. Massachusetts has enacted a number of initiatives to improve provider prescribing behavior, including residency training contracts with state professional schools and a system to ensure that the use of multiple medications is safely accomplished. While there are multiple medications for the treatment of schizophrenia, all research-based guidance shows that decisions about which medication to use with a particular individual must be individually determined—the way each patient reacts to a medication and the side-effects they experience are not predictable and vary greatly between patients. Thus, the commonwealth's continued threat to appropriate and effective access provides a real threat to public health and, ultimately, costs. It is absolutely necessary that decisions about medication access in Massachusetts be made individually and under the guidance of optimal clinical knowledge, including the Department of Mental Health, and that cost offsets of limitations on medication access be provided to the tax-paying public of Massachusetts.

Limiting access to vital psychiatric medications can be detrimental to patients with mental illness and family members. These are vital treatments in children and adults for Attention Deficit Disorder, mood disorders, and/or psychosis. All anti-psychotics, antidepressants, and anticonvulsants used for the treatment of mental illness should be made available. NAMI believes that individuals with brain disorders must have access to treatments that have been recognized as effective by the FDA and/or NIMH. NAMI strongly opposes measures that limit the availability and right of individuals with brain disorders to receive treatment with "new generation" medications. Restricting access to these and/or other medications with polices that do not allow for flexibility for the patient and the complexities of the human brain can be detrimental and ultimately cost the Commonwealth more in the long run because;

• Restricting access to effective and/or innovative medications, especially those for acute mental illness, can easily require more costly inpatient treatments and emergency services in the long run.

• Mentally ill patients do not have universal therapeutic effects from anti-psychotic medications. Some psychiatric patients believe that any change in medication itself will harm them and this belief in and of itself can create a self-fulfilling prophecy where the patient deteriorates. Some patients for whatever physiological reason have different clinical outcomes, which is not surprising given the complexity of the brain.

• Clinicians already speak of being inundated with paperwork and regulations. The professionals who work directly with the patients are the best suited to determine the most appropriate clinical needs and treatment of the individual psychiatric patients. The decision of which medication to prescribe at any given time should ultimately be with the clinician.

People with mental illnesses and their families know, perhaps better than anyone, that the lack of access to appropriate medications can quickly unravel and destroy lives. These treatments can mean the difference between hope and despair, recovery and struggle, and even life and death.

Partial List of NAMI related bill priorities

Chairman Tolman, Contact: Elizabeth (617) 722-1280

SB 428, An Act Relative to Medicaid Prior Authorization – This bill will ensure that the restricting of access to effective and/or innovative medications, especially those for acute mental illness will not be occurring without public input.

Senator Walsh, Contact: Jay Harrington at (617) 722-1348

S434, An Act Relative to Medicaid Prior Authorization – This bill will ensure that the restricting of access to effective and/or innovative medications, especially those for acute mental illness will not be occurring in the Commonwealth..

Representative Stanley, Contact: Judith (617) 722-2575

H1907, An Act Relative to Reimbursement for Drugs to Treat Mental Illness – This bill will protect access to vital medications for those afflicted with severe mental illness.

Housing Page

It is a cruel irony that 163 years ago, Dorothea Dix began her crusade to improve care for people with severe mental illnesses in Massachusetts. For two years, she visited jails and almshouses throughout the state, providing witness to the shackling and torture endured by individuals with mental illness. This witness was the impetus for the state's expansion of psychiatric asylums. Today, there are fewer than 900 state hospital beds, 300 of which are for forensic patients. With today's modern medications and community based treatment the majority of people living with chronic mentally illness can successfully live in the community. Yet given the crushing blows to mental health's budget and the lack of community placements, investigations of Massachusetts jails and streets would reveal horrors similar to those found by Dix in 1841.

Currently, thousands of DMH clients are living in affordable housing units throughout the state. These are individuals who otherwise would have nowhere to go, and could have ended up on the streets or in jail if they were not able to access safe, affordable housing. Chapter 40B has been a critical tool that has directly allowed many DMH clients to reclaim their lives and start anew through their access to affordable housing created under 40B. These new beginnings have a positive effect beyond just the individual who secures affordable housing. When we as a society choose to provide housing opportunities for our most vulnerable members, there is a decrease in expensive emergency service use and a strengthening of the community fabric. Affordable housing is good for individuals, and it is good for society. We respectfully ask the Legislature not to weaken or dismantle 40B, a vital statutory resource for our community .

Principles for Redeveloping Former and Current State Hospital and State School Sites

It is a bedrock principle of the Americans with Disabilities Act (ADA) and other civil rights law that the existence of housing programs serving only people with disabilities cannot be the basis for excluding people with disabilities from conventional housing programs. Any state hospital or state school property that closes and is sold must provide benefits for the people with disabilities that once used such facility. With the advent of more cost-effective, humane, community based services, it is now possible to consolidate these properties and the antiquated physical plants that are costly to maintain. This saves valuable tax dollars and frees the sites for new uses. The sale of these properties offers the opportunity to convert them to a community resource particularly for people with disabilities. Access to housing and jobs is essential to people with disabilities and their families.

The state hospital and school sites should be disposed of in a manner that maximizes benefits to clients of the Departments of Mental Health (DMH) and Mental Retardation (DMR).

The disposition benefits will vary by site. Some sites will include affordable community-based supported housing pursuant to applicable state and federal guidelines and employment opportunities on-site; other sites will generate a sales value that should be captured to support DMH and DMR housing and employment initiatives in the region.

The National Alliance on Mental Illness of Massachusetts (NAMI-Mass) supports the principles filed by Representative Kay Khan. A section contained in H3770 (Rep. Flynn, Chair), H55 (Rep. Sanchez) and the S57(Sen. Spilka), is a variation on H37, a bill sponsored by Kay Khan and supported by The Arc and NAMI Mass. that would create a set-aside account for funds derived from the sale of state school (DMR institutions) and state hospitals (DMH) deemed surplus, for the creation of housing for individuals served by each respective agency.

NAMI is a grassroots family based advocacy and education group dedicated to improving the quality of life for people affected by mental illness. We believe that;

That any state hospital or state property that closes and is sold must allow a funding set aside for housing for the disabled. Funds derived from the sale, lease, sublease, granting of easements or other conveyances related to former state hospital parcels shall be credited to the state hospital disposition fund to create community based housing units. The units must be must be funded in such a way that there is a long term subsidy for the disabled at 15% of the poverty guidelines, not simply a set aside that can be rented at market rent.
These state hospitals were originally intended to serve the mentally ill, and with the advent of more cost effective, humane, community based services, it is now possible to consolidate the hospital and save valuable tax dollars.
These properties must be converted to community resources for the mentally ill. Not only is this good economic and public policy, it is prudent and just.

To preserve their dignity and independence, many frail elders and people with significant disabilities are no longer accepting that they must live in isolated institutional settings, even when their need for supports increases. Community-based care and services now assist many people who formerly had to be institutionalized, helping people to maintain a high quality of life. Such community-based services are also more cost-effective; research on individuals accessing community-based services in Massachusetts has shown annual savings of between $15,000 to $80,000 in annual per person savings . The U.S. Supreme Court, in Olmstead v. LC, found that states must offer people with disabilities-- including elders-- the opportunity to receive services in the community when possible. Affirmative steps are needed, especially in view of the state's 2001 Report on Long Term Care, which found that Massachusetts had a 65% greater rate of Medicaid nursing facility utilization than the national average. In order to bring this average down, meet federal requirements and benefit from the cost savings, additional community-based housing alternatives for people with disabilities and elders need to be developed.

People with mental illness and their families know, perhaps better than anyone, that the lack of access to appropriate medications can quickly unravel and destroy lives. These treatments can mean the difference between hope and despair, recovery and struggle, and even life and death. Access to housing is essential to patients with mental illness and family members. We look forward to your response.

Partial List of NAMI related Priorities

Representative Khan, Contact: Sarah (617) 722-2140

H37, An Act Relative To Former DMH Property – This will provide affordable housing for mentally ill and disabled citizens upon the disposal of state-owned property.

Jail Diversion and Coordinated Re-Entry Services From the Criminal Justice System Page

According to the Massachusetts Department of Corrections, in March 2003, 20.85 percent of the prison population—1,999 people—have a serious mental disorder, with 1,391 individuals receiving psychotropic medication. According to national statistics from the National GAINS Center and the Bureau of Justice Statistics, 1,016 individuals in Massachusetts' prisons have a severe mental disorder—schizophrenia or other psychotic illness, bipolar disorder, or severe depression. Another 718 individuals in Massachusetts' jails were estimated to have a psychotic or severe mood disorder.

Jail Diversion: Massachusetts does not have a statewide jail diversion program. There is one prebooking jail diversion program in Framingham through the initiative of Advocates, Inc., who got a grant to work with and train the Framingham police. There is one post-arraignment jail diversion program that is phasing out at the West Roxbury District Court due to lack of funding and there is one pre-booking jail diversion program being planned by the Massachusetts Jail Diversion Program under the auspices of UMASS Medical School. Only four police forces have had training on how to deal with people with mental illness in crisis resulting in as many as eight mentally ill persons killed by police during the last two years. Massachusetts does not have any mental health.

Cost-Benefit Fact Sheet: Jail Diversion for the Mentally Ill

The funding cuts in mental health services have great implications for society as a whole. The American Psychiatric Association notes that “access to…care is fragmented, discontinuous, sporadic and often totally unavailable” (“Misplaced prisoners,” Boston Globe, November 10, 2003).

Fiscal implications of inappropriate jailing of people with mental illness :

According to the Pennsylvania Department of Corrections, the cost of incarcerating a person with serious mental illness is $140 per day. It costs only $80 per day to incarcerate the average inmate (Criminal Justice/Mental Health Consensus Project [CJMHCP], n.d.).
A study conducted in Washington state showed that providing emergency services to 20 mentally ill individuals who were repeatedly hospitalized, jailed or admitted to detoxification centers cost the county approximately $1.1 million dollars (CJMHCP, n.d.).

Monroe County, New York spends $315,000 per year on overtime for officials conducting suicide watches (CJMHCP, n.d.).
The Miami-Dade Department of Corrections in Florida spends approximately $4 million annually in overtime costs alone to manage inmates with mental illness (CJMHCP, n.d.).
The entire Framingham Jail Diversion Program costs only $150,000 per year (“Misplaced prisoners,” Boston Globe, November 10 2003).

• A study of three models of police responses to people with mental illness showed that collaborations between the criminal justice system, mental health system, and advocacy community along with essential services reduces the inappropriate use of U.S. jails to house people with mental illness (Steadman, Deane, Borum, & Morrissey, 2000).

• Intensive community-based programs for individuals with mental illness who have been involved in the criminal justice system have proven to be very cost-effective.

		Jail/Hospital Costs Per Person
Program	Number of participants	PRIOR to involvement	DURING involvement (plus program cost)	Cost savings per person
Thresholds Jail Program, IL	30 (two years)	$53,897	$35,024	$18,873
Project Link, NY	44 (one year)	$73,878	$34,360	$39,518

Chart courtesy of The Criminal Justice/Mental Health Consensus Project.

References

Criminal Justice/Mental Health Consensus Project (n.d.). Fact sheet: Criminal victimization of people with mental illness. Retrieved March 22, 2005 from http://www.consensusproject.org/factsheets/fact_crime_victims .

Criminal Justice/Mental Health Consensus Project (n.d.). People with mental illness in the criminal justice system: About the problem. Retrieved March 22, 2005 from http://www.consensusproject.org/infocenter/factsheets/factsheet .

Criminal Justice/Mental Health Consensus Project (n.d.). People with mental illness in the criminal justice system: Fiscal implications. Retrieved March 22, 2005 from http://www.consensusproject.org/factsheets/fact_fiscal_implications .

Lamb, H.R. & Weinberger, L.E. Persons with severe mental illness in jails and prisons: A review. Psychiatric Services, 49 (4), 483 – 492.

Misplaced prisoners. (2003, November 10). The Boston Globe . Retrieved March 26, 2005 from http://jdp.framinghampd.org/misplaced.htm .

Steadman, H.J., Deane, M.W., Borum, R., & Morrissey, J.P. (2000). Comparing outcomes of major models of police responses to mental health emergencies. Psychiatric Services, 51 (5), 645 – 649.

Op.Ed. by Representative Ruth B. Balser, House Chair of the Joint Committee on Mental Health and Substance Abuse; Laurie Martinelli, Executive Director, National Alliance on Mental Illness of Massachusetts

Kudos to the Globe's spotlight team for exposing the terrible plight of people most would prefer to ignore – prisoners who are severely mentally ill. The U.S. Department of Justice reported in 1999 that about 16 percent of the population in prison or jail has a serious mental illness. The Massachusetts Department of Corrections has reported that approximately 25% of the state prison population are severely mentally ill. That the prisons and jails have become mental health facilities is the tragic consequence of a failed public policy. The goal of deinstitutionalization was the successful integration of the mentally ill into the community. Inadequate insurance coverage and an insufficient public commitment to providing necessary services have resulted in growing numbers of mentally ill being housed in the most restrictive institutions in our society – our prisons and jails.

There is much that can be done to prevent the mentally ill from becoming involved in the criminal justice system. That is the topic for another day. Today, we write to support legislation that would require Massachusetts prisons to provide the mentally ill in their custody the treatment they need to ensure their own stability, the stability of the institution, and their successful re-entry into the community upon release. Such legislation is humane, cost-effective, and, because 97% of prisoners eventually return to the community, will protect the public's safety.

Many prisoners with serious mental disorders spend at least 23 hours a day locked in small segregation cells where they eat, sleep, and wrestle with their demons . They are sent to isolation as a punishment for behavior, behavior that is oftentimes a manifestation of an acute phase of their illness. Without proper training, corrections officers are unable to de-escalate difficult behavior and see segregation as the only response. These prisoners become sicker, many mutilate themselves, and as the Globe has so poignantly described, some commit suicide.

H1313, filed by Representative Ruth B. Balser, would require that all prisoners sent to segregation would receive a timely and thorough mental health assessment, and that those who are deemed mentally ill would be sent to maximum-security residential treatment units rather than to isolation. Correctional staff who will work in these units will receive extensive mental health training. Similar policies have been adopted successfully in California, New York, Wisconsin, Indiana, New Mexico, Texas, Ohio and Pennsylvania.

For twenty years, experts have recommended that Massachusetts provide treatment for mentally ill prisoners rather than isolating them. Last year, the Department of Corrections hired Lindsay Hayes, a national expert on prison suicides, to review policies, and he recommended residential treatment units. A November 2005 survey by the Boston Foundation shows that the public strongly supports treatment and programs that reduce recidivism.

The initial investment in establishing sufficient numbers of secure treatment units would be offset by significant savings. In the absence of such treatment, the state is presently wasting money on costly ambulance and emergency room trips, and repeated hospitalizations at Bridgewater State Hospital. The cost of segregation, with its high officer to prisoner ratio, is higher than necessary. Additionally, costs stemming from the high rate of recidivism that results from moving inmates directly from segregation to the streets, are staggering.

In 1841, Dorothea Dix began to visit the jails of Massachusetts and was appalled to find them crowded with the mentally ill who were being mistreated. She called upon the Massachusetts Legislature to act, to create humane conditions for the mentally ill. In response, Massachusetts led the way for the nation to recognize the needs of the mentally ill. How tragic that we have come full circle. We call upon the Commonwealth to honor the memory of Dorothea Dix and return to the historic commitment Massachusetts made, by rebuilding our mental health system and by treating those mentally ill in the prisons in a way that is not only humane but will better protect the public.

Partial List of NAMI related bill priorities

Chairwoman Balser

HB1313, An Act Relative to Confinement Conditions and Treatment of Prisoners with MI . - This bill will ensure that inmates are not subject to unwarranted restraint and seclusion without consultation with a clinician. Require that a residential treatment unit be established at each DOC and HOC facility and that all correction staff be given training on the nature of mental illness and dealing with mentally ill inmates in crisis.

Representative Khan,

H1887, An Act Providing for a Massachusetts Prison Mental Health Services – Whereas a large number of people with mental illness are in prison (and especially in jail) they should have access to mental health services. Not only is this good economic and public policy, it is prudent and just.

Representative Rushing

HB 1896 , An act relative to the treatment of Prisoners – This special commission will help to study the detrimental effects of suicide and mental illness with in the correctional facilities.

Children's Mental Health Page

Children with serious mental disorders also face historic lack of services in Massachusetts. The problem is dramatically revealed in the juvenile justice system, which shuddered from the suicide of two young people who were in the correctional system instead of receiving appropriate treatment this last year. The state's Department of Youth Services expects to find in their current assessment that at least half of the girls and boys entering juvenile justice have a serious mental disorder. The young people are warehoused in facilities that are often decrepit. In the Dorchester facility, for example, the girls' wing has erratically working heating and air conditioning, as girls are lodged two by two in small cells that the corrections officers cannot get in, according to a Boston Globe article. Massachusetts estimates that there are 59,338 young people between the ages of 9 and 18 with extreme dysfunction due to a serious emotional disturbance; 93,246 children and adolescents in that age group are estimated to have substantial functional impairment due to a serious emotional disturbance. Another 18,446 children below the age of 9 are estimated to need mental health services. Of this more than 100,000 children and adolescents with serious emotional disturbance, less than 5 percent, by the state's own assessment, receive case management services, residential services, or any other community based care. The Department of Mental Health acknowledges as well, in its 2003 Block Grant application that there are long waiting lists for case management and residential services

Massachusetts Lawmakers Consider a Step in the Right Direction in Children's Mental Health Bill, H 4276

By Ann Rudy, Consumer and NAMI Massachusetts Volunteer

Relief may soon be available for the frustrated parents whose children have fallen through the cracks of our fractured mental health care system. Representative Ruth Balser and Senator Steven Tolman have filed a bill that would begin to change the mental health delivery system for all children and provide more effective mental health services. This legislation, An Act Relative to Children's Mental Health (H4276) may eventually impact mental health treatment for all children in the Commonwealth. The bill makes some improvements for children and adolescents with MassHealth and for children and adolescents with private health insurance.

The bill would establish a Children's Behavioral Health Council to study issues of concern to NAMI families who are caring for young children suffering from mental illness. Specifically, the Council is charged with determining best practices in identification and treatment of mental illness in children and establishing goals according to evidence-based measures. The Council would also evaluate the demand and cost of services provided by the Commonwealth and would be required to furnish annual summaries of its findings.

Recognizing the crucial role of schools in identifying and treating mental illness in children, the bill would also establish a task force to study how schools may assist children with mental illness. The task force would be charged with evaluating access to appropriate services in schools and how schools may better coordinate with other care-providers. Accordingly, the task force would be charged with developing a model that would link school-based services to other community-based treatment to help kids achieve both their academic and social potential. It is expected that the task force would pilot a program in ten schools to determine its efficacy before replicating it statewide. To implement future changes, the bill would also mandate professional development education for school personnel regarding meeting the needs of mentally ill kids.

The bill would also address some particular needs of children who are receiving MassHealth benefits. Importantly, the bill mandates reimbursements by MassHealth for pediatricians to enable them to screen and diagnose children with mental illness at routine well-child visits. This screening should lead to earlier diagnoses and better treatment outcomes for many children. “I would say the single biggest flaw in the current system is the lack of an early diagnosis for many of these kids and their families,” said Laurie Martinelli, Executive Director of NAMI-Mass. “This is a huge step in the right directions for kids with MassHealth,” Martinelli concluded.

If this bill becomes law, it would greatly impact mentally-ill children with the most complex needs by requiring service-coordination when children are receiving care from multiple state agencies. With new inter-agency teams, parents can expect that services provided by the Departments of Education, Early Education, Mental Health, Social Services, Mental Retardation, Youth Services, and Public Health would be more easily utilized. Along with appropriate treatment, this assistance with service-coordination could allow parents to focus energy on helping their children recover rather than struggling to access and coordinate vital services.

To encourage comprehensive care, the bill would require that private insurers reimburse overburdened mental health professionals for the collateral services that greatly improve treatment for mental illness. These “collateral” services could include any consultation by psychologists, psychiatrists, clinical social workers, counselors, educational psychologists, or nurses with any party determined by the licensed mental health professional to be necessary to make a diagnosis, and develop and implement a treatment plan. Hence, initial outreach to families to begin therapy, arranging classroom observations, and conversations between social workers and prescribing physicians should be part of covered services for each child.

This bill is not yet law and NAMI members must raise their voices to pressure legislators to support House 4276. Please contact your legislators and request that they provide the means to effectively treat vulnerable children by supporting H.4276. Address letters as follows: Name, State House, Room ____, Boston, MA 02133 or call (617) 722-2000 to speak with your elected official . Each call or letter is important and tells the lawmakers that NAMI members will demand what children deserve.

The passage of this bill can begin to pave the way for important future changes for all children and adolescents. If you have any questions, please call the NAMI-Mass office at 781-938-4048 or email Laurie Martinelli at Lmartinellinami@aol.com.

Rosie D. v Patrick: New hope for children with mental illness

By Ann Rudy, Consumer and NAMI Massachusetts Volunteer

Finally, hope is on the horizon for children with mental illness and their families. Hope that kids will receive appropriate and effective behavioral health services that would allow them to recover and thrive in their families, schools, and communities. Hope that families can remain strong and intact in the face of devastating illness.

In a landmark decision regarding Rosie D. v. Patrick , U.S. District Court Judge Michael Ponsor ruled that Massachusetts is violating the federal Medicaid Act by failing to provide adequate mental health services to over 15,000 seriously emotionally disturbed (SED) children receiving MassHealth benefits. Under the federal Medicaid law, the Commonwealth is charged with promptly identifying children with serious emotional disturbance, providing a comprehensive assessment and an overarching treatment plan, that will actively involve and empower the family in treatment decisions for their children. So incensed was the Judge that he wrote in his decision on January 26, 2006, “Without such services a child may face a stunted existence, eked out in the shadows and devoid of almost everything that gives meaning to the gift of life.”

Recognizing that too many mentally-ill children are being removed from their families and relegated to isolating institutional care, the judge demanded a remedy that would deliver care to children in their homes. Judge Ponsor specifically ordered MassHealth to provide 1) periodic behavioral health screenings 2) mobile crisis intervention and crisis stabilization services, 2) in-home therapy services, 3) independent living skills training, and 4) parent-caregiver supports. These vital services will keep families intact, provide the most therapeutic environment for the child, and will afford the support necessary for families to cope with the most difficult of situations.

Already, MassHealth has begun to meet its obligations. Effective 1/2/08, primary care doctors or nurses who see any child patient who is on MassHealth must give that child a behavioral health screen as part of the periodic well-child visits. This change should foster the types of early intervention that allow children with mental illness to recover and thrive. (CLICK HERE FOR COPY OF MASSHEALTH LETTER)

The judge ordered that all changes must be phased in by June 30, 2009. Despite the force of this lawsuit, it is crucial that NAMI members continue to speak for children with mental illness and their families. To ensure that the new delivery system will meet the actual needs of MassHealth children with mental illness and their families, NAMI Massachusetts is currently organizing a Children's Mental Health Advisory Board to monitor the implementation and advocate for the most appropriate services.

For more information on the NAMI Children's Mental Health Advisory Board, please contact Laurie Martinelli, Executive Director at NAMI Massachusetts at Lmartinellinami@aol.com or (781) 938-4048.

ROSIE D Lawsuit (for NAMI-Mass website)

12/27/07

Kids on Mass Health to Get Access to Mental Health Screenings

In a landmark decision, Rosie D. v. Patrick , U.S. District Court Judge Michael Ponsr ruled that Massachusetts is violating the federal Medicaid Act by failing to provide adequate mental health services to over 15,000 children on MassHealth. Under the federal Medicaid law, the Commonwealth is charged with promptly identifying children with serious emotional disturbances, providing a comprehensive assessment and an overarching treatment plan, overseeing services, and providing essential home-based behavioral support systems.

Unfortunately, children on MassHealth have not been receiving the mental health services to which they are entitled. The lack of an early diagnosis makes it particularly difficult for parents and family members to advocate for the mental health services their child needs.

Effective 1/2/08, primary care doctors or nurses who see any child patient who is on MassHealth must give that child a behavioral-health needs assessment at all periodic well-child visits.

MassHealth has mailed thousands of notices to its members telling them about this new important development. CLICK HERE TO READ THE MESSAGE FROM MASSHEALTH.